Doctors in Paras Hospital - Sushant Lok
Patient Review Highlights
I found the answers provided by the Dr. Manish Mannan to be very helpful. Dr manish manan my baby chekup very Good and i am satisfied dr manish excellent Docter for children
It was a false appointment. Dr. Sanjay Sharma had no OPD yesterday still my appointment was booked. It was a waste of effort for me. Poor service.
Rajesh Kumar M
Dr. Priyanka Prakash provides answers that are knowledgeable, well-reasoned and saved my life.
Dr. Aruna Kalra provides answers that are very helpful. Thnx .....
Sexual problems might mean you have a broken heart, literally. The most common sexual problem in men is erectile dysfunction (ED). Erectile dysfunction affects >30% of men between 40 and 70 years of age. There are several different causes of ED, including depression, low testosterone, neurological problems, and some medications, such as beta blocker but the most common cause is a problem with the blood vessels called atherosclerosis.
Erectile dysfunction is frequently a sign of atherosclerosis, that can be the first clue to heart disease in men. It usually comes 3 to 5 years before a heart attack, so after ED is diagnosed, there is time to treat atherosclerosis and prevent a heart attack.
Sexual Activity and Cardiovascular Disease
Decreased sexual activity and function are common in patients with CVD and are often interrelated to anxiety and depression. In fact research has proved that there is a strong link between erectile dysfunction and heart disease. Studies have shown that if a man has ED, he has a greater risk of having heart disease. For instance, in one study, 57% of men who had bypass surgery and 64% of men hospitalized for a heart attack had had ED.
Several having ED can predict that a man will probably have heart disease symptoms within five years. In fact, having ED is as much a risk factor for heart disease as a history of smoking or a family history of coronary artery disease.
The Stockholm Heart Epidemiology Programme (SHEEP) study of post-MI patients (50% women) found that those who were sedentary had a higher risk of MI with sexual activity (relative risk 4.4) than did those who were physically active (relative risk 0.7).
How is the Heart and ED Related?
Deposition of cholesterol in the arteries causing atherosclerosis is taken as the most important reason for ED as the plaque formation reduces the blood flow in the penis, thereby affecting the erection process. However the latest studies show that ED is also due to the dysfunction of the inner lining of the blood vessels (endothelium) and smooth muscle. This causes inadequate blood supply to the heart and the penis which also aids in arthrosclerosis. Hence ED and heart disease are found to be inter related.
What to do?
Various studies and researches have been able to prove that women outlive men. In fact they are expected to live at least 7 years more than men. More men are living with and dying of Coronary Heart Disease (CHD) than women and have more hospital discharges for Cardiovascular disease (CVD) and CHD. The prevalence of CHD is higher in men within each age stratum until after 75 years of age, which may contribute to the perception that heart disease is a man's disease.
The classic risk factors for CVD are the same in women and men, but there are gender differences in the prevalence of risk factors. Dr Bernadine Healy first introduced the concept of the Yentl syndrome in 1991, suggesting gender bias in the management of CHD.
HEART DISEASE AND SEX DIFFERENCES
Reasons for Cardiovascular Disease:
There are a number of risk factors that affect the men more than women. The following are few aspects that are reasons for the rising incidences of heart disease in men:
High cholesterol level
Sedentary life style
Unhealthy food habit
Lack of exercise
It is important that men take control of their health. Opt for regular cardiac screenings tests, yoga, stress management and ensure that they live a heart healthy life.
Even after putting her best in her family, Radha's husband was shouting at her again, her children were again complaining about the food, her mother-in-law about her joint pains and even when she had a million issues on her mind, the one bothering her most was her board presentation scheduled tomorrow in office.
Tired, exhausted and challenged she smiled remembering her mother's words-
'They say it's difficult to be a woman! You need to think like a man, act like a lady, and look like a girl and work like a horse.'
From an amoeba to higher species four aspects are common-Nutrition, Reproduction, Excretion and the fourth one is Stress. Working professional or a home maker, a woman's plate is always full with multiple projects and a huge list of things to do. Cooking, washing, cleaning, picking & dropping kids, homework, spouse attention, extended family, social obligations, and dependency on maids, over demanding workplace, sometimes obnoxious co-workers, and long commuting hours are facets that bother every woman today.
All these activities and stressing situations are disturbing. The human mind is not conditioned to handle so much. The result is emotional disturbance- anxiety, energy drain and undue stress.
We need to understand that we have the power to be happy, stress free, peaceful and only we can help ourselves. Hence it's important to take charge of situations causing stress. We should try to go easy on ourselves and accept the following:
We are not Durga or an Octopus with multiple hands: We need to understand our limitations and should not stretch ourselves. We can always ask for help from others. Sometimes people around us are just unaware about our needs. We should ask our family, friends, co-workers for help bluntly, rather expecting them to read our mind.
Don't try to control the uncontrollable: We should not get tense unnecessarily when something happens unplanned and hampers your schedule. We need to accept facts -we can't change the weather, situations, how others behave. The best way is to relax and accept situations and re-plan your day.
Don't be a perfectionist: Expecting perfection from others adds on to our stress. Not everyone can be organised like you. Your maid might not be able keep your home spotless, your daughter's hand writing could be as poor as the girl you hated in your class, and your co-worker might not be good in MS Excel. A perfectionist cannot delegate work. Be easy on yourself and on others. Most importantly don't nag people about issues; it can make them feel suffocated.
Self-compassion: Be compassionate with yourself too. Don't feel pressure to perform every time. Don't try to put extra efforts beyond your limit to please others. Give some room to others to make mistakes- after all people learn from them.
Stay on schedule: An organised approach to handle tasks always gives a pleasure of accomplishment and it's very important to design a balanced routine and stick to it. A 'Me Time' is very important when you budget your day.
Simplicity reduces stress: Keeping less stuff helps us to manage and organise things better. Don't buy or store things you don't need.
Take care of your health: Our mind, body and soul are inseparable. Taking care of your health, practicing yoga, and exercising, eating a healthy diet is important to fuel better emotional well-being.
Tears are not sign of weakness! Don't feel guilty: Yeah! Shedding tears does not make you weak. Don't feel miserable for being sensitive. Express yourself openly!
Be assertive in communication style: We can always put across our points assertively without sounding irritated, frustrated or angry. It's important to put your thoughts and difference of opinion constructively.
We look around at our friends' marriage and often conclude that their marriage is better than ours. No wonder we turn to self-pity mode for not being to lucky to have a happier and exciting relationship. Who knew the love shall fade away! Where is the harmony and intimacy we always dreamt of ??
Why does romance not last? When we need someone to love and more importantly to be loved. All success, a seven digit salary, and big cars, nothing. nothing lets us feel content unless we have someone to share it with. Probably you have been married for years and have lost the romantic spark you had. And you look back and start analysing, where, what, when and how things went wrong?
And blame game starts; you curse circumstances and try to justify your actions
Ritikaa and Mehul fell in love at first sight. Despite family resistance they married. After a few months, they were arguing for small things and wondering why did they have married. Dr Radhakrishnan is a scientist married to a pathologist; he is looking from separation from his wife after 26 years, though he is not seeing anyone else.
Suchitra and Prakash married ten years ago, they divorced after two years of their marriage. They don't have kids. There were no obligations but they reunited four years back and divorced again, but still the relationship is not broken.
Do happy couples exist??? Heartbroken Alok who is just 32 yrs old, asked me with teary eyes - I earn 4 crores a year, but I feel lonely, unloved and dejected!
Every day I listen to stories of heartache! And my belief in the power of love and affection is growing many folds.
Marriage is more than being a room partner! Not only marriage but any relationship is like a plant, we need to nurture it to blossom. Every marriage faces its own challenges at different time and for different reasons. We need to consciously work on it but with ease.
No marriage is boring or perfect! It's about how do we respond to our marriage.
Every couple has to face common issues related with adjusting with new families, career balance, baby plans (in some cases), spending, eating, hygiene (bathroom etiquettes) habits of spouse, interest and hobbies, gender specific responsibilities and of course money matters.
Let it be anything . .Assertiveness is key to success.
Watch your own actions:
Are you imposing thoughts and actions on your spouse: you have imagined a world, and are trying to move things as per our own wish?
Are you expecting without explaining to her/ him: you might be soul-mates, but don't forget that no two people can be the same. Explain your expectations but don't put conditions to get it accomplished. Allow your spouse to take her or his call.
Are you respecting differences in opinion- disagreement is not disrespect for your views and opinions. It's about perspectives (based on pre conceived notions)
Are you reading your spouse's mind and assuming? Stop assuming, ask but be assertive, use appropriate words, tone and pitch.
Are you giving some room for mistakes? Give people some space to make mistakes, forgive them and self too. Communicate if something bothers you a lot.
Are you judging by actions not understanding intentions? Relax! Before you make opinions and decide you can't take it anymore. Sometimes your spouse is completely clueless and unaware about your mind.
Are you trying to bridge the gap between your spouse and your parents? Relationships are very one-to-one. Never try to bridge the gap between them, you shall end up being a sandwich and will spoil your relations too. Let them grow their own relationship.
Communicate clearly and explain your expectations about money matters - involve your spouse in your financial planning, it's a way to generate trust between you and spouse and it helps to work on budgets and spending habits.
Express clearly about sexual needs and desire. Physical intimacy plays a very important role in marriage. Seek professional help to sort things out before you think you are incompatible.
Make a choice not a sacrifice (otherwise you shall expect your spouse to repay it in the way you want).
Mood swings bother you and everyone around you!
Everyone experiences disappointment or sadness in life. When the "down" times last a long time or interfere with your ability to function, you may be suffering from a common medical illness called depression. According to research, women experience twice the rate of depression as men, regardless of race or ethnic background. An estimated 1 in 8 women will face major depression in their lifetimes. Despite high prevalence rates people are reluctant to acknowledge clinical depression as a disorder that should be evaluated and treated.
Researchers suspect that, rather than a single cause, many factors unique to women's lives play a role in developing depression. These factors include - genetic and biological, reproductive, hormonal, abuse and oppression, interpersonal and certain psychological and personality characteristics. However the stages in a woman's life can also subject her to depression- menstruation, pregnancy, child birth and menopause. Given below are some of the signs and symptoms that you may be experiencing related to your life stage.
Premenstrual Dysphonic Disorder - This affects around 3-8% of the women. In this behavioral changes are observed in women 5 days prior to the commencement of their menstrual cycle. The common symptoms are:
Lack of interest in common activities, such as hobbies
Moderate to severe feelings of tension or anxiety with low energy
Mood Swings , such as feeling overly sensitive
Moderate to severe feelings of hopelessness or depression, feeling overwhelmed
Physical symptoms, such as weight gain, joint or muscle pain, or a headache
Changes in sleeping patterns, such as sleeping too much or too little
Changes in eating habits or food cravings
Problems focusing or concentrating
Unusual irritability or anger
Management: Be calm and relaxed. Keep a check and monitor your cycle and emotional outbursts. If you notice some continuity it's important that you consult a specialist. Ignoring the issues can have an effect on your relationships. Be open and talk to your family and your partner about the same.
Pregnancy and Post Partum Mood Disorders- Pregnancy is a stage in which a woman's body is going through a number of hormonal changes. These changes can have a major effect on the mood and can increase the risk of developing depression. Even post pregnancy the risk doesn't end. The following are a list of symptoms. Be informed if you are pregnant or have just delivered a child.
Lifestyle or work changes resulting in relationship problems
Episodes of depression and irritability
Feeling of lack of social support and lost feeling
Mixed feelings about being pregnant
Feeling that pregnancy has pulled you down
Please note that a woman can feel depressed during pregnancy and the feeling can become worse post child birth. It affects 10-25% of women in India. It's important to understand that it's not just you but your body that is going through change. Hormonal fluctuations, psychological pressures and social support all attribute to the same. Be open and consult specialists. Also talk to your family and your spouse.
Peri Menopause and Menopause Depression- Risk of depression may increase during the transition to menopause, a stage called Peri menopause, when hormone levels may fluctuate erratically. Depression risk also may rise during early menopause or after menopause - both times when estrogen levels are significantly reduced.
Women need to aware that they are vulnerable to develop depression and need professional help to avoid it from causing personal and functional impairment.
Be informed and consult a Psychiatrist if you are experiencing any of the above.
Stress in mechanics is a load, pull or force or a system of forces producing a strain. In life, any event or situation that produces a strain therefore induces a physiological strain.
At work place, a system of forces work to produce desired results which more often than not produce a state of strain or makes an individual's life stressful. But the consequences of chronic stress are not just on individual health and well being but on the organizations as well. This affects the productivity and competitiveness. When an organisation faces a challenge, the flight or fright reaction ensues leading to increased threat perception, alertness and activity. In short term, it can improve productivity, but in case a state of threat is perpetually present like in case of a team led by an anxious or high strung individual, it produces chronic stress leading to lowering of performance. More often, sources of stress at work place are poor communication, unclear roles, discrepancies in expectations and skills, insecurity and sudden and significant change in work structure , to list a few.
Sources of Organisational Stress
Unclear role / objectives
Role conflict (project management)
Over / under promotion
Lack of training
Social or physical isolation
Unrealistic deadlines / targets
Lack of control over decisions
Lack of feedback on good performance
Work overload / underload
Long working hours
The nervous system of an individual facing work stress due to any factor will react by producing a flight or fight response with ensuing physiological and/or psychological changes. These changes produce behavioural effects which if prolonged can be identified as signs of stress. While physical effects of stress lead to higher sick leaves, accident and absenteeism, psychological effects cause high anxiety and irritability leading to lower performance, disturbances in interpersonal relationship and more mistakes and miscalculations due to disturbance in concentration and self confidence .
Signs of rising stress:
Loss of pleasure in things once enjoyed
Irritability and impatience
Tiredness, lack of energy
Inability of concentrate, meet deadlines or make decisions
Increasing cynicism or loss of trust
Sense of losing control over events
Concerns over the effects of organizational stress on productivity, absenteeism and health related problems and consumption have substantially increased over past few decades. Employee health and well being are important assets to organizations and businesses. The Human Resource Department thus needs to watch for signs of stress in the employees and create an environment where the effects of stress can be mitigated. It requires understanding individual skills and deficiencies, clear and adequate communication, promoting an environment where deficiencies can be worked on without lowering self esteem or producing insecurity, encouraging support among team/staff members etc. On a personal level, individuals need to reduce stress by prioritizing their goals and following time management and self -fulfilment activities.
Ways to control stress
Participate in decisions
Ensure travel commitments are reasonable
Make time for yourself
Allocate 'self' time
Pursue a hobby
Look after yourself
Access support (Manager, Occupational Health / HR, Local agencies)
An in house counsellor who can maintain confidentiality and acts a bridge between the organization leaders and teams goes a long way in ensuring adequate stress management.
According to recent statistics only 40% of Indian women opt for preventive health check. Majority resort to self medication and ignore the signs and symptoms of a major illness. Ignorance and neglect leads to complications and fatality. It is important that every woman understands the importance of her health and prevention. Given below are some aspects that ever women needs to consider and implement:
- Physical examination every 2 to 3 years.
- Breast check- to identify early signs of breast cancer. Mammography- every 1 to 2 years after the age of 40 years.
- Screening for thyroid should be done at regular intervals.
- Screening for diabetes- every 3 years after the age of 45 years.
- Screening for cholesterol and blood pressure - every 5 years after the age of 35 years to reduce the risk of heart diseases.
- Women should undergo screening for osteoporosis. Bone mineral density test helps to identify problems early and treatment should be started to prevent fractures.
- Eye examination is essential after every 1 year to prevent eye related problems.
- PAP Smear test - Women at the age of 21 to 30 should undergo a pap smear test every 3 years. This is an essential test for checking cervical cancer. After the age of 30 years. PAP smear+ HPV test should be done every 5 years.
- Screening for ovarian cancer- a vaginal ultrasound is recommended to patients with a family history of cancer in ovary or any pelvic pain should undergo this test.
Consult for any abnormality:
Most importantly if you detect any abnormality in your body it is essential that you consult a doctor immediately. Ignoring or neglecting the signs and symptoms can complicate matters.
Can Stress Have an Effect on Your Fertility?
If your mind and body is under stress your body is signaled to release a hormone - Adrenalin. This is a stress relieving hormone and gives your body the rush to face the stress. This hormone inhibits the utilization of the hormone Progesterone, which is essential for fertility. Also during stress Prolactin, another hormone, is relapsed which also interferes with infertility. Hence to conceive its essential that your anxiety levels are under control.
Chronic Stress also decreases libido:
Chronic stress may cause lack of libido as well as a decrease in general fertility. This has become such a common issue that they have created a name for it Stress Induced Reproductive Dysfunction. These facts are very important to consider if you have been trying to conceive with no results. It also shows that stress relief should be a part of every couple's conception plan even if they are going through IVF.
Ways to reduce stress & improve fertility:
If you are having difficulty to conceive, it's imperative that you get fertility tests done and also evaluate your life. Look out for the stress points that may be hindering a relationship. Remember defeating the stress may be the solution to your worries.
Reduce stress in your life: The issues in your life may be work or result related. You need to learn to balance your personal and professional life. The sooner you do it the better; after all you are preparing yourself to welcome a new born in your life.
Change your reactions: Get a hang of the situation and react accordingly. Over reaction to a situation can harm your body and mind. Stop bothering so much about the future.
Let few things be the way they are: Stop getting bothered about people. Remember by nature everything will fall in place. Let few things be the way they are.
Make it your habit to reduce stress: Call it an obsession or a practice, train your mind to choose options where there is less stress.
Sleep well: A good rest is essential for a healthy mind and body. Meditate, do yoga or seek counseling. Go for facials if it sooths you.
Please note that if your fertility reports are normal, then it's just a matter of time. Give you, your partner and your body time. There are certain medical complications or disorders that can also be responsible for infertility. Be calm and composed so that you are able to face the rough waters clearly with your partner.
Hirsutism is a condition of unwanted hair growth in certain areas of a women's face and body, such as upper lip, beard area, chest and abdomen, that creates a "male pattern" of hair growth. It affects around 5-10% of the women and is a common presenting complaint among females for cosmetic reasons.
Hirsutism is attributed either to increased production or increased sensitivity of the hair follicles to the male hormone- testosterone. Polycystic ovary syndrome (PCOS), which causes irregular menstrual cycles, is the main cause of the same. However in some cases the reasons for the same can be unknown as all reports may seem normal. Such a type is called Idiopathic Hirsutism. It is important for women to not feel shy and embarrassed about the situation. Often resorting to excessive bleaching and razers can harm the skin and the self image of a woman. You should come forward and talk to either a Gyneacologist or an Endocrinologist. The doctors after taking the complete history would advice certain tests that would measure the amount of certain hormones in the blood. If the androgen levels are elevated, doctor may recommend an ultrasound or a CT scan to check ovaries and adrenal glands for tumors or cysts.
The main causes of Hirsutism are:
- Polycystic Ovary Syndrome: In 70% of the cases PCOS is the cause of Hirsutism. Women with PCOS often have hirsutism in combination with acne, balding near the front of the head, and menstrual irregularities. PCOS is also accompanied by infertility (due to menstrual irregularity), obesity, diabetes , High cholesterol and possible heart disease.
- Idiopathic Hirsutism: Idiopathic hirsutism refers to hirsutism that has no identifiable cause. It is usually a mild variation of PCOS. A gradual increased growth of coarse body hair is typically the only symptom in women with this condition. Menstrual cycles are normal in women with idiopathic hirsutism.
- Drug Induced: Certain drugs and steroids taken the past can trigger a hormonal imbalance and cause hirsutism
- Adrenal or tumour causes: These are rare and are related to tumours or abnormal functioning of the adrenal gland.
Since Hirsutism can be a combination of medical issues self medication is not recommended. There are a variety of ways through which the same can be managed or cured. The treatment options are:
- Medical Management: The doctors can recommend a combination of drugs such as oral contraceptives (contain estrogen & progestin that inhibits the male hormone), anti-androgens and insulin sensitive drugs.
- Cosmetic Hair Removal: Electrolysis and the modern day safe Laser therapy are sought after cosmetic ways for removal of unwanted hair. The procedures destroy the hair follicles and prevent the hair from growing.
- Surgical Therapy: Only in specific cases Laparoscopic ovarian drilling or removal of ovarian & adrenal tumours can help treat Hirsutism.
It is important to understand that this problem is medical and can be treated, managed and cured with expert advice & guidance. Women usually get depressed and have image issues. One should not get distressed; it may be a possibility that the reason may be just a little imbalance in your hormones. Eating healthy, weight loss and exercise are tried and tested natural ways to keep your body fit & balanced.
Stress is very common now a day's and it is affecting all age groups - Be it school going children, young adults or working professionals. No one is immune to stress in the present fast and competitive world.
So, what is stress? Stress is the body's response to any kind of physical or emotional demand or threat. Body releases certain stress hormones under these pressure conditions. On long term basis , stress can lead to many chronic conditions affecting the heart and can cause mental disorders like depression, sleep disorders or affect the social well being also.
Women and Stress:
Women deal with stress differently than men. Women are generally soft, caring and gentle. They have to manage their personal and professional life and generally get less support at both fronts.They generally spend their life taking care of others and give least attention to their own needs( emotional and physical). As women progress through different life stages her emotional balance also changes affecting her emotionally making her vulnerable to stress and depression.
Ways to handle Stress:
Relax - don't take each and every situation seriously , take a deep breath, not all emergencies are a do or die situation.
Make time for yourself - love yourself and take care or yourself and then you can love and care for others as well. Take out time to do things which you like.
Sleeping is a great way to help both your body and mind. Try to get atleast 8 hours of sleep.
Get a hobby and immerse yourself in doing something creative and constructive.
Do regular exercise- it is the best way to bust stress in a healthy way.
Make new friends or travel to new places. Explore the unknown and spend time with people.
Focus on one thing at a time.
How to manage stress:
Don't let stress make you sick . Often people are not aware of the stress levels and how they are affecting them. One should pay attention to themselves and focus on their emotional and physical needs. Take a break, go on holiday, eat what you like, go out with friends and relax. Live life, love yourself, listen to your body.
Side effects of Stress on Women:
Menstrual problems: Stress can cause delay in periods or sometimes short cycles.
Infertility : Stress can affect the hormonal levels leading to an ovulation and infertility.
Hair loss : Many women complain if losing hair and biting their nails in stress.
Eating disorders : Either women end up binging on healthy food items or completely refuse to eat anything. In stress the best is to out ant divert your attention to something constructive.
Sleep disorders: Trouble in falling asleep is common in women under stress.
Heart disease: High blood pressure., stroke and heart attack are common ailments caused due to stress. This is because women take stress to heart and are more susceptible to go through heart disease due to stressful situations.
Depression : Women can go into a shell and suffer from acute depression. If you are getting self loathing or helpless thoughts, reach out to your loved ones and talk. If talking and reaching out also doesn't resolve the situation, consult a specialist. Medical expertise can ensure that stress doesn't affect your health.
Weight gain : Women stop going out, start eating unhealthily and restrict their interaction with people in depression and stress. The result is that they start to gain weight. It is best that you keep a check on the scales and opt for a strict diet.
Decreased libido: Stress affects the sex life the most. A decrease in libido can affect relationships and create distances. Talk to your partner and of needed opt for medical advice.