Tour the Thakurdwara : साढ़े सात बजे शुरू होता है 103 किलोमीटर लम्बा टूर द ठाकुरद्वारा। 15 किलोमीटर साइकिल चलाने के बाद हम पहुंच जाते हैं कोहलपुर। स्थानीय लोगों ने हमारे लिए स्वादिष्ट नाश्ते का प्रबन्ध किया था जिसमें शामिल थे अण्डे, जलेबी, काला चना और चाय। यहां भी मानो किसी को नाश्ते की चिन्ता नहीं थी और सबके अन्दर के “रिहाना” और “दोसांझ” फिर जाग जाते हैं और शुरू हो जाता है धमाल।
संजीव जिन्दल
हम लोग आठ फरवरी को प्रातः साढ़े आठ बजे बरेली से नेपालगंज के लिए रवाना हुए। अपराह्न करीब दो बजे हम नेपालगंज में नेपालगंज साइकिलिंग क्लब के कार्यालय में पहुंच गये जहां हमारा तिलक लगाकर स्वागत किया गया। चाय-नाश्ता कराने और टूर द ठाकुरद्वारा (Tour The Thakurdwara) में पहनने के लिए शानदार टी शर्ट देने के बाद हमें एक फाइव स्टार होटल में कमरा आवंटित कर दिया गया। यह भी बताया गया कि रात का भोजन कहां करना है। (Cycling in Nepal)
हमारी तरह ही 200 साइकिलिस्ट दुनिया के अलग-अलग कोने से नेपालगंज (Nepalganj) पहुंचे थे। सबसे मुलाकात होती है और इन यादों को सेल्फी के रूप में सहेज लिया जाता है। इसके बाद सब अपने-अपने हिसाब से घूमने निकल जाते हैं और रात को भोजन पर इकट्ठा होते हैं। 200 के 200 “रिहाना” और “दलजीत दोसांझ” थे, डिनर की किसी को भी चिन्ता या जल्दबाजी नहीं। म्यूजिक सिस्टम लगाकर नाच-गाना शुरू हो जाता है। खूब धमाल होता है। रात को 11 बजे के आसपास सभी लोग अपने-अपने कमरे में सोने चले जाते हैं। नौ फरवरी को सुबह ठीक साढ़े छह बजे सभी बागेश्वरी देवी मन्दिर के प्रांगण में इकट्ठा होते हैं। मन्दिर कमेटी की ओर से सभी का शानदार स्वागत कर चाय-नाश्ता पेश किया जाता है।
साढ़े सात बजे शुरू होता है 103 किलोमीटर लम्बा टूर द ठाकुरद्वारा (Tour The Thakurdwara)। 15 किलोमीटर साइकिल चलाने के बाद हम पहुंच जाते हैं कोहलपुर। स्थानीय लोगों ने हमारे लिए स्वादिष्ट नाश्ते का प्रबन्ध किया था जिसमें शामिल थे अण्डे, जलेबी, काला चना और चाय। यहां भी मानो किसी को नाश्ते की चिन्ता नहीं थी और सबके अन्दर के “रिहाना” और “दोसांझ” फिर जाग जाते हैं और शुरू हो जाता है धमाल।
आखिरकार आयोजक दखल देते है, “चलो भाई, अभी बहुत लम्बा सफर है।” जैसे-तैसे यात्रा आगे बढ़ाई जाती है और 15 किलोमीटर का सफर तय करके हम लोग पहुंच जाते हैं केदारेश्वर धाम। यहां स्थानीय लोगों ने स्वागत के बाद हमें स्वादिष्ट खीर पेश की। एक बार फिर नाचने-गाने का दौर शुरू हो जाता है। फिर सभी से विदा लेकर आगे की यात्रा शुरू होती है। यहां से 20 किलोमीटर लम्बा सफर तय कर हम लोग पहुंचते हैं एक घने जंगल के बीच जहां लगभग 200 स्थानीय लोग हमारा इन्तजार कर रहे थे। ऐसा आत्मीय स्वागत जिसकी कल्पना अम्बानी के मेहमान भी नहीं कर सकते! यहां दोपहर के भोजन की व्यवस्था थी। भोजन में शामिल थे चिकन, दाल और मिक्स वेज चावल। 400 लोगों का खाना था और प्लेट मात्र डेढ़ सौ। सभी लोग खाना खाने के बाद अपनी-अपनी प्लेट साबुन से अच्छी तरह धोकर टेबल पर रखते गये, ताकि बाकी लोगों को भी प्लेट मिल जाए। यह सच में बहुत अद्भुत था।
यहां थारू जनजाति के लोगों ने हमारा स्वागत किया जिनका गीत-संगीत और नृत्य के साथ चोली-दामन का साथ है। करीब एक घण्टे नाचने-गाने के बाद बड़ी मुश्किल से सभी साइकिलिस्टों को आगे की यात्रा के लिए रवाना किया गया। फिर हर 10 किलोमीटर बाद जो भी गांव या कस्बा पड़ता था, वहां हमारा स्वागत कर चाय-नाश्ता या फलों का सेवन करवाया गया। इस तरह नाचते-गाते हुए हम लोग सायं करीब छह बजे भगवान ठाकुरद्वारा के प्रांगण में पहुंच गये। यहां हमारा स्वागत नृत्य से किया गया। हरिद्वार में जिस तरह मां गंगा की आरती होती है, वैसे ही यहां भगवान ठाकुरद्वारा की महा आरती का आयोजन किया गया। इसके बाद हम लोग पहुंचे बर्दिया के एक फाइव स्टार रिसॉर्ट। यहां हमारे स्वागत में चाय और स्नेक्स का इन्तजाम था। फिर सब अपने-अपने कमरे में नहाने-धोने के लिए चले गये क्योंकि 103 किलोमीटर के सफर में हम सभी पसीने और धूल-मिट्टी से सन चुके थे।
रिसॉर्ट में कम से कम 10 जगह कैम्प फायर का इन्तजाम था। हम लोग छोटे-छोटे ग्रुप बनाकर बियर की चुस्कियों के साथ गाने-बजाने में मगन हो गए। अद्भुत आनन्द था! किसी को रात के खाने की फिक्र ही नहीं थी। होटल मैनेजमेन्ट और नेपालगंज साइकिलिंग क्लब (Nepalganj Cycling Club) के सदस्यों ने किसी तरह सभी को भोजन कराया। कोई रात के 12 बजे तो कोई दो बजे अपने कमरे में गया। 10 फरवरी फ्री दिन था। घोषणा कर दी गयी कि जिसको जंगल सफारी करनी है वह जंगल सफारी पर निकल जाये और जिसको जंगल में साइकिल चलानी हो वह साइकिलिंग करे।
टूर द ठाकुरद्वारा (Tour The Thakurdwara)। का आखिरी 10 किलोमीटर का रास्ता बर्दिया नेशनल पार्क (Bardia National Park) से होकर जाता है जिसमें अन्य वन्यजीवों के साथ करीब 80 बाघ भी रहते हैं। इस पार्क और बर्दियां गांव में घूमने का अलग ही आनन्द है। रिसॉर्ट के स्वीमिंग पूल में भी धमाल कर सकते हैं।
20 किलोमीटर दूर कर्णाली (घाघरा) नदी के क्रिस्टल क्लियर पानी का भी मजा ले सकते हैं। हम लोगों में से जिसको जो पसन्द था उसने वही किया। शाम को चार बजे सभी साइकिलिस्टों को मोमेन्टो दिया गया। रात को हम लोगों ने छोटे-छोटे ग्रुप बनाकर अपने-अपने कैम्प फायर पर जमकर मस्ती की। रात के दो कब बज गये किसी को पता ही नहीं चला। 11 फरवरी को सुबह आठ बजे नाश्ता करने के बाद सभी लोग एक-दूसरे गले मिलकर अपने-अपने घरों को रवाना हो गये।
अब आप ही सोचिए, हमारा टूर द ठाकुरद्वारा (Tour The Thakurdwara)। अनन्त अम्बानी के विवाह समारोह से कम था क्या?
साधारण लोगों का आसाधारण काम (Extraordinary work of ordinary people)
क्या दो साधारण लोग अपने छोटे-से शहर को अपनी लगन और मेहनत के बल पर दुनिया के पर्यटन मानचित्र पर ला सकते हैं? जी हां, बिल्कुल। ऐसा ही किया है सतीश निरौला और गगन थापा ने। छह साल पहले दोनों ने नेपालगंज को दुनिया के नक्शे पर लाने के लिए टूर द ठाकुरद्वारा साइकिल यात्रा शुरू की। मकसद था बर्दिया नेशनल पार्क में पर्यटन को बढ़ावा देना। बहुत छोटे-से बजट में कुछ लोगों के साथ यह यात्रा शुरू हुई। आज छह साल के बाद टूर द ठाकुरद्वारा साइकिलिंग का महाकुम्भ बन चुका है और नेपालगंज साइकिलिंग के क्षेत्र में पूरी दुनिया में अपना स्थान बना चुका है। आज हर साइकिलिस्ट का सपना है कि वह अपने जीवन में एक बार टूर द ठाकुरद्वारा में आवश्य शामिल हो। यह यात्रा है मस्ती की, अनुशासन की, जात-पात और धर्म को भूल जाने की, नाचने-गाने की और एक-दूसरे को दिल की गहराइयों से प्यार करने की। मेरी नजर में यह यात्रा नहीं, एक विश्वविद्यालय है जहां यदि आप अपने बच्चों को लेकर जाते हैं तो उन्हें केवल चार दिन में ही बहुतकुछ सीखने को मिलेगा।
पर्यटन : नेपाल से सीखो (Tourism: Learn from Nepal)
पर्यटन आज दुनियाभर में बहुत बड़ा उद्योग है। यह लाखों-करोड़ों लोगों को रोजगार देता है। नेपाल, मालदीव, फिजी, थाईलैण्ड समेत कई देशों का पूरा अर्थतन्त्र ही पर्यटन पर टिका हुआ है। भारत एक विशाल देश है पर पर्यटन के मामले में अभी भी काफी पिछड़ा हुआ है। यदि हमें भारत में पर्यटन को बढ़ाना है तो नेपाल से बहुतकुछ सीखना होगा।
टूर द ठाकुरद्वारा (Tour The Thakurdwara) के दौरान हम जब बर्दिया पहुंचे तो वहां कई विदेशी पर्यटक दिखे। मैंने और रूबीना मल्ला ने उनसे काफी देर बातचीत की। हमने उन्हें बताया कि हम लोग नेपाल सरकार की तरफ से हैं और सर्वे कर रहे हैं कि आपको नेपाल में कोई दिक्कत तो नहीं हुई ताकि सुधार किए जा सकें। मुझे यह जानकर हैरानी भी हुई और खुशी भी कि सभी पर्यटक नेपालियों के व्यवहार, आतिथ्य और प्राकृतिक सौन्दर्य को देखकर अत्यन्त प्रसन्न हैं। बार-बार पूछने पर भी सभी ने कहा कि सच में उन्हें कोई दिक्कत नहीं है और वे अपनी इस यात्रा का भरपूर आनन्द ले रहे हैं।
अब करते हैं भारत की बात। घुमक्कड़ी के अपने शौक की वजह से मैं भारत में तमाम स्थान घूम चुका हूं, खासकर पर्वतीय क्षेत्र। इस दौरान जब भी विदेशी पर्यटकों से बात करता हूं तो वे तीन परेशानियों के बारे में खुलकर कहते हैं- स्वच्छता की समस्या, भिखारियों द्वारा पीछा करना और सड़क पर समान बेचने वालों का उनके साथ जबरदस्ती करना। अपने नेपाल घूमने के अनुभव के आधार पर मैं कह सकता हूं कि इस छोटे-से देश में ये तीनों ही समस्याएं नहीं हैं। सबसे बड़ी बात यह कि नेपाल जैसे छोटे-से देश ने अपने आप को पर्यटन के अन्तरराष्ट्रीय नक्शे पर स्थापित कर लिया है।
बर्दिया में मिले बुजुर्ग अमेरिकियों के साथ काफी देर तक गपशप हुई। वे सभी काफी खुश थे पर एक बात को लेकर मलाल था कि उन्हें बर्दिया नेशनल पार्क में अभी तक बाघ नहीं दिखायी दिया। इस पर उनका मन हल्का करने के लिए मैंने चुहुल की, “इसमें उदास होने वाली क्या बात है? मुझे देखिए।” यह सुनकर उन्होंने ठहाका लगाया। इस बीच उनके एक मित्र कहीं से वापस आ पहुंचे। सब मेरी तरफ इशारा करके उनसे कहने लगे, “देखो बाघ…देखो बाघ।” इसके बाद भी हम काफी देर तक हंसते-गपियाते रहे।
इन पर्यटकों में शामिल लिजा अमेरिका से आयी थी जबकि मां-बेटी की एक जोड़ी जर्मनी से यहां पहुंची थी। प्रेमी-प्रेमिका का एक जोड़ा नीदरलैण्ड से नेपाल घूमने आया था। प्रेमिका 42 साल की थी और प्रेमी 34 का।
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Dbol Cycle For BeginnersLength, Dosage, Results, And Gains
**Short‑form take‑away:**
| Topic | Key points |
|——-|————|
| **What are anabolic steroids?** | Synthetic derivatives of testosterone that increase protein synthesis
→ muscle mass, strength, red‑blood‑cell production. |
| **Historical use** | From early 1900s “steroid” experiments → first legal prescription (synthetic testosterone) in the 1930s;
widespread doping by athletes from the 1960s onward.
|
| **How they work** | Bind to androgen receptors → gene transcription → muscle
fiber hypertrophy, erythropoiesis, fat loss. |
| **Benefits for athletes** | ↑ Power‑output, faster recovery, improved VO₂ max (via more RBCs).
|
| **Risks / side effects** | • Cardiovascular: hypertension, atherosclerosis,
arrhythmias
• Hepatic: cholestasis, liver failure (especially oral steroids)
• Endocrine: testosterone suppression, gynecomastia,
infertility, hot flashes
• Psychological: aggression (“roid rage”), mood
swings
• Long‑term: potential for irreversible organ damage.
|
| **Legal status** | • Many anabolic agents are banned
in sport (World Anti‑Doping Agency).
• Some steroids have legitimate medical uses (e.g., testosterone therapy),
but prescription and monitoring are required.
• Use without prescription or for performance enhancement is illegal in many
jurisdictions. |
—
## 2. Why These Drugs Are Often Misused
| Drug | Primary medical use | Typical dosage & duration | Common misuse patterns
| Rationale for misuse |
|——|———————|————————–|————————|———————-|
| **Methylphenidate (Ritalin, Concerta)** | Attention‑deficit/hyperactivity disorder (ADHD) in children/adolescents and adults; narcolepsy.
| 5–60 mg/day (split doses). Duration: as needed for symptom control, often lifelong.
| • Taking higher than prescribed dose.
• Using “bottle” or “tablet” to get rapid onset.
• Crushing tablets to snort or inject. | Stimulant effect improves focus and alertness; high abuse potential due
to euphoric effects. |
| **Lisdexamfetamine (Vyvanse)** | ADHD in children/adolescents and adults;
binge‑eating disorder (adults). | 20–70 mg/day. Duration: chronic use, often many years.
| • Taking more than prescribed.
• Chewing or crushing for snorting or injecting.
| Longer‑acting stimulant; abuse potential similar to other amphetamines.
|
| **Methylphenidate (Ritalin, Concerta)** | ADHD in children/adolescents and adults.
| 10–60 mg/day. Duration: long‑term treatment over many years.
| • Taking higher doses.
• Crushing for snorting or injecting. | Dopamine reuptake inhibition; high potential for abuse
when misused. |
| **Atomoxetine (Strattera)** | ADHD in children/adolescents and adults.
| 40–100 mg/day. Duration: long‑term therapy.
| • Not typically abused due to no stimulant properties,
but some misuse reported with higher doses.
| Nonstimulant; minimal abuse potential. |
| **Clonidine (Kapvay)** | ADHD in children/adolescents and adults.
| 0.1–0.2 mg twice daily (children); dosage varies by age.
| • Minimal abuse potential; some misuse at high doses reported.
| Alpha‑2 adrenergic agonist; low abuse risk. |
| **Atomoxetine** | ADHD in children, adolescents, and adults.
| 0.5–1.2 mg/kg/day (max 100 mg). | • Low abuse potential; rare reports of misuse at high doses.
| Selective norepinephrine reuptake inhibitor. |
| **Bupropion** | Off‑label use for ADHD in adolescents and adults.
| 150–300 mg per day. | • Moderate abuse potential
due to stimulant effect. | Norepinephrine-dopamine reuptake inhibitor.
|
| **Guanfacine** | Off‑label treatment of
ADHD symptoms in children, adolescents. | 0.5–1.5 mg/day (max 3 mg).
| • Low abuse potential. | α2-adrenergic agonist. |
> **Clinical Takeaway:**
> – Stimulants have the highest efficacy but also carry a higher risk of misuse and side‑effects such as insomnia, appetite suppression, or cardiovascular concerns.
> – Non‑stimulants (atomoxetine, guanfacine) are useful when stimulants fail or pose safety issues.
> – Bupropion may be considered if depressive symptoms coexist
and stimulant contraindications exist.
—
## 3. Evidence‑Based Treatments for ADHD with Anxiety/Depression
| Category | Key Findings & Recommendations |
|———-|——————————–|
| **Pharmacologic** | • Stimulants (especially methylphenidate) are effective; monitor blood pressure, heart rate.
• Non‑stimulant atomoxetine may be chosen when anxiety is severe to avoid potential
agitation.
• Bupropion shows moderate efficacy for ADHD and depression but requires caution in patients with a history of mania or suicidality.
• Combining an SSRI (e.g., sertraline) with methylphenidate has been shown to reduce depressive symptoms without significant
interaction, provided cardiovascular monitoring is done.
|
| **Psychotherapy** | • Cognitive‑behavioral therapy (CBT) tailored for ADHD improves executive function and coping skills.
• Mindfulness‑based CBT helps regulate emotional lability and reduces anxiety.
• Psychoeducation for the patient and family promotes adherence to medication schedules.
• Family‑focused interventions improve communication and reduce conflict that can exacerbate
depressive symptoms. |
| **Lifestyle** | • Structured daily routine, including a consistent sleep
schedule, regular exercise, and balanced nutrition, enhances mood stability.
• Limit caffeine testosterone enanthate and dianabol cycle sugar intake
as they may worsen anxiety and disrupt sleep.
• Encourage creative outlets (music, art) for emotional expression. |
—
### 5. Practical Implementation & Monitoring
| Time Frame | Action | Responsible |
|————|——–|————-|
| **Day 1–7** | Initiate medication changes; begin CBT modules on negative thought patterns;
set up sleep hygiene routine; schedule first follow‑up visit in 2 weeks.
| Patient, prescribing clinician, therapist |
| **Week 2–4** | Review medication tolerability; adjust doses if needed; continue CBT; assess mood with PHQ‑9 and anxiety with GAD‑7
at each visit. | Clinician, therapist |
| **Month 1–3** | Reassess treatment efficacy; consider
adding or adjusting adjunctive therapy (e.g., propranolol) if PTSD
symptoms persist. Continue psychotherapy for trauma processing.
| Multi‑disciplinary team |
| **Quarterly thereafter** | Monitor long‑term maintenance of mood and anxiety
control; adjust psychotherapy focus toward relapse prevention and functional recovery.
| Clinician, therapist |
—
## 4. Summary
The patient presents with a complex psychiatric picture that includes:
– **Major Depressive Disorder (MDD)** – moderate to severe.
– **Generalized Anxiety Disorder (GAD)** – chronic worry
symptoms.
– **Post‑Traumatic Stress Disorder (PTSD)** – trauma‑related re‑experiencing, avoidance,
hyperarousal.
– **Potential Substance Use Disorder** – ongoing alcohol
consumption.
**Differential Diagnosis** must consider mood and anxiety disorders in the
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**Treatment Recommendations** involve a multimodal approach: pharmacotherapy (SSRIs + SNRIs/serotonin modulators),
psychotherapy (CBT, EMDR, ACT), sleep hygiene,
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This comprehensive plan is designed to address the complex interplay of
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