About Dr Manali Rao

Dr. Manali Pawan Rao is a general practitioner who believes that lifestyle modification plays a major role in today's' world of the sedentary living. According to her eating healthy and regular exercise has worked miracles in the life of many. She has had 2 years work experience as a Medical officer and Primary consultant physician in Sion Hospital-Mumbai, Nightingales home health services, and My Care. As much as she advises others to follow a lifestyle modification, she personally too stays healthy by exercising regularly. She is trained in yoga and is a professional Bharatnatyam dancer and teacher. All of these activities helps her stay calm and happy.

June 9, 2017 By Dr Manali Rao Leave a Comment

Vaccination: Prevention is better than Cure!

All of us have seen Mr. Amitabh Bachchan saying ‘Do boondhZindagiki’, but very few of them would have realized the magnitude of importance of that advertisement. The fact that one of the most vivacious and accomplished Bollywood star is chosen as the brand ambassador for the campaign of immunization shows us the important role it plays in every child’s life.

What lead me to writing this blog?

Having a month old baby at home and finding myself pouring over the immunization schedule made me think that there are so many people unaware of the importance of vaccination.

The last week of April is the World Immunization Week. It is a global public health campaign to raise awareness and increase rates of immunization against vaccine-preventable diseases around the world.Each World Immunization Week focuses on a theme and this year it is “VACCINES WORK”.

So what is IMMUNIZATION?
It is the process by which an individual’s immune system becomes fortified against an agent (known as the immunogenic).

Immunization is done through various techniques, most commonly vaccination. Vaccines against microorganisms that cause diseases can prepare the body’s immune system, thus helping to fight or prevent an infection.

Immunization can protect against 25 different infectious agents or diseases, from infancy to old age, including diphtheria, measles, pertussis, polio and tetanus. The World Health Organization (WHO) estimates active immunization currently averts 2 to 3 million deaths every year.

The WHO lists 25 diseases for which vaccines are available:

Anthrax
Measles
Rubella
Cholera
Meningococcal disease
Influenza
Diphtheria
Mumps
Tetanus
Hepatitis A
Pertussis
Tuberculosis
Hepatitis B
Pneumococcal disease
Typhoid fever
Hepatitis E
Poliomyelitis
Tick-borne encephalitis
Haemophilusinfluenza type b
Rabies
Varicella and herpes zoster (shingles)
Human papilloma-virus
Rotavirus gastroenteritis
Yellow fever
Japanese encephalitis
Malaria
Dengue fever

There are also some vaccine-preventable diseases, which are not on the WHO-list, probably either since the vaccine is not very good according to present standards, or the disease is not any longer a threat.

Anthrax
Plague
Q fever
Smallpox

IMMUNIZATiON SCHEDULE :

SL. NO.	AGE	VACCINE	DISEASE
1.	Birth	BCG + OPV	Tuberculosis + Polio
2.	1.5 months	DPT + OPV + IPV + HBV + HiB	Diphtheria Pertussis Tetanus Polio Hepatitis B H Influenza B
3.	2.5 months	DPT + OPV + IPV + HBV + HiB	Diphtheria Pertussis Tetanus Polio Hepatitis B H Influenza B
4.	3.5 months	DPT + OPV + IPV + HBV + HiB	Diphtheria Pertussis Tetanus Polio Hepatitis B H Influenza B
5.	9 months	Measles	Measles
6.	15 months	MMR	Measles Mumps Rubella
7.	18 months	DPT + OPV + IPV + 1st booster HiB	Diphtheria Pertussis Tetanus Polio
8.	4.5 – 5 years	DPT + 2nd booster OPV	Diphtheria Pertussis Tetanus Polio
9.	10 years	Tdap/ Td	Diphtheria Pertussis Tetanus

VACCINES UNDER SPECIAL CIRCUMSTANCES;

SL. NO.	AGE	VACCINE	DISEASE
1.	2 years Booster dose to be given every 2-5 years	Meningococcal	Meningitis
2.	< 9 years : 2 doses to be given every year. > 9 years – 1 dose to be given every year	Influenza	Flu
3.	0,3,7,14,28 days	Rabies	Rabies

SIGNIFICANCE:

Vaccination protects children from serious illness and complications of vaccine-preventable diseases which can include amputation of an arm or leg, paralysis of limbs, hearing loss, convulsions, brain damage, and death.

Elimination of polio in India:

Polio was last reported in India in West Bengal and Gujarat on 13th January, 2011.

On 27th March 2014, the World Health Organization (WHO) declared India a polio free country, since no cases of wild polio had been reported in for three years.

As of mid-2016, only Afghanistan, Nigeria and Pakistan have wild polio cases.

The Pulse Polio Initiative (PPI) aims at covering every individual in the country. It aspires to reach even children in remote communities through an improved social mobilisation plan.

No child should miss the immunization.
Cases of acute flaccid paralysis (AFP) are to be reported in time and stool specimens have to be collected within 14 days.
Outbreak response immunization (ORI) should be conducted as early as possible.
Maintaining a high level of surveillance.
Performance of good mop-up operations where polio has disappeared.

ADULT IMMUNIZATION:

Even adults need to be immunized from time to time. It is recommended for adults who meet the age requirement, lack documentation of previous vaccination or lack of evidence of previous infection. Also older adults with medical conditions like Diabetes need to be immunized as recommended by their Doctor.

IMMUNIZATION AGAINST CERVICAL CANCER:

> 10 years females

0 dose

After 1 month

After 6 months

Protects against HPV (HUMAN PAPILLOMA VIRUS) which causes cervical cancer.

Immunization is one of the safest ways for you to protect your health. Vaccine side effects are usually mild and go away on their own. Severe side effects are rare.

Regular immunization of your child will prevent many serious diseases. Follow the schedule and the advice of your child’s Pediatrician. Minor illnesses are not a contraindication to vaccination. Report any adverse events following immunization.

May 31, 2017 By Dr Manali Rao 1 Comment

Hypertension during Pregnancy

Pregnancy is one of the most blissful times in every woman’s life. Along with the happiness comes a sense of responsibility. Along with the responsibility come all the advices and the worries about antenatal period. What to expect? Whom to believe? What advices are to be followed? Having gone through all of this recently myself, I can say that pregnancy is one heck of a roller coaster ride.

Many women face complications during pregnancy. Some related to Physical health and some related to Mental health. Out of the problems related to physical health, Gestational Diabetes (GDM) and Pregnancy induced Hypertension (PIH) are of utmost concern.

What is Pregnancy Induced Hypertension (PIH)?

PIH is the development of hypertension for the first time after 20 weeks of gestation without the presence of protein in urine or other signs of pre-eclampsia (a potentially dangerous pregnancy complication characterised by high blood pressure along with swelling of hands and feet.). Hypertension (HTN) is defined as blood pressure more than 140/90 mmHg.

What can cause PIH?
There are several possible causes of PIH, namely;
● Being Overweight or Obese
● Lack of Activity through the day
● Smoking and Alcohol
● Family history of PIH
● PIH during previous pregnancy
● Multiple pregnancy (like twins)
● Maternal age (over 35 or adolescent pregnancy)
● Living with a single kidney
● IVF mothers
● Past history of diabetes, hypertension, renal disease
● Placental abnormalities

What are the types of PIH?

● Gestational Hypertension:
Women with gestational hypertension have high blood pressure that develops after 20 weeks of pregnancy. There is no excess protein in the urine or other signs of organ damage. Some women with gestational hypertension eventually develop preeclampsia.

● Chronic hypertension:
Chronic hypertension is high blood pressure that was present before pregnancy or that occurs before 20 weeks of pregnancy. But, because high blood pressure usually may not be present with any symptoms, it might be hard to determine when it began.

● Chronic hypertension with superimposed preeclampsia:
This condition occurs in women with chronic HTN before pregnancy who then develop worsening high blood pressure and protein in the urine or other health complications during pregnancy.

● Preeclampsia:
Sometimes chronic HTN or gestational HTN leads to pre-eclampsia, a pregnancy complication characterized by HTN and proteinuria (protein in urine)— usually after
20weeks of pregnancy. If left untreated, preeclampsia can lead to serious — even fatal — complications for mother and baby. Previously, preeclampsia was only diagnosed if a pregnant woman had HTN and proteinuria. However, experts now know that it’s possible to have preeclampsia, yet never have proteinuria.

● Eclampsia:
In a woman with pre eclampsia, if tonic clonic seizures appear it is considered as eclampsia.

What signs and symptoms should one look for?
● Presence of protein in the urine or additional signs of kidney problems
● Severe headaches
● Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
● Upper abdominal pain, usually under your ribs on the right side
● Nausea or vomiting
● Decreased urine output
● Decreased levels of platelets in your blood (thrombocytopenia)
● Impaired liver function
● Shortness of breath, caused by fluid in your lungs
● Sudden weight gain and swelling (edema) particularly in your face and hands — often accompanies preeclampsia. But this can also occur in many normal pregnancies, so they’re not considered reliable signs of preeclampsia.
● Spots before your eyes
● Blood in the urine
● Dizziness
If you experience any of the symptoms mentioned, immediately report to your Gynecologist or health care provider.

What problems can you face if you develop PIH?
1. PROM – pre mature rupture of membrane can happen before the mother goes into labor
2. Placental abruption- in which the placenta partially or completely separates from your uterus before your baby’s born. This can deprive your baby of oxygen and nutrients, and cause severe bleeding that can be dangerous to you both.
3. Premature delivery
4. IUGR baby (Intra Uterine Growth Restriction)
5. Liver, kidney and blood clotting problems
6. IUD – Intra Uterine death

What is best way to manage PIH?
Consult your Doctor at the earliest and keep up with your follow ups and the prescribed medications. Along with medicines make sure you follow a healthy lifestyle keeping a close watch on your weight gain. Include the below to aide a normal pregnancy.
1. Bed rest depending on your blood pressure.
2. Manage your stress with the help of Meditation and try indulging in hobbies.
3. Salt restriction goes a long way in reducing your blood pressure.
5. Maintaining a healthy and nutritious food pattern is the best remedy for any form of disorder and works for PIH too.

It is very important to maintain a healthy blood pressure through the entire pregnancy and one must not wait till pregnancy to start adopting good lifestyle practices. Always remember Healthy Mother – Healthy Baby !!

January 29, 2017 By Dr Manali Rao Leave a Comment

Pregnancy and Depression

The most wonderful time in a woman’s life is during her pregnancy. It’s a miraculous time when a little prince or princess is growing within us and for the first time in our life we are unconditionally in love with this little unknown being. We cherish every pain that we go through during these 9months. It’s as if all your happiness, your desires revolve around the yet to be born baby.

It’s a magical time. Or so everyone says. But, is it so for every pregnant woman out there?? Everyone expects the expectant mother to always be happy all the time. Pregnant woman is also told how she is not supposed to be crying or throwing tantrums or thinking negative. Well, believe me, this is easier said than done. Yes, the mother is happy, nobody could possibly be as happy as her. She is the one carrying the baby for 9 Months in her womb remember! And, yes she’s happy that she has made the entire family happy by this great news.

But,most forget that to-be-mothers are also human!!! So what’s wrong if she’s a little anxious! What’s wrong if she doesn’t feel elated every single moment of the day! What’s wrong if she weeps for some silly reason! What’s wrong if she gets upset or fusses over little things! Just because she is pregnant, it doesn’t mean she’s not a normal human any more right??!!!

Most women end up feeling guilty for being sad or upset during pregnancy! Why so?? Well, thanks to the expectations of everyone around them. They get a sense of fear towards their unborn child. They become increasingly unsure of their parenting abilities.Nobody is a perfect parent. We all learn through mistakes. Why do people forget that? Fear of the unknown is obvious. But, the unknown isn’t always bad right??

These thoughts precisely has led me to write this blog on Pregnancy and depression.

Depression during pregnancy also known as antepartum depression, and depression after delivery known as postpartum depression is a mood disorder just like clinical depression. All women experience depression and anxiety at some point of their pregnancy. During pregnancy, a woman’s body goes through many changes be it physical/mental/emotional. Hormonal changes occur during pregnancy and all these lead to mood swings which are perfectly normal during pregnancy. So when do we actually worry and differentiate between the normal pregnancy symptoms or symptoms of actual depression.

Here are few symptoms to look out for:

Feeling sad and anxious all the time
Loss of interest in activities
Not pursuing hobbies anymore
Sleeping too little or too much
Feeling of hopelessness or worthlessness or guilt
Thoughts of death or suicidal tendencies
Inability to concentrate
Withdrawal from family and friends
Crying spells
Recurring nightmares

Risk factors:

Troubled family life
Lack of emotional support from the family especially spouse
Past history of clinicaldepression
Family history of clinicaldepression
Any persisting or past psychiatric illness
Miscarriage in the past
Conception post infertility treatment
Any medical condition Or past illness

Apart from antepartum depression a woman can also go through Postpartum depression (PPD).
Many new moms experience the “postpartum baby blues” after childbirth, which commonly include mood swings, crying spells, anxiety, difficulty in sleeping, difficulty bonding with your baby, fear that you are not a good mother and even thoughts of harming yourself or your baby. Baby blues typically begin within the first two to three days after delivery, and may last for up to two weeks. It can affect both parents.

How does one overcome depression??

Family’s support, understanding, love and care can work wonders especially the attention of your spouse. Everyone should understand that a woman goes through so many changes duringpregnancyand that the symptoms vary from one person to another. Some women may have a hassle free pregnancy, while others may not and understanding this is most important. Nobody will fake any ailment. So if a woman says she has some trouble, be it a simple backache or a headache or excessive nausea vomiting, trust her that she does.
Indulgein hobbies: Indulge in activities that make you happy. If you are inclined to sketching, singing or any other hobby try pursuing these hobbies during your pregnancy and that can keep you calm and happy.
Do not hesitate to seek help. Many families still think seeking help means either you are weak or something is wrong with you. And most conclude you have either gone crazy or have lost your senses, it is certainly not so. Any person may experiencedepression. That does not make the woman crazy. It’s just a phase of life. Like every other problem women have to fight it and overcome the same.
Eathealthy. Nutritious diet is most important along with folic acid/iron/calcium supplements duringpregnancy.
Sightseeing – going out and getting some fresh air with your spouse even if its just for walks can always cheer you up.
Rest -Yes it is very important to be active to ensure normal delivery and lesser complications. But at the same time getting ample amount of rest is equally important.

Management:

Instead of jumping to drugs as the first line of treatment we must try CBT (Cognitive Behavioral Therapy) accompanied by support of the family, healthy diet, meditation and making sure the mother incorporates hobbies in her everyday routine.

Don’t ever think twice to seek help. Ignore the stigma that the society has shown towards depression during pregnancy. It’s no one’s fault. It can happen to anyone. What’s important is to recognize the symptoms, remain strong, face it and overcome the same.

January 19, 2017 By Dr Manali Rao Leave a Comment

Fading Memory : Know ALZHEIMER’s DISEASE

Allie and Noah, the all-time romantic couple from the fairytale romantic novel, ‘The Notebook’ by Nicholas Sparks, adapted into a motion picture come to my mind as I wonder how to start this blog. It reminds me of a beautiful scene from the movie, an old man now, Noah, reading out a story to Allie, while she listens to the story totally amazed and completely unaware that the story is, in fact, hers. As the story comes to an end we see how it all starts coming back to her. That it was her Noah narrating their story as he had promised before her disease set in. The disease was Alzheimer’s.

Alzheimer’s is a progressive neurologic disorder which results in memory loss, personality changes, global cognitive dysfunction and functional impairments. It is the leading cause of dementia in the elderly. The disease begins at a slower rate initially; it captures the brain and slowly overcomes human thoughts, activities, and language as well. People start having trouble in remembering things and the one evident sign is forgetting names of people.

CAUSES:

Exact etiology is unknown, but few risk factors can be marked out:

Age: incidence and prevalence increases after the age of 60
Family History: first-degree relatives at greater risk
Genetic: ApoEepsilon 4 gene
Lack of Sleep
Regular and high consumption of Junk food

CLINICAL FEATURES:

Progressive memory loss and decline of higher mental functions.

Example: problem-solving small issues, confusion in time, date and month, the problem faced in doing family activities of daily routine, misplacing things, poor judgment and problem in speaking and writing as well.

Difficulty in naming and understanding what others are speaking.
Apraxia – inability to carry out skilled motor activities, inability to recognize objects/places/people.
Behavioral changes: agitation, aggression, wandering and persecutory delusions, loss of insight, depression.
Loss of inhibition leading to inappropriate social behavior.
In advanced stages a person may be mute, inactive and can succumb to different infections.
Inability to recognize color and visual picture.
In case there is an underlying cause additional clinical features may be present.

MANAGEMENT:

Mainly supportive – physical, mental and moral support from family members and caregivers.
Antioxidants (Vitamin E) can slow the decline of cognitive function.
Drugs like anticholinesterase inhibitors (like donepezil, rivastigmine, galantamine), memantine, N-methyl-D aspartate (NMDA) receptor antagonist.
Ginkgo biloba, a plant extract has been shown to be useful.
Treatment of the underlying cause, if any.

ALZHEIMER’s and AYURVEDA:

According to the principles of Ayurveda, Alzheimer’s is caused as a result of the imbalance in vata – this imbalance is quite common as a person begins to grow in age. It affects the vata – in the tissues of the central nervous system of the body – mainly the brain which then slowly becomes imbalanced.

Treatment begins with a vata balancing diet. Withaniasomnifera (Ashwagandha) in the powdered form along with either ghee or milk is included in the patient’s daily diet. This helps charge and soothe the vata. Herbs such as Brahmi and Ashwagandha that serve as nerve tonics are mainly used.

An oil massage daily, prior to a bath is also considered significant in this form of treatment. Ayurveda specialized preparations for Alzheimer’s treatment that are made from rice have proved highly beneficial to the patients besides providing the required nutrients to the old age person.

TURMERIC and ALZHEIMER’s:

Turmeric orHaldi as it’s known in Hindi is a part of almost every Indian recipe. It is known all over the world for its antibacterial, anti-inflammatory, antitumor, anti-spasmodic, anti-allergic properties and hence is used in medicines, cosmetics etc.

Curcumin that is found in turmeric has radical scavenging properties thereby preventing damage that can be caused by the cells of our body by free radicals. Alzheimer’s alleviation could be based upon the ability of curcumin to combat the development of amyloid plaque (accumulation of protein) in the brain leading to inflammation and impairment of cells.

PREVENTION:

There’s no real guarantee when it comes to preventing Alzheimer’s, but the only way to minimize your chances is by living a healthy and balanced lifestyle.

Make sure you don’t stop learning new things. Continuous learning like a musical instrument, a new language or any subject that you didn’t have knowledge about keeps the memory intact.
Forget your phone and start memorizing important numbers like bank accounts, mobile numbers, life insurance/investment policy numbers, credit and debit card numbers, passwords and recalling them when needed is an easy way of jogging your memory.
Make sure you get your hands on challenging puzzles like Sudoku, different crosswords
Consumption of antioxidants via diet/supplements is helpful in preserving memory function.