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Overview

Hypercholesterolemia: Treatment, Procedure, Cost and Side Effects

What is the treatment?

Hypercholesterolemia is a condition of really high blood cholesterol levels. Cholesterol is a fatty, waxy substance manufactured by the liver and found naturally in the body. Cholesterol has a number of functions and is often converted to hormones. The body produces sufficient amounts of cholesterol and you only need a very small portion of cholesterol from the outside in order to keep you healthy and fit. This additional cholesterol source comes from dietary cholesterol in form of meat, dairy products, eggs (egg yolk particularly), meat, fish and poultry. These food items are really high in saturated fats and Trans fats. So consuming these items in excess can trigger the body or more specifically the liver to produce an overabundance of cholesterol. This can in most cases lead to hypercholesterolemia.

Aside from hormones cholesterol is also needed by the body for the functioning of cell membranes and production of substances which is in turn required for fat digestion. A surging cholesterol level can heighten the chances of a coronary artery disease. The excess cholesterol levels in the bloodstream lead to the formation of fat deposits in the coronary artery walls. The rising cholesterol levels narrow and at the same time harden the walls of the artery. This condition is known as atherosclerosis.

With the passage of time the arteries can get blocked thereby cutting off the supply of oxygen-rich blood to the heart. This contributes to the risk of heart attack, stroke and angina. Other conditions where the fat deposits get stored in the tissues and tendons of the body are known as familial hypercholesterolemia. Hypercholesterolemia occurs due to unhealthy eating habits and unhealthy lifestyle with almost next to zero physical activities.

How is the treatment done?

Hypercholesterolemia shows very little symptoms and only way it can be detected is by getting a blood cholesterol level check done. This is referred to as a lipid profile. This comprises of an overall test of the LDL cholesterol, HDL cholesterol, total cholesterol and triglyceride levels. A cholesterol level that is 200 mg/dl is considered to be high. People who are diagnosed with hypercholesterolemia will be initially recommended by the doctor to make necessary changes to their diet and also advised to take part in physical activity on an everyday basis. It is advised that the saturated fat consumption for men should be about 30 grams everyday in case of men and for about 20 grams everyday in case of women.

If the cholesterol level continues to hover near the high range then the patient will be prescribed a set of medications. These include bile-acid binding resins, statins, and cholesterol absorption inhibitors.

The liver makes use of cholesterol in order to produce bile acids is required for the process of digestion. Therefore, the bile acid-binding resins bind to the bile acids. These leads the liver get access to excess cholesterol so that it can still manufacture the acid. This has a lowering effect of the blood cholesterol levels. Statins act as a barrier to a substance that is needed by the liver in order for cholesterol synthesis. In the small intestine the cholesterol is absorbed from food sources within the bloodstream. Cholesterol absorption inhibitors help to lower the cholesterol level in the bloodstream.

Who is eligible for the treatment? (When is the treatment done?)

All those suffering from high cholesterol levels are eligible to hypercholesterolemia treatment.

Who is not eligible for the treatment?

People who are allergic to any of the ingredients contained within the medications mentioned above are not eligible to go for this treatment. Also women and people, who are aged 65 years and older, stand at a greater risk of developing certain adverse effects from taking statins. Also, people who suffer from kidney or liver disorder are more vulnerable to suffer from side effects of statins.

Are there any side effects?

Patients taking statins are most likely to experience side effects such as muscle pain, muscle damage, nausea, diarrhoea, constipation, liver damage, type 2 diabetes and neurological side effects. Bile acid binding resins can cause side effects such as flatulence, bloating, diarrhoea and constipation. Patients who have been prescribed to take cholesterol absorption inhibitors are likely to experience side effects such as fatigue, muscle soreness and stomach pain.

What are the post-treatment guidelines?

The post-treatment guidelines for hypercholesterolemia includes lifestyle changes that should comprise of a diet that is low in saturated fat, managing their weight in case the patient is overweight or obese and taking the medications prescribed by the doctor on time. Also, regular exercise is highly recommended in order to keep cholesterol levels on the low side.

How long does it take to recover?

On an average it takes about three weeks to lower cholesterol in adults and about two weeks in children. If someone is put on the Pritikin Program of diet it will take about three weeks reduce the cholesterol levels.

What is the price of the treatment in India?

A monthly course of statins would cost you about Rupees 250 in India. A strip of 10mg of Ezedoc tablets which fall under the category of cholesterol absorption inhibitors would cost around 110 rupees.

Are the results of the treatment permanent?

The results of the treatment can be permanent in so far as the post-treatment guidelines which include lifestyle changes, exercising regularly and taking the medications on time, are strictly adhered to.

What are the alternatives to the treatment?

The alternative of a medical treatment for Hypercholesterolemia would be adopting some natural remedies such as making dietary changes that include foods rich in soluble fibres such as fruits, vegetables; olive oil; omega 3-fats; herbs; garlic. By eating the right foods and avoiding food that are high in saturated fats one can easily maintain their cholesterol levels.

type diabetes
Safety: High Effectiveness: High Timeliness: Medium Relative Risk: Low Side Effects: Medium Time For Recovery: Medium Price Range:

Rs. 100- Rs. 500

Popular Health Tips

Dealing with Cholesterol Disorders

MBBS, MRCGP ( UK), Diploma in Diabetes (UK), DFSRH (UK), DRCOG (UK), CCT (UK)
Endocrinologist, Hyderabad
Dealing with Cholesterol Disorders

Most may not be aware of the fact that the human body requires cholesterol for normal functioning. Though normal levels of cholesterol are essential for proper functioning, any fluctuations in these levels can lead to disorders like hyperlipidemia and hypolipidemia.

Cholesterol, a soft, fat-like substance helps in building new cells and secreting hormones. While 80% of the cholesterol is produced by the liver, 20% is obtained from the food you eat. The cholesterol sticks to a protein called the lipoprotein and along with it travels through the bloodstream. Among these lipoproteins, HDL (High-Density Lipoprotein) is good for the body, and the other four namely LDL (Low-Density Lipoprotein), VLDL (Very Low-Density Lipoprotein), and Triglycerides are bad for your body.

Complications
While high blood cholesterol can lead to complications such as heart attack or stroke, low blood cholesterol would indicate the presence of an underlying condition and in either case, proper treatment and management are essential.

Managing high cholesterol

  1. Diet and exercise: The first line of treatment begins with an active lifestyle and a healthy diet. Choosing healthier fats, avoiding trans fats, limiting dietary cholesterol, including whole grains, vegetables, and fruits, and limiting alcohol consumption along with adequate exercise should reduce the levels without medication.
  2. Medication: If the cholesterol levels do not reduce despite m lifestyle changes, the physician will prescribe a combination of medications, considering several factors such as the individual’s age, present health condition, and the side effects of the medication. The common drugs used to reduce high cholesterol are statins, bile-acid-binding resins, cholesterol absorption inhibitors, and injectable medications.
  3. Managing low cholesterol: In the case of being diagnosed with low cholesterol, the treatment focus would be handling the underlying condition. 

Irrespective of the type of cholesterol disorder, it is essential to follow the doctor’s advice in both cases to avoid the risk associated and lead a healthy life.

In case you have a concern or query you can always consult an expert & get answers to your questions!

4394 people found this helpful

Tips To Help You Lower Your Cholesterol!

DM Cardiology
Cardiologist, Delhi
Tips To Help You Lower Your Cholesterol!

Low density lipoprotein or LDL is the bad cholesterol that adds to plaque development alongside triglycerides, which is another lipid. High density lipoprotein or HDL is the good cholesterol that diminishes plaque development. Plaque can hinder the blood supply to the heart, brain, legs or kidneys, leading to heart attacks, stroke or even death. To lower the cholesterol for a younger heart, you may follow the below steps:

  1. Reduced fats: Do without greasy meats such as bologna, salami, pepperoni and wieners; and greasy red meats such as ribs and prime cuts of hamburger, pork, veal or sheep. Likewise, you must abstain from skip skin on chicken or turkey. Stay away from full-fat dairy items including whole grain, cheese, cream, cream cheese and spread. These food items contain saturated fat and cholesterol. Both are connected with higher blood cholesterol and plaque development.
  2. Intake fiber: In particular, get used to food items which are high in dissolvable fiber. In the gut, dissolvable fiber can provide bulk to the bile and easily expel it from the body. Search for dissolvable fiber in oats, oat wheat, ground flaxseed, psyllium, grain, leafy vegetables, in addition to some whole grain oats.
  3. Go veggie: Pick no less than one meatless meal for every week. Substitute animal protein (meat, poultry, eggs, cheddar) for plant-based protein such as beans, lentils, tofu or quinoa. Consume these plant-based proteins with a plate of mixed greens, soup, panfry, or a burrito.
  4. Be aware of carbs: Following a low-carb eating routine can help you get in shape and decrease cardiovascular hazards. Pick high fiber sugars like oats, whole grain, starches, beans, lentils, and organic products, which will give you the energy you require, apart from keeping you feeling full.
  5. Lose some weight: In case you are overweight or stout, shed the additional pounds. Weight reduction brings down the LDL levels. Reducing even 10 to 20 pounds can have a positive effect.
  6. Move more: Do an hour and a half of cardiovascular exercise every day for an ideal heart wellbeing and weight reduction. Cardiovascular exercise implies any action that uses muscles in an efficient way and builds the heart rate. Strolling, cycling, paddling and swimming can be helpful. In case you discover an hour and a half overwhelming, begin with 30 minutes and work your way up a little at once. For a few people, 45 minutes to an hour of cardiovascular practice is sufficient.
  7. Pick the correct rhythm: Go for a direct level of work out. You will know you have achieved it when you can bear on a discussion when you work out, yet cannot sing. High intensity workout is better at raising HDL levels. However, it additionally expands your danger of wounds, making it difficult to keep working out.If you wish to discuss about any specific problem, you can consult a Cardiologist.
4144 people found this helpful

Cholesterol - Lifestyle Habits That Help Control it!

MBBS, MD - Medicine, DM - Cardiology, Fellowship In Interventional Cardiology, Interventional Cardiology & Cardiac Electrophysiology
Cardiologist, Delhi
Cholesterol - Lifestyle Habits That Help Control it!

Cholesterol is one of those terminologies that need a clear and fresh understanding, right from scratch. It is nothing but obvious and common for you to primarily know about the ill effects of cholesterol and what it does to your body; from increasing the risks of cardio-vascular diseases to adding to your waistline. However, it is time we all got a fresh perspective on what cholesterol is.

So, to start off, what is actually cholesterol?
It is waxy substance produced by the liver which plays an important role in the proper functioning of the cells, digestive process and synthesis of Vitamin D in the body. As cholesterol is a fat based substance that does not dissolve in blood, it is transported, throughout the body, by a protein called the ‘lipoprotein’. The lipoproteins that carry cholesterol are of two types: Low-Density

Lipoprotein (LDL) and High Density Lipoprotein (HDL)

Why is LDL ‘bad’?
LDL is known as ‘bad’ cholesterol as it is responsible for plaque formation that reduces flexibility of the arteries and tends to clog them.

Why is HDL ‘good’?
HDL is known as the ‘good’ cholesterol because it gets rid of excessive LDL from the arteries and transports them to the liver where they can be broken down. Too much of bad cholesterol in the body can lead to clogged arteries that may result in stroke or a heart attack. Now that you know that too much LDL cholesterol is bad for you, you need to keep it under control while raising the good cholesterol (HDL) levels.

In order to do that, you need to make certain modifications in your lifestyle.

Some of them can be:

  1. Eat foods that are good for the heart: Avoid eating saturated fats and trans-fats as they raise LDL levels in the body. Instead, choose foods that are rich in the heart healthy monounsaturated fats such as almonds and olive oil. Also, include foods that are rich in Omega-3 fatty acids such as fish oil; these fatty acids increase HDL levels in the blood.
  2. Exercise regularly: Exercise not only helps you to lose calories but also increases the good cholesterol levels in the body. Aim for 20-30 minutes of cardiovascular exercises in the form of brisk walking, running or cycling to keep your heart muscles healthy.
  3. Stop smoking: Smoking can cause the blood vessels to narrow down, thus increasing blood pressure, owing to the constriction of the blood vessels. Quit smoking right away and your ticker will thank you for it. Remember to limit alcohol consumption as well.
  4. Maintain optimal weight levels: It’s time to get rid of all the excess fat from the body, especially the visceral fat (abdominal fat). Obesity increases the risk of heart diseases and also has a negative effect on the cholesterol levels. If you wish to discuss about any specific problem, you can consult a cardiologist.
2085 people found this helpful

High Blood Pressure - All You Need To Know About It!

Non Invasive Services
Cardiologist, Mohali
High Blood Pressure - All You Need To Know About It!

The heart is a muscular organ that pumps blood to the entire body through a network of arteries and veins. This network contains big vessels which branch out further to supply blood to the distant organs. There is, therefore, some pressure that the heart and thereby the vessels need to exert to push the blood through these vessels. This is known as blood pressure, and normal pressure levels range from 90-140(systolic)/60-90(diastolic) mm of Hg. However, due to various reasons, this pressure could be more, which is one of the first signs of heart disease.

Causes of increased blood pressure: 

  1. Thickening of the blood vessels. With age, the elastic blood vessels naturally turn rigid and less elastic, so there is more pressure required to push blood. It is natural for people over 55 years of age to have higher readings of blood pressure. This is known as primary hypertension (HTN).
  2. Narrowed blood vessels. This happens due to cholesterol accumulation along the walls of the blood vessels. Faulty dietary habits along with sedentary lifestyle have increased the incidence of hypertension due to this condition, known as atherosclerosis. Critical atherosclerotic narrowing of renal arteries lead to renovascular HTN that is one of the commonest of secondary HTN. 

Other Causes of secondary hypertension are: 

  1. Kidney problems
  2. Thyroid hormone disorders 
  3. Congenital heart defects 
  4. Chronic alcohol abuse 
  5. Adrenal gland tumours 
  6. Chronic use of medications like birth control pills, pain killers, etc. 

Unidentified and uncontrolled hypertension can be silent and can lead to more severe conditions like heart attack and stroke. India is fast becoming the new hypertension capital of the world. Some of the common risk factors are: 

  1. Age 
  2. Family history 
  3. Being obese or overweight 
  4. Sedentary lifestyle
  5. Smoking 
  6. Alcohol consumption 
  7. Excessive salt intake 
  8. Stress levels 
  9. Ethnic background 

Symptoms: 

  1. Hypertension can go undetected for years together, but if there are risk factors like diabetes and high cholesterol, it is advisable to periodically monitor blood pressure. 
  2. Headaches, nosebleeds, and shortness of breath should not be ignored. These can be the first warning signs of hypertension, and if detected early, preventive measures can be taken. 
  3. If there are co-morbid risk factors, it is advisable to constantly keep a check on BP readings. 

Management: 

This includes a combination of diet and lifestyle modifications. 

  1. Quit smoking and alcohol: Of the many wonders quitting smoking can do, reducing BP readings is just one. The improvement would be almost instantaneous. Quit or else reduce alcohol and see dramatic improvements. 
  2. Weight management: Through a combination of diet and exercise, ensure that weight is brought under control. Set a target BMI (Below 26 kg/m2) and work towards it religiously. 
  3. Diet: Reduce salt, increase potassium, increase vitamin D, eat a heart-healthy diet, and see the hypertension readings improve. Please find attached and reviewed copy for health tip for posting. If you wish to discuss about any specific problem, you can consult a cardiologist.
4193 people found this helpful

Coronary Artery Disease - Know the Primary Signs!

MBBS, MS (Gen. Surgery), M.Ch - Cardio Thoracic & Vascular Surgery, DNB (CTS)
Cardiologist, Noida
Coronary Artery Disease -  Know the Primary Signs!

Your heart is the most important and vital organ of all and regulates the flow of heart to all parts of the body. Thus, the valves and the arteries which take the blood to your heart are also an important component in ensuring that the circulation is constant. Thus, any hindrance to this process will put a lot of pressure on your heart and lead to more serious problems in the long run. Coronary artery disease is one such problem and can seriously put the health of your heart at risk.

What is coronary heart disease?
Coronary arteries are very important blood vessels, which carry nutrients, blood and oxygen to your heart. If the level of bad cholesterol is high in your blood, it will start leaving deposits on the walls of the arteries which are commonly known as plaque. This plaque will start building up over time causing blockage of the arteries and disrupting proper blood flow. Excessive build up of the plaque may then rupture the lining of the plaque. This will then induce blood clotting and further prevent the normal flow of blood.

Symptoms
Primary symptoms may include

  1. Shortness of breath: This may occur while you are exercising or performing activities which are mildly exerting.
  2. Heart beats very hard and fast: Your heart may beat very hard and fast, especially when doing everyday activities such as climbing stairs or walking for a prolonged distance.
  3. Angina or chest pain: You may experience pain in your chest as if someone was pressing against it with a lot of force. Angina is also triggered due to stressful activities or even emotional stress. It usually occurs on the left or the middle of the chest and may even be felt in the back, arms, and neck.
  4. Heart attack: Heart attacks are the most common and the most serious complications of coronary heart disease. You would feel extreme pain, akin to crushing on your chest, shoulder, or arm. It may even be accompanied by jaw pain, and sweatiness.

Treatment
Non invasive forms of treatment are always preferable rather than invasive surgeries or procedures to treat coronary heart disease, especially where the risk of serious complications such as heart attack are still on the lower side. Some of the treatments used for coronary heart disease are as follows:

  1. Making lifestyle changes: Quit smoking, reduce alcohol consumption along with consumption of regulated diet will automatically start cleaning plaque that has built up within the arteries. Losing weight also tends to help.
  2. Medications: Special medications can take care of cases wherein the deposits are still lesser and the plaque buildup can be removed without the requirement of extensive surgery. Anti-cholesterol medications are one example of this.
  3. Surgical procedures: These are usually employed when the blockage is severe and cannot be corrected by the conventional methods mentioned above. Some of the procedures are angioplasty, stent replacement, as well as coronary artery bypass surgery. If you wish to discuss about any specific problem, you can consult a cardiologist and ask a free question.
1747 people found this helpful

Popular Questions & Answers

Hi! My I’m a female 48 years old. Recently I did my blood cholesterol test and the reports are as follows TOTAL cholesterol (CHO): 232 mg/dl HDL: 52 mg/dl LDL: 194 mg/dl VLDL: 22 mg/dl Triglycerides: 134 mg/dl As is clear that my LDL and Total cholesterol levels are high. Do I need to worry? What measures should I take? And what kind of food should I avoid? Thanks.

MBBS, MD - Internal Medicine, DM - Cardiology, Cardiac Device Specialist (CCDS - Physician )
Cardiologist, Delhi
Your total cholesterol and LDL are high and so you should immediately start with lifestyle mdofications measures like - 1. Daily exercise for atleast 40-45 mins in the form of brisk walking etc 2. Quit smoking & drinking. 3. Get a detailed diet counselling for a healthy heart diet which should be low in fried food, sugars and sweet and high in fibres, fruits, proteins etc. Get in touch with a cardiologist locally and get a baseline evaluation done with echo, ecg, TMT and thyroid profile. Follow these precautions for 8 weeks then repeat your lipid profile, if it is still high you will need to start medications.

Hi, Triglycerides: 216 mg per dl Creatine 1.18 mg per dl Vit D 21.5 Ng per ml Calcium 8.13 mg per dl Earlier TSH was more hence dose changed from 50 to 75 After 3 months it reduced to 0.2 you per ml I am taking thyronorm for hypothyroid.

MBBS, CCEBDM, Diploma in Diabetology, Diploma in Clinical Nutrition & Dietetics, Cetificate Course In Thyroid Disorders Management (CCMTD)
Endocrinologist, Hubli-Dharwad
Mr. lybrate-user, Thanks for the query. I have gone through the details given. Your Vit D level is low, may need supplementation. Total cholesterol is fine. Creatinine is also good. Ideally TSH should be in the normal range. ).3 to 4 mU/L or so. Thanks.
1 person found this helpful

My mother has high cholesterol. Here are the details HDL: 19; LDL: 165; VDL: 77; TRIGLYCERIDES: 382. She's 65 years old. Please suggest me the risk factor and can we go for Niacin? Help will be highly appreciated.

MBBS, MD - Cardiology, DM
Cardiologist, Mumbai
Does she suffer from Diabetes, Hypertension, Cardiac Problem, Family h/o heart disease Her Triglycerides and LDL Cholesterols are quite high, she need to take dietary and Lifestyle modification along with medicines Statins are first line treatment for Dyslipidemia, if still LDL and TG High, one can add Niacin or Gemfibozil. Problem with Niacin is Its side effects of Flushing and Pruritis.
1 person found this helpful

Does triglycerides are related with higher value of TSH. My triglycerides is 319 and TSH 5.80.should I go with stanlip 145 fenofibrate and Thyroid 50 mcg for 3 months.

MBBS, CCEBDM, Diploma in Diabetology, Diploma in Clinical Nutrition & Dietetics, Cetificate Course In Thyroid Disorders Management (CCMTD)
Endocrinologist, Hubli-Dharwad
Mr. lybrate-user, Thanks for the query. No drug is recommended when TSh is below 10 mU/L. Similarly when TGL levels are below 500 mg, no treatment is required. Only proper exercise and diet control is enough. Thanks.

Table of Content

What is the treatment?
How is the treatment done?
Who is eligible for the treatment? (When is the treatment done?)
Who is not eligible for the treatment?
Are there any side effects?
What are the post-treatment guidelines?
How long does it take to recover?
What is the price of the treatment in India?
Are the results of the treatment permanent?
What are the alternatives to the treatment?
Play video
Know More About High Cholesterol
Causes of High Cholesterol and its Home remedies


Good morning. Mera naam hai Dr. Amol Bamane. Main M.D Ayurved hu aur humara Rasyog Ayurveda naam se clinic hai. Aaj main aapko high cholesterol ke baare mein information dena wala hu. High cholesterol ke causes aur uske home remedies mein main aapko aaj batane wala hu. High cholesterol mainly aapko 30% jo aap diet lete hai toh usme se aapko cholesterol milta hai aur usme se high cholesterol ke through aapko various heart related issues ho sakta hai, heart attack, heart related cholesterol ke wajah se heart blockage toh ye issues saamne aate hai, isliye main aapko home remedies bhi batane wala hu.

Aur cholesterol level jo aapke 30% jo diet hai, aar aap diet ache tarah se follow karte hai toh aap 30% cholesterol reduce kar sakte hai by using home remedies jo aapke high cholesterol to reduce kar sakte hai. Use causes hai over weight, pastries, cakes, butter, meat, fish, eggs, smoking, drinking, and stress is also one of the causes of high cholesterol. First home remedies jo main aapko batane wala hu wo hai ke aap 1 spoon coriander seeds lijiye, usse crush kijiye aur water mein daal dijiye. Fir usse boil kijiye aur usse chaan kar thanda hone ke baad din mein 3 baar pijiye. Isse aapka cholesterol level kam karne mein bahut hi helpful hai. Dusra remedy high cholesterol ke liye hai ki wo watermelon seeds ka hai. Aap watermelon seeds ko dry kijiye, usse roast kijiye, aur iske baad mein aap usko store karke rakhiye. Everyday aap 1 teaspoon watermelon seeds ko crush karke 1 glass paani mein ubaaliye. Ubalne ke baad usse thanda kijiye, baad mein chaan kar, din mein 1 bar ye process kijiye aur ek glass ye pijiye aur iska aapko bahut acha results milega. Teesra jo home remedy hai high cholesterol ke liye hai ye sabse badhiya hai ye sabse asardaar saabit hua hai jo basil leaves and margosa leaves ka hai. Aap 10-15 basil leaves lijiye aur 10-15 margosa leaves lijiye, usse aap early morning before breakfast crush kijiye aur ek glas paani mein mix kijiye fir usko chaan ke morning mein before breakfast lijiye. Ye sirf din mein ek baar hi kijiye par 1 month ke liye kijiye aur isse aapko bahut hi acha effective results high cholesterol ke liye milega. Jo bhi maine home remedies bataya hai ye 1-2 months follow kijiye aur isse aapko bahut hi acha results milega.

High cholesterol ke liye jo tips hai wo LDL cholesterol jo hai wo good cholesterol hai aur jo HDL cholesterol hai wo bad cholesterol hai. Iske liye tips ye hai ke din mein 1 litre paani peejiye aur diet control kijiye. Yahi sabse best tareeka hai aapka cholesterol ko normal rakhne ke liye aur iske through aapki life healthy rakh sakte hai. Uske alawa medicine toh ek factor hai hi par ye home remedies use kijiye agar usse bhi aapko itna acha result nahi mil raha hai toh aap hume consult kar sakte hai ya humare website pe jaa sakte hai aur hume connect kar sakte hai aur humare website ka address hai www.rasyog.com.

Aapko cholesterol ke baare mein aur adhik jankaari ke liye, aap mujhe lybrate.com pe bhi sampark kar sakte hai aur consult bhi kar sakte hai.
Having issues? Consult a doctor for medical advice