Monday, January 26, 2015

Announcing India's first ever Dialysis Olympiad!

NephroPlus is organising India's first ever Olympic style Games event for dialysis patients! We at NephroPlus firmly believe that dialysis patients can lead normal lives. What better way to prove this that organising such an event?

It is going to be a one day event conducted in Hyderabad. The event is open to all dialysis patients across the country. There are events like 50 and 100 meters sprint, 250 meters walkathon, 500 meters cycling, table tennis, badminton etc. For those not inclined to exert too much, there are events like chess and sudoku!

The event will end with our signature event - Aashayein!

All in all we promise a super duper fun event!!!

To make sure patients who stay in other parts of the country who do not want to miss their dialysis, a participation allowance is being given for early registrants that should cover flight tickets as well!

If you want to come and spend a few days in the city of Hyderabad also, you could use the allowance to cover your accommodation! Dialysis can be arranged at a NephroPlus centre at a reasonable price.

So, if you are on dialysis or know someone who is, please register today!

Thursday, January 15, 2015

Mumbai Diary

I have fond memories of this city. My aunt stayed here until a few years back. As a kid, I have spent many summer days here. The idlis at Sukh Sagar, the pizzas at New Yorkers, my aunt's cooking itself was no less a treat! Then we had a summer camp here as well where cousins from all over gathered and had a blast for a couple of weeks. I remember the drive to Kalambole where we had our fill of water melons from the road side shops that stocked mounds and mounds of this delicious fruit and we kids along with the adults trooped into a shop and finished off 15-20 water melons in one stroke!

Going back to this city is always enjoyable with all these memories!


We partnered with the renowned Dr. Umesh Khanna (well-known for his landmark paper "The Economics of Dialysis in India" among several other accomplishments - but I have always associated him with this paper only!) to run his massive dialysis centre at the Lancelot Compound in Borivali West.

I had a great interaction with all the guests (patients, for those uninitiated in NephroPlus jargon!) there. They all seemed genuinely happy. Dialysis, in some ways, can be a humbling normaliser. Whether your nett worth is a crore or a thousand, you use the same needles, the same machine and the same technique to get your body cleansed.

Annual Patient Picnic of the Mumbai Kidney Foundation

The next day was Sunday and the Annual Patient Picnic of the Mumbai Kidney Foundation (MKF). This was truly an amazing event. It was held at Borivali National Park. Dr. Umesh Khanna (who founded MKF) along with his wife, Dr. Molina Khanna, who happens to be a gastroenterologist were exemplary hosts, literally running from here to there to ensure that every patient and family member had a great time. Handling the mammoth crowd of more than 300 people was quite a task.

This reminded me of NephroPlus' very own Aashayein event. Patients need such outings and events to meet fellow-patients and have a day of complete fun!

With Dr. Umesh Khanna

Dialysis Patient singing 'Ek Chatur Naar'

With the NephroPlus team

With Dr. Umesh Khanna and Dr. Molina Khanna (second from left)

Attitude of the patients 

One thing I noticed was that most patients in Mumbai - and I met and saw quite a few during this trip - were generally happy despite the burden of a chronic disease. Few complained. They were all having a gala time. One patient sang the whole 'Ek Chatur Naar' song from the film Padosan while the others egged him on. It was a truly pleasurable sight!

The other patients also were very strong-willed and cheerful. They looked determined not to let the disease get the better of them.

Vada Pav

I asked one of our techs at NephroPlus, Mumbai where we got great Vada Pav, the snack, Mumbai is world-famous for and he took my colleagues and me to a 'bandi' called Mangesh Vada Pav. The crowd there was insane. People were literally falling over one another to get their hands on a Vada Pav. I have no idea how the guys there managed the stall. It required some deft pushing and pulling by the tech and my other colleagues to get our hands on some Vada Pavs. They were really awesome!

My cousin, Deep

I got to know of Deep from another uncle of mine who stays in the US. I had no clue that my own cousin was on dialysis. Deep has a condition called Neurogenic Bladder which causes the kidneys to get damaged and lose function. He has been on dialysis for a couple of years now. He is only 23. I can completely relate to Deep because I was also diagnosed at 21. When I came back from Mumbai, I got Deep back with me and both of us spent some quality time together. Here are some pics from Deep's visit to Hyderabad.

Wednesday, January 14, 2015

Jain Cosmology revisited

(Disclaimer: Read only if you're Jain. You may not get this post otherwise.)

I have always wondered about how Jain cosmology was so wrong. Everything else I have read in the Jain scriptures seemed to be in consonance with science. Why then was there so much difference between Jain cosmology and what modern science says about the universe?

I have been searching for explanations for this difference. I never found any. Then yesterday, I suddenly found this article by Amit Jain titled "A Reevaluation Of Space And Time Descriptions In Jain Annals". This article offers a series of very rational hypotheses on the Jina's teachings on cosmology and how these could correlate to what modern science says.

The trouble is in the misinterpretation of the Jina's teachings. Over-enthusiastic sadhus down the ages have corrupted these teachings and many other teachings of the Jinas so much that the current form of the religion is very, very different from what the Jinas preached.

Coming back to the article, the author provides a good summary in the following lines:

This paper is an attempt to introspect the annals and introduce an alternate model that is based on the Sutras of Jina, and is also in sync with modern science and its findings. This model tends to convey that the current interpretation of Jain Sutras on cosmology is wrong on below points:
  • Interpreting Bharat-Kshetra[1] as India is wrong and not in sync with Jain annals.
  • Interpreting Jambudvipa[2] with Earth is wrong and not in sync with Jain annals.
This paper tends to conclude that
  • Jambudvipa is actually this entire multiverse of which our planet earth is a part off.
  • There may exist two suns and moons, but the second set is not in our part of the universe.
  • Mt Meru is the central axis of cosmos on which our multi-verse revolves around and thus is not on planet earth.
  • The revolving of our part of world (Bharat-Kshetra) around Mt Meru leads to Kala-Chakra[3].
  • This universe is revolving in nature that leads to self-repeating epochs.
When you think about it, this makes a lot of sense. For those who are well-versed with the Jain version of the universe and the scientific version, these hypotheses make a lot of sense. Of course, none of this can be proved. Who can prove such things though? But this did put my mind at ease.

Namo jinanam!

Saturday, December 27, 2014

The difference a good doctor can make - and its not just medicine

I have been bogged down with bad bone pain for the last few months. Various trials and errors have yielded some benefit but nothing permanent or long lasting. I started getting severe localised bone pain at various places from time to time. Recently, I have been bothered with pain in my left rib. I was referred to an orthopedician, Dr. Veda Prakash of Care Hospitals, Banjara Hills for this. This doctor prescribed some tests. I had also mentioned to him about the Cam Impingement. He passed on my case to Dr. Praveen Mereddy, his colleague also in the same hospital who specialised in the hip area.

I met Dr. Praveen Mereddy yesterday. He did a great analysis of my X Rays, my MRIs and other history and concluded that the pain was more likely related to the mineral imbalance in my body and suggested that I saw an endocrinologist. The good part about Dr. Mereddy was that he took pains to explain his analysis to me. He showed me why he thought the pain was more related to the mineral imbalance rather than the cam impingement. He seemed apologetic about referring me to another specialist for this but I was convinced with his explanation.

Next stop was Dr. Srinagesh, the endocrinologist, also at Care. Another great doctor! Dr. Srinagesh analysed my history and zeroed in on the probable cause soon enough. He also explained to me in detail what the problem was and how it was acting. It all seemed very convincing. He also gave me his card and told me to call him or email him if I had any problem. After I went home, later in the night, I received a text message from him advising one more test which would help!

I was feeling really depressed yesterday and these two doctors really made my day. I actually felt cheerful after walking out of the hospital! And I hadn't even started the treatment!

Doctors can make such a difference. Even without beginning the treatment, they have the power to make you feel better! Just by treating you with respect, acknowledging that it is YOU who are suffering, it is YOU who need help and that is why it is my duty to educate YOU about the problem can make so much difference.

Little gestures, all it takes are little gestures. We patients have low expectations. History has made us like that. So, treat us with respect. Don't think all of us are dumb fucks. Well, truth be told, some of us are. But not all! Explain to us what you're thinking. Involve us in your decision. It is our body after all. Is this too much to ask?

Thanks Dr. Mereddy and Dr. Srinagesh for making my day. I want your treatment to work. For me, for you.

Sunday, December 21, 2014

Kolkata Diary

I haven't been traveling lately because of my bone pain. So, I was really feeling bad that I would not be able to go to Kolkata. The Annual Conference of the Indian Society of Nephrology, called ISNCON at Kolkata was where NephroPlus was presenting two oro-posters, as they call it. For the first time, we had analysed a large amount of data and came up with two significant abstracts based on possibly, the largest ever Indian patient base! I was involved in this project right from conceptualisation to actualization. I thought about it long and hard and decided to bite the bullet and go to Kolkata.

First impressions

It was more than 20 years since I had been to Kolkata. The last time was even before kidney disease had struck. It was on a holiday to Darjeeling with my family. Now, of course, West Bengal has broken off from the shackles of the Left Front and was being governed by someone who promised to bring in poriborton or change. I was there for too little time to reach any conclusion on whether there was any change or not. From TV debates, it does not seem that much has changed on the ground. But then, TV debates are hardly any indication of what the truth is! From the brief journeys by cab between the airport and hotels, one thing struck me. There were vast swaths of wasteland interspersed with posh looking buildings which were quite a contrast.

Breaking new ground

The main purpose for which we went to Kolkata - the presentation of our abstracts - was on the morning of Friday at the Hyatt Regency near Salt Lake Stadium. As soon as we got there, we got to work. We set up the posters and then got ready to take questions. There was quite a bit of intrigue for our work. The judge came after about an hour and a half of setting up the posters. She was very interested in the paper on 'Evolving Dialysis Practice Patterns in India'. Indeed, we had, for the first time in the country documented dialysis care patterns in India in such a large number of patients!

Being the largest dialysis provider in the country, NephroPlus has a huge advantage because of its presence in different parts of the country which makes the population being studied all the more representative rather than most other studies which are typically from one hospital or at best one small part of the country.

"Evolving Dialysis Practice Patterns in India"

"Anemia Management in Patients on Chronic Dialysis in India"

From L to R: Dr. Dilip Bhalla, me, Dr. Georgy Nainan, Vikram.

Nephrologists, nephrologists, nephrologists...

Almost everywhere you looked inside the Hyatt, you would see a nephrologist! The ISNCON is the single most important event in the Indian Nephrology calendar. Most nephrologists make it a point to attend this conference. While talking to the delegates, I learnt that the participation has been improving steadily. A few years back, while they would receive about 50-60 abstracts, the number has been continuously rising and this year, they received about 300 abstracts! The attendance at the lecture halls has also been very encouraging of late with this year seeing barely an empty seat for most talks!

I got an opportunity to meet with some of the stalwarts of the Indian Nephrology community, most of whom were very happy to meet someone who has been on dialysis for almost eighteen years!

With Padmashri, Dr. D. S. Rana, Gangaram's Hospital, Delhi.

Jhal muri, Mishti doi

The two days at ISNCON were so packed that I did not get a chance to sample any traditional Bengali fare. So, at Kolkata airport, I was keen to correct this. Luckily, I found a food court where I got a chance to try the Jhal Muri and the Mishti Doi.

The Jhal Muri looks similar to the Bhel Puri that most of us are familiar with. There are two very important differences which make the taste very different from Bhel puri. There are no chutneys added. The base mixture is completely dry. The second difference, which gives the Muri a completely unique taste is the mustard oil that is added. The result is a real treat to the taste buds!

The Mishti Doi is a very simple sweet dish which literally means sweet curd. It is prepared with curd and caramelised sugar. The best things in life, they say, are the simplest. The Mishti Doi is a perfect example of this statement!

Friday, December 12, 2014

PM Modi must rein in the loony fringe in the Parivar

Its been about six months since the Government took over. When the Government was sworn-in, I had written about how very rarely, in this day and age, does a Government get such an overwhelming majority in the Indian Parliament and why this opportunity must not be squandered.

Though the Government has done a decent job on a lot of fronts, the danger of not succeeding lies within. We see, with amazing alacrity, every now and then, some Hindutva-obsessed lunatic making a remark or doing something so crazy that the Government has to spend an inordinate amount of time defending this.

Let there be no mistake. This Government was not elected on the Hindutva platform. There was nary of mention of religion in Modi's speeches. Yes, there was the odd ridiculous speech here and ludicrous interview there. But, by and large, it would be safe to say that this election was won on the platform of development.

There is so much to be done by the Government. Some very good initiatives have been rolled out, some are on the drawing board. India can ill-afford to have the Government's focus shift away from these critical issues. Let us not forget that we may not see a Government with a majority in the near future.

Another important aspect is that there was a lot of distrust of Modi among the minorities. That did reduce recently. A large number of Muslims and Christians voted for Modi assuming that he would solve their basic problems. When the demented dudes and dudettes of the Parivar are given a free rein, and some actually encouraged, these minorities would feel let down. They will never vote for Modi again. The task at hand for the Prime Minister is not one that will be accomplished in one term. We need a strong Government for at least two terms to give any positive direction to the country. Without the support of the minorities, I am afraid, such a majority in Parliament would not be possible.

Modi is seen as a strong leader. Few doubt his intentions. If he does not act soon enough to control these loose canons and makes sure he takes the entire country with him in the march to development, he would have lost a huge opportunity to make a real difference. He would have only himself to blame for this.

Thursday, December 4, 2014

When talking about the dialysis diet was called 'vulgar'

I was talking to a group of dialysis patients a few months back. I first did a general talk about how to have a good quality of life despite being on dialysis. I then had a Q&A. Typically, questions in this kind of a session invariably turn towards the diet. Diet, for most dialysis patients, is the worst problem if you don't count fluid restrictions.

I was answering some of the general questions on diet when a gentleman, probably about 60 years old started shouting. His contention was that any talk about things like diet was totally unnecessary and he even called it vulgar. I was quite taken aback. He said his wife was on dialysis and their entire life's savings have been spent on her treatment. The anger in his voice was palpable. For him, any talk that purportedly gives support to dialysis patients should only be about how patients should work together to get the government to subsidise dialysis or even make it free.

I explained to him that while I understood the financial problem of dialysis patients and their families, for the patients, diet is a big problem. Addressing the financial issues was going to take time in a country like India because a huge, concerted effort from patients, families, providers, doctors etc. would be needed and the process would be very slow. In the meantime, what was wrong in patients getting some queries answered on their diet and other simple things that could make their life better?He softened up after this.

I could totally understand his problem though. While in developed countries, patients don't need to think about how much their treatment costs, in India, treatment options are primarily dictated by ability to pay. When patients are often wondering how long they would be able to continue dialysis, talk about diet, exercise, quality of life etc. may appear vulgar!

When I talk about more frequent dialysis, I realise that a large number of patients would do it if they could afford it. When the constraints are not in your control, what really can you do?

Honestly, I was quite shaken up by the gentleman's outburst. Their life probably turned upside down after the diagnosis. All their plans probably went haywire. He needed some place to vent. He obviously couldn't vent in front of his wife. I am at least hoping that he didn't do that! A guilt trip is the last thing a dialysis patient needs!

This is why I am fully supportive of any attempt at Government sponsored healthcare. We need to eventually get into a mode where an individual gets the treatment he or she needs without having to worry about where the money for this is going to come from.