Saturday, September 2, 2017

A life on the cloud



I was always someone who had everything on his laptop. Email and files would all be on my laptop at all times. I took backups using Apple’s Time Machine and had another Carbon Copy Cloner copy. I used to take two backups almost daily! 

The reason for this was that I used POP for my email and I had set it up so that my mail client (Apple Mail) would delete the copy of the email from the server. If anything happened to my laptop which caused me to lose my data, I would be stranded without my email forever! 

I had this bad experience at one point when both my hard disks crashed and the only copy of all my mail and files was on my laptop. I became paranoid after this incident.

Recently, I decided to put an end to this dependency on hard disks once and for all. I painstakingly moved all my email to IMAP. I had to create folders in the IMAP account and then drag and drop email from the corresponding POP folder to the IMAP folder. This was the worst part of the entire exercise.

Then came the files. I already had a Dropbox Plus account which gave me 1 TB of data storage on the cloud. I wasn’t using this enough. I took the big decision of moving all my files to Dropbox. I first spent some time cleaning up my files on the laptop. I removed a lot of files that were just lying there without being loved for years. I moved all of them to Trash. I also structured my folders better. Then, I finally moved everything to Dropbox from the laptop. 

There, I was done!

I recently moved to an iPad Pro 10.5” as my primary work computer. To get it all setup, I simply had to setup my Gmail account and my Dropbox account and then in Dropbox, I had to set all my files to “Make Available Offline”. Once this was completed, I was all set.

There are many advantages to this. I can practically work from any computer. I am not tied down to using my own. Even if my iPad goes down, I would not lose a single email or file. The only downside to this is the availability of the internet to sync. But this is not needed all the time since I always have the most recent copy on my iPad. Changes would get synced when the connectivity was restored.

I think moving to the cloud is a great change from the way I used to work. It is very efficient and safe. I don’t have to ever worry about losing any data or taking backups. A life on the cloud is a good thing!

Wednesday, August 9, 2017

Fresenius acquires NxStage: what this means for those who want Home HD in India

In a surprise press release, Fresenius Medical Corporation announced the acquisition of NxStage, the company that produces the world’s only portable hemodialysis machine. I just wrote about NxStage completing ten years a couple of days back.



This acquisition could be good news for patients in India looking to have access to home hemo infrastructure. Why did NxStage not come to India? As I said in my last blog post, this was primarily due to the lack of a large number of patients who would be able to afford a machine like the System One and more importantly the per-session cost of the consumables.

How can that change with Fresenius coming in? Fresenius already has a well-established presence in the country. They are the country’s largest dialysis machine suppliers and they have a decent penetration when it comes to consumables for dialysis as well. Add to that their solid service infrastructure which consists of well-trained engineers and you have an end-to-end dialysis solution. The Fresenius team can theoretically make the NxStage machines available pretty soon in the country. They would need to figure out a way to manufacture the NxStage specific consumables at a lower cost. They can easily get their Indian engineers trained in the NxStage machine. All this would actually make it possible for Indian patients to get access to the NxStage machine!

However, all this is assuming that Fresenius would want to bring the machine to India. That is quite a big assumption. It is rarely the case that patients like me can gauge the real reasons for these multi-billion dollar acquisitions! We might never get to know the real reasons behind the acquisitions. Press notes are drafted to make the right noises. People might make guesses about the real motive. However, no one apart from the people right at the top would know the real reasons.

Anyway, I am strongly hoping that Fresenius will find a way to bring the machine to India and will want to do so. The large population here does have people who will want the convenience it offers. So, to those Indians on dialysis who want better options: don’t lose hope yet!

Sunday, August 6, 2017

NxStage System One completes ten years, no signs of coming to India

The revolutionary portable dialysis machine that has enabled home hemodialysis for many patients in the US has completed ten years. More than a hundred patients recently celebrated their ten year anniversary with the machine. Despite criticisms of the machine by renowned experts especially with regard to the high blood flow rates (necessitated by the low use of dialysate to make it portable), this machine has really changed life for many. 

When you think about it, though home hemo in itself is a huge life-changer, the added convenience of a portable hemodialysis machine takes this freedom achieved due to home hemo to a whole new level. 

For me personally, the inability to travel without the shackles of a fluid and diet restriction is a major killjoy. Who wants to have these sickening restrictions on a vacation? In fact, when you’re used to not having any restrictions at home, having them on a vacation actually makes the outing sometimes feel torturous!

The fact that not one company has been able to come out with an alternative to the System One is quite astounding. Ten years is a long time. Though there are many companies that have a machine in the works, not one has been able to hit the market. 

And what keeps the System One from India? Are we more than ten years behind the US? This is a really sorry state of affairs. I complain about the lack of Soliris to enable me to have a kidney transplant. I have stated in the past that I will stop complaining; just give me the NxStage machine!

Saturday, August 5, 2017

Watching streaming video

I recently got myself an Amazon Fire Stick. It is a very simple device that plugs into the HDMI port in your television and connects to a power socket. Using Wifi and various apps available for it, it can stream a lot of content from around the world.

I have watched a lot of stuff since I got the device - House of Cards, Silicon Valley, Inside Edge, The Crown. Its an amazing device with the simplicity of any Apple product. 

I remember reading about television content that you could watch at your own convenience long, long back in a book. To me, at that time it seemed almost impossible. And here I am actually using such a device. The pace at which technology is progressing is almost mind-numbing. I recently was told about a blog called Wait, but why? In it the author writes some really amazing stuff about how technology is changing our world and the rapid pace at which this is happening. I am going to write a complete post about that some other day.

Back to five nights a week

I have been dialysing for six nights a week for a long time now. I did dabble with various other routines and settled on six nights a week. That worked well for me. For the last year or so. I have been having Carpal Tunnel Syndrome which did not allow me to sleep beyond very early in the morning and I would get up with severe numbness in my left hand. Strangely, on dialysis nights, I could sleep up to 5 am. So, it kind of made sense for me to do dialysis on more nights!

Recently, I got operated for  Carpal Tunnel Syndrome on my left hand and my right hand is getting better with a device under clinical trial. So I am able to sleep till longer. I thought recently that I should try to do five nights instead of six nights and see how it goes. I have been doing that for the last two weeks and find it going quite well. I will be continuing this for some time now.

What, you might wonder, do I like about my nights off-dialysis? Well, who likes to dialyze? Who likes their fingers to be tied with a string to prevent the hand from moving too much in the night so that the needles don’t come off? Who likes needles in their arm, isn’t the first place? Not me! I also like the fact that I am alone in my room. I feel free. Honestly, it is difficult to describe.

I have been putting on less fluid weight recently and that has helped to make this decision. If I know me well enough, the less fluid weight gain is not going to last long. In that case, I will switch back to six nights a week. That is the whole damn advantage of home hemo. You can choose when to dialyse and when not to. You can choose when to start your session and when to end it. You can dictate your treatment without worrying about schedules, about timings, about so many other things. I am so grateful that I have access to this wonderful modality. I so wish many others could do this as well!

Sunday, July 30, 2017

“God doesn't exist. But don't tell that to my servant...”



“God doesn't exist. But don't tell that to my servant because I am afraid he might kill me while I sleep.” - Voltaire

I came across this quote in the book Sapiens by Yuval Noah Harari. It struck me as really profound. The concept of God was probably created to bring some kind of order to society. Think about it. Do you think a majority of the people who do not have the fear of divine punishment would stay away from things we consider ‘wrong’? Granted, there are some people who would not do ‘wrong’ because it is ‘wrong’. But how many such people are there? My thinking is that a vast majority of human beings, sapiens if you will, don’t do ‘wrong’ because of the fear of punishment of some kind - by the law or by God.

Take away the fear of punishment and then the world would quickly descend into chaos and anarchy. People would be doing all kinds of things - murder, rapes, cheating, dacoity, you name it.

Having law was simply not enough. People would be punished only if they got caught and then there was also the burden of finding evidence to prove your guilt. There was something more powerful than law that was needed. God fitted the bill nicely.

The trouble is the concept of God relied on something called faith. You did not need evidence to prove anything. Nobody could question anything. Dogma was the order of the day. This lead to some rather unfortunate consequences: rituals and rules.

I think religion was a good thing that man made. However, the real problems began when layers kept getting added to every religion. With every generation came another layer - a layer of rituals and rules. “You should not do this”. “If you do this, this will happen”. “If you do this ritual, this can be cancelled out”. The rituals and rules became so complex and so irrational that religions today are probably completely unrecognisable when compared to their original forms. And the most important rule was “Theirs not to reason why, Theirs but to do and die.” No questions could be asked. That would be blasphemous. With this came absolute power for the clergy and unquestioned obeisance from the laity.

In the end, religion has become a monster that is being misused so badly that it completely defeated the purpose for which it was created.

Wednesday, July 26, 2017

Keeping busy is the best way to restrict fluids for those on dialysis

If you asked me what was the toughest thing about dialysis, I would say the fluid restriction. Restricting all fluids put together to a litre a day, which is the typical fluid volume most people are allowed is very difficult. Many people give different suggestions on how to limit fluids. Use a one litre water bottle and drink only out of that, squeeze a lemon in a glass of water and freeze it in an ice tray and then suck on a cube when thirsty, limit salt etc.

These options are great. However, I think the best way to restrict fluids is to keep busy. Working full time obviously, is the best option. If not full time, at least part time. If working is not an option at all, then find something productive to do that keeps your mind occupied. Everyone needs something to look forward to. In the book, ‘Being mortal’, Atul Gawande recounts how adding a vegetable patch and some pets to a home for the aged improved outcomes dramatically for all the people staying there. Everyone started looking forward to doing some work for the patch and the pets. They had something to do. They had something to look forward to.

In dialysis, apart from the mental benefits in terms of being productive, limiting the fluid intake is an added advantage. If you believe it is thirst that is causing you to drink more water, think again. This is completely a mental game. The mind is like a spoilt child. Tell it that you cannot have something and it will crave only that. If you keep it busy with something else, it will forget about what it cannot have.

Most people I know that have survived long on dialysis have been working. It need not be a regular job. It could be anything. It does not have to pay anything either. The mental benefits are far greater than anything else that you may gain from this.