Saturday, December 9, 2017

Why home hemodialysis?



Many people ask me why I choose to do home hemodialysis. To me the answer is quite simple. The main reason I do home hemodialysis is that it makes it easy for me to do daily nocturnal dialysis. This begs the question, why daily nocturnal?

I’m going to let you into a secret here. 

Many people do daily nocturnal hemodialysis because they say the outcomes rival those of a deceased donor transplant (cadaver transplant). They say the risks of organ stunning, damage to the heart and many other co-morbidities associated with long term kidney failure (and hence dialysis) are much lower with daily nocturnal hemodialysis than the regular thrice a week modality.

Honestly, for me all that does not matter much. I do daily nocturnal only for one reason - no diet and fluid restrictions. I eat and drink pretty much what I want and how much I want. I don’t stop to think whether something is high potassium or high phosphorous. I don’t stop to think how much I have drunk today before sipping on a cola. 

This freedom to eat and drink without any restriction is the main reason I do home hemo. 

That said, there are other things that are good about this modality:

- Flexibility to do dialysis when you want to. You can skip when you choose not to do dialysis. You can choose to do dialysis if you feel like it.

- Flexibility on the time of dialysis. I got late at a party? No problem. Dialysis will begin late and will be only 6 hours instead of the 7 1/2. 

- Full control over dialysis parameters. I can play around with the dialysate temperature and sodium level based on how I feel and what I have read helps.

All this is good. But the main reason is no diet and fluid restrictions. Period. 

Tuesday, November 28, 2017

Who’s right about the economy - the pro Modi or the anti Modi camps?



I have never read The Economic Times. I can’t make sense of most of it. So, when I hear diametrically opposite viewpoints about how the Indian economy is doing under Prime Minister Narendra Modi, I am thoroughly confused.

On the one hand you have people claiming that the Indian economy is in dire straits. On the other hand, you have reputed agencies such as Moody’s who have upgraded India’s rating recently.

The irony is that both these parties say their conclusion is due to things like demonetisation and GST. How can both use the same two policies of the government and arrive at such contradicting results?

I have noticed one thing after Modi came to power. People rarely change their perception about the man. Take any decision of the government. Take any policy of his government. People who support him will find a hundred reasons to support it whereas people against him will find a hundred reasons to criticise it. It all depends which side of the fence you are on.

There is no such thing as objectivity here. You either love the man or hate him. Forever. Whatever the case may be.

In my adult years, I have never seen the country so polarised as it is today when it comes to the Prime Minister. Some people compare him to Indira Gandhi. I was a kid when she died so I cannot make the same comparison. The lines of division are so complete, so thick that whatever happens, people will not change their views about him, reason be damned.

I am still at a loss on how the country’s economy is faring. For every gloomy chart put out by the haters, there’s a cheerful chart that is thrust in your face by the bhakts. For every upward statistic put out by the bhakts, there is a downward statistic quoted by the haters.

So, how does a person like me decide on how the government has done on the economy?

Sunday, November 26, 2017

Have those protesting against the film ‘Padmavati’ seen it?



The protests against Sanjay Leela Bhansali’s film Padmavati have reached sickening heights. Some have called for the beheading of Bhansali while others have threatened to chop off Deepika Padukone’s nose. A state chief of the ruling Bharatiya Janata Party has openly announced an additional reward for Deepika’s nose.

I have only one simple question for the protesters. Let us keep aside the aspect around freedom of speech and expression for a minute. Let us assume that we are a society where one cannot speak out against anyone or anything. Let us assume that we are still under Indira Gandhi’s emergency. Now, have the protesters and the thugs demanding Bhansali’s head and Deepika’s nose seen the film? Do they know exactly what they’re protesting against? Are they certain that the Queen Padmini is shown to be attracted to Alauddin Khilji in the film?

The fact of the matter is that no one who is protesting has actually seen the film.

Bhansali has shown the film to certain sections of the mediaJustice Arnab Goswami was one among them. Here are his words about the film: “...every scene of this film is a cinematic tribute to Rani Padmavati. .... when the movie will be released, Karni Sena will appear like idiots.”

So, what is this fuss all about? Why are state governments, one after another, banning the film? Why has the producer been forced to delay the film to next year? Is it going to be released when certain elections have been completed? See a pattern here?

Have we as a society, degenerated so much that we get carried away by mere rumours and speculation? Why are the BJP ministers silent? Why are some of them tacitly supporting these villains?

Coming back to the issue of freedom of speech, the constitution of India guarantees every individual to speak his or her mind provided this does not incite violence or cause a law and order problem. As a society, we should have been mature enough to hear out different points of view and express our own. If you don’t like a film, don’t watch it. If you don’t like a book, don’t read it. It is as simple as that. Nothing should be banned because a certain section of the population does not like it.

We, as a nation need to grow up. The government needs to step up and act against elements who incite violence. We don’t want mini-Gujarats-2002 all over the country.

Friday, November 17, 2017

130/80 is the new high



A few months before beginning home hemodialysis, I was diagnosed with Left Ventricular Hypertrophy (LVH), a condition that is associated with long term kidney failure. I was put on some medication to try and control the problem. Gradually my blood pressure started reducing. At one point I used to be at pressures of around 90/60 to 100/70. During my next visit to the cardiologist, I asked him what is a good blood pressure? Was 90/60 too low?

“Lower the better” was his response. He said as long as I did not have symptoms of hypotension like feeling dizzy, the lower the pressure the better it was for my heart.

New research released recently has found that a blood pressure of 130/80 or above is dangerous for the human body. The earlier guideline had pegged this at 140/90. This would bring a lot of people into the ‘hypertensives’ bucket. The important thing to note, as the co-chairman of the group that released this report says is, “The risk hasn't changed. What's changed is our recognition of the risk.”

People with high blood pressure are known to be at risk for “cardiovascular disease, strokes, severe kidney disease and several other problems” that can kill them. Not everyone with this blood pressure needs to be put on medication. Many people who are diagnosed in early stages of the condition can correct it simply with “lifestyle changes such as losing weight, improving their diet, getting more exercise, consuming less alcohol and sodium and lowering stress”.

It is important to check your blood pressure from time to time. Early diagnosis, like in almost every other condition, is the key. 

It is sad that despite knowing that lifestyle changes can correct this problem, people all around me will still live in denial, refusing to acknowledge that they have a problem, refusing to change their lives and ridiculing the people who actually do.

People give me examples of their uncle who drank, smoked, never exercised and ate all the unhealthy food you could ever imagine and yet lived to a ripe old age of 90. What they do not realise, very sadly for them, is that for every such uncle, there are a hundred other people who died early, in the prime of their lives just because they did not take care of themselves.

I read this important advice somewhere: “It is ok to lie to your parents, to your children, to your boss, to your spouse, heck, it is ok to even lie to your God. But one thing it is not ok to do is to lie to yourself.” These people are lying to themselves. It is going to be a very expensive lie.

Wednesday, November 8, 2017

Overusing the exclamation point!!!!



So many people get this so horribly wrong. Especially on social media, the exclamation point is probably the most abused punctuation. I have friends and colleagues who overuse exclamations like nobody’s business. I probably overuse it a little myself. In fact, earlier posts on this very blog have probably one exclamation too many.

I read somewhere that for most people, one exclamation per month of writing is all that is actually needed if used the right way. I know people who use an average of one per sentence. 


Exclamation points were originally called the “note of admiration.” They are still, to this day, used to express excitement. They are also used to express surprise, astonishment, or any other such strong emotion. Any exclamatory sentence can be properly followed by an exclamation mark, to add additional emphasis.”

Simple enough?

With the increasing use of social media to express opinions on every single issue these days, people use exclamation points even when completely unnecessary. Good writing should convey the same excitement with an appropriate choice of words rather than rely on punctuation to express strong emotion.

The most abhorrent of all exclamation point abuses is the use of multiple exclamation points. I know people who use five to six after wishing anyone about anything. Sample this:

Happy Birthday XYZ!!!!!!

It’s as if he was even more excited about XYZ’s birthday than his own.

I think it’s high time the exploitation of this punctuation be made a worldwide crime and exemplary action be taken against the offenders.

Sunday, November 5, 2017

Drug interactions

I was put on a new medication recently. The trouble with this medication is that it needs a slightly acidic medium in the body to act effectively. So, I was asked to stop an antacid in the ‘Proton Pump Inhibitor’ (PPI) class which I have been taking for a long time now. I was told to take another milder antacid and take a syrup for times when the symptoms were bad. 

Within a few days, my appetite has gone down dramatically. I can barely eat a third of what I used to. Due to this, I have lost about 3 kgs in less than three weeks!

I am not sure if my appetite with the PPI was unnaturally high but I do remember being hungry all the time. I remember my nephrologist saying that a very strong antacid will not allow the minerals and vitamins to be absorbed by the body (or something like that). I tried looking this up on the internet. I did not find any mention of antacids increasing the appetite. 

For now though, I am unable to have a full pizza or more than a couple of idlis which is disastrous news! I hope I will not need to take this medicine for a long time - the doctor says a few more weeks. So, there’s still hope.

There’s a silver lining to this though - the weight loss. With no effort, I have lost 3 kgs! I don’t feel like I’ve eaten less. I am not hungry. My fluid weight gain between sessions has also gone down. Yesterday after a dialysis gap of a day, I had only 3.1 kgs of fluid on me!

Thursday, October 26, 2017

Let’s not force people to wear patriotism on their sleeve



In an outstanding example of judicial overreach, the honourable Supreme Court passed a judgement a few months back that the national anthem must be played at the beginning of screening in all movie halls. Ever since then, during our Sunday evening picture routine, my parents and I have been standing for the national anthem. Just when we would have settled down in our seats with pop corn and a cool drink, suddenly the screen would say, “Please stand for the national anthem.” My father, forever the willing patriot would happily stand up, my mother would also stand up, not with that much enthusiasm and I would have a tough time getting up from the seat due to my knee problem with a curse muttered under my breath to the honourable Supreme Court.

When you force someone to do something, they develop an aversion to it. Why do we need such symbolic gestures to display our patriotism? Why do we need these forced shows of proving our love for the motherland? 

Thankfully, the honourable Supreme Court looks like it is going to reverse that decision. In remarks made a couple of days back, it questioned the concept and said that the words “national anthem should be played” could be changed to “national anthem may be played”. 

I so wish that the time spent by the honourable court on this silly, trivial issue could have been spent in dealing with the thousands of more serious cases pending before it.