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Dr. Aloke Dhar

Radiologist, Delhi

Dr. Aloke Dhar Radiologist, Delhi
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My favorite part of being a doctor is the opportunity to directly improve the health and wellbeing of my patients and to develop professional and personal relationships with them....more
My favorite part of being a doctor is the opportunity to directly improve the health and wellbeing of my patients and to develop professional and personal relationships with them.
More about Dr. Aloke Dhar
Dr. Aloke Dhar is one of the best Radiologists in Paschim Vihar, Delhi. You can meet Dr. Aloke Dhar personally at Sri Balaji Action Medical Institute in Paschim Vihar, Delhi. Save your time and book an appointment online with Dr. Aloke Dhar on Lybrate.com.

Lybrate.com has an excellent community of Radiologists in India. You will find Radiologists with more than 41 years of experience on Lybrate.com. You can find Radiologists online in Delhi and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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Causes and Symptoms of Uterine Fibroids

Fellowship In Minimal Access Surgery, MS - Obstetrics and Gynaecology, MBBS
Gynaecologist, Hyderabad
Causes and Symptoms of Uterine Fibroids

Uterine fibroids are referred to as benign, abnormal growths which tend to develop in the uterine walls of a woman. The size of such growths can range from a few centimeters to even excess of a few inches. As such, they can cause the uterus to increase to the size of a five month pregnancy. Although, the symptoms of fibroids are not always apparent, they often cause heavy bleeding and pain in women. A recent research concluded that around 60 to 75 percent women contract such fibroids by the age of 50, at least once in their life.

Depending on the site of formation, uterine fibroids are distinguished into different types. Intramural fibroids in the lining of the uterus and subserosal fibroids which develop outside the uterus are the most commonly observed fibroids.

What causes Uterine Fibroids?
Although, the exact reason for the formation of fibroids are obscure, medical professionals have determined certain factors that may affect their formation. Some of them are:
1) Hormones: Progesterone and estrogen, produced by the ovaries regenerate the uterine lining during each menstrual cycle and trigger the growth of fibroids.
2) Family history: If you have had a family history of uterine fibroids, then you're likely to develop the condition yourself as well.
3) Pregnancy: The production of progesterone and estrogen increases during pregnancy which increases the likelihood of fibroids.

What are the signs of the condition?
Depending on the location and size of the tumors, symptoms of such fibroids include:
1) Heavy bleeding and blood clots during periods
2) Pain in the pelvis
3) Frequent menstrual cramps
4) Pressure and pain in the lower abdomen
5) Swelling in the abdomen
6) Pain while intercourse

What is the procedure of the treatment?
Ultrasound and pelvic MRI are common diagnostic procedures to check for uterine fibroids. After diagnosis, depending on your age, size of the fibroid and your comprehensive health, the doctor would prescribe you with appropriate medications. Only after medications prove futile, doctors opt for minimally invasive surgeries. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.

2789 people found this helpful

I am 26 years old boy, I am suffering fron hip disorder problem, Avn. How to get rid out of this, I do not have money for operation,

Fellowship of the Royal College of Surgeons (FRCS), Membership of the Royal College of Surgeons (MRCS)
Orthopedist, Trichy
AVN of the hip at this age is usually due to either Alcohol intake or Steroid intake. Once AVN has developed then it depends on the stage of the disorder. if its advanced then only hip replacement will help.
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I have L4, L5 disc bulging problem , some time it pains me that I am unable to move also , How to recover from this. Please help me out.

MBBS, MS - Orthopaedics
Orthopedist, Delhi
I have L4, L5 disc bulging problem , some time it pains me that I am unable to move also , How to recover from this. ...
Spine physiotherapy, posture care and pain killer as and when needed. If persistent problem, please visit.
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I am suffering from disk and Knee joint pains for the past 10 years I have already done panchakarma treatment. There is no result? What can I Do?

MD - Alternate Medicine, BHMS
Homeopath, Surat
I am suffering from disk and Knee joint pains for the past 10 years I have already done panchakarma treatment. There ...
Just do this small exercise: Sleep with legs raised up from waist against the wall straight up, making 90 degree angle for 5 mins. Its better you do in early morning, else you can do it anytime. This will make your blood flow increased towards brain and increase your memory and physical strength too will be increased. And your knee joint pain will also be relieved. And try to apply ice-packs over it for 2 times in a day for 5 mins. Still if you have any queries, please ask. Take care. :)
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Please suggest exercises for disc bulge L4-5 and L5-S1 level indenting anterior thecal sac effacing bilateral recesses and impinging on descending nerve roots AP canal diameter- 1.3 cm (L4-5 level) and 1.2 cm (L5-S1) please suggest the best exercises to cure it fully and strengthen the particular area thanks help would be appreciated :)

DNB (Orthopedics), Fellowship in Spine Surgery, Diploma In Orthopaedics (D. Ortho), Diploma SICOT, Fellowship in Endoscopic Spine Surgery
Orthopedist, Vadodara
Exercise doesn't cure a MRI report just lead a healthy lifestyle with good cardio exercises and back exercises.
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Sir I have a problem of slipped disc in cervical spine. I am a dance choreographer so I should do my profession or I should stop it.

Fellowship in Shoulder and Upper Limb, Fellowship in Joint Replacement, MS - Orthopaedics, MBBS
Orthopedist, Mumbai
If the problem is recent and correctly diagnosed you should take rest for a couple of weeks and then start gradually with neck physio. Once your neck muscles are strong then you can gradually restart your dance activity.
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Uterine Fibroids: 5 Surgeries that are Done to Treat them

MBBS, MD, Registrar, DNB, MNAMS
Gynaecologist, Delhi
Uterine Fibroids: 5 Surgeries that are Done to Treat them

Uterine fibroids, also known as leiomyoma or myoma, are benign growths on the uterus, occurring mostly during the years of childbearing. Few of the common symptoms of fibroids are leg pain or backache, constipation, difficulty in emptying the bladder, frequent urination, pain or pressure in the pelvic region, menstrual periods stretching over a week and excessive menstrual bleeding.

Causes:

  1. Certain genetic changes of the uterus which are different from the ones normally present in the muscle cells of the uterus can cause this disorder.

  2. Certain hormones such as progesterone and estrogen that prepare the body for pregnancy are even responsible for triggering the development of fibroids.

  3. Substances which help the body maintain its tissues trigger fibroid growth as well.

  4. Family history, excessive consumption of alcohol and red meat while going low on foods such as dairy products, fruits, green vegetables and vitamin D, obesity, usage of birth control pills and early onset of the menstruation cycle are other factors that may escalate the risks of one suffering from fibroids.

Treatment:

  1. Be careful and take a closer look: Fibroids are fundamentally non-cancerous and they hardly interfere with pregnancy. Often, they do not exhibit notable symptoms and are prone to shrinkage after menopause. Hence giving them and yourself some time might be the best option.

  2. Medications generally aim at the hormones controlling the menstrual cycle and treating symptoms such as pelvic pressure and excessive menstrual bleeding. However, they do not treat fibroids completely but work towards contracting them. They include-

    • Gonadotropin-releasing hormone (Gn-RH) agonists to block estrogen and progesterone production

    • Progestin-releasing intrauterine device (IUD) to alleviate severe bleeding caused due to fibroids

    • Tranexamic acid to ease excessive menstrual periods

    • Progestins or oral contraceptives to regulate menstrual bleeding

    • Nonsteroidal anti-inflammatory drugs (NSAIDs) to ease pain associated with fibroids

Surgeries to Treat Fibroids:

Depending on symptoms and whether medical therapy has failed, the patient may have to undergo surgery. The following surgical procedures may be considered:

  1. Hysterectomy: removing the uterus. This is only considered if the fibroids are very large, or if the patient is bleeding too much. Hysterectomies are sometimes an option to prevent fibroids coming back.

  2. Myomectomy: fibroids are surgically removed from the wall of the uterus. This option is more popular for women who want to get pregnant.

  3. Endometrial ablation: removing the lining of the uterus. This procedure may be used if the patient's fibroids are near the inner surface of the uterus; it is considered an effective alternative to a hysterectomy.

  4. UAE (Uterine artery embolization): this treatment cuts off the fibroid's blood supply, effectively shrinking the fibroid.

  5. Magnetic-resonance-guided focused ultrasound surgery: an MRI scan locates the fibroids, and sound waves are used to shrink the fibroids.

2809 people found this helpful

This is my Mri report impression. Disc degeneration and disc bulge is seen at L5/S 1 level indenting the thecal Sac without any nerve root compression. Annulus tear is noted. 2 this r my x ray report impression. Pid L5. S 1.

FRHS, Ph.D Neuro , MPT - Neurology Physiotherapy, D.Sp.Med, DPHM (Health Management ), BPTh/BPT
Physiotherapist, Chennai
This is my Mri report impression. Disc degeneration and disc bulge is seen at L5/S 1 level indenting the thecal Sac w...
Do Take Physiotherapy treatment of IFT and vacuum Therapy Physiotherapy treatment for pain relief for 12 days followed by strengthening exercise from physiotherapist Best wishes.
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Breast Cancer Awareness

BHMS, Certified in Aesthetic Skin Treatments, Certified in Applied Behaviour Analysis
Homeopath, Mumbai
Breast Cancer Awareness

Breast cancer awareness

October is breast cancer awareness month and a great time to highlight the importance of maintaining healthy habits to support breast health. One disease that most women fear these days, you would probably reply" breast cancer.

Understand what you can do to reduce your breast cancer risk. So follow these guidelines and know that you are doing all that you possibly can to protect yourself from developing breast cancer. Be thankful every day that your breasts are healthy. 

Check your own breasts regularly. Do monthly self-breast examinations after your period is over. If you find any lumps or tenderness that concerns you, have it checked out right away. Fortunately, 80% of breast lumps are benign. When you examine your breasts, remember that lumps which are soft, movable, and change with your menstrual cycle are much less likely to be cancerous. Any discharge from the nipple other than breast milk should be checked out by your health professional.
Get regular mammograms. In a woman without breast symptoms and with no significant risk of breast cancer, I recommend mammograms beginning age 35 or 40 every two years. For women without breast symptoms who are at higher risk of breast cancer, I recommend yearly mammograms beginning at age 35. Beginning at age 50, the rate of breast cancer goes up, so yearly mammograms are advised.

Limit alcohol intake. The more alcohol you drink, the greater your risk of developing breast cancer.

Get to and maintain a healthy weight - if your bmi is out of the healthy range, find a program and tools to help you get to a healthy weight, which is important for maintaining health in general, including breast health. Obesity, particularly after menopause, can greatly increase your risk of breast cancer. Aim for gradual weight loss by choosing minimally processed foods and eating smaller portions.

Don't smoke - accumulating evidence suggests a link between smoking and breast cancer risk, particularly in pre -menopausal women.

Exercise regularly - physical activity can help you maintain a healthy weight, which, in turn, helps prevent breast cancer. 

Limit dose and duration of hormone therapy - if you're taking hormone therapy for menopausal symptoms, ask your doctor about other options. You might be able to manage your symptoms with non-hormonal therapies and medications.

Choose the right supplements - filling in nutrition gaps with supplements can help you support breast health. Look for options that contain vitamin d and omega-3 fatty acids, as they have both been associated with maintaining breast health.

Breast-feed your babies for as long as possible - women who breast-feed their babies for at least a year in total have a reduced risk of developing breast cancer later.

2 people found this helpful

I am 29 years old. I am from bangladesh. I have a problem with my backbone. I have slipped disc. I have been suffering from this since 2011. I consulted with some local doctors. They prescribed me with some exercise but no improvement till now. I feel that a bone or two is/are displaced somewhere my waist. I need expert suggestion.

MPT - Orthopedic Physiotherapy, BPTh/BPT
Physiotherapist, Noida
I am 29 years old. I am from bangladesh. I have a problem with my backbone. I have slipped disc. I have been sufferin...
Ok as your requirement avoid all exercise for 3 days and do rest tk physiotherapy treatment for few days swd ift ultrasonic therapy it will help you and giving you relief after 3 days you can start spine extension exercise with treatment. For future avoid forward bending, heavyweight, long sitting and standing keep your posture straight.
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I am an advocate and have got sitting job for long hours and walking job too. I am suffer from slip disc. Any treatment?

Fellowship In Arthroplasty and Arthroscopy, MS Orthopaedics, MBBS
Orthopedist, Gurgaon
Regular exercises and maintaining good posture whie sitting is the key to avoid most of the back pain problems. Please do take frequent breaks every hr and strech your muscles and do not sit for long.
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Lung Cancer: Causes, Symptoms and Treatments

MD PULMONARY, DTCD
Pulmonologist, Faridabad
Lung Cancer: Causes, Symptoms and Treatments

Lung cancer is the uncontrolled growth of abnormal cells in one or both lungs. These abnormal cells do not carry out the functions of normal lung cells and do not develop into healthy lung tissue. As they grow, the abnormal cells can form tumors and interfere with the functioning of the lung, which provides oxygen to the body via the blood.

Lung cancer is the most common cause of death due to cancer in both men and women throughout the world. According to the U.S. National Cancer Institute, approximately one out of every 14 men and women in the U.S. is diagnosed with cancer of the lung at some point in their lifetime. Lung cancer is predominantly a disease of the elderly; almost 70% of people diagnosed with lung cancer are over 65 years of age, while less than 3% of lung cancers occur in people under 45 years of age.

What Causes Lung Cancer?

The development of lung cancer is strongly associated with cigarette smoking, approximately 90% of lung cancers are attributable to use of tobacco. Pipe and cigar smoking can also cause lung cancer, but the risk is not as high as with cigarette smoking. Tobacco smoke contains more than 4,000 chemical compounds, many of which are cancer causing (carcinogens). Passive smoking, i.e. the inhalation of tobacco smoke by non-smokers who live or work with smokers, is also an established risk factor for the development of lung cancer.

Genetic susceptibility (i.e. family history) may play a role in the development of lung cancer. Other causes of lung cancer include air pollution (from vehicles, industry, and power generation) and inhalation of asbestos fibres (usually in the workplace).

Lung Cancer Symptoms:

Early symptoms and signs of lung cancer:

There may be no symptoms at the onset of the disease. When present, common symptoms of lung cancer may include:

  1. Coughing: This includes a persistent cough that doesn't go away or changes to a chronic smoker's cough, such as more coughing or pain.
  2. Coughing up blood: Coughing up blood or rust-colored sputum (spit or phlegm) should always be discussed with your doctor.
  3. Breathing Difficulties: Shortness of breath, wheezing or noisy breathing (called stridor) may all be signs of lung cancer.
  4. Loss of Appetite: Many cancers cause changes in appetite, which may lead to unintended weight loss.
  5. Fatigue: It is common to feel weak or excessively tired.
  6. Recurring infections: Recurring infections, like bronchitis or pneumonia, may be one of the signs of lung cancer.

Signs of advanced stages of lung cancer: Advanced stages of lung cancer are often characterized by the spread of cancer to distant sites in the body. This may affect the bones, liver or brain. As other parts of the body are affected, new lung cancer symptoms may develop, including:

  1. Bone pain
  2. Swelling of the face, arms or neck
  3. Headaches, dizziness or limbs that become weak or numb
  4. Jaundice
  5. Lumps in the neck or collar-bone region

Treatment: Treatment for cancer involves a combination of surgery to remove cancer cells, chemotherapy and radiation therapy to kill cancer cells. Lung cancer is incurable unless complete surgical removal of the tumour cells can be achieved. Surgery is the most effective treatment for lung cancer, but only a few percentage of lung cancers are suitable for surgery i.e. Stage I and II NSCLC and cancer that has not spread beyond the lung.

Radiation therapy may be used for both NSCLC and SCLC and is a good option for people who are not suitable for surgery or who refuse surgery. Chemotherapy is used for both NSCLC and SCLC. Chemotherapy drugs may be given alone or in combination with surgery or radiation therapy. Chemotherapy is the treatment of first choice for SCLC since it has usually spread extensively in the body by the time it has been diagnosed.

Also used in the treatment of lung cancer are targeted therapies. These are drugs (gefitinib and erlotinib) or antibodies (cetuximab, bevacizumab) that block the growth and spread of cancer by interfering with specific molecules involved in tumor growth and progression. They are used in some patients with NSCLC that does not respond to standard chemotherapy.

3095 people found this helpful

How To Prevent Sagging of Breasts?

Vaidya Visharad
Ayurveda, Narnaul
How To Prevent Sagging of Breasts?

How to prevent sagging of breasts?

Home remedies for sagging breasts

Breast sagging is a natural process that happens with age wherein the breasts lose their suppleness and elasticity. Breasts do not have muscle. They are made of fat, connective tissues and milk-producing glands, and they need proper care to keep them in good shape.

Yoga


The benefits of yoga for the entire body have been widely studied, and it is primarily a mechanism of toning the body and increasing flexibility. Some of that toning can occur within the breast, depending on which positions you commonly practice.

Massage

Massage your breasts at least 2-3 times per week with olive oil. It will help add firmness to the skin as well as improve the skin tone and texture. It will also tone your chest and increase the elasticity of the skin.

Pomegranate

Pomegranate is considered a wonderful anti-aging ingredient and can help prevent sagging breasts. Pomegranate seed oil is rich in phyto-nutrients that can lead to firm breasts.


    Make a paste of pomegranate peel and some warm mustard oil. Use it to massage your breasts in a circular motion for 5 to 10 minutes daily before going to bed.
    You can also use pomegranate seed oil to massage your breasts 2 or 3 times daily.
    Another option is to mix 4 teaspoons of neem oil with 1 teaspoon of dried and powdered pomegranate rind. Heat this mixture for a few minutes. Allow it to cool and then use it to massage your breasts twice daily for several weeks.


Avoid loose fitting bra / wrong bra size

Some women feel that they would feel comfortable if they wear loose bra. But this is totally a wrong step. You are going to invite your saggy breast by doing this. Avoid this and go for the best fitting bra to keep your breast stay upright and firm. For more details visit us at www.malhotraayurveda.in

49 people found this helpful

Neck Pain - Health Tip

Master of Physical Therapy MPT CARDIO, BPTh/BPT
Physiotherapist, Rajkot
Neck Pain - Health Tip
Herniated disks or bone spurts in the vertebrae of the neck may become the reason behind severe neck pain. They sometimes take too much space and compress the nerves branching out from the spinal cord.
10 people found this helpful

5 Ways to Deal With Uterine Cysts

Diploma in Advance Endoscopy, Royal College of Obstetricians and Gynaecologists (MRCOG), MS, MBBS
Gynaecologist, Delhi
5 Ways to Deal With Uterine Cysts

A uterine cyst, also called as ovarian cyst, is the formation of a fluid-filled sac within the ovary of a woman. Uterine cysts may sometimes cause several physical symptoms. They can cause great pain and unpleasant sensations. Most cysts go away by themselves, but still sufficient measures should be taken to deal with the inconvenience caused by a uterine cyst. In severe cases, the cyst can damage the ovaries. Scar tissue is also likely to build up in such cysts to form an adhesion, which causes discomfort.

Uterine cysts can cause great damage to the sexual organs of a woman, and hence, it should never be ignored. Here are 5 ways to deal with uterine cysts:

  1. Using Birth Control Pills: In case of recurrent uterine cysts, you can take oral contraceptives with the prescription of a doctor. This will prohibit ovulation, and the development of new cysts will be prevented. The risk of ovarian cancer is also reduced.

  2. Laparoscopy: In case the cyst is small, a laparoscopy surgery can be conducted by a doctor. This will enable the surgical removal of the cyst. The process of laparoscopy involves making of a small incision around the navel region. A small instrument or device is inserted into the abdomen, which removes the cyst.

  3. Laparotomy: Laparotomy is a surgical procedure of removing a large uterine cyst. This procedure is applied when a cyst becomes too large to be removed using laparoscopy. The procedure involves the removal of the cyst via an incision made in the abdomen. An immediate biopsy is conducted and in case the cyst is found out to be cancerous, a hysterectomy surgery is conducted, which removes the ovaries and uterus completely.

  4. Herbal Tea: Moving from medical procedures to natural ways for dealing with uterine cysts, herbal tea is believed to be one of the best natural treatments for uterine cysts. Herbal tea helps in the breakdown of large cysts and the side effects of the cysts such as discomfort or pain are eased. Have a cup of herbal tea every day to get rid of uterine cysts.

  5. Diet: Uterine cysts may develop due to an unhealthy diet. Modern food items contain synthetic and natural estrogens, which cause disruption in ovarian health. Consuming adulterated meat, where the animals are given hormones, and antibiotics may result in uterine cysts. Soy contains a great amount of estrogen, which leads to uterine cysts. All the food items which may lead to ovarian cysts should be avoided.

Uterine cysts are common in women and are caused due to several complications. You should not let uterine cysts develop as development increases severity.

2464 people found this helpful

Good day to you. For a few months i've been having numbness and weakness in my left leg and scrotum. Got my mri results back and they say. Mild scoliosis at L4 L5 region with minor disc bulge with no nerve compression. No sign of cauda equina. Small annular tear at L4 region with muscular spasm. What's causing my numbness? How do I fix the disc bulge?

MBBS, MD - General Medicine, DM - Neurology
Neurologist, Hyderabad
Good day to you.
For a few months i've been having numbness and weakness in my left leg and scrotum. Got my mri resul...
Most likely, the cause of your symptoms are disc bulge. The best treatment at this stage is physiotherapy. Medications such as pregabalin and gabapentin are also helpful.
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I have back pain L4. L5 problem fast in 5 years. I want to reduce pain with out operation is possible. Please Inform

M.Ch, DNB (Orthopedics), MBBS
Orthopedist, Mohali
You should do a proper regime of medicaton and Exercises for 3 months. the kind of exercises depend on your x-ray and mri reports. Only of this fails completely then we think of other measures like injections to the spine, surgery etc. the basic principle of spine therapy is minimal intervention.
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I am having slip disc. I want to know to cure it with exercises and what are the precautions to took for this?

MS - Orthopaedics
Orthopedist, Surat
Till you have pain, exercises would have little help. Initially you have to take bed rest. Avoid forward bending & cross-legged sitting on ground. Sit with a straight back. You can wear l. S. Belt temporarily. When pain subsides you can start exercises as guided by your doctor to prevent future disc problems.
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Diet Tips After Kidney Transplant

M.Sc. in Dietetics and Food Service Management , Post Graduate Diploma In Computer Application, P.G.Diploma in Clinical Nutrition & Dietetics , B.Sc.Clinical Nutrition & Dietetics
Dietitian/Nutritionist, Mumbai
Diet Tips After Kidney Transplant

Post kidney transplant, most people have a low immunity due to the powerful medications that are prescribed to avoid rejection of the organ. These medications tend to make the patients more prone to infections and hence, following strict dietary guidelines is necessary to avoid any complication. Also, as most people suffering from kidney failure are diabetic, hypertensive or suffer from heart disease, dietary control is mandatory. Moreover, the use of immunosuppressive drugs can increase your risk of diabetes, hypertension or heart disease. 

#1: eat a protein rich diet

After a kidney transplant, the body requires more proteins to aid in the healing process and improve immunity. This is the reason, why consuming proteins should not be limited. Also, patients who were previously on dialysis had a lower protein intake, post kidney transplant, the consumption of proteins is recommended to be increased. Here are 6 protein sources for vegetarians.


#2: do not eat raw fruits

Intake of raw fruits is not advised as there is a high risk of infection due to raw food. However, you can eat fruits in stewed form as cooking lowers the active bacterial load, thereby lowering your risk of infection.


#3: include curd in your diet

Curd contains good quality protein, which is required for healing post-transplant, hence, curd should be eaten. As far as sour foods like lime and tamarind are concerned, eating them is also okay. But avoid eating grapes as they are known to interact with immune suppressive drugs and hinder healing of the kidney. Also read about 11 diet do’s and don’ts for people with kidney problems.


#4: you need not avoid fruits/ vegetables with seeds

Foods with seeds like tomato, brinjal, ladies finger, guava, watermelon, etc are considered harmless and can be taken after transplant, provided other biochemical parameters like electrolytes and cholesterol are within normal range. Also, ensure that the level of potassium in the blood is within control. However, if you are suffering from kidney stones, it is better to avoid these foods.

#5: you might need to take protein supplements

People who undergo kidney transplants are recommended protein supplements during the initial stage, however, it varies from person to person. In most cases, post kidney transplant, patients recover their appetite, hence there’s no need for any supplements. However, if the patient feels that his protein intake is not optimal, he can continue taking supplements post-transplant, but only after consulting a nephrologist.

Unlike the common misconception that kidney transplant recipients can eat everything after a transplant, you need to follow a disciplined dietary routine with numerous restrictions, depending upon your overall recovery and health. You can start eating out after three to six months of kidney transplantation, as it is the average time taken for the immuno-suppression to be stable and be at a low level. However, raw food, salads, fruits and foods kept open should be strictly avoided, even in general.

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