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Dr. Pankaj Shah

MBBS, MS - Obstetrics and Gynaecology

Gynaecologist, Mumbai

32 Years Experience
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Dr. Pankaj Shah MBBS, MS - Obstetrics and Gynaecology Gynaecologist, Mumbai
32 Years Experience
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Personal Statement

To provide my patients with the highest quality dental care, I'm dedicated to the newest advancements and keep up-to-date with the latest health care technologies....more
To provide my patients with the highest quality dental care, I'm dedicated to the newest advancements and keep up-to-date with the latest health care technologies.
More about Dr. Pankaj Shah
Dr. Pankaj Shah is a trusted Gynaecologist in Goregaon West, Mumbai. He has been a practicing Gynaecologist for 32 years. He studied and completed MBBS, MS - Obstetrics and Gynaecology . You can meet Dr. Pankaj Shah personally at Pooja Hospital in Goregaon West, Mumbai. Save your time and book an appointment online with Dr. Pankaj Shah on Lybrate.com.

Lybrate.com has a nexus of the most experienced Gynaecologists in India. You will find Gynaecologists with more than 42 years of experience on Lybrate.com. You can find Gynaecologists online in Mumbai and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.

Info

Education
MBBS - Gujarat University - 1985
MS - Obstetrics and Gynaecology - Gujarat University - 1989
Languages spoken
English
Hindi

Location

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Pooja Hospital

101, Onyx Building, Opposite Petrol Pump,Next To BSES & LIC Office, S V Road, Goregaon WestMumbai Get Directions
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While fucking my girlfriend my condom was torn and sperms has gone inside her vagina and I have done sex with her many times without using condom will she be pregnant and if she will so which medicines will help her out.

MBBS, MD - Obstetrtics & Gynaecology, FMAS, DMAS
Gynaecologist, Noida
While fucking my girlfriend my condom was torn and sperms has gone inside her vagina and I have done sex with her man...
Hello, yes there is all likelihood that she may get pregnant. She should be protected with emergency contraception within 72 hrs of last intercourse. There are high chances of pregnancy.
2 people found this helpful
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My wife is pregnant but the baby is located in lower abdomen or at zero degree position what precaution should be taken?

MS - Obstetrics and Gynaecology
Gynaecologist, Ludhiana
My wife is pregnant but the baby is located in lower abdomen or at zero degree position what precaution should be taken?
Hi, feeling of heaviness in lower abdomen is common feature in pregnancy and it's due to pressure effect of enlarged uterus on adjacent organs. To avoid/ eliminate this one must avoid prolonged standing, hactic activity, any downward straining e. G. Constipation, coughing etc. Take frequent small breaks to take rest and while resting keep feet raised. Regular prenatal check up is must to rule out any problem.
2 people found this helpful
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Hypnotherapist, DCS, BSIC, Advanced Trainee of Transactional Analysis, Advanced Skills in Counselling
Psychologist,
11 tips to overcome loneliness

I have seen in my practice as a counsellor too often, that people are living in big cities, full of people, but they feel very lonely from within and at the brink of anxiety and depression.

Simply defined, loneliness is a condition of emotional disconnect, socially feeling misfit and never ending solitude. Lonely people often feel insecure and pessimistic about finding desirable and compatible friendships. Poor self-esteem and an underdeveloped sense of one's worthiness, likeability and attractiveness prevent the lonely person from taking risks and venturing out into new relationships. Hence, they typically lack confidence and enthusiasm to pursue new relationships or nurture existing ones. As a chronic condition, it can be emotionally and psychologically debilitating.

Contrary to what many people believe, loneliness isn't just a result of being alone or an absence of friends. It is a deeper problem that is caused by thoughts and feelings of inadequacy, imperfection and shame. Chronically lonely people are often holding onto pessimistic predictions about the prospects of finding companionship, social connections and supportive relationships.

The lonely often suffer in silence. For many, it is hidden behind a facade of normalcy. While smiling and having fun, many hide their core feelings of loneliness. For these people, loneliness is not a reflection of what is happening in their lives at any given moment, but what occurs secretively and silently within them. When around people they know, they pretend to be upbeat, positive and happy, while at the same time feeling unworthy and insecure. Since it is a shame-based experience, it is typically kept a secret.

Lonely people inadvertently put themselves in a catch-22 situation: social opportunities seem like a heavy burden fraught with the potential of rejection or abandonment. The more you feel lonely, the more you feel inadequate and unworthy, the more you stop believing anyone will ever like or love you, the more you isolate. With a belief of potential rejection or abandonment, the lonely person is unable to put their best foot forward in any given social situation. Hence, loneliness feeds on itself.

The causes of loneliness are varied and multi-dimensional, including social, psychological and physiological factors. The major cause of chronic loneliness is often attributed to early developmental factors such as a child's lack of attachment to their adult caregivers who only conditionally love (love with strings attached) their children. Similarly, childhood neglect, abuse and abandonment are early childhood factors that eventually manifest into adult loneliness.

Since loneliness is a deeply embedded psychological experience (condition), having enough friends can never result in feeling secure and lovable. Building up one's self-esteem and ability to love, respect and care for oneself is fundamental in solving and healing the deeper psychological conditions that create chronic loneliness. Counselling helps people to explore their early childhood wounds in a safe and confidential space and learn new ways to" re-parent" themselves by learning to love, acknowledge and appreciate themselves.

Life is too short to waste on suffering from core loneliness. Please heed to my suggestion: open up, take a chance and access the hidden part of you that deserves true and loving companions. Heal your childhood wounds. Learn to love yourself and eliminate loneliness from your life!

The following are 10 tips to battle and conquer loneliness:

1. Catch your inner critic's attempts to sabotage yourself. Pay attention to self-degrading thoughts like" I am too fat for anybody to want to date" I wish I were funnier and had interesting things to say" or" people never seem to understand me"

2. Replace negative self-talk with affirming messages, such as" I am perfectly lovable just as I am" and" I welcome love, friendship and support into my life"

3. Fight the urge to isolate. Isolation validates your fears that you are not worthy of the love and support you absolutely deserve. Sometimes you have to force yourself to do exactly that which you are dreading -- like putting yourself out there.

4. Weed out the toxic relationships and create space in your life for relationships that fuel your spirit. You can't grow lovely succulent vegetables with a large patchwork of weeds.

5. Nurture your support network. Even if there is only one person to start with, you can build on it. Don't underestimate the importance of what you have to offer.

6. Expand your social network. Online social sites such as meetup. Com are an ideal place to meet people and to explore hobbies, interests and social groups.

7. Open your self-up, take risks, and allow yourself to be vulnerable. Since loneliness results in isolation, experiment by sharing aspects of yourself, including experiences, feelings, memories, dreams, desires, etc. This will help you feel more known and understood.

8. Ask for what you need. Find your voice. Tell people what you need from them to alleviate the loneliness. Friends respond to direct messages for help and support. Give it a try, you might be surprised!

9. Take action. Don't wait for an invitation. Be willing to take a risk, be proactive and invite people to share in your life, whether it is for coffee, lunch, a walk, an event or a gathering in your home.

10. Recognize the importance of being alone and enjoying solitude. Being alone is not the same as being lonely. Peace, quiet, freedom, space and the opportunity to connect with your deeper self.

11. Consider therapy. Counseling is something that is healthy and proactive that can help you overcome the self-defeating behaviors that exacerbate loneliness. With the support of a therapist, you can change your thinking and relationship patterns and achieve the life you want!
9 people found this helpful

I have missed my period by 6 days. I doubt about my pregnancy. I have tested at home through prega news kit. It shows 1 dark line and one very light pink line. What does it mean?

Diploma In Postpartum Depression, Formerly , House Job , Gynecology, MBBS
Gynaecologist, Delhi
I have missed my period by 6 days. I doubt about my pregnancy. I have tested at home through prega news kit. It shows...
This can happen either in early pregnancy or that the pregnancy has happened but could need certain medications by a gynaecologist to take it further.
2 people found this helpful
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Graves' Disease - Things You Should Know About It

MBBS & Post Graduate Course in Diabetology, Fellow of Academy of General Education (FAGE), CCEBDM
Endocrinologist, Bangalore
Graves' Disease - Things You Should Know About It

The body has multiple chemicals called hormones, which regulate many of its functions. Increased or decreased levels of these hormones affect various functions including metabolism, growth and sexual functions. Thyroxin produced by the thyroid (situated in the front of the neck) is one such hormone, which has a significant role to play in metabolism.

Graves’ disease is one of the main causes of hyperthyroidism, where there is excessive production of thyroid hormones. Graves’ disease is an autoimmune disorder, wherein the body reacts against its own tissues. It is very common in women than men, especially after 20 years of age. Family history also has a strong correlation in developing Graves’ disease. The high levels of thyroid hormone increase the rate of metabolism, thereby altering weight, mental energy levels, physical stamina, and also mood.

Thyroid hormone is related to metabolism and more amount of it lead to higher metabolism. This causes the following symptoms.

  1. Intolerance to heat
  2. Excessive sweating
  3. Nervousness and anxiety
  4. Inability sleep, as the mind is always excited
  5. Increased appetite (sometimes despite weight loss) due to higher metabolism
  6. Irregular menstrual cycles
  7. Palpitations (rapid, loud heartbeat)
  8. Irregular heartbeats (tachyarrhythmia)
  9. Fine tremors of the extended arms
  10. Breast enlargement in men, known as gynecomastia
  11. Extreme moodiness, causing irritability and anger
  12. Inability to focus and concentrate
  13. General fatigue and shortness of breath with any exertion
  14. Increased frequency of bowel movements

In addition, the eye symptoms are quite diagnostic including:

  1. Protrusion of the eyes (exophthalmos), giving an impression that they are going to fall out
  2. Double vision
  3. Excessive tearing
  4. Increased irritation in the eyes

Diagnosis: The first symptom would be the presence of an enlarged thyroid gland (front of the neck above the collarbone), and the some of the above symptoms would be present.
In addition, tests to check for thyroid gland functioning including T3 and T4 levels would reveal increased amounts of hormone in the blood stream.
As a confirmatory test, the radioactive iodine uptake test also is done, which will indicate increased uptake by the thyroid gland. This indicates that the gland is functioning at an increased pace and requires additional iodine for the production of thyroid hormones.

Treatment: There are two approaches to it, one to control the symptoms and the other to control the thyroid gland per se.

  1. Beta blockers are very useful in controlling rapid heart rate and anxiety.
  2. Prednisone may be used to control eye irritation and swelling
  3. Antithyroid drugs are used to control the production of thyroid
  4. Radioactive iodine is given orally to control excessive thyroid production
  5. In severe cases, thyroid gland may be surgically removed partially or completely

Graves’ disease is not life-threatening and once symptoms are controlled, the patient’s quality of life improves drastically. If you wish to discuss about any specific problem, you can consult a endocrinologist.

3050 people found this helpful

I am in pregnancy with two months. But I have stomach pain please suggest how to control.please help.

MBBS, MD - Obstetrtics & Gynaecology, FMAS, DMAS
Gynaecologist, Noida
I am in pregnancy with two months. But I have stomach pain please suggest how to control.please help.
hello, please get an ultrasound pelvis down to rule out any retroplacental hemorrhage and viability of uterus as this may be sign of a threatened abortion. Please visit your obstetrician.
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Hi im 21 years women I have some problem during periods I have serious stomach pain it cause me unconscious I took tablet when I have that kind of stomach pain seriously I dnt like that, is there any other way to treat this kind of stomach bcoz during college day I dnt want to face that kind of causes so please help me to treat this stomach pain.

fellow in Obstetric Medicine , MS - Obstetrics and Gynaecology, FMAS, DMAS, MBBS
Gynaecologist, Hyderabad
Hi im 21 years women I have some problem during periods I have serious stomach pain it cause me unconscious I took ta...
hello priya, itz fine to take tablets for period pain..! so if they make you feel better take them regularly during periods.! you could also try hot water formentation!
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I am 6 month pregnant what should diet I follow during this period. And I have continues pain in upper abdomen.

DGO, MD, MRCOG, CCST, Accredation in Colposcopy
Gynaecologist, Kolkata
I am 6 month pregnant what should diet I follow during this period. And I have continues pain in upper abdomen.
With regards to diet I would advice you to read my health tip on Healthy eating in pregnancy. However because you are having pain I would advice you to see an Obstetrician so that you can be examined.
3 people found this helpful
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Psychosomatic Disorder - Only Homeopathy Cures

BHMS
Homeopath, Ahmedabad
Psychosomatic Disorder - Only Homeopathy Cures

It is said that the mind controls the body. If the mind is healthy so will the body be. The condition of the mind is often reflected in bodily symptoms and conditions including illnesses.

The temptation in mostly to treat with heavy drugs that might offer temporary relief but have dangerous side effects and do long term harm.

Homeopathy tackles this issue considering safety and cure in a balanced manner to ensure recovery but without harmful side effects.

The concept of psychosomatic disorders has been in existence since the time of Sigmund Freud. The belief is that with the varied emotions that a person experiences, each disease manifests with a different set of symptoms in each person, implying that each person needs to be treated differently and not given the same disease-specific medication. This is where homeopathy plays a very strong role in psychosomatic disorders as it also believes in treating the person as a whole and not just the symptoms.

In homoeopathy, we base our prescription on what we call constitutional symptoms where we give lot of importance to the mental symptom as well as to the characteristic physical symptom. Hence every prescription from a Homoeopathic physician will surely include an element of psychosomatic angle. It is beyond the scope of this editorial to mention all the remedies of Materia Medica which has the scope for the treatment of psychosomatic disorders.

The homeopath always undertakes a thorough discussion with the patient to understand the accompanying symptoms in detail and then arrive at a customized treatment plan.

Some of the most common psychosomatic disorders include irritable bowel syndrome, migraine, GERD, ulcerative colitis, and allergy disorders.
Specific substances are given to manage anxiety, depression, irritability, insecurity, paranoia, etc. These feelings are considered inducers for the above disorders, and managing them can help bring about a harmony in the patient's overall health.


GERD: Gastro esophageal reflux disease is a disorder that results from stomach acid moving backward from the stomach into the esophagus. GERD usually happens because the lower esophageal sphincter (LES), the muscular valve where the esophagus joins the stomach, opens at the wrong time or does not close properly.

Homeopathy For GERD:
Homeopathic medicine relies not only on identifying the symptoms of the disease, but on a variety of personality traits, the person's mental state and other characteristic symptoms a patient exhibits which correlate to any particular remedy. When choosing a correct remedy for the treatment of heartburn, all aspects of the patient are taken into account.
These are some of the Homoeopathic medicines that may prove beneficial:- Argentum nit, Cal.carb., China, Carbo veg, Lycopodium, Nat. phos, Nux vomica, Phosphorus, Pulsatilla, Robinia, sulphuric acid etc.


Migraine: Migraine is a form of headache. The pain is usually throbbing, pulsating and bursting in character. At times, the pain is one sided or may involve the whole head. Such pain may last for hours or even days. It is often accompanied by other symptoms like nausea or vomiting. At the same time, there is increased sensitivity to light and sound. In some cases, the pain is preceded by some warning symptoms like flashes of light, temporary blindness or tingling sensation in the limbs.

Homeopathy for Migraine:
Belladonna is widely used homeopathy remedy for migraines, where headache is throbbing and violent, occurs suddenly, worsens on touching, and relieves with pressure. Glonoine is useful in congestive headaches with a reddened face that is worsened by sun or heat. Natrum Mur is useful in cases where headache is brought on by grief or stress.

Ulcerative colitis: Ulcerative colitis is a serious chronic inflammatory disease of the large intestine accompanied by ulcerated lesions of the intestinal tissues. It is characterized by episodes of abdominal pain with profuse diarrhea in which large quantities of blood, pus, and mucus are present in the feces. There is an urgency to move the bowels, as many as, three to ten times per day. It may be accompanied with pain, nausea, and vomit. Because of the loss of blood, the patient may become dehydrated and anemic.
Complications of ulcerative colitis includes liver and kidney disease, peritonitis, toxic mega colon, and risk of developing colon cancer.

Homeopathy for Ulcerative Colitis:
To identify the actual inducing agent, some foods are removed to see if they are inducing attacks. Once identified, that is removed from the patient's diet. In addition, aloe, arsenicum album, carbo vegetabilis, colocynthis, are commonly used remedies for ulcerative colitis. The patient is asked for associated symptoms like bleeding diarrhea, color of the feces, involuntary defecation, abdominal pain, anxiety, cramps, and stress before deciding on a treatment mode.

Irritable Bowel Syndrome: Irritable bowel syndrome, also known as spastic colon is a functional disorder characterized by recurrent abdominal pain, cramping, and bloating. Some people suffer from constipation, which means hard, dry stools, difficult to eliminate, leading to straining without success. Some people experience diarrhea, with frequent loose watery stools.

Homeopathy for Irritable Bowel Syndrome:
Sulphur, Pulsatilla, Phosphorus, Nux Vomica, Lycopodium clavatum, Argentum Nitricum, and Silicea are commonly used homeopathic remedies. Associated symptoms that need to be considered before deciding on a therapy include frequency of stooling, nature of stools, abdominal bloating, restlessness, irritability and nervousness.

Homeopathy is a preferred mode of treatment for psychosomatic disorders as they aim at a holistic treatment of the individual and not just at symptom management.

Allergy: Allergy is an abnormal reaction or increased sensitivity to certain substances. The allergic individual produces symptoms when exposed to these substances, which are harmless to non-allergic people. The main reason for this is that allergic people make a special type of antibody called immunoglobin E (IgE), which can react with environmental substances in harmful way. These substances which lead to secretion of IgE antibodies are called allergens.

Homeopathy for Allergy:
Few important remedies for the homeopathic treatment of allergy are- Histamine, Natrum Mur, Kali Bich, Sepia, Hepar Sulph, , Carbo Veg , Sulphur, Bryonia, Nux Vom, Apis Mel, Ailanthus, and Justicia adhatoda.

2837 people found this helpful

Sir meri Bibi ko 2 bacche he Dono dilivry operation he to kya me 3 bacche k liye bivi ko pragnet kar Sakta hu koi problem to nahi hongi na Please btaye.

DHMS (Diploma in Homeopathic Medicine and Surgery)
Homeopath, Ludhiana
Sir meri Bibi ko 2 bacche he Dono dilivry operation he to kya me 3 bacche k liye bivi ko pragnet kar Sakta hu koi pro...
I think there will be no problem in going for 3rd baby but be particular regarding health of your wife during pregnancy and have her regular check ups from a gynaecologist.
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Hi actually I ask personal question I was married last two years but I don't know my vagina is very loose please give me and how to tight and I am too weak and how to increase my weight.

Net Qualified In Community Health And Social Medicine, M.Sc - Dietetics and Community Nutrition
Dietitian/Nutritionist, Durgapur
Hi actually I ask personal question I was married last two years but I don't know my vagina is very loose please give...
You can practice kegel exercises to tighten your loose vagina. And you can consult famous sexologist Dr kamaksha prasad in Lybrate for further recommendations. For weight gain -Drink mango shake and banana shake,followed by mango and banana.
4 people found this helpful
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If i-pill is taken today after the sex, and within 24 hours again sex is enjoyed, is there a need to take i-pill again? Suppose it is taken again I. E. I-pill consumed twice in less than 36 hours is there any side effects or can it delay menstrual cycle?

DGO, MAOGD, MBBS
Gynaecologist, Panchkula
If i-pill is taken today after the sex, and within 24 hours again sex is enjoyed, is there a need to take i-pill agai...
Hi I understand your concern. If you have taken I pill after one episode of unprotected intercourse no need to take it again. Yes, it can delay the periods or can cause intermenstrual bleeding because these are high dose hormones. So avoid taking I pill again and again.
4 people found this helpful
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I'm suffering from severe pain in Lower and upper stomach My periods is late in this month and I can't be able to sleep with this pain doctor recommended me medicines and in ulta sound it's be cyst. Left Overy shows cyst of size 3.4×3.5 cm with free fluid in pod? Pid I'm working person. I can't be able to go daily office What will I do. I must be to bed rest or what should I do please ans me.

MD - Obstetrtics & Gynaecology
Gynaecologist, Mumbai
I'm suffering from severe pain in Lower and upper stomach My periods is late in this month and I can't be able to sle...
For pain you can take meftal spas and rantac. Cyst is not causing any problem you r suffering. Menses will be late if you develop cyst in the ovary which will resolve on its own without any treatment.
1 person found this helpful
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Nowadays am got negative thoughts too much. L don't know what s the reason. I have pcod problem also . Sometimes am not sleeping in night .that time I got scared and depressed too much. I have acidity problem also. Please tell me how to cure.

MD - Psychiatry, MBBS
Psychiatrist, Patan
Nowadays am got negative thoughts too much. L don't know what s the reason. I have pcod problem also . Sometimes am n...
Dear service user, thank you for writing to lybrate. I understand your concern. Depressed mood, decreased interest in pleasureable activities, sleep disturbance, appetite change, anxiety, negative thoughts, inappropriate guilt and worthlessness are symptoms of depression. For diagnosis of depression, doctor needs your clinical history and examination of your mental state. Stress is also a signifucant factor leading to acidity. Depression is curable. The antidepressant medications and counseling cognitive behaviour therapy are proven effective for this. Kindly consult psychiatrist for this. Wish you good health and rapid recovery. Regards.
3 people found this helpful
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Does Celiac Disease Reduce Fertility?

MRCOG, MD - Obstetrics & Gynaecology, DNB (Obstetrics and Gynecology), MBBS
Gynaecologist, Delhi
Does Celiac Disease Reduce Fertility?

Celiac disease is a condition in which the small intestine becomes sensitive and reactive to gluten, leading to difficulty in digesting food. Gluten is a kind of a protein found in wheat or barley. In reality, if either of the partners is suffering from celiac disease then you are prone to fertility related issues.

Impact of Celiac disease

As compared to men, this disease is more common among women in general. Women suffering from the disease are generally more prone to infertility and other genealogical problems like preterm births and miscarriages. In the case of men, the disease causes the infertility problems including sperm abnormalities such as low count, abnormal shape, reduced function and such others. Additionally, men with the untreated celiac disease might also have reduced levels to testosterone.

Infertility and Celiac disease

Infertility is one of the lesser known effects of the celiac disease, which is relatively uncommon amongst people. The disease causes infertility by affecting the menstrual cycle among women either in a direct or indirect manner. Some of the infertility related problems caused due the disease are listed below.

  • Delayed occurrence of menstruation
  • Early menopause
  • Secondary amenorrhea (a medical condition associated with sudden cessation of menstruation for 6 months or more)
  • Hormonal disruptions and abnormal changes

Diagnosis

Celiac disease is usually diagnosed by its own set of underlying symptoms such as chronic fatigue syndrome, irritable bowel syndrome (IBS), iron-deficiency anemia, and such others. Additionally, the condition can be diagnosed if a person is having repeated miscarriages or inability to conceive for unidentified causes.

What can you do about it?

If you experience symptoms of Celiac disease, consult your doctor at the earliest and follow the treatments and preventative measures suggested. Additionally, you can also consult a dietician who will help you to move on to a low grain or no grain diet that would help you further to avoid the disease.

Tip: How Stress and a Sedentary Lifestyle Make You Infertile

3883 people found this helpful

I hv a periodcycle of 34 to 36 days. My last periods were on 19 june .plzz tell around how many days of my last period I ovulate? Wht would have been my ovulation days for this month.

MD - Ayurveda, Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda, Jammu
I hv a periodcycle of 34 to 36 days. My last periods were on 19 june .plzz tell around how many days of my last perio...
The best method to find out the day of ovulation is temperature method. In this technique, womens body temperature is recorded every morning. When these temperatures are plotted on a graph we get a curve. The temperature is low during actual bleeding. Subsequently it rises. At about the middle of cycle there is a sudden fall in temperature followed by a rise. This rise in temperature indicates that ovulation has occurred. You can msg me to discuss in detail to know the exact day of your ovulation. I will help you.
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Yesterday and day before yesterday we had oral sex with my girlfriend. And she also rubbed my penis in her vagina and I also did fingering in her private place. Now she is facing itching in her private parts from today morning. Is this a serious issue? What should she do please tell urgently? Thank you.

DNB (Obstetrics and Gynecology), PGDHHM, MBBS
Gynaecologist, Delhi
Yesterday and day before yesterday we had oral sex with my girlfriend. And she also rubbed my penis in her vagina and...
it may be due to infection advice her to keep clean and dry vaginal portion.apply anti fungal cream or ointment for itching.
2 people found this helpful
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I am 24 years old I got married since 6 months before but still I am not able to conceive and hymen is not tar pls tell your suggestion.

MBBS
General Physician, Mumbai
I am 24 years old I got married since 6 months before but still I am not able to conceive and hymen is not tar pls te...
I will suggest you to do sexual activity from 10-20 th day of your menstrual cycle and follow up after three months.
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