Friday, October 31, 2008

My experience with buttonholes

The buttonhole method is widely acclaimed as 'the thing' for daily dialysis whether short or nocturnal. The needles that are used generally for dialysis have sharp ends so that they can make their way through the tissue and reach the artery or the vein.

The downside to using them is that there is pain during insertion and often during dialysis because of the sharp ends. A little Xylocaine is often used to reduce the pain. Also, a different pair of sites for the arterial and the venous accesses is used for each dialysis session. This is called the step ladder method.

In the buttonhole method, blunt needles are used instead. For the first 4 or 5 days, sharp needles are used at the same pair of sites. This makes a 'tunnel' at the two sites. From the next day, blunt needles are used. Since there is already a tunnel in place, the blunt needles go in easily and you don't actually need sharps.

This is less painful and also safer since if you're dialysing at night, like I do, there is a possibility of moving your arms and sometimes the needles may move so much that if they have sharp ends, they might actually pierce the walls of the artery or vein and cause bleeding. This is rare, of course, but nevertheless, a possibility.

I started using buttonholes a little less than three years back. To start with, things were really excellent. At that time, the tech who initiated my dialysis would do the cannulation. There was absolutely no pain. I remember making a comment to my vascular surgeon, Dr. P. C. Gupta that if I turned the other way while the tech was doing the cannulation, I wouldn't even know when the needle was inserted!

After a few months however, there was pain during cannulation. I had to start using Xylocaine. But I noticed that after using Xylocaine for a couple of weeks, I did not need to use it. But again, after a few weeks of not using it, I would need to use it!

I then changed the location of my buttonholes and found that the pain was much less. So, I am quite confused about the whole buttonhole methodology.

I have only seen one person on the home dialysis forums saying that she needed to use an anesthetic like Xylocaine inspite of using buttonholes. I was quite relieved to see that post actually because I was wondering why I seemed to have pain while others were so happy with this technique.

Each individual's body is different and what works for one may not necessarily work for another. I am still using buttonholes but I'm really wondering if I should switch to sharps. Especially since I need to get the buttonhole needles from the US. They are not available in India.

Again, I am not sure. I have used sharps only on a few occasions in the last three years. Maybe the possible risks are higher. Buttonholes have shown to improve the life of a fistula. I don't want to take any chances. So, maybe I will continue to use them for some more time.

Wednesday, October 29, 2008

The alternate medicine hoax

A large number of alternate medications are available these days for every medical condition imaginable. Practitioners claim to have prevention and cures for things ranging from cancer to AIDS to chikungunya. How true are these claims?

The biggest problem is that the entire alternate medicine industry is not regulated. So, you can actually be selling plain water and claim that it can cure cancer and nobody can touch you. A large number of gullible people are taken in by these claims and spend fortunes on these medicines with no results.

Medical problems are such that you like to take a shot at anything that has some hope of solving your problem. Especially chronic problems. There are many conditions for which modern medicine only has supportive treatment. There are no cures available. These are usually the conditions which these alternate therapies claim to cure.

Allopathic medicine (a term not used by allopathic practitioners) or the regular stream of medicine which is widely used and practiced is governed by stringent rules, approvals and peer reviews that make it very difficult for false claims to be made. This is not the case in most alternate streams of medicine.

I am not making the case that all these alternate streams of medicine are hoaxes. But I definitely believe that most are. Without regulation, they take innocent people for a ride.

It is not only the financial aspect that bothers me. Take a person who is afflicted with a chronic disease. He will clutch at every straw that is available. When he comes across an alternate therapy that people claim can cure his condition, his hopes are raised. He follows the strict diet regimen that usually accompanies these therapies and he starts dreaming of a 'normal' future. Only, within a few weeks his hopes start dwindling. Just like the last thing he had tried a few months back.

The mental aspect of this can only be understood by someone who has gone through this.

The general public is usually more sympathetic towards practitioners of alternate therapies. The methods are never questioned. The educational background of the 'doctors' is never verified. Most 'doctors' are anyway not qualified to treat patients. The treatment they give is also not backed by any formal education in the subject.

Most people decide to try these therapies based on hearsay. 'Someone became totally ok after just two weeks of that treatment'. That sentence is enough for them to go rushing to the 'doctor' to try out the same treatment.

It is entirely possible that alternate therapies like Ayurveda or Unani medicine might actually have some benefits in certain diseases. Even yoga could help in some cases. But the claims which are made these days by quacks without any basis needs to be checked immediately.

Then there are things like Reiki, Pranic healing, faith healing and similar crap. These people claim to cure chronic diseases. Like fuck they will. By putting their hands on my stomach or by moving their hands in the air, do they really think they are going to get my kidneys to start working? Am I an imbecile?

Regulation is really, really required. This is an area where government is required. Arrest people making such claims. Advertise against these people. Educate people and prevent them from falling prey to such unholy practices. This really must stop.

Tuesday, October 28, 2008

In search of the perfect Diwali mithai

Diwali is often synonymous with eating sweets. This is a time when everyone is exchanging 'mithai dabbas'. Even if you just taste a bite of everything that comes home, you would have put on quite a few extra kilos by the end of the season!

Very often, the sweets that are gifted are made of dry fruits like almond, cashew and pista. They come in a gamut of designs and colors. But the taste is pretty much the same. After eating a few of these, the novelty wears off. You get tired of the taste.

This is however not true of the sweets traditionally made at home. Take the 'mohanthaal' for example. It is a traditional Gujarati sweet usually not available in sweet shops. Made with 'khova', wheat flour, ghee, sugar and broken almonds, the 'mohanthaal' is an all time favorite. You can eat it for days and yet not tire of it. A good 'mohanthaal' is soft and coarse and has just the right amount of sugar.
Another favorite is the 'ghughra'. The 'ghughra' is basically a layer of wheat dough filled with either a coconut or a 'khova' based stuffing , rolled over and deep fried. The 'ghughra' is also rarely available in shops and is usually made only at home.
There is something about homemade sweets that is missing in sweets that are bought from shops. You can eat much more of the homemade stuff than you can of the stuff bought from shops.

One problem of Diwali though is the amount of fried stuff you eat. Everything that is made is usually deep fried! For example, the 'pakvan' which is wheat dough arranged in layers with some ghee to hold the layers together and then deep fried in ghee. Even while writing that sentence, I put on about a kilogram! You can imagine what would happen if you actually ate a 'pakvan'.

But I guess its all right. This is one time of the year when it is ok to indulge. I guess I will make it up by a few extra rounds of swimming.

Happy Diwali!

Monday, October 27, 2008

Teaching kids about religion

"Religion should never be forced on children", I have heard this quite a few times. I totally agree. Never force kids to accept your religion. Never force them to perform rituals or visit the place of worship etc. But does that mean you don't teach them about religion? I don't think so.

Children are like a piece of white paper. The first few strokes on that piece of paper are always drawn by the parents. They dictate to a large extent what the painting is going to eventually look like.

I believe that parents need to teach their kids about religion like they teach them so many other things. Parents don't say they're not going to force their kids to go to school, do they? They make sure they go. Similarly, parents should make sure their kids are exposed to the religion they're following.

This should be done till a point the child is big enough to decide on things for himself or herself. At this point, let the child make the call on religion too. But let the parents not make this call so early in the child's life that he or she does not even know about the option so that a decision can be made later in life. By teaching kids about religion, the child is given a choice on whether to follow it or not. It is too unrealistic to expect the child to discover religion without any such exposure.

Religion often offers a way of experiencing peace. However unscientific it may be, it gives a means to achieve 'closure' on many of life's problems. We don't have to prove or disprove anything as long as it gives us peace of mind. Spending time in a temple or with a 'sadhu' often gives us respite from the daily grind.

This opportunity should be given to a child. Parents should not snatch this away forever from a child's life. Teach them about religion. But don't force them once they're big enough. That, I believe should be the mantra.

Wednesday, October 22, 2008

Abhishek Bachchan dances to Appadi Pode Pode

Have you heard the song Appadi Pode Pode? Its an awesome song. The beat is just too good. And in the most trying of circumstances it will have you sway your head with the rhythm.

And there is an ad featuring Abhishek Bachchan where he dances to this song in the bathroom. The ad is also hilarious. It was taken off air for some reason only a few times after it was shown. I would really like to know why. However, there is a video on You Tube that has the ad. Here it is:

Tuesday, October 21, 2008

Custom ringtones on the iPhone - solution, well, sort of

I had posted about the problems I've had with creating custom ringtones on my iPhone. Aditya suggested trying out iPhone Ringtone Maker.

After downloading the Mac version, I had a few problems that were fixed after I wrote to their support. I tried creating a couple of ringtones. They were much better than the ones made by GarageBand.

They were not what I would have liked, however. The quality is still not 'perfect' - something you would expect from Apple. But it is vokay.

I went ahead and bought the full blown version yesterday - not bad at $7.50.

Monday, October 20, 2008

In search of the perfect Khubani ka meetha

No true Hyderabadi meal is complete without the Khubani ka meetha. The taste of this dish is quintessential Hyderabad. If the Charminar had a taste, it would be this!

The basic ingredients are dried apricots and sugar. The apricots are soaked for five to six hours in water and then blended. Sugar is added and the mix is cooked slowly over fire till the apricots turn dark brown.

The apricots have seeds which when broken reveal an edible nut that is used to garnish the meetha. A spoonful of cream is often added as a topping.

Some people add a scoop of vanilla ice cream to the meetha. This is nothing but sacrilege! The pure flavor of the meetha should never be spoilt by having it with ice cream. The best way of course, is to have it plain. Cream, if you wish. Never ice cream.

I stay in Hyderabad and have a really good choice of places to taste the Khubani ka meetha. Quite a few restaurants serve it. Utsav in Secunderabad really makes good Khubani ka meetha. The Parivar Dhaba close to the zoo also makes really good Khubani ka meetha.

But the best place to try the meetha is a muslim wedding. You get the dish prepared by some of the most experienced chefs in the city. You sometimes wonder what could be different with such a simple recipe? Don't wonder. Try it. There is something in the hands of these chefs that adds that element of magic.

Especially to things like the Khubani ka meetha.

Friday, October 17, 2008

Of roads and cheeks

Lalu Prasad Yadav is known for his rustic humour. Recently he became more famous for turning the Indian Railways around. So much so that he was invited to one of the IIMs to do a guest lecture!

Many years back, however, when Lalu became the Chief Minister of Bihar for the first time, one of things he promised was that he would make the roads of Patna as smooth as Hema Malini's cheeks!

The roads of Patna never even came close to the cheeks above.

Down south, roads have been a constant problem in many of the state capitals. Hyderabad, however, boasted of really good roads during the reign of Chandrababu Naidu. A friend traveling by bus from Hyderabad to Bangalore once commented that he could tell when the bus had crossed over at the border from Andhra Pradesh to Karnataka. The bus ride would suddenly become extremely bumpy!

After the change in the government and especially in the last few months, the roads of Hyderabad have deteriorated terribly. The rains have totally spoilt most of the roads in the city. In fact, they now remind me of a set of cheeks too - that of actor Om Puri! Sample this: (with apologies to the great actor!)

Thursday, October 16, 2008

My home hemo journey - Epilogue

The best part about nocturnal daily home hemo is that there are no dietary and fluid restrictions. Since you are getting 7 to 8 hours of dialysis, you can remove a lot more. 3.2 kgs should be very comfortable. Because that is what the body can easily tolerate. Not many people can drink more than that in about 16 hours.

16 hours - that’s the time you are not on dialysis. So, however much you try, you cannot build up too much fluid and toxins that can make you feel bad.

I have felt 100 times better than what I did when I was on hospital dialysis. There are no ‘crashes’ because there is no rapid fluid removal. My energy levels are much better. I am back to work full time. And I put in about 8 to 10 hours of productive work every day.

I go for a swim every morning and do 10 lengths. That’s the best part of my day. This was something I missed when I was on PD too. I am so glad I am able to swim now.

My hemoglobin has drastically improved. My need for erythropoetin has reduced. I had left ventricular dysfunction before I was on daily dialysis. That has improved considerably and my cardiologist was pleasantly surprised to note this and was thinking it was due to the daily dialysis. He hadn’t seen this at all in his entire career!

I would say I sleep about 80% on weekdays when I am on dialysis compared to perfect sleep on Sundays when I am not on dialysis. But its not bad at all. I feel completely rested.

Travel is an issue. Now that I am doing daily nocturnal, I completely abhor regular 4 hour sessions. So, when I travel, I cannot dialyze. That restricts travel plans to being away from home for a maximum of two nights. Well, theoretically I can be away for more nights but I will need to do one or more regular hospital dialysis sessions when I am away. I don’t like these sessions at all. And I doubt if hospitals and dialysis centers will allow me to dialyze the whole night. So, currently I am limited to 2 night vacations.

Overall, my life has improved dramatically. No one can say I am unwell without actually knowing about my medical condition (except of course if they happen to see my fistula which can give nightmares to kids!).

This has been entirely due to nocturnal home hemodialysis. I must really thank my nephrologist, Dr. Girish Narayen who advised me and encouraged me to try this when so few (maybe no one else?) people were on this modality in India.

Wednesday, October 15, 2008

My home hemo journey - Part 4

Its been more than two years since I started nocturnal home hemodialysis.

I have come a long way indeed.

I slowly started learning the ropes. At first I just learned how to mix the bicarbonate solution that is used in conjunction with the acid solution that forms the dialysate. This was a piece of cake. You just needed to get the proportions right. Then I learned how to prime the dialyser and tubing before dialysis. This was not rocket science either. For a long time, I used to prepare the bicarb solution and finish the priming before the tech came and he would come and do the cannulation and start dialysis.

I read on the internet that the best thing a dialyzor can do is to cannulate himself. This offers a great advantage. You can actually feel the needles in you so you know exactly how to put them in. So, gradually I gathered the courage to do this. And within a few days I was cannulating myself! This was a great leap for me.

I then also learned to start the whole dialysis myself. Preparation of the bicarb solution, priming, cannulation and then starting dialysis by actually connecting the tubes to the needles and starting. This was great.

From the last month or so, I start off and am into an hour or more of dialysis before the tech comes. He is pleasantly surprised.

The toughest part about starting dialysis is putting the tapes on the needles after cannulation. You have only one hand to do this since the other arm is what you are working on! But I manage somehow.

This is a little risky however since there could be an emergency which I may not know how to deal with. I need to read up on this. But I do it inspite of this because I love the independence this offers. I can start dialysis whenever I want and not have to wait for the tech.


Tuesday, October 14, 2008

My home hemo journey - Part 3

I did some research about the dialysis machine and the RO plant, the two main pieces of equipment required for home hemodialysis.

The best option would have been a portable hemodialysis machine, something akin to the NxStage System One that many people used in the US with great results. I for one, love to travel. And travel would be restricted to short weekend trips with hemodialysis. But the NxStage machine was not yet allowed to be sold outside the US. Moreover, even if I bought it there and brought it here, servicing and repair would be an issue.

So, I decided to go with the Fresenius 4008 S, a sturdy machine used widely in India. I also bought an Ion Exchange RO 100 liter/hour plant. The hemodialysis machine was setup in my bedroom. The RO plant in the terrace of my two storey house. The necessary electrical and plumbing work was done. An RO water connection was given to my bedroom for the HD machine and in my bathroom for the cleaning of the tubes and dialyser after dialysis.

Everything was finally ready by May 13th, 2006.

I decided to go for short daily to start with and then when things settled down to switch to nocturnal.

My first short daily session was good. The tech did everything. I dialysed in the evening for two hours. I continued short daily (except Sundays) for about 20 days. I then thought things were going well enough for us to switch to nocturnal.

The tech would come in around 10 in the night. He would start me off and he would sleep in the same room to take care of any alarms and any other problems that came up. I slept fairly well.

There were hardly any alarms from the machine. Most of them needed a ‘Reset’ button press to take care of.

There were however some other problems. Sometimes, blood would ooze from my arterial and venous sites. The tech was very well equipped to handle these emergencies. These incidents were due to my moving my hands in my sleep that would cause the needles to move around and cause the oozing. We then decided to tie my finger in a manner that would allow some movement of my arm but not enough to cause any oozing.

Once we did this, the oozing stopped completely.

One important thing we did was to use the buttonhole technique. You can find a lot of information on the buttonhole technique on the internet. But in this technique, the regular sharp needles are used for four to five days in a row. Cannulation is done at exactly the same sites (as opposed to the step ladder method) and the same angle. This causes a tunnel to develop. Once this tunnel has developed, we switch to blunt needles. And then cannulate at the same sites using the blunt needles everyday.

This helps in two ways. One - the pain during cannulation is reduced greatly. Two - the needles cannot puncture through the artery and vein in case the arm is moved too much and this protects against bleeding etc.

Part 4

Monday, October 13, 2008

My home hemo journey - Part 2

Dr. Girish Narayen, my nephrologist suggested I try daily home hemodialysis. I started looking it up on the internet. I found a lot of positive comments about this. I started digging deeper.

I could not find any references of daily home hemodialysis being done in India. However, I did find out that there were a very small number of people doing dialysis at home. But only the regular twice or thrice a week sessions.

Also, in the US, apparently, there is an entire infrastructure set up to manage emergencies. In fact, some centers also have online monitoring of the dialysis treatment performed at home.

Here, in India, of course, no such infrastructure is present. That was one of the risks. But I thought I could get a dialysis technician to come home and do the treatment for me. The dialysis technician at the hospital I was undergoing dialysis in was very good at his work.

I thought this through completely. I thought about the pros and cons. I had to rely a lot on the posts in mailing lists and forums on the internet. It was abundantly clear that daily nocturnal dialysis - 7-8 hours every night, 6 to 7 nights a week offered the best outcomes in terms of well being, longevity, minimizing co-morbidities (side effects of kidney disease like heart conditions etc.). The next best was short daily dialysis (2-4 hours every day, 6 to 7 days a week). The worst was the 4 hours thrice a week regimen.

There was no one I could contact who was doing daily dialysis in India. So, I could not get first hand, the experience of the Indian situation. This was quite unnerving.

I was clear about one thing though. I did not want to continue the way I was. I could not tolerate this at all. I needed a better life.

I decided to go for it.

Part 3

Sunday, October 12, 2008

My home hemo journey - Part 1

(Cross posted from Home Hemo training in India)

After the tsunami, in less than a year I was off PD and back on hemo in the hospital. I hated hemo in the hospital. Here's why.

Hemodialysis in a hospital is done twice or thrice a week and for each time between three and five hours. Compare this with the functioning of a kidney. A kidney functions seven days a week and 24 hours every day! So, this kind of dialysis is woefully inadequate.

Because of this intermittent cleansing of the blood, dialyzors (I prefer this term to ‘patients’) undergo a yo-yo effect. Continuous ups and downs. Once a dialysis session is done, your blood is somewhat clean and the excess fluid is removed. But until the next dialysis session, life is a constant struggle. Drink less water. Watch your potassium. Don’t have too much fruit.

The energy levels are horrible. After a dialysis session, dialyzors feel a ‘crash’. This is a term loosely used to describe the horrible feeling after dialysis. You feel weak, tired, listless. Completely drained. I could not do anything after dialysis. I had to go and crash on the bed and doze off.

I had a full time job during this period. But I could not do much. I spent less hours at work. Even when I was there, I would not feel like doing much. It was really terrible.

I am that kind of a person who does exactly what he is advised not to. I guess many of us are like that. If the doctor restricts our fluid intake, fluids are all we want to have. I suddenly started craving fruits and liquids like crazy.

My weight gain between treatments would be a minimum of 4 kgs. Removing 4 kgs in a span of 4 hours can be pretty taxing on the body. The maximum rate of removal of water from the body that can be tolerated by us is 400 ml/hour. There are a number of sites which explain this in more detail. But when you’re removing water at the rate of 1 kg/hour, it can be very bad. The ‘crash’ after dialysis is chiefly due to this.

I understand doctors asking us to limit our fluids. But believe me, dear doctors, this is not something we’re doing intentionally. This is all about human nature. The human mind craves what it is forbidden. Please, please try this out yourself. Just for the heck of it. Just so that you understand what your patients are going through. For a week, restrict your fluids to a liter a day. And then see what happens. Don’t even undergo dialysis. Don’t even restrict your fruits and other things that we need to restrict. Just try the fluid restriction for a week. Let me know how it goes.

The dialysis process itself was horrible. Lying down in the bed for 4 hours without having anything to do can be very frustrating. With every passing minute, you feel worse because fluid is being removed at such a high rate. All around, you see people feeling miserable. The whole experience can be quite distressing.

I would be lucky if I got an hour or two of sleep. And the rest of the time would be just waiting for the whole damn thing to finish. Continuous looks at the watch. Time would move so slowly, it was almost as if the whole world has slowed down.

And I had to go through this torture just to be able to live. What kind of a life was this? Is this kind of a life really worth living?

There is a fellow dialyzor in the US called Stacy (without an ‘e’). He described it very beautifully when he said that dialysis had killed a part of his soul. This is so true. That is exactly what I felt.

Part 2

Common misconceptions about a renal transplant

There are many misconceptions about a transplant which exists among people, even doctors not associated with nephrology.

The most common one being that a kidney is replaced. This is not usually the case. Mostly, a kidney is added to the already existing two. There are some cases where the native kidneys are first removed and the new one then added. But this is very rare. The normal practice is to simply add the new one.

When people get to know that I have a kidney problem, they often ask, "One kidney or both?". If one kidney of an individual stops working, no one would ever know. This is because the other kidney takes on the responsibility of both and performs as well as two kidneys. So, if your renal function declines, it is because both kidneys are impaired.

In fact, an aunt of mine has had one kidney since birth. She got to know when she was around 55 years old when her radiologist son was using his portable ultrasound machine to scan everyone in the house for fun!

Another common misconception is about the role of the urologist versus the role of the nephrologist. The urologist is the person who does the actual surgery. He or she takes the kidney from the donor and places it in the recipient and does all the connections of the various arteries and veins.

The nephrologist is the person who takes care of the medication. Deciding which anti-rejection drugs to use, the dosage of each drug and all the treatment before, during and after the transplant is handled by the neph.

The urologist's work is definitely important but it is quite mechanical. Cut this vein. Cut that artery. Put the new kidney in place. Join this with that. Stitch this here. No novelty. No uncertainties.

It is the nephrologist's work that is more complicated. Keeping in mind the person's history. Zeroing in on the correct combination of immunosuppression. Deciding the dosage. Getting the correct tests done. Reacting appropriately when the results come. Being ready to course-correct at times. Suddenly changing the immunosuppression when something adverse happens. Clearly, the neph's work is more critical.

The outcome of a transplant largely lies in the hands of the neph. Many doctors also do not realize this and they talk about this urologist being better than that one. Or this urologist's success rate is the highest in the city and so on. This is primarily because it is the urologist who does the surgery, the 'main thing', the high point in the treatment, when all the drama happens. The neph works when things are much cooler. Things happen more gradually.

Nephrology is one field which many people, even in the medical field are quite uneducated about. When an individual is brought into casualty, if it is a nephro case, immediately the general medical folks are wary. They will immediately send for someone from the Nephrology department. They don't want to touch the case because they know little about the subject.

I really wonder why this is so.

Thursday, October 9, 2008

A surfeit of smileys

Sample this:

Enthusiastic Friend: Hi Kamal :-)
Kamal: Hi
Enthusiastic Friend: How are you doing? :-)
Kamal: Good. How are you?
Enthusiastic Friend: I'm fine. :-) :-) :-)
Enthusiastic Friend: So, you have a holiday today? :-)
Kamal: Yes
Enthusiastic Friend: Great, relaxing huh? :-) :-)

...well, you get the picture.

Some people use so many smileys. Well, I have nothing against smiling but a smiley must be used on chat only when the person typing is really smiling.

People tend to become over expressive while chatting. For example, if I say something even slightly funny, they will type:


which translates to Rolling on the floor laughing. Excuse me, if you were rolling on the floor laughing, how the hell did you type 'rofl'? And btw, there was nothing that funny about what I just said.

Some people, like my enthusiastic friend above use smileys so often that when they don't put a smiley while saying something, I start worrying if I have said something that offended them.

There should be a rule that says that only the emotion that is really displayed by the person chatting should be typed in the chat window. Why put a smiley when you are really not smiling?

Do people really think that typing a smiley in a chat window actually exercises all those face muscles that are supposed to get exercised when a person actually smiles?

Also, there are so many 'emoticons' available nowadays in chat software that I don't know what half of them mean. So, when someone uses them, I am not sure what to make of them. Are they happy, are they upset, are they sticking their tongue out (what does this mean anyway?), what exactly are they saying?

Of course, the smiley is probably the most abused of them all.

'Wish you the same'

You must have heard this a gazillion times:

'Happy Dassera/Diwali/New Year/whatever'

'Wish you the same'

Why 'wish you the same'? It sounds so drab, dull and unemotional. Why can't the person addressed to respond with a return 'Happy Dassera/Diwali/New Year/whatever'?

Sometimes fads like these catch on and it actually becomes fashionable to do such stupid things. When the person has wished us let's say with a 'Happy Dassera', we can easily say, 'Happy Dassera to you too!'. Now, what's wrong with that? Sounds so much better than a 'Wish you the same'. Or even worse, a 'Same to you' which throws out even the 'wish' part of it!

A greeting is a nice way of wishing someone. Add a smile and you have contributed to building a lifelong bond with the person. It should be genuine, heartfelt, warm. And 'Wish you the same' kills all that.

It is used to avoid being repetitive, did I hear you say? Rubbish! When someone says 'Hi', do we respond with a 'Wish you the same'? No. We return the 'Hi'. Then why not respond with a greeting when someone greets us?

And yes, Happy Dassera to you! (Don't you dare say you-know-what!)

Sunday, October 5, 2008

Deja vu at Ethipothala

About a year back I had written about a trip to Nagarjunasagar Dam and the Ethipothala waterfalls.

This Thursday being a holiday on account of Gandhi Jayanthi, a few friends and I decided to go there again. It was a trip planned at short notice. Funny that trips planned too much in advance never work out while trips planned with really short notice usually happen successfully.

So, there we were on Thursday morning - LN, Thrinath, Sunil, Sriram, Veera, Ramana, Subhash, Jiten and I in a Qualis making our way to the Ethipothala falls. Last time we had learnt our lesson and so this time we decided to avoid the Nagarjunakonda island and the (oh my gawd) boat ride which is 'being taken for a ride' in the truest sense.

We stuck to the basics. Go to the waterfall, have lunch and get to the base and well, enjoy!

We got there around eleven instead of the planned nine o' clock thanks to one of our nonchallant group members (please don't get me started on this one). It was quite a hot day. We ordered ourselves some lunch which was being custom made so would take some time. In the meantime we took some pictures from the vantage point at the top.

View from the top

Lunch was pretty basic stuff - phulkas, dal and fried rice. The dal was quite tasty though and not surprisingly got over and they refused to give us more. The problem is they make food only to order. So, if you're going there and plan to have lunch, order extra in advance!

The way Ethipothala is structured - there is an enclosure that takes you to the vantage point and this enclosure also has the restaurant and an unimpressive lawn and outside this enclosure before the ticket counter, to the left, is a rustic path that takes you to the base of the falls. Many people don't even know where this goes. They come here, take pictures from up and then leave without even getting wet. What a criminal waste of time!

We headed towards the base of the falls. There are some very basic steps upto a point and then you have to make your way to the falls through rocks, shrubs and trees. The trek is arduous but well worth the effort.

Jiten and me on the way to the base

Once we got within striking distance of the base of the falls, we stripped to our swimming trunks, put our belongings on a rock and plunged into the water and carefully reached the rocks where the full force of the River Krishna could be felt on our heads.

The base of the falls

The feeling was absolutely exhilirating!

We had to be very careful as the rocks were very slippery due to a thin layer of moss. They were not rolling stones after all and they did gather moss!

The rest of the group joined us below the water and we had fun for a long time trying out different areas under the water, shouting and posing for pictures.

Under the water

We tried a lot of things we hadn't done last time. We swam quite a lot in the water near the falls. Last time we were a little nervous because we had heard stories of crocodiles frequenting the place. Also, there was no one apart from our group at the base of the falls last time. This time we were much more at ease because there were other people who had also come to the base.

The time we spent under the falls really washed away all the exhaustion of the hours before in the hot sun.

After a couple of hours there we trudged back up and started back for home. We made a quick trip to the dam just to see if the crest gates were open. They weren't. We then headed back for home. I reached home at 9 in the night.

Ethipothala is a classic case of "Jisko dhoondhte the gali gali, woh ghar ke pichhwade mili" which translates to "What I was searching for in the lanes and bylanes of the city, I found in the backyard of my house"!

I was yearning to visit a good waterfall for years and did not even imagine I would find one roughly two hours from my house. It looks like a visit to these falls is becoming an annual ritual!

What I like most about Ethipothala is the natural surroundings. The whole approach to the falls and the falls themselves are barely touched by development. The electrical connections for the 'sound and light show' they have these days (why on earth?) are almost concealed.

For those in Hyderabad that haven't been there, take my advice and go there. You will love it.

Saturday, October 4, 2008

Arterial buttonhole pain

My arterial site is paining again. The pain around the buttonhole was paining almost the whole of yesterday. I was tempted to change the site last night but decided to try it one last time.

It was all right to start with. But a few hours into dialysis the pain was quite bad. I could not sleep properly. The pain was a sharp stinging kind of pain. It was only in the arterial side.

I had the tech close dialysis about 45 minutes before the scheduled time.

My arterial site is always a problem. I don't know why. The venous site never seems to give me problems. I have changed my arterial site thrice already. And now the pain is back. Its more than an hour since I have got off dialysis and the sharp stinging pain is still there.

The pain is there till about an inch from the buttonhole. This means that I cannot cannulate a little away too. I will have to try a totally new site today. I am really nervous.

Thursday, October 2, 2008

The mafia of the clergy

Religions have changed so much over time. Take any religion and see how it was practiced a thousand years back and how it is practiced today. You will find many differences.

One might argue that time changes everything. So, why should religions be different. You have to adapt to the changing circumstances. Agreed.

I strongly believe, however that the changes in a religion should not alter the fundamental principles of the religion. And this happens ever too often.

Why do such changes happen?

I believe that a section of the clergy of most religions have vested interests in promoting their own 'interpretation' of the religious texts and they promote and expound these interpretations as if they were the 'absolute truth'.

Further, they also add the rider that their interpretations are 'God's word' and going against them is equivalent to blasphemy. The laity have no option but to acquiesce.

Many of our religious texts are written in languages that are not widely spoken today. This makes it all the more difficult for common people to read the texts and get a first-hand account of what they say.

The clergy have usually studied these languages and are therefore able to read these texts and understand them. Many of these texts are also written in a form of poetry. Liberal use of analogies and maxims offer themselves for varied interpretations. Theoretically, we cannot find fault with an interpretation. But it is possible that the interpretation is at variance with what was originally intended by the author.

Another tactic used by the clergy is to tell the laity that they are not 'intelligent' enough to question the knowledge of the monks that existed hundreds of years back. So, if a group of monks laid down a law two hundred years back, they knew what they were doing. Never mind if it goes against an individual's common sense. Again, blasphemy if you question.

It is only a part of the clergy that has these traits. Definitely not all. There are many who genuinely strive for the common good without any selfish motives.

Religion is an intensely personal thing. It should not be followed due to scare of something bad happening. It should be followed voluntarily, if at all. It is there to give us peace. It is there to fulfill the need for filling up a spiritual vacuum.