Only in the U.S.

I was inspired to write this post after having a conversation with a friend of mine about why single bed is called twin-bed in the U.S. There are few stuffs that probably happens or exists only in the U.S. The only disclaimer to my readers is that the information stated in this post are solely based on my personal experience and assumptions. As I haven’t had much chance to extensively travel to other parts of the world, these things might exist in other countries too; yet, they seemed little weird and different to me, and so have I tried to dig into what those weird issues are and the reason behind those being different.

  1. Twin-bed, not single bed: We were at this store looking at the mattress covers where I told my friend that I didn’t find any covers for single-bed mattress. “They are called twin-bed not single-bed here in the U.S.”, said my friend. I asked him why it was said so. He didn’t know it either. The only God I believe in – Google- had to help me find an answer. A person in one of the forums writes, “Twin bed is either of a pair of matching single beds ready to be joined to another twin bed to create twin beds. The word simply describes a bed which is stackable with another bed.”
  2. Double door in buildings: There are back-to-back doors a few feet apart in almost all the buildings in the U.S. I had guessed that having the doors few feet apart would be useful in maintaining the temperature inside the building. Since opening the door frequently allows easy exchange of the air outside and the air inside the building, it would be difficult to maintain the temperature inside the building. This logic really seemed to be true.
  3. Trucks and semi: Trucks in Nepal and probably all over the world would mean these:

 

semi truck

However, in the US trucks are these:

So, what is the vehicle in the first picture called in the U.S.? It is called “semi” or “semi-truck”. This is because the front portion (the half of the truck) with engine, dash and driver’s seat is separate with the container box. But how can trucks be smaller than semi-trucks? The answer is simple, “I don’t know!”

  1. Nice to meet you: This is how people introduce and exchange greetings when they meet for the first time:

Me: Hi, I’m Prayash

Other Person: Hi, I’m Smith. Nice to meet you!

Me: Nice to meet you too.

These are the times when I’m compelled to say it was nice meeting the person because how can you feel nice as soon as you meet the person and you have just told your name? I’m sorry, but I obviously need a little longer conversation to decide if I really felt nice meeting you.

  1. Everything is flavored: The height of consumerism can be felt in this nation so much that you can get every food in every flavor. You can have a vegan food made of soybean which instead is chicken flavored. Most of all I am amazed to see varieties of flavored water. Peach flavored, passion-fruit flavored, orange flavored… Why does the water have to be flavored? Isn’t that supposed to be called a juice?! I had never or would have never imagined of flavored water in my life. Am I too dumb about this?
  2. Cold inside, hot outside: This happens during the summer. When it’s way too hot and humid outside, you get this blissful moment as you enter a building since they have their ACs turned on. But as you sit in a place for a while you tend to feel cold and need a jacket. And it’s not just me who feels so, even the people who have lived in the US for a long time feel so. Why don’t they increase the temperature a little bit?
  3. Pizzas!: So this day we were at a mess/dining place for breakfast at 7AM in the morning. I started exploring the breakfast items that were available. One of the queues, to my surprise, happened to be for pizzas! People have pizzas for breakfast as soon as they wake up? God bless them!
  4. Water with ice and straw: The temperature might be negative 35 degree with piles of snow outside, but water with ice is a culture in the U.S. No matter how much you shiver with cold people sip in water with ice using the straw. More than the culture, I’m concerned about discarding the plastic straws which is used for a single-time. Thanks to one of the states – California, for banning on use of single-use plastic straws in full-service restaurants beginning 2019.

Having said that, the best thing about being in U.S. is that there are easy solutions for all our problems. Every problem is thought of and so do every problem has a well thought solution in this country! Cheers’

Keratoconus Diaries

Perhaps it was during the month of February or March when it hit me with an abrupt wish to put on spectacles for no reason. It was pretty normal for a kid of around eleven years, back then, to have such an illogical wish. I wanted it because I had collected some money out of the dakshinas during my bratabandha held back at our village in Eastern Nepal.  Every time I had some money I would give it to my parents and maintained a good record of the amount my parents owed to me. Once in a while, I would then ask my parents to buy me something out of my savings. Sometimes it would be a bicycle (gear-wala-cycle), or a Walkman, or some other stuff I had seen from my friends or on TV. Now was the time for spectacles.

With no other options left, my parents had to get their son a new pair of spectacles. However, they decided to take me to a doctor for an eye examination before getting one of those pairs. I clearly remember visiting the Lions Eye Hospital at Tinkune for the first time. Crowded with people all around, it had taken almost half of the day to have my turn and get done with the examination. The doc had prescribed me a pair of spectacles with corrective glasses for my myopic eyes. My first spectacle frame in blue color with lenses made up of glasses; I still remember the first time I wore them. It felt weird as I saw everything smaller and little shaken.

What I really see without the glasses or contact lenses.

I should have visited Lions twice or thrice every six months for the regular follow-ups for a few years. One sudden day, one of the doctors there told that I had this disorder called “Lazy Eye” and suggested me to visit some specialist who had her clinic at Tripureshwor. After visiting the specialist, I was asked to put on eye patch on my “active eye” and asked me to look only through the “lazy eye” for certain number of hours each day. It wasn’t an easy task to see through an eye with blurred vision. I struggled in the classroom to see what the teachers wrote. Not at all did it work well. After figuring out about the failure to use an eye patch, my dad then took me to TU Teaching Hospital’s eye department for the examination. Queues after queues, rooms after rooms, my examination was done. Although the term “lazy eye” vanished from the doctor’s report, I was told to have some other disorder in my eye. I was too small to understand or remember the term, but the docs had prescribed me a hard contact lens as a cure.



Putting on hard lens, in simple words, was clearly a torture. I would have rather chosen putting on eye patch, rather than this super hard plastic like material which felt like thorn in my eyes every time I had to wear them. I was in grade eight (around fifteen years) when I went to the school with that pair of lenses and would have more of my attention towards my eyes than towards the course work. I wonder how easy or difficult this thing would be to put those on these days as a grown-up man. I wonder if it really was such a pain in the ass because I was a kid or was it really a nasty little thing?!

I stopped putting on the hard lens and wore specs for a year. Sometime during this time, a relative of mine told about a specialist who was said to be a really good doctor. I started to visit him. Every time I visited him, he would have the power on my glasses changed. That was all that happened for next two years – a new pair of glasses in every six months.

After two years new pair of glasses session with the doctor, dad meet another doctor who sounded more promising. After couple of visits to this doc, I was suggested to put on soft contact lenses for better vision. Soft contact lenses worked like gem. I could see things a lot better. Almost five years I visited him. He was a good guy and took well care of my eye. However, sometime in between those five years, in 2015, I heard about the new laser surgery started at Tilganga Institute of Opthalmology and decided to try it. After visiting Tilganga and having a few examinations, I was asked to meet an consultant optometrist who revealed that I had a disorder called Keratoconus. The consultant asked me to visit some other specialist or visit his own clinic for a follow up. “Too commercial person” my mind thought when the doctor himself asked me to visit his clinic while I was right in front of him. Having no trust on the doctor, I continued with my previous doctor for the regular checkups.

Over the years, the lenses of my spectacles got thicker. I had begun my always on with chasma (glasses) life at the time when plastic made lenses was something new and I preferred the cheaper glass made lenses which would get scratches very easily. However, by 2015 the lenses were available in varied options and the glass made lenses were rare. The first time I had wore my glasses had a power of around -1 spherical power on both of my eyes. Now, it was around ten on my right and six on my left with cylindrical power added to it. I felt my eyes to have severely deteriorated and it showed no sign of stopping. I then decided to speak to one of my relatives who was also an optometrist. I told him about my regular doctor and about the incident at Tilganga. He then suggested me to have a thorough check-up at Tilganga once again.

November 2016, I visited Tilganga again. The optometrist who checked my vision coincidently told that my eyes seemed to be Keratoconic. He then told me to visit another room and asked me to tell the doctor that I could possibly have Keratoconus. The checkup was conducted, and the reports clearly showed both my eyes were Keratoconic. Keratoconus deals with the cornea of the eye and so was I asked to meet a cornea specialist. Upon meeting Dr. Reeta Gurung at Tilganga, I was told about a procedure called collagen cross linking (CXL). Since Keratoconus has no cure, she suggested me to have epi-on CXL which does not really cure the disorder but strengthened my cornea to stop the vision to worsen.

As one of the websites states, Keratoconus is a progressive eye disease in which the normally round cornea thins and begins to bulge into a cone-like shape. This cone shape deflects light as it enters the eye on its way to the light-sensitive retina, causing distorted vision. Keratoconus can occur in one or both eyes and often begins during a person’s teens or early 20s. Often, keratoconic patients experience changes in their eyeglass prescription every time they visit their eye care practitioner. It is caused when the corneal tissues weaken. Unfortunately, the reason behind this weakening isn’t much known.



CXL, one of the only options, except cornea transplant, to halt the progression involves putting on drops of Riboflavin (vitamin B) in the eyes for certain period of time and exposing it to the UV rays. There are two versions of corneal crosslinking: epithelium-off and epithelium-on. With epithelium-off crosslinking, the outer layer of the cornea (called the epithelium) is removed to allow entry of riboflavin, a type of B vitamin, into the cornea, which then is activated with UV light. With the epithelium-on method (also called transepithelial crosslinking), the corneal epithelium is left intact during the treatment. The epithelium-on method requires more time for the riboflavin to penetrate into the cornea, but potential advantages include less risk of infection, less discomfort and faster visual recovery, according to supporters of this technique.

It still took me a year to figure out if CXL was a right option. Firstly, I was afraid because I had been diagnosed with numerous disorders so far and wasn’t sure if the diagnosis was proper this time. Secondly, CXL was a very new procedure which was under clinical trials in several countries. In US, FDA was yet to approve the epi-on CXL while epi-off was just approved in April 2016. Europe had only recently approved it. The long-term outcomes and consequences of the procedure was/is still unknown. I also found out that epi-off seemed more successful then epi-on. Yet, with no better options and with a little hope to stop the worsening of my vision, I decided to go for CLX for both of my eyes in March 2017.

I had read and seen videos on CXL so much that the procedure didn’t seem much new to me. CLX for the first time was done in my right eye. It took me about three days to recover and get back to work. The second time, during the CXL of my left eye, I knew so much about the procedure that I was the one to brief about the disease to the assisting doctor during the procedure in the operation theatre. After almost a month, I was prescribed with disposable soft contact lenses for a few months until the hazing in UV exposed cornea was gone and the effectiveness of the procedure was could be analyzed. As I was out of the country for a year, I couldn’t go for any follow-ups.



After a year, I was back to Nepal. The very next day of my arrival, I went for the follow-up. Things seemed to have settled and CXL seemed to have worked. I was then suggested to go for mini scleral contact lens which could superficially correct my vision. Several trials and I ordered this super expensive lens. It was a magical moment reading the letters in the eye chart. Although the shadow of the letters couldn’t fade much, I could read almost until the last line. 6/4 is what I had achieved (it feels like 6/6 to me). As my optometrist said, I had gained a fine quantitative vision but not qualitative vision.  It had been quiet a while I had not seen such a picture-perfect world.

Normal vision, me without glasses or contact lenses, and with glasses. With the mini scleral lenses I see somewhat similar to the normal vision but with some shadow of the image.

In these few months, my achievement has been my friends asking me to read the letters and numbers which they cannot read from far, my courage to drive and walk in the dark, watch the 4K and HD videos with HD eyes, and see the world as it is. No more difficulties to figure out who is waving or is calling my name from a few meters away. Hopefully I will not have to go through the trouble of cornea transplant which has a risk of tissue rejection at any point of time in life. And that’s all in my Keratoconus diary so far!

Join the Facebook community of Keratoconus Patients, and Doctors in Nepal: https://www.facebook.com/groups/993265627680756/ 

Trek: Tilicho Lake – 5 days in Summer

This trek took just 5 days to complete including our travel to and from Kathmandu via Manang. This was one of the times I realized the courage of Nepali drivers (passengers too!) who drove through the super rocky off-road track conquering the hills one after another.

This trek took just 5 days to complete including our travel to and from Kathmandu via Manang. This was one of the times I realized the courage of Nepali drivers (passengers too!) who drove through the super rocky off-road track conquering the hills one after another.

During the first day, journey from an altitude of 760 meters (Besisahar) to 3200 meters (Pisang) was a memorable one. Terrain began from the plains with lush green forests beside us and ended up at the coniferous trees on the semi-bare hills. This adventurous ride had begun after we had hopped into a Mahindra Bolero promising to take us to Khangsar by the next day. Our travel had begun at around 1pm after reaching Besisahar about an hour before. Reaching Besisahar was easy; it was just around 5 hours drive in Toyota HiAce (microbus) from Kathmandu (Gongabu’s New Bus Park).

We were fortunate to find a didi in the microbus to Besisahar, who had contact with a driver and had promised to take us to Khangsar the very day. Had this didi not been in the micro, our stay would have been at Besisahar for the day until we could arrange a Bolero for the next day.

Although the ultimate destiny through Bolero ride was Khangsar, the destiny for the day was Pisang (3250 meters). On our way to Pisang we passed through several waterfalls, river crossings, wooden cantilever bridges, and the beautiful villages. We rejoiced the fresh air and praised the scenic beauty of the hills. Tal, a village by the bank of Marsyangdi River, somewhere in the middle of the way seemed to be a lovely place. Our driver said that a lot of trekkers prefer to begin their journey on foot from this place. One of our teammates also did notice the yellow Himalayan raspberry (aiselu) bush on the way, and so did we enjoyed stopping by and having a few of those. We reached Pisang late in the dark at around 8.15pm. Including the lunch for about an hour at Dharapani, we had spent almost two hours for rest and short breaks in between during the ride. After having Nepali Thali set we called it a day, and headed to our rooms agreeing to leave early morning at 6am to Khangsar (3756 meters)  the next day.

Leaving Pisang at 6.30am, we reached Khangsar after two complete hours. Then we bid good-bye to our driver dai, and grabbed some food and some garlic soup; the diet for the day. Grooming up as trekkers, we left Khangsar at 9.30am, and began using the trek sticks on the sunny day. We had taken some Diamox tablets to make sure no one was caught with altitude sickness. Stopping after almost every 10-20 minutes of walk as we reached higher, we cherished the landscape which got bare and barren throughout the walk up-hill. It was the real “I reached Manang” like feeling for me. Somewhat similar to what I had expected, the hills we passed through had no trees after walking for almost two hours from Khangsar. At times the trek would get mindboggling. Simply jaw dropping! Gravel would slide off the slopes as we passed through them. On the other side we would hear and even see the rocks sliding off into the river down below. It was simply thrilling to imagine oneself slipping off a foot and skidding to the river. But the beauty of bare hills above the snowline altitude was splendid. I called this terrain the “Grand Canyon” of Nepal.

Just as it started to snow, at around 2pm, we got the sight of the hotels at Tilicho Base Camp. Clinching the height of around 4200 meters was a no joke. For sure we were tired as hell. After pleasing the tummy with a plate full of dal-bhat, the team took a good rest while it had been heavily snowing outside. It got cold, and so did we sleep with our jackets and trousers on. Altitude had created a problem to one of us. My friend did get sick for a while but recovered pretty soon. As the day darkened, I spent a good time with the bed.

I slept fine, but my friends said that the night didn’t pass with ease for them. Another friend was struck with acute mountain sickness (AMS). The pills did not work well for him. We had decided to leave early in the morning to summit the snow-covered mountain and explore the lake. However, we started off a little late at around 6.40am. Most of the trekkers had left for the Lake by that time. We walked through the snow with freezing hand and face. I must say, snow was totally not in our plan. But the breadth taking view of the mountains and the blue-sheep (the Bharals) grazing on the hill exhilarated us to step further. We had to make it to the top somehow!

Exactly at 9.50am we reached the Lake. We had made it up to 4919 meters; highest altitude I had ever stepped on. The front portion of the lake had melted but the portion behind was all frozen. We took snaps to make sure we would have the something to “showoff on Facebook”. Little flakes of snow soon began to add up on the ground. Staying just for around fifteen minutes, at 10.05am, we began to descend. Once again one of our friends seemed a little unwell. We hurried to get to the lower altitude.

Reaching the Base Camp at 12.15pm, we had our lunch. Leaving the hotel at 2.30pm, the walk back to Khangsar took us another 4 hours. We stayed at Khangsar that day. Next day we once again took the Bolero ride for the whole day and reached Besisahar at 4.30pm. With a bunch of memories to cherish, and splendid views and moments captured on our cameras, we headed back to the busy bustling Kathmandu city on the fifth day of our journey.

Facts:

  • Altitude of the Lake: 4919 meters
  • Average number of days required: 5 days
  • Cost per person on average: NRs. 15,000

Here’s the rough timeline of our trek:

Day 1

  • Left Kathmandu (Gongabu) 6AM, reached Besisahar 12:30PM
  • Left Besisahar 1PM, reached Pisang 8:15PM

Day 2

  • Left Pisang 6:30AM, reached Khangshar 8:30 PM
  • Rest at Khangshar 8:30 – 9:30 AM
  • Left Khangshar 9:30AM, reached Tillicho Base Camp 2:15PM

Day 3

  • Left Tillicho Base Camp 6:40AM, reached Tillicho Lake 9:50AM
  • Stayed Tillicho Lake 9:50AM – 10:05AM
  • Left Tillicho Lake 10:05 AM, reached Tillicho Base Camp 12:15PM
  • Rest/Eat at Based Camp 12:15PM to 2:30PM
  • Left Base Camp 2:30PM, reached Lower Shreekharka 5:20PM
  • Left Lower Shreekharka 5:30PM, reached Khangshar 6:45PM

Day 4

  • Left Khangshar 7:40 AM, reached Besisahar 4:30PM

Day 5

  • Besisahar to Kathmandu after five hours of drive. 

Financials:

  • Ticket from Kathmandu to Besisahar (one way): NRs.420
  • Bolero ride from Besisahar to Khangsar (one way): NRs.2500 per person for Nepalese
  • Average cost of a meal per person: NRs.350-600 (price escalates with the altitude)

Do:

  • Carry and have the altitude sickness pill
  • Carry chocolates, protein bars and nutri-bars
  • Carry plenty of water and stay hydrated
  • Eat well enough
  • Sticks might be very helpful!
  • Begin the walk early in the morning each day allowing ample time to rest and reach the destiny for the day
  • Watch out for landslides and go slow in the landslide zones

Don’t:

  • Drink or smoke
  • Climb or drive more than 1300 meters once you are above 2500 meters.