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Dr. Anandamoyee Dhar

Radiologist, Delhi

Dr. Anandamoyee Dhar Radiologist, Delhi
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I'm dedicated to providing optimal health care in a relaxed environment where I treat every patients as if they were my own family....more
I'm dedicated to providing optimal health care in a relaxed environment where I treat every patients as if they were my own family.
More about Dr. Anandamoyee Dhar
Dr. Anandamoyee Dhar is a trusted Radiologist in Saket, Delhi. You can consult Dr. Anandamoyee Dhar at Max Super Specialty Hospital-Saket in Saket, Delhi. Book an appointment online with Dr. Anandamoyee Dhar on Lybrate.com.

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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.

1 person found this helpful

Doctor my 13 year old daughter has developed slip disc in her L4 and L5 vertebrae. What should be her treatment?

MBBS, MS - Orthopaedics
Orthopedist, Delhi
Disc prolapse at age of 13 years is not common, though it still may occur. Treatment is analgesics, back care, rest and physiotherapy. However, the child needs to be examined before I can suggest precise treatment
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Fibroid Tumours - 8 Signs You are Suffering From it

MBBS, MD, Registrar, DNB, MNAMS
Gynaecologist, Delhi
Fibroid Tumours - 8 Signs You are Suffering From it

Fibroid tumour is the abnormal cell growth in the uterus and they are mostly benign. Fibroids usually affect women in the age bracket of 30 - 40. Fibroid tumours are of three types, depending on their location:

  1. Submucosal fibroids: The tumour develops under the lining of the uterus
  2. Intramural fibroids: The growth is found amongst the muscles in the wall of the uterus
  3. Subserosal fibroids: The growth develops on the wall of the uterus right in the pelvic cavity

Causes behind it
The exact cause of fibroids in not known clearly. But certain factors have been discovered that might influence their formation. These factors include:

  1. Hormones: Progesterone and estrogen are the hormones responsible for recreating the uterine lining during every menstrual cycle. These hormones might trigger the formation of tumour.
  2. Family history: If any member in your family; your mother, grandmother or sister has/had fibroids in their uterus, you may also develop it.
  3. Pregnancy: Your body produces excessive progesterone and estrogen when you are pregnant, which may cause an increase in the size of a pre-existing small fibroid. Myomectomy can be done by giving incision on the abdomen or by laparoscopy depending on the size and location of the fibroids.

Signs You are suffering from it

  1. Heavy bleeding along with blood clots during or between your periods
  2. Lower back or pelvic pain
  3. Elevated menstrual cramping
  4. Frequent urination
  5. Pain during sex
  6. Longer than normal periods
  7. Bloating or pressure in lower abdomen
  8. Enlargement or swelling of the abdomen

How it can be treated?
Your doctor will formulate the right treatment depending on your age, the mass of the fibroids and your overall health. Your doctor may choose a combination of treatment to cure your fibroids, and they include:

  1. Medication: Gonadotropin releasing hormones (GnRH) agonists, birth control pills and ibuprofen (anti-inflammatory medicine) are prescribed. GnRH agonists reduce the level of progesterone and estrogen in your uterus.
  2. Surgery: Myomectomy and hysterectomy are two common surgical procedures to treat fibroids. Myomectomy is performed by removing the fibroids only by making an incision on the abdomen. But hysterectomy completely removes the uterus. The latter is reserved for serious cases.
  3. Non-invasive surgery: Forced ultrasound surgery, myolysis (shrinking fibroids with laser or electric current), cryomyolysis (fibroids are frozen) and endometrial ablation (an instrument uses heat, hot water, microwaves or electric current to destroy fibroids) are some non-invasive surgical procedures. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.
2512 people found this helpful

5 Easy Ways to Decrease Your Breast Cancer Risk

MBBS, MS - Obstetrics and Gynaecology
Gynaecologist, Noida
5 Easy Ways to Decrease Your Breast Cancer Risk

Breast cancer is the form of cancer that occurs from breast tissues in women. Signs of breast cancer may include a lump in the breast, changes in the shape of the breast, dimpling of the breast skin, a fluid coming out of the nipples or development of red scaly patches on the skin. There might be pain in the bones, swollen lymph nodes, shortness of breath, or the skin turning yellow and pale.

Breast cancer is a fatal mode of cancer in women, and one must try to abstain from this cancer in all possible ways. Here are 5 ways you can decrease the risk of breast cancer.

  1. Keeping a check on your weight: Although the process is tough to maintain, keeping up a sound and healthy weight is a critical objective for everybody. Being overweight can expand the danger of a wide range of cancers, including breast cancer, particularly after menopause in women. Exercise is very important for maintaining a healthy body and lifestyle. Women who exert physically regularly are fitter than others and are at a much lower risk of acquiring diseases of any kind. Regular exercise decreases the chance of getting breast cancer and also keeps the body weight in check.
  2. Maintaining a healthy diet: Maintaining a healthy and balanced diet is a key for keeping away from any kind of cancer or major health problem. Include a sufficient amount of fresh fruits and green vegetables in your daily diet to ensure the supply of all vital nutrients to your body. This would increase your immunity.
  3. Avoid smoking and consume less alcohol: Smoking is a very unhealthy and harmful habit. Smoking lowers the quality of your life, and causes numerous diseases. Heart diseases, stroke and many kinds of cancer, including breast cancer can be caused from smoking. If you drink alcohol, you should moderate your drinking habits and drink less, as drinking in excess may lead to breast cancer.
  4. Practice breast feeding: Breast feeding your children for a span of one year or more is likely to reduce the risk of breast cancer.
  5. Avoid taking birth control pills: Birth control pills, in spite of having several benefits are associated with risk factors as well. Birth control pills have got worse effects in younger women than older aged women. Using birth control pills may cause breast cancer and these pills should be avoided.

There are many ways, adapting which you can lower the chances of getting breast cancer.

2 people found this helpful

Hello Dr. Sir, I am Harvinder singh from yamunanagar, Haryana. I have lower back pain since last 2 years. Its slip disc and sciatica pain in left leg. I am very unhappy with this problem. Please advice me best of best treatment for the same and where I can get the same.

BAMS
Ayurveda,
Hello Dr. Sir, I am Harvinder singh from yamunanagar, Haryana. I have lower back pain since last 2 years. Its slip di...
You may use yogi joint pain churna for few days, if its helpful for you, then continue to get relief from sciatica.
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How to Reduce Urea Levels in Blood Naturally

Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda, Navi Mumbai
How to Reduce Urea Levels in Blood Naturally

All healthy individuals will always have some amount of urea in the blood. Yet, when the urea level in the blood becomes too high, that means there is a malfunction in some part of the body due to which the body is not being able to remove this excess urea successfully. This urea can be formed in the liver when there is a process in terms of the protein metabolism's chemical balance. This urea is then transported to various parts of the body until the kidney cleans it out as urine. But when this urea does not get cleaned out properly, the urea gets concentrated in the blood and signifies a problem with the kidneys and other internal organs as well as the blood flow to the kidneys. 

The cause may include burns, heart failure, renal artery embolism, vomiting and loose motions as well as more serious ailments like Diabetes. This can lead to long term kidney damage and symptoms like thirst, fluid retention, headaches, fatigue, dizzy spells, accelerated pulse, restlessness in limbs, pain in the abdomen and more. Here are the best ways to reduce the blood urea levels in a natural manner.

Herbal Medicines:

Ayurveda is an ancient science that can be used for the benefit of many patients suffering from chronic and painful ailments like diabetes, kidney failure, cardiovascular ailments and more. One of the mainstays of Ayurveda includes the use of herbs to create medicines and concoctions that will help in giving relief with their 100% natural elements. Medicines like Mutrakrichantak Churna, Punarnava Mandur, Varunadi Vati and many others can be used to avoid dialysis and bring down the urea levels in the blood by aiding better functioning of the kidneys.

  1. Punarnava: The name of this herb has been derived from two words - Puna and Nava. While Puna means again, Nava means new and together they help in renewed functioning of the organ that they treat. This herb helps in flushing out the excess fluid in the kidneys by reducing the swelling without any side effects. This herb is basically a kind of hogweed.
  2. Varun: This is the common caper which can be used to break down the stones present in the renal region and even as a cure for urinary tract infection. This herb helps in removing any element that may be obstructing the urinary tract and finally removes the excess fluid build up and inflammation.
  3. Gokshur: This is a diuretic that can be used as a herbal tonic to give strength to the weak kidney cells for regeneration.

Other aspects of Ayurvedic treatment for this condition include proper protein intake and better hydration along with massages and Yogic postures.

3266 people found this helpful

Know All About Gynae Laparoscopy Surgery

Panchkula & Delhi
Mother and Child Care, Panchkula
Know All About Gynae Laparoscopy Surgery

Q1. What exactly is Laparoscopy?

Laparoscopy is an alternative to 'Open' surgery wherein the abdomen is opened by tiny 'key hole' incisions and surgery is done. 'Scopy' means the use of an endoscope or telescope to see inside the abdomen. This is attached to a camera and a light source and the inside of the abdomen is projected on to a monitor. The surgeon performs surgery looking at this screen. The surgeon makes a total of 2-4 small cuts on the abdomen ranging from half to 1 cm through which the telescope and other thin surgical instruments are passed into the abdomen. When the uterus is removed , known as hysterectomy, there is also a cut at the top of the vagina where the uterus is attached.

Q2. What kind of gynaecological surgeries can be performed by Laparoscopy?

Most surgeries done in gynaecology can now be performed by Laparoscopy and do not require the large incision as for open surgery. Laparoscopy can be done sometimes only for diagnosis and is called Diagnostic Laparoscopy, as in checking whether the tubes are open or not and to look for any causes of infertility or pain outside the uterus. In women who are unable to conceive, Diagnostic Laparoscopy is often combined with Hysteroscopy (endoscope inside the uterus, inserted from below, via the vagina). When laparoscopy is done to perform some surgical procedure inside the abdomen it is called Operative Laparoscopy. This may be for simple procedures like sterilization, minor adhesions, drilling ovaries; or for intermediate or major reasons like fibroids, endometriosis, removal of ovaries or tubes or both or removal of uterus, for staging of cancers or radical surgeries for cancer. However, about 5% of all surgeries including those for cancer or very large tumours may benefit from open surgery.

Q3. Why does an expert surgeon recommend Laparoscopy over Open Surgery?

Laparoscopic surgery has many advantages above open surgery: the incisions are much smaller (open surgery incisions are 8-10 cms long), therefore pain is much less; requirement for pain killers (which can have side-effects like sleepiness, impaired judgement) is lesser; hospital stay is shorter; complications fewer; requirement for blood transfusions infrequent; recovery in terms of physical, emotional and mental state is much better and quicker; return to work is faster with consequent lesser loss of working and earning days. Surgery with laparoscope is more precise because it is magnified view. Further vision is much better because it's like having your eye behind the structure because you can see with the telescope at places where the surgeon's eye cannot reach.

Q4. If the cuts on the abdomen are so small in Laparoscopic surgery, how do you remove the uterus or a large tumour from inside the abdomen?

Quite often if the tumour is not malignant and contains fluid, it is punctured to collapse it into a smaller size. If it is solid, it can be cut into smaller pieces inside the abdomen using a special instrument. The collapsed or cut structures can be removed gently through the 1 cm cut on the abdomen which may be increased a bit if required. After hysterectomy, the uterus can be removed easily from below, through the vagina.

Q5. Will there be much pain or discomfort after Laparoscopic Surgery?

There may be some pain and discomfort in lower abdomen for one day to few days after Laparoscopic surgery but this is much less as compared to open surgery because the incisions on the abdomen are much smaller and there is much less tissue handling inside the abdomen by fine instruments instead of rough, big, gloved hands which can cause tissue injury in open surgery. There may be some pain in the shoulder following laparoscopy. This is not serious and is due to the gas used in the surgery to make space for instruments.

Q6. When can I be discharged from hospital?

Following Diagnostic Laparoscopy or with simple Operative Laparoscopy you can expect to be discharged from hospital latest by the morning after surgery. In most other cases of intermediate or even major surgery, discharge is generally 1-2 days following the surgery unless there is some health issues prior to the surgery or any complication during the surgery. The complication rates for Laparoscopic surgery are not more than for open surgery and depend upon patient factors like anaemia, diabetes, obesity and skill of the surgeon.

Q7. When can I perform routine household activities or return to work after Laparoscopic Surgery?

Recovery after surgery depends upon many factors: presence of health problems before surgery; why the surgery is required; what surgery is being done; problems or complications of surgery, anaesthesia or blood transfusions. If all is well, one can perform routine household activities by 1 week, provided one doesn't feel tired. Although there may not be any harm, it may be unwise to be normally active within 48 hours of procedure. Following Diagnostic Laparoscopy or Operative Laparoscopy for simple procedures, one can return to work in 1 week. For other procedures, a 2-3 week off from work is reasonable. It depends on the type of work you are returning to. Avoid too rapid return to work if it is manually hard or requires standing for long durations of time. Sometimes a surgical procedure brings on a well needed rest and break from a lifetime of work. Mostly, when you return to work depends upon your own body and its signals of tiredness. You need to listen to those signals.

4326 people found this helpful

My mother is suffering from disc extrusion in L5, is surgery necessary? Or something other will be helpful.

MPT - Orthopedic Physiotherapy, BPTh/BPT
Physiotherapist, Noida
My mother is suffering from disc extrusion in L5, is surgery necessary? Or something other will be helpful.
avoid surgery do physiotherapy treatment for few days and spine stretching and strength exercise. avoid long sitting toward bending lifting weight. posture correction must
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Dear sir. My mother is suffering from pain in waist and legs unable to stand for sometime and unable to walk due to L5 L6 displaced and make pressure on nerve. I don't want to operate for this . Is any other solution.

Dip. SICOT (Belgium), MNAMS, DNB (Orthopedics), MBBS
Orthopedist, Delhi
Hi , This is Dr Akshay from Fortis Hospital. Kindly upload her x ray and MRI images so that i can see and opine accordingly. Thanks & Regards Dr Akshay Kumar Saxena
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I am 22 year running. I am suffering from slip disc problem since last 1 & half year. My pain is increasing day by day. Its start with lower back and now its come in my left leg. I am done many things for it but still I am suffering for with this. What can I do I cant understood.

MBBS, MS - Orthopaedics
Orthopedist, Delhi
Sleep on a hard bed with soft bedding on it. Use no pillow under the head. Kindly take biod3 max 1 tab dailyx10 paracetamol 250mg od & sos x5days do back (spine)/shoulder/knee exercises make sure you are not allergic to any of the medicines you are going to take do not ignore it. It may have to be further investigated. It could be beginning of a serious problem. If no relief in 4_5 days, then contact me again. Contact your family doctor or nearest hospital for emergency help.
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sciatica

BPTh/BPT
Physiotherapist, Pune
Prolapsed Disc
Also known as slipped disc, herniated disc or sciatica. The discs are the shock absorbers of your spine. When they are injured the inner soft part of the disc can protrude out through a tear in the outer lining of the disc. This disc material can press on the nerves in the spinal column, injuring them through direct pressure and causing inflammation.
The most common age to develop a disc prolapse is between the ages of 30-50 years., twice as many men as women are affected. Prolpased discs occur mainly in the low back (lumbar) spine. Less than I in 20 cases of back pain are due to a disc prolapse, most are due to mechanical back pain. (see section back pain).
Symptoms
A slipped disc is characterised by sudden, severe back pain that is often made worse by movement and which can usually be eased by lying down flat.
Nerve root pain (sciatica) can also occur because a nerve is trapped or irritated by a prolapsed disc. Although the problem is in the back, patients experience pain along the course of the nerve, for example, down a leg to the calf or foot.
With a prolapsed disc, the sciatic nerve is most commonly affected. The sciatic nerve is a large nerve that is made up from several smaller nerves that come out from the spinal cord in the lower back and travels down each leg. The irritation or pressure on the nerve may also cause pins and needles, numbness or weakness in part of a buttock, leg or foot.
In rare cases, cauda equina syndrome can occur. This is a disorder where the nerves at the very bottom of the spinal cord are trapped. It can cause low back pain as well as problems with bowel and bladder function and weakness in one or both legs. These symptoms need urgent medical treatment to prevent permanent damage to the nerves that supply the bladder and bowel.
A large number of people can have a prolapsed disc without any symptoms if it doesn’t trap or irritate the nerve.
Investigation
A doctor will normally be able to diagnose a prolapsed disc from the symptoms and by examining the patient.
In most cases, no tests are needed, as the symptoms often settle within a few weeks.
Tests such as x-rays or scans may be advised if symptoms persist. In particular, an MRI scan can show the site and size of a prolapsed disc. This information is needed if surgery is being considered
12 people found this helpful

I have slipped disk and doctors told me to get admitted and I have another option to go to the bone setter what should I do?

BHMS
Homeopath, Hyderabad
I have slipped disk and doctors told me to get admitted and I have another option to go to the bone setter what shoul...
surgery is not the first choice, if presently if pain is acute. just take rest laying on hard surface Even floor etc.. Doing yoga esp bhujangasana regularly at lest for 5 mints will help you to reduce the pain as well as the disc bulge. Along with bhujangasana, if you do ardha shalabhasana with each leg for 5 mints & shalabhasana for 5 minits. There will be complete recovery. Along with yogaasan stat using homeopathy medicine to prevent the backache in future.
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What are the alternatives to avoid surgery for my brother aged 47 identified with Listhesis with foot drop and disc extrusion. In fact I had disc bulge (L3 L4 L5) at the age of 41 in 2013 and took oil massage in Kerala for 15 days and I am doing good now.

FRCS Orth, MCh Orth, MS Orth
Orthopedist, Delhi
You can use good quality lumbosacral belt but with neurological involvement, surgery is unavoidable. Consult spine surgeon.
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Breast Cancer - Local and Systematic Form of Treatment!

MBBS, DNB (Obstetrics and Gynecology), MNAMS, Training in USG
Gynaecologist, Delhi
Breast Cancer - Local and Systematic Form of Treatment!

Breast Cancer - What exactly is it?
‘Breast cancer’ is a term that is used to refer to a malignant tumour, which has developed from cells present in the breast. Generally, all tumours can be divided into two categories i.e. benign and malignant and it is the malignant tumour that is responsible for causing cancer. Breast cancer generally originates in the cells the  milk producing glands of the breast's or the passage, which carries milk from the glands to the lobules. Additionally, breast cancer can also originate in the stromal tissues, including the fibrous and fatty connective breast tissues.

Breast Cancer: Treatment Options
Treatment for breast cancer depends upon two things: the exact type of the cancer and how advanced the cancer is. Treatment options for breast cancer can thus be broadly divided into two categories as Local treatments and Systemic treatments.

Local Treatments
Treatments that target the tumour without having any effect on the rest of the body are called local treatments. The following types of local treatment options are available for treating breast cancer:

  1. Surgery: Surgical breast cancer treatment involves removal of the malignant cancerous tumour in an operation. Smaller tumours can be removed using a surgical process referred to as ‘lumpectomy’, wherein the tumour along with a small amount of healthy tissue surrounding the tumour is removed. For larger tumours, removal of the entire breast becomes mandatory, in a surgical process known as ‘mastectomy’. Women who undergo mastectomy can choose to undergo reconstructive plastic surgery for reconstruction of the removed breast(s).
  2. Radiation Therapy: This basically involves using radiation to kill cancer cells present in the body. Radiation therapy is a long-drawn process that usually involves a set number of treatments administered over a long period of time. Radiation therapy is also generally the follow-up procedure after a lumpectomy, or more rarely, a mastectomy.

Systemic Treatments
Treatments involving drugs that are administered via either the mouth or direct injection into the bloodstream are called systemic treatments. These include:

  1. Chemotherapy: This includes using drugs to destroy the cancer cells present in the body by stopping the cancer cells from growing and dividing. Chemotherapy can be administered using either an IV (intravenous) tube or via pills that can be swallowed.
  2. Hormone Therapy: This treatment option is used for treating tumours which have tested positive for progesterone or oestrogen receptors. Blocking hormones that fuel the tumour’s growth is the basis of this therapy.
  3. Targeted Therapy: This targets specific proteins and genes which contribute to growth and survival of the cancer cells. Targeted therapy is an extremely focused treatment, and is very effective in blocking the growth and division of cancer cells, as well as minimizing damage to surrounding healthy cells.
2586 people found this helpful

I have a herniated disk (bulged disk/slip disk) at c7 and the c7 nerve is compressed for last 2 months. Do you have treatment in ayurveda ?

MBBS, MS - Orthopaedics
Orthopedist, Delhi
However you may try sleep on a hard bed with soft bedding on it. Use no pillow under the head. Kindly take biod3 max 1 tab dailyx10 paracetamol 250mg od & sos x5days do back (spine)/shoulder/knee exercises make sure you are not allergic to any of the medicines you are going to take do not ignore it. It may have to be further investigated. It could be beginning of a serious problem. If no relief in 4_5 days, then contact me again. Contact your family doctor or nearest hospital for emergency help.
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Back bone slip disk, sitika. I ask in Hindi rid ki haddi ke manke sarke hue hai. Unka koi ilaj hai kya. Koi bhi ilaj jese aurved ya koi or ilaaj hai to please batana. Unko bahut pain hota hai. Or koi kam bhi nahi kar sakte hai. Pura bed rest hai.

BPTh/BPT, MPTh/MPT
Physiotherapist, Noida
Back bone slip disk, sitika. I ask in Hindi rid ki haddi ke manke sarke hue hai. Unka koi ilaj hai kya. Koi bhi ilaj ...
Apply hot fomentation twice daily. Avoid bending in front. Postural correction- sit tall, walk tall. Extension exercises x 15 times x twice daily. Bhujang asana. Core strengthening exercises. Back stretching. Do the cat/cow stretch.
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I am suffring from slip disc, hernited disc problem sence last 1 year.Please do help

MBBS, MS - Orthopaedics
Orthopedist, Delhi
This is quite a common condition rule out diabetes & vit. D deficiency. Sleep on a hard bed with a soft bedding on it. Use no pillow under the head. Any way take caldikind plus 1 tab daily for 10days paracetamol 250mg tds x 3 days contact me after that. Make sure you are not allergic to any of the medicines you are going to take. It may have to be further investigated.
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