While being pregnant or having a baby is a happy occasion, it can also be a time of overwhelming stress for many women. Joining me for straight talk on postpartum wellness and mental health is holistic psychiatrist and neurologist Dr. Aparna Iyer.
Dr. Iyer completed her residency training in psychiatry at Albany Medical Center in New York, where she was selected as a chief resident and continued on to work as an Assistant Professor and faculty member. Dr. Iyer also served as an assistant professor in the Department of Psychiatry at the University of Texas Southwestern Medical Center. She has been recognized as one of D Magazine's Best Doctors in Dallas and Best Doctors in Collin County. Dr. Iyer has a private practice in Frisco, Texas where she sees outpatients and has a special interest in working with women who are pregnant and postpartum.
Therapist Unplugged is brought to you by The Montfort Group. Each episode will feature the unplugged views of guests and fellow therapists as we navigate hot topics, therapy trends and the world around us.
*The Montfort Group provides a serene, calming setting where you can feel challenged, supported, and motivated. Our skilled therapists bridge specialized backgrounds and varied philosophies together to create one unified strategy. Rather than steer you away from your own natural abilities, we help you maximize your unique strengths. We do not view a broken history as the end of a story, we see it as an opportunity for a new beginning.
While being pregnant or having a baby is a happy occasion, it can also be a time of overwhelming stress for many women. Joining me for straight talk on postpartum wellness and mental health is holistic psychiatrist and neurologist Dr. Aparna Iyer.
Dr. Iyer completed her residency training in psychiatry at Albany Medical Center in New York, where she was selected as a chief resident and continued on to work as an Assistant Professor and faculty member. Dr. Iyer also served as an assistant professor in the Department of Psychiatry at the University of Texas Southwestern Medical Center. She has been recognized as one of D Magazine's Best Doctors in Dallas and Best Doctors in Collin County. Dr. Iyer has a private practice in Frisco, Texas where she sees outpatients and has a special interest in working with women who are pregnant and postpartum.
Therapist Unplugged is brought to you by The Montfort Group. Each episode will feature the unplugged views of guests and fellow therapists as we navigate hot topics, therapy trends and the world around us.
*The Montfort Group provides a serene, calming setting where you can feel challenged, supported, and motivated. Our skilled therapists bridge specialized backgrounds and varied philosophies together to create one unified strategy. Rather than steer you away from your own natural abilities, we help you maximize your unique strengths. We do not view a broken history as the end of a story, we see it as an opportunity for a new beginning.
while being pregnant or having a baby as a happy occasion, they can also be a time of overwhelming stress for many women. Joining me today for straight talk on postpartum wellness and mental health is holistic psychiatrist and neurologist Dr. Aparna Iyer. She completed her residency training in psychiatry at Albany Medical Center in New York, where she was selected as a chief resident and continued on to work as an Assistant Professor and Faculty member. Dr. Iyer also served as an assistant professor in the Department of Psychiatry at the University of Texas Southwestern Medical Center. She has been recognized as one of D Magazine's Best Doctors in Dallas and best doctors in Collin County. Dr. Iyer has a private practice in Frisco Texas where she sees outpatients and has a special interest in working with women who are pregnant and postpartum. Welcome, Aparna. And thank you for joining us on therapist unplug. This is such an important topic. And we are in dire need of some straight talk about women's mental and emotional health, during pregnancy and postpartum. So I am delighted to have this conversation with you today. Me too. Thanks
Dr. Iyer:for having me.
Laurie Poole:Absolutely. My pleasure. So tell me, you know, um, as I was mentioning, before we got started, I had my first baby almost 40 years ago, and was debilitated with postpartum anxiety. I couldn't eat, I couldn't sleep, the community health nurse told me that if I didn't stop crying, my husband wouldn't come home. People did not talk about what happens emotionally, and mentally, maybe even physically after you have a baby. So I'm curious, like, how did you get interested in this whole area of psychiatry.
Dr. Iyer:So I find that a lot of us like you, like me, who have ended up working with a lot of patients in this field, have a personal story that drives our passion for it. So like you, I had postpartum you know, I can't even I don't even know what it was, it was such a haze. But I had, I definitely had postpartum something. And I felt like nobody really noticed. And I strong armed my way through it. It was only retrospectively that I was able to say, I think that was a thing that I experienced. And I felt so very alone, when that happened. Even though I had all the support in the world, it was like I couldn't access any of that goodness. And I think that at that point, I realized that I did not want anybody else to have to go through what I went through. Which is why I ended up in this field, I ended up kind of throwing myself into the data, and tried to figure out data driven, compassionate ways to help moms who are pregnant or postpartum get the emotional support they needed.
Laurie Poole:Fantastic, I think there's such a need for that. And even though we talk about it more today, it's still very much one of those topics that I think when patients are going through it, they don't necessarily talk to others to say, Hey, I'm having these weird feelings, or I just don't feel myself, or this is more than the baby blues, whatever, the baby blues. But there's, there's a hesitancy to be transparent about what patients are actually experiencing while they're in it. So I guess where I would like to start today is what's normal? And what are some of those symptoms or feelings or emotions that you should take that one should take notice of? That could be indicators, they should probably be speaking to their doctor.
Dr. Iyer:You know, I'm really glad that you're asking this question with regards to what's normal, I think it would surprise a lot of people know, we live in this era of social media, where people will tend to post these pictures of themselves having these idyllic moments. And then they write these words of extraordinary gratitude, these beautiful words around how perfect their bond is with their baby. And I could see how a woman who might be in a more emotionally vulnerable spot or maybe just had a baby and what they're not feeling that way in particular, they could feel like there's something weird or abnormal about about that experience. But the reality is that I wish that there was more transparency around this and that we could talk to our friends and peers and other moms who could openly express their own experiences rather than being invested and trying to keep up this appearance. The perfect because they never are. Actually what's normal is for people to have ambivalence during pregnancy and postpartum To say, you know, I have all these mixed feelings, and they're so strong, and it feels overwhelming, that I feel extremely happy, and I feel grateful. But at the same time, I feel really sad and angry. I think what can be so disorienting about that is that those feelings are exact opposites of each other. And yet they can coexist in your brain around the same time around something that maybe might be like, the happiest time in your life otherwise. Yeah, you know, to answer your question, um, you know, a lot of women postpartum as their bodies are transitioning and sort of adjusting to not only these hormonal shifts, his biological and physiological shifts, but also a true identity shift, not only as an individual and as a mother, but also within your marriage, that you can have all of these shifting emotions, and that's normal. What. What I would like to say, though, is that it can be really hard sometimes to identify, where's that line where I should seek additional support professional help? versus what's like, okay, yeah, are you feeling right now. And for example, you know, when we think about depression, for example, people are not sleeping, maybe people are not eating the way they normally do, maybe they have low energy, well, you have all of that postpartum anyways, right, you have low energy, your sleep, your sleep is super choppy. So it can be hard to differentiate. But I find that there are some key pieces here, where we can point to them and say, if this is what you're experiencing, you absolutely should go to your doctor and just say, hey, I need another set of eyes on me, you can tell me what you think. Okay, for example, if you feel happiness and sadness, and your feelings are fluctuating, and you're having, like a lot of different emotions, that might be totally healthy and normal as you adjust. But if you start finding that your sadness, moments of sadness become periods of sadness, and they start to become more sustained, and it starts to get worse, it starts to feel excessive to you. You know, maybe you're having recurrent crying spells, it starts some of these feelings, start to impact your functioning. And especially if you have thoughts to hurt yourself, or you have thoughts to hurt your baby, all of those more and, you know, immediate medical care.
Laurie Poole:Is that something that a patient should be going to their OB for a parent? Is it something they should seek out a psychiatrist like yourself? Like, where? Where do Where do mothers start with this?
Dr. Iyer:So the good news is that if you are not feeling well, I think that it's important to let someone that you know and trust know, immediately, okay, of course, if it's I think it kind of depends on what it is you're struggling with, you know, I mentioned the thoughts to harm yourself or harm the baby that warrants an immediate call to 911 or to the emergency room. But any of the other stuff that I was mentioning, I would seek medical care with whoever can see you soonest. So a lot of women choose to just go see their OBGYN because they can get in much more quickly. And they have a an ongoing relationship with their OB land. But if you're seeing a therapist, or if you're seeing a psychiatrist or another physician, I, you can certainly get in and let them know and they are equipped to kind of help direct you at that point
Laurie Poole:is good advice. Good advice. Is there such a thing as postpartum anxiety? Or does that coexist with depression? I've heard that term come up more recently. And I'm wondering if that's something that is more something been diagnosed with in the last several years, or do they go hand in hand. So
Dr. Iyer:it is its own entity, and they can go hand in hand. And in fact, in the majority of cases, anxiety and depression, postpartum or otherwise do go hand in hand. And sometimes it can be driven by one. So it could be predominantly a depressive experience with anxiety kind of creeping in or the other way around. But postpartum anxiety is very, very common. And we're starting to recognize it as more of a pervasive and debilitating issue than what we had realized before. So I feel like we're just we've been talking about postpartum depression for a little bit now. And now I think we're really starting the conversation around postpartum anxiety as well. I think one of the things about postpartum anxiety is that it's really easy to kind of frame it as Oh, well. I'm just being a protective mom. But when, when your worry about your child starts to feel, starts to dip into more of an irrational space, it starts to feel excessive, it starts to impact your functioning. You start getting panic attacks, or obsessive If thoughts, then we're really kind of looking at something different that I think might warrant a need to seek that professional support. You know, the one of the ways that post that anxiety, we all have anxiety to some extent. But one of the ways that postpartum anxiety is sort of its own different entity compared to just regular anxiety that people might experience is that it typically centers around the safety and health of the baby. Okay. It could be quite paralyzing. And sometimes it makes it difficult, you can get really rigid around it. And it can be really difficult to make decisions. Or, you know, we can sometimes get ritualistic around certain things because at some level, we feel like it's the in the best interest of the baby. But it might not be,
Laurie Poole:I can see to a partner where that would be very difficult for partners and spouses to feel as though they can be part of the child's the caretaking and the relationship with mom, when that rigidity, overprotectiveness or the rituals and the anxiety really locks them up in a way that they can't be fully present, because of the preoccupation. And I'm wondering if you hear about, you know, challenges in relationships after a baby is born with that
Dr. Iyer:kind of thing. So 100%, I mean, I think we can both agree that having a baby is probably one of the biggest, if not the biggest challenges in terms of this transition in your relationship. So I think that this is an added layer on top of all of that. But I think that what happens is that a lot of times, if a partner if one partner is having some sort of postpartum anxiety, AND, OR, AND or depression, and the other partner maybe has not had those experiences, it kind of feels like you know, there's a lack of understanding or maybe a disconnect, or it can be hard to feel to know how to be supportive of your partner, and how to kind of speak with them on a logical level in terms of like, let's make a plan in terms of baby. But then also, if one person has this rigidity around like, No, this is what's best for baby and the other partner disagrees. That's challenging, how do you move very,
Laurie Poole:very, very challenging. That's when I see couples come in for therapy. And I'm always so grateful that they do because you're quite right, having a baby is a huge change across the board, for each individual and for their relationship, and navigating some of those waters is really tough. So being able to talk through that, and, you know, allow room for both opinions and so on to coexist, as you talked about coexisting emotions. You know, I think the same is true in this case as well. Are there other signs, symptoms, things that people should keep their eye out for?
Dr. Iyer:No, I think that the big thing here is to remember that the symptoms are, what we find is that it's more about sustained, sustained symptoms, that you know, snapshots of sort of symptoms and emotions, agitation, irritability, anger, sadness, that those that range of emotions, I think, is okay and normal to experience. And they can fluctuate, but the sustained level of negative emotions or difficult emotion towards debilitating emotions is in particular, what is challenging. And I think one of the things is to keep in mind that the timing is really important also to be able to determine what it is you're experiencing. So for example, postpartum depression, we typically look at the postpartum timeframe frame for this purpose as the first one to 12 months postpartum
Laurie Poole:one to 12 months.
Dr. Iyer:Okay, when we typically see symptoms starting to occur is in the first six months. Okay. Now, the one thing I will tell you when you ask about what other symptoms could occur, we have sort of a textbook viewpoint. And we have that down pat, in terms of what is depression, you can Google that and see like a list of symptoms that come up from our DSM or our diagnostic manual. You know, there's some people where they don't present that way. I don't know if it's that there just shows up differently for them, or maybe they're not comfortable expressing those emotions. But we'll see people come in sometimes, and their initial complaint is, I'm having marital difficulties. My husband's being so difficult. I don't know why he's being so difficult. Or sometimes they manifest physically like in what we call somatic Press. patient might my tummy keeps hurting, I can't, I have so much gastric upset. My chest is tight, my neck is tight. I'm feeling weird numbness and sensations all over my body. I mean, there's there's a multitude of symptoms, sometimes shallow breathing, it's hard to catch my breath at times. And so it's easy postpartum to look at that and say, Well, is there something physiologically that shifted in the body after giving birth? But a lot of times, it's not that it's a manifestation of these sort of emotional struggles. Something's happening. Okay?
Laurie Poole:Interesting. So it can it can be, it can present to someone else, as though there are complaints about other things outside or within right, that whole mind body connection, when you don't speak, your body starts speaking on your behalf.
Dr. Iyer:Exactly. Exactly. And, you know, we do see that with a number of people. Right, I find that that is a typical, more typical presentation, is sometimes in people who might not feel like they have the language to be able to express their emotional sort of status or needs. And a lot of times in more traditional cultures, where mental health discussions are not, we don't speak about us openly, maybe that's not those are not the words we use to express it. So then your body says, Well, I have to express it somehow.
Laurie Poole:That's right. And then it becomes something more tangible when your digestive system is upset, or you have migraine headaches, are present in other ways, that's an easier way to get help. Absolutely. When it's physiologic or somatic is, as you've described, what are the types of treatment that you recommend for patients, I know that sometimes, you know, when you talk about, even with pregnant women who may experience you know, escalated anxiety, as part of their pregnancy, are very reluctant to think about medication or to consider medication. And I know, this is something you just posted about on Instagram, can you give our listeners some guidelines, or just some in insight about medication when you are experiencing postpartum depression or anxiety during pregnancy, or any of these sort of emotional and, you know, mental concerns, mental health concerns. So,
Dr. Iyer:you know, I'm glad we're talking about this, because I just, I just told you kind of give you a bleak view of kind of depression, anxiety postpartum. But the good news is that they are both very treatable, and treatment is typically very rapidly effective. Okay. And the other positive that we don't talk about the treatment is that sometimes when you have a baby, it can almost expose the cracks that were already there that maybe we weren't paying attention to, and can actually move us forward not just from an acute place, but in a big picture perspective, it can make our marriages stronger, it can make us feel safer and stronger. And really, I mean, incredible things can come from treatment, do you want to just, you know, take a step back and tell you that there are a lot of women, and I was one of them, who want to just be as organic and as natural as possible. Because they feel like that's what's best for baby. And part of that feels like, you know, they feel this pressure to be met for your drug free during their pregnancy or during breastfeeding. And so I'm going to tell you that when I first went, I had my firstborn. during my pregnancy, I was I, you know, tried to get all organic, spent my whole paycheck on organic foods. You know, I made my own spices, it was just incredible, a little excessive, but you know, I really, really, really, truly bought into this. And there was nothing wrong with I was feeling like I could control the goodness that comes into my body, the nurse is my baby. Well, you know, there's a couple things to think about with that I would have given anything, I would have gone on medications on hindsight, to protect myself from what happened next, from the postpartum depression that I had experienced. Because I lost six months. I don't remember anything from the first six months of my child's life, I have to go back and look at pictures and he looks like a stranger to me, because I don't remember I was in a fog. I can't tell you how many times I've heard that from women. That if only I could have gone back and done something differently. I would give anything to have experienced those moments with my child. Well, you know, medications are not off the table. Even for those of us who want to be natural and conservative, there's ways to do it even if you need to go on vacation. So first, as as you know, you know, treatment for mental health even went during pregnancy or postpartum. It could mean therapy. It could mean medications. It could mean both. It could mean a number of things. If we're talking about the medication piece, it is reasonable to meet with a psychiatrist or with your physician, your OBGYN and to say, Hey, this is what I'm experiencing, what do you think? Do you think I need to go on medications, and just have that discussion to kind of know what your options are. And remember that there, it's not typically a black and white meds are good or bad, but rather, weighing out the potential risks and benefits, right? Sometimes people think of it as only one way skill, we look at the risks and benefits of this medication on my brain, my body, my breast milk, the baby or my fetus in my belly. But actually, there's two ways skills occurring simultaneously. The other one is what is the risk of untreated or undertreated depression and or anxiety, during pregnancy, or postpartum. And that's a concern, because our data is not great. Like it doesn't show good things about that. Sometimes women will say, if I take a medication, my baby's going to get exposed. Well, guess what, if you're experiencing severe depression and anxiety, your baby's getting exposed to both. Absolutely. And that's not safe either. In fact, our data shows definitively, there's a lot of risk that is associated with the baby being exposed or the pregnancy being exposed. So we want to take that into consideration as we have the medication discussion. But like I said, treatment is rapidly effective. And the ways that we can be conservative with regards to medications is tried to take the lowest effective dose, try to use the least number of medications, maybe one over two, and maybe just stay on the medications for a shorter time as possible. You know, of course, you and your doctor have to come up with that plan, I would never recommend someone just discontinue it on their own. And then the other thing to think about is that in the last couple of years, there is a new medication that was it's called Work sent alone and it was introduced into the market. The fact that it was fast tracked into the market should really tell us something about the need.
Laurie Poole:Yeah, absolutely.
Dr. Iyer:But it is a rapidly effective infusion. So it's a medication that is given through the IV. For specifically for postpartum depression, it's the only medication out there that is only approved for postpartum depression. That is a group proposal.
Laurie Poole:You know, I will say, a Purna in my own experience as a couples therapist, when I have worked with women who are having I'm going to say postpartum distress, like mental distress, the effect of medication is really remarkable how quickly they feel better, and more present and can enjoy their baby more. And, you know, it seems to me that with in combination with therapy, or something like yoga, or whatever it is, that helps helps women to feel better by moving their body in proper nutrition. And these kinds of holistic approaches as well, combined with medication can make a world of difference. I wish I had had something that I could have taken. You know, as I as I just I mean, it was a horrific situation. I don't think I've ever felt that bad in my life.
Dr. Iyer:I think one of the things also to consider, or is, you know, when we don't treat it, it could resolve or it could continue? Yes. Not sort of like, oh, I stubbed my toe, and the pain is just temporary, and it's going to go away. The other concern that we have is that when we don't treat it, if you have a lasting impact in regards to you know, how well do you bond with the baby? How much are you able to emotionally attend to his or her needs? What about with your marriage? What about with other aspects of your life? So, um, so those were all kind of things that we had to take into consideration too. And I agree with you, if I had allowed myself to reach out for help. When I needed it, I think everything would have been different with my life. Everything would have been different with my relationship with my firstborn.
Laurie Poole:Yes, no, I concur. I think that is true for me, too. It was a very, very tough time. A pirnas. We're talking we haven't talked much about pregnancy. And I don't we don't have a lot of time left. But I wonder if you might talk a little about what happens with women during pregnancy. Because there can be, as I say, increased anxiety or this feeling of ambivalence and self judgment that kicks in and so on. And I'm wondering, what do you see amongst pregnant women coming in seeking treatment?
Dr. Iyer:A lot of this stuff that we had talked about with regards to postpartum I think holds true during pregnancy to a lot of mixed emotions, even if this is a pregnancy that you've always wanted. It is common and normal to have a lot of ambivalent emotions around it. But I think that there are a few other things to take into consideration. That. One is sometimes it can be challenging to look at your growing body that's changing shape and changing size and maybe gaining weight. And certainly it's true in postpartum as well that your body has completely shifted, I can't tell you the number of women who look at themselves and they say, Oh, my goodness, this is so different than how I was before. So that can be really challenging. And I think that the other piece too, is that if a pregnancy is difficult in terms of physical symptoms, like nausea, you know, especially chronic sort of nausea, pains or, you know, sleeplessness or whatever it may be, that can be really challenging for women, and can have some impacts on their emotional wellness as
Laurie Poole:well. Okay, very good. Tell me about any trends that you saw during the pandemic, I know we're still in it. But I can only imagine that it's been a particularly difficult time for new mothers and pregnant women, when they have been isolated the fear of their children getting sick. Are you seeing any of this sort of amplifying anxiety and worry and so on?
Dr. Iyer:Absolutely, absolutely. I think one of the really hard pieces is that a lot of the women that I see, tend to be pretty perfectionistic. And, you know, solution focused. And, you know, they have they enjoy having like data and more full linearity upon which to make decisions, right algorithms, things like that. But during the pandemic, it was very disorienting half of the time, you know, especially 2020, half the time, nobody had any idea of like, with regards to what was safe and what was not safe. And I think that that's really disorienting, particularly if you have a child who's looking to you to keep him or her safe. Or if you're pregnant, and you know, like, how do you approach that, but then so you know, some part of you wants to kind of stay in your house and socially distance. But the problem is that during pregnancy and postpartum at any point in motherhood is when you need your village more than ever, so true. How do you toggle that fine line, you know, I want to keep myself physically safe. But also front and center was my mental wellness, I need to keep myself emotionally healthy as well. So it was very, very challenging. A lot of women who were looking to have their family members or friends come help them postpartum. And maybe even just watch the baby while they slept. They couldn't do that. So everything fell on them. I think also during the pandemic, you know, there was a lot of economic uncertainty and job uncertainty and instability that just added another layer. Plus you had both partners, a lot of times you were both working from home and the house at the same time all the time, which added another layer of complexity to the whole marital situation.
Laurie Poole:Oh, it's been terrible for a lot of people for all of those reasons. Apparently, you mentioned, I think on what I saw last night on your Instagram that you are preparing for the release of a book coming up. Can you tell us a little bit about that?
Dr. Iyer:Yeah, actually, we have an I have a few. But I think the one that I am releasing, first we're going to be publishing first is a coloring book. It's a meditative experience from from others. And it's kind of a gentle recognition that motherhood may not be exactly what we anticipated it was going to be, but there's a beauty in sort of the growth and the transition and the highs and the lows of it. And to be able to kind of meditate on that at times when you need it the most. So that the adult coloring book thing is sort of a new way to engage in artistry and tap into mindfulness at the same time. We do have a couple others, you know, I have a guided journal that is coming out that's also geared towards mothers. And so our goal here is to really helped form a sense of community amongst mothers, I know that that's front and center.
Laurie Poole:badly needed.
Dr. Iyer:The last one, and this is the book that's been in the works for a while here is really about inclusion. And so all of these topics are sort of related, but it's about it's a children's book, but you know, all these kids will eventually grow up. So we wanted to start sending out that message early the importance of inclusion. Maybe for a child who might feel like he or she is different, and classmates or peers.
Laurie Poole:Beautiful. Well, we will look forward to those books. And people who are listeners who are interested in learning more can follow you on Instagram At Aparna Iyer, MD, and we look forward to the launch of those books, any parting advice, Aparna guidance you'd like to offer before we wrap up? Or Hado?
Dr. Iyer:Yes, I will tell you, Laurie, I've had the good fortune of treating women and men at all ages really, really young, much older and everywhere in between, and from all walks of life. And I will tell you, the one consistent thing that I find is that people eventually, especially people who tried to strong arm their way through their mental health struggles without ever seeking professional support, will eventually typically come to the realization that there's no glory, and that the glory is in a life well lived. Someone who might be struggling and might need that extra support. It's really, really important that you give yourself some grace and allow yourself the your life is important. Your health is important. So allow yourself to get that support that you need.
Laurie Poole:That's a beautiful message, there is no glory in the struggle and strong arming your way through it. That is absolutely true. Aparna next time, maybe we can talk about men and mental health because I think that's a really, really important topic, as and we didn't talk about men very much today. But I know men are profoundly affected by their wives postpartum experience, and their emotional and mental health as well. It affects partners deeply. And that's something that actually in our previous podcast, Kristen, and Jason talked about the importance of teamwork and partnership, and being tuned into each other, because it's experienced differently by men and women. And sometimes it can create the Great Divide, but in fact, there's parallel experiences going on at the same time. And it's really important to talk about how men experience all of this as well.
Dr. Iyer:Well, Laurie, you know, the other thing is that there's a growing pool of data with regards to postpartum depression in men it's not something we ever talk about and we have to Yes, we have to talk about that maybe next time around how much time do you Oh apparently
Laurie Poole:this is this I did not realize that there that this is becoming something that is recognized amongst medical professionals postpartum and men. That's really interesting. Okay, the conversation will continue. Thank you so much for your time today Aparna, I really really appreciate it and so do our three listeners. This is This is essential information and I hope for folks out there it will provide support, Insight normalize, you are not alone and we at the mount for group welcome you anytime couples who are struggling or new moms, pregnant women who are struggling for therapy services, and you can follow us to at therapist unplugged on Instagram. Thank you so much, Aparna for today.
Dr. Iyer:Thank you, a wonderful day. Thank you. You too.