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The Many Faces of Postpartum Depression

Jun02

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Photo by Porcelaingirl°
(I know, I know. Exercise. I kind of forgot and wrote this instead.)

I heard a LOT about Postpartum Depression when I was pregnant for the first time. Women were finally opening up about their experiences, the media was talking about it, there were brochures and book chapters and checklists about the signs and symptoms. By the time I was discharged from the hospital, I was completely sick of the topic. Yes, yes. Depression, sleep problems, loss of appetite, fatigue, feelings of worthlessness, thoughts of suicide. Seek help. Speak up. Postpartum Psychosis requires an immediate call to 911. Got it, check. As someone who had been through bouts of the regular old-fashioned kind of depression and YEARS of anxiety problems, I figured I would be more than capable of recognizing PPD if it were to happen to me.

And you know what? Absolutely NONE of those symptoms ever did. I had the postpartum blues (or baby blues) for a week or so — lots of crying while I struggled to breastfeed, viewing everything that was “wrong” with Noah as some kind of colossal failure on my part — but once the hormones regulated all that went away and I was a confident, happy new mom who you would never, ever peg as having anything remotely close to PPD.

Except for, you know, the fact that I was terrified out of my gourd a good 75% of the time.

Sure, there’s always fear when you have a new baby — of course you’re going to fret about SIDS and milestones and sleep and worry about dropping the baby on the kitchen tile. That was actually the sort of stuff that rarely occurred to me to really worry about. Instead, I went out of my way to invent stuff to be afraid of.

I secretly, internally, obsessed about the future, imagining all kinds of awful worst-case scenarios. That Noah would get sick and die of cancer, or in a car accident. That he’d be kidnapped and hurt and molested and killed. Every sad news headline spawned an alternate reality where it was US, it was NOAH, it was my child, my loss, my tragedy. Now that I had a baby, I was acutely aware of just how much I had to lose, and it drove me a little crazy there, for awhile. I couldn’t think about how much I loved Noah without getting overwhelmed by how vulnerable my heart was now. I bit my nails and lost weight (“I’m just losing baby weight! That’s all!”) and read the newspaper to torture myself on purpose, thinking that I could force myself to grow a thicker skin. I only cried over superficial stuff like dropping Noah off at daycare or mean comments about me on the Internet, and never uttered a word to anyone about my intrusive dark thoughts and fears and fantasies. It got worse right around the end of my maternity leave and continued for a few months after that. At some point, and I really don’t remember when, it just…stopped.

Did I have a classic debilitating case of true PPD? No, I didn’t. More like a postpartum anxiety disorder — which, considering my long, storied history with anxiety and panic, I SHOULD HAVE RECOGNIZED. In fact, it never really occurred to me that something was ever wrong until after Ezra’s birth. Because I DIDN’T have any of those thoughts. I’ve had some anxiety issues related to Noah and his special needs, but it’s a concrete sort of worry. I don’t start shaking and gasping on the highway because I can’t stop visualizing a car smashing into the baby’s carseat, and THEN start worrying that I had somehow actually glimpsed the future or that my thoughts would actually will the accident into existence. Yeah. Nothing like last time.

Cough.

Perhaps I missed it, but I really didn’t know just how many flavors of Postpartum Depression there are, and how many of them don’t actually manifest in a classic sort of depression, where you can’t get out of bed and fantasize about swallowing pills. For some women, it’s anxiety. Panic. Others get something more like Obsessive Compulsive Disorder, fretting about hand-washing and germs and toxins in foods and the environment. Some women describe an irrationally short fuse — anger and rage, usually directed at themselves for “failing,” but sometimes they lash out at their partners or strangers. Basically, if there’s a mental condition out there, it can take a special hellish form in the postpartum months.

So. Yeah. I should have spoken up last time. Maybe I needed medication, maybe I needed to talk to someone, maybe I just needed to let Jason know what was going on in my head so he could help me redirect and talk through my anxious energy. But I just honestly didn’t know that what was happening wasn’t NORMAL rookie-mom worry, that it was excessive and not something I should have been internalizing and keeping to myself. I was *okay* in the end, obviously — it ran its course and evened out eventually — but I think if more people had stressed to me that hey, Postpartum Depression is not always just depression, that it actually can manifest in a number of mood and anxiety disorders, that it’s (GASP OMG CONCEPT) different for different women, I would have been a bit more self-aware that I didn’t have to live like that. Postpartum depression — in all its faces and forms — is completely treatable AND curable. And it happens to the best of us, and the BEST OF MOTHERS. No shame.

If you’re concerned about yourself or someone you know, check out Postpartum Support International’s website or call their helpline (800-944-4PDD). Your OB or midwife or primary care doctor should also be able to help you — it’s just important to CALL SOMEONE. If you’re having serious problems and thoughts of harming yourself or others, call Hopeline at 800-SUICIDE — they can help you find specialized postpartum resources in your area.

If you landed here but are still pregnant, visit Amalah’s Pregnancy Calendar. You won’t regret it.

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About the author

Amalah

http://www.amalah.com
Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy's daily mothering adventures at Amalah. Also, it's pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to amyadvice@gmail.com.

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.


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24 Responses to “The Many Faces of Postpartum Depression”

  1. chiquita Jun 02 at 12:10 pm Reply Reply

    Amy, thanks for this. I was very anxious after the birth of my first baby and could. not. sleep when the baby slept. I hated my husband for going to work. I fortunately was in therapy throughout my pregnancy, so had some professional oversight, but it was a hard, hard couple of months. I think it is hard for many women to figure out what is going on b/c we expect it to be hard and to be anxious. So it is hard to tell when it crosses a line. I think telling someone else is key so they can help you determine when it is too much or you need help.

  2. Kari Weber Jun 02 at 12:12 pm Reply Reply

    With my first son, I didn’t feel any of the symptoms either. Just a need to do everything myself. I thought that if I asked for help, someone would just remind me that I was the wone that wanted the baby. And then I would… feel bad? I don’t know really what it was that kept me from asking for help. At the time, it seemed like a much bigger thing. I was breast feeding, so I just justified in my mind that it was just “easier” for me to do all the diaper changes since I was feeding him anyway. My son had acid reflux, so we didn’t do the bottle for a few months, and then pumping was just providing a while I was at work supply, I couldn’t get a drop more. The thought of supplementing with formula? Yeah. I don’t know why that didn’t occur to me… But, it wasn’t long before I couldn’t do anything without the baby because I wouldn’t have enough pumped milk left over for daycare the next day. That meant that all the things I wanted to do… I didn’t get to. No scrapbooking, no day out with the girls… just me and the baby. Eventually, as with what you said about Noah, it just went away. I actually drove myself to stop cold turkey breast feeding at 7 months because I couldn’t handle the stress anymore. But after that, it got a bit better. I realized that things were not such a big deal. With my second son, it was different. For me it was a bit of the baby blues, but more the thought that I had maybe “ruined a good thing” by wanting another baby. Suddenly I started seeing behaviors in my first son that I didn’t like. Tantrums, defiant behavior. Absolutely NOTHING directed towards the new baby– he was great! Just towards mommy. Bad Bad Mommy. Which all cemented that I had made the wrong decision. I love my new son, and never would want to reverse him! However, it was hard to get used to the “new” us. The family of FOUR. My first son was not just my baby anymore, but a big brother… nobody really tells you about the change in family dynamic, and how that can trigger the feelings of PPD or even just Baby Blues. At 6 weeks post delivery, I feel MUCH better. More confident about our family. My first son’s behaviors have calmed down a bit, and I am feeling good about how I am balancing two boys. But every once in a while, I still have to pull my mind away from going down “that path”. Thank you for this much needed post. I think if more women heard stories of other REAL women’s experiences, and not just a checklist of clinical terms from their doctor, we WOULD recognize it in ourselves a bit better.

  3. beanery Jun 02 at 12:33 pm Reply Reply

    “I had somehow actually glimpsed the future or that my thoughts would actually will the accident into existence.”
    Oh my god, yes! That was totally me. So glad you got through that (me too!). Thank you for writing this.

  4. Kellie Jun 02 at 12:48 pm Reply Reply

    I got PPD with my son. It went undiagnosed until he was almost 2. He also was diagnosed around the time with Autistic Spectrum Disorder so my docs wondered if it really was PPD or actual depression from the insane and confusing life we had been living up until that point.
    When my daughter was born 21 months ago, I made sure I was aware of the old signs and symptoms. It had been a full 6 months that I was off everything before I got pregnant with her and I didn’t want to have to go back on meds.
    I felt fine with her. What I didn’t realize is when you are terrified that a tire is going to fly of the car in front of you and smash into your car any second and kill you all pretty much your whole drive, your dealing with some PPD. I was a nervous wreck behind the wheel. I just kept thinking it was because I had a newborn again and was nervous or something.
    Mine eventually evened out as my hormones evened out, but holy cow. When I think about how insane my thoughts were while I was driving? It was wild.

  5. madison Jun 02 at 1:35 pm Reply Reply

    Wow. I don’t know where to start. My first son is 6 months old on Monday & I suffer from everything you all mentioned. I cry when I drive accross bridges, I haven’t let anyone, even my parents, babysit, I envision people breaking into my house and stealing him so much so that he has never slept a night alone in his crib.. I didn’t know it could be PPD because I’ve never thought of hurting him. I’m doing everything right. The breastfeeding, the organic baby food making, throwing stupid parties for Easter, his half birthday etc. I didn’t think “good moms” had PPD. Hearing you admit to these things feels like a weight off my shoulders because I look at you as one of the “good ones”. Thank you.

  6. madison Jun 02 at 1:35 pm Reply Reply

    Wow. I don’t know where to start. My first son is 6 months old on Monday & I suffer from everything you all mentioned. I cry when I drive accross bridges, I haven’t let anyone, even my parents, babysit, I envision people breaking into my house and stealing him so much so that he has never slept a night alone in his crib.. I didn’t know it could be PPD because I’ve never thought of hurting him. I’m doing everything right. The breastfeeding, the organic baby food making, throwing stupid parties for Easter, his half birthday etc. I didn’t think “good moms” had PPD. Hearing you admit to these things feels like a weight off my shoulders because I look at you as one of the “good ones”. Thank you.

  7. Jamie Jun 02 at 2:00 pm Reply Reply

    I had the same anxiety issues as you did with my second. Nothing with my first. With my second I would be terrified of things like driving the car because I just knew I was going to get in a horrible accident. I finally told my husband about it. I told him I didn’t think I needed medication yet, I wasn’t thinking of hurting myself or anyone else, but if the anxiety didn’t start getting better soon I was going to go see the Dr. It started clearing up a couple weeks later.

  8. She Likes Purple Jun 02 at 2:01 pm Reply Reply

    Although I had a smattering of symptoms, the worst was my insomnia. There were days I wouldn’t sleep at all and not because Kyle wasn’t sleeping but because I could never unwind long enough to sleep. I saw 6 a.m. without ever going to sleep more times than I can count. When I finally started sleeping and gave up breastfeeding, I regained my sanity and exhaled for the first time since he was born (two months in).

  9. She Likes Purple Jun 02 at 2:19 pm Reply Reply

    Although I had a smattering of symptoms, the worst was my insomnia. There were days I wouldn’t sleep at all and not because Kyle wasn’t sleeping but because I could never unwind long enough to sleep. I saw 6 a.m. without ever going to sleep more times than I can count. When I finally started sleeping and gave up breastfeeding, I regained my sanity and exhaled for the first time since he was born (two months in).

  10. Di Jun 02 at 2:53 pm Reply Reply

    Thank you, thank you, thank you.
    You’ve summed it up so perfectly. Right now I’m wrestling with the aftermath of PPD with Claire (who turned two a week ago) so that the anxiety I’m feeling now doesn’t turn into PPD when The Tadpole is born in September.

  11. shriek house Jun 02 at 6:58 pm Reply Reply

    You make a great point, that PPD can present in a variety of ways. I always thought the development of PPD had a lot to do with whether the woman was prone to melancholy or anxiety already (raising hand), but the fact that you didn’t have it with your second child seems to indicate otherwise.
    It’s funny though, I just wrote a rambling post about learning to let go of fear & anxiety, and as soon as I hit “publish” was overwhelmed with the thought that I’d just jinxed something somewhere badly. Sigh.

  12. Shylo Jun 02 at 10:19 pm Reply Reply

    Last week I was given the option to go to the emergency room or get in to see a therapist for PPD ASAP. Luckily, I did not need to head to the emergency room that day. But there had been some days when things were more acute — and when I could not have even found shoes, much less my car keys.
    I had an idyllic delivery, but the breastfeeding — oh my God has that been tough. It’s hard to bond with something that causes you pain, and it’s hard to relax enough to sleep when you know you’re just going to have to go through the pain in another couple of hours. Getting the breastfeeding working has been/is key for me to feel more positive about being a mother.
    Also, it’s important to find a therapist who knows how to deal with PPD issues in a way that’s right for you, whether that’s solely talk therapy or with medication or whatever else.

  13. Amalah
    amalah Jun 02 at 10:35 pm Reply Reply

    shriek house: Actually, women who have a history of depression/anxiety ARE more likely to struggle with PPD. Women who are bipolar are more likely to suffer from postpartum psychosis. But that doesn’t preclude someone withOUT a history of mood disorder suffering from a form of PPD. So there is a connection, but statistics and “more likely” are never the full story. Every woman and every pregnancy is different.
    With my second baby, breastfeeding went perfectly, there was no trauma or danger at delivery (scheduled c vs. emergency c w/ fetal distress, meconium & macrosomia), I asked for help when I needed it. (I was like Kari with my first — REFUSED to ask or accept help and had to do it ALL.) I ate better postpartum, was just generally less “afraid” of stuff. I have had some anxiety, it just hasn’t escalated to the levels I had before. The differences are subtle, but I guess they count. Or I just got lucky.
    madison: Please email me if you need to talk or need help. Yes, good moms get PPD and it’s NOT FAILURE. It’s *&$(ing hormones. amalah AT gmail dot com.

  14. Catherine S Jun 03 at 9:12 am Reply Reply

    Oh man, this one really hits close to home. Like, sobby, weepy mess by the end of reading your post close to home. My son is 9 months old on Thursday and I would not repeat the first 5 months of his life if someone told me that I would inherit 30 bazillion dollars and have sex with Brad Pitt for the rest of my life.
    The PPD, well, it was just bad. The insomnia started the day he was born and is just now getting better. I would not let anyone put ribbons or bows on our mailbox because I thought someone would take my child. I thought that there were people standing outside my house waiting for me to turn by back for just a minute so they could take him. The insomnia and fear got so bad, that I wanted something bad to happen to him or to me, just so I could get a break from the non-stop anxiety. Here it is in black and white, I wanted to hurt my son. This is something that I will be ashamed of for the rest of my life.
    My husband, who is old school Asian, thought that PPD was something made up by bored housewives in need of attention (yeak, I KNOW!!). Until one day, after many nights of screaming at him, the baby, and myself, he politely suggested that things seemed a little off and that I maybe, should perhaps think about “talking to someone.” After one particularly bad night and really thinking that it would have been better if my son was never born, I did decide to go see my doctor. Put on Lexapro immediately and should have gone and seen a therapist, but couldn’t afford to financially. Before we have our next child, I am going to have to just deal with the cost and talk to someone just to make sure I have dealt with everything appropriately and make sure it never gets that bad again.
    I am off the medication and still have some sporadic bad days, but think that just be the nature of being a mother and a human being. The good days are way more common now and I am really glad that I got help.
    I did not call them myself, but I heard that Postpartum Support International has a hotline if anyone needs to talked down from the ledge literally or figuratively. Their website is http://www.postpartum.net I think.
    Good luck to all you mums out there and if you think for a second that you are having symmptoms of PPD, talk to someone about it!

  15. kelly Jun 03 at 2:32 pm Reply Reply

    Thanks, Amalah. I’ve been having problems with those fears you describe, and hadn’t really realized that that’s an expression of PPD. However, on Monday, I spent most of my day at work reading the blogs of parents who’ve had children die, trying to inoculate myself to the possibility. Near the end of my day, seeing the whole pile of work that I didn’t get done, feeling totally sad and depressed by all my reading, I realized, um, yeah, I need to talk to somebody, and made an appointment to see a therapist. So, this was a very timely post for me. And affirming, too, in a strange way, to know, yeah, actually something IS going wrong, something I can get help with.

  16. SUPAHMAMA! Jun 03 at 10:36 pm Reply Reply

    now see, after my first was born i just thought my husband had turned into an idiot and it was normal to make him sleep in the other room as far away from me as possible. i also thought it was completely normal to rage at him in my head and then get pissy with him when he had NO IDEA WHY I WAS THROWING “LASER BEAM EYES!!!” at him every time he came into the room. let me just tell you, the drugs are the best thing that happened to me. i was even able to be convinced into bringing another baby into the world. this time? i’m not nearly as crazy, and that’s pretty tough to fix considering i’m crazy enough to begin with.

  17. Photomom Jun 04 at 9:12 am Reply Reply

    I had the ppd- anxiety version, too. There were lots of stressful things going on not related to the baby, but it adds up. I just kept imagining I heard her cry at night, and got up to check her 3-4 times when she was snoozing away. I had zoloft for about 9 months, and while I wasn’t suddenly Woohoo rainbows and flowers, I could sleep better, didn’t imagine disaster scenarios from every day things, and stopped being so aggravated with my husband. (My girlfriend mentioned that she was more bitchy postpartum, and I told her , no , my husband even breathes in an irritating way.) Talk to your dr, get some help, ask your partner to help you get some time to yourself. ( I remember leaving the baby with my husband just to go walk around the mall, and I had no idea what to do with myself without the baby) It gets better. really.

  18. Ysha Oakes Jun 07 at 2:44 pm Reply Reply

    Hi Amalah and All Dear Mamas! My problem is after 17 years carrying the great positive effects of Ayurvedic postpartum care for preventing ppmds and reversing early or non-medicated later stages of anxiety, depression, and many other symptoms – I”m still swampt by how to use the media to get the good news out there. you can see some deceptively simple tips at my website, and links for more. I’m starting to blog, twitter and facebook too, tho the reason there are so many forms of this so called disease is each person has individual needs to balance. AND each mom DOES have many common contributing factors by the nature of birthing. I didn’t say much here, sorry, there is so much to share…

  19. Angela Jun 09 at 4:32 pm Reply Reply

    Like everyone else, just want to thank you for running this. But with as much as PPD has been publicized in the last couple years, it seems like a lot of medical professionals still aren’t getting the point. I’m not quite 3 weeks pp, and at my 2 week incision check I mentioned to my OB that I was suffering, and had after the birth of my three year old as well. He told me to make time for myself. Heh. Called my PCM and was given an appointment for next week, that was the earliest possible. THEN I called my OB office again, and a nurse called back and asked if I wanted to hurt myself or the kids, and when I told her that I did not, she pretty much told me that there was nothing they could do and I needed to deal with this through my PCM. It really frightens me that I have gone out of my way to ask for help and have been brushed off, because that means that people who don’t ask but are displaying obvious signs of PPD/Psycosis probably aren’t getting the treatment they need either.

  20. sarah Jun 09 at 9:23 pm Reply Reply

    hi, as i read this i couldnt help but think about my postpartum depression and imagining taking pills and everything. i finally do not feel alone, my daughter is now almost a year and half and i cant imagine going back to that. i fear that having another child will bring back my negative state of mind. i hope theres hope for me. i felt so alone and still do, somedays. i was depressed my whole pregnancy and i ended up with an emergency c-section. my boyfriend broke up with me 2 days after i had my daughter and i feel things could have went the way i pictured it, but they didnt and i have to live with this horrible feeling
    _______________________
    Editor: if you ever need to talk directly, please do contact us or the professionals at Postpartum.net. Just please DO reach out. Postpartum depression is treatable.

  21. Becca Jun 11 at 3:35 am Reply Reply

    I was fine with my first born….just the typical hormonal things all new moms go through. Worry, fatigue, blues.
    With my second daughter I was full-on PPD. I wound up with a prescription for Zoloft (approved for breastfeeding, I heard) and must say it did me a world of good! I still suffered from horrible insomnia (that I still have remnants of now….3.5 years later).
    The insomnia really is the worst because it makes all the other symptoms so much more exaggerated. But with #2 I had as close to an actual breakdown as you can get….I lost all confidence in myself as a mother, individual and woman. Luckily my OBGYN asked the right questions and got it diagnosed on the spot. I was back on track by the time by Roo turned a month old!
    NEVER be afraid to talk about your depression….be it PPD or non-PPD. Talking about your feelings is the only way to really figure out if they are grounded.

  22. paranoid Jun 13 at 6:37 pm Reply Reply

    I’m sitting here crying with recognition right now. My second daughter is four months old right now, and it took 18 months, two losses and IVF to get her. I look at her and my life and know that I should be happy (and many days, I am happy, really!), but still, there’s this hair-trigger temper. And rage. And the feeling that I just want to sit on the sofa and not talk to anybody or do anything but stare at the television but oh my god the three-year-old wants to play pretend ponies AGAIN. Even my husband thinks, at this point, that there might be a little more going on here than postpartum hormones.
    And still, I’m having a hard time accepting that perhaps I could use some help. I’m going head over to the PPD website and see if maybe I can figure out what the hell is wrong with me.
    _________
    Editor: thank you for being so open with us. We are contacting you privately.

  23. Landie Nov 07 at 2:55 pm Reply Reply

    Reading these statements from mothers has been so amazing. I have PPD, but it wasn’t diagnosed until my son was almost a year old.
    I had a horrible birth experience (11 days overdue), ended up with a C section and was in the hospital for 6 days because my enormous son (10lbs, 8oz – and I didn’t have gestational diabetes and only gained 30lbs) was dropping weight like crazy. I had a horrible feeling from the very beginning that something was wrong and I had a very difficult time bonding with him. Turns out that there WAS something terribly wrong, he had a very serious congenital heart defect which was diagnosed at 4 weeks.
    Thus began a whirlwind of medications, doctor’s appointments and open heart surgery at 4.5 months. It was hell, but throughout it all I was calm and somewhat detached. I sat on all my anxiety and emotions. Everyone was freaking out, so I needed to make sure my son had someone calm and strong to be with. Never mind that throughout this period I hated my husband with a passion and raged at him regularly. Never mind that I didn’t sleep. Never mind that I was also trying to keep my career going. Never mind that I was recovering from major surgery and running the whole household myself with a husband who was working 80 hours a week and couldn’t help as much as he promised and wanted to. It was HELL. I wanted to hurt myself on almost a daily basis and often thought about just running away.
    My son did very well post-surgery, but I didn’t really manage to relax until my husband took parental leave at the end of July (my son was born at the beginning of October). Then I totally fell apart.
    Out of desperation, my husband talked to a couple of friends of mine and they staged a mini-intervention a la “Dude, you have PPD and you need help” and I saw a psychiatrist and got some medication just before my son’s first birthday. Although that seems really late for PPD, apparently if you have sick child, the symptoms emerge much later because you’re so busy dealing with your baby. Add an overdue baby, a c section, relationship issues and a sick baby and you’ve got a surefire PPD recipe. I still felt like a failure though for not being “tough” enough to get through it with flying colours.
    All this to say that I am feeling better, but I have decided never to have another child. I can’t go through that again and I’m terrified that a second child might have similar health issues.
    If you’re feeling bad, GET HELP. And know that you’re not alone.

  24. Tamara Mar 07 at 1:50 pm Reply Reply

    I’m reading this and realize its a long time past the original post date – but I’m going to comment anyway. I didn’t ‘discover’ for lack of a better term that I had had PPD until recently. My daughter is a month shy of being 3 years old. My PPD was like all of you have said unique to me. I couldn’t say no to people, yet hated them for being in my house and taking my baby. I was paranoid about the most crazy things and some actual real things that had to be hashed out with the In Laws in a very serious sit down manner. My husband didn’t have a clue and was actually battling his own undiagnosed depression at the time so yeah a whole lotta emotional hormone un-doing in our house. I just thought I’m having a rough time and if *this* <- whatever that was at the time would happen I would be ok. I also had a horrific end of pregnancy with lots of scary things and a horrendous labour ending in a C section with a baby who would. not. latch. so basically I was prefectly set up for PPD and never ever realized it. Until it was recently pointed out to me by my mother that yes in fact you did go through that. Looking back its so clear but had anyone told me 'hey I think you might have PPD' I probably would've bitten their head off and refused to believe them. I'm currently 4 months along with number 2 and wow hopefully I open my eyes this time if God forbid I should get it again. Thanks for writing this and thanks to the commenters.

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