Thursday, December 31, 2009

2009 - a roundup

2009 has been a mixed year for me. The year started on a painful note with hemorrhoids that I got towards the end of last year. I tried everything - from regular medicines to Ayurvedic medicines from Chennai. The hemorrhoids looked like they had settled down but within a few days, the pain had restarted. After going back and forth between the urologist (prostatitis?) and the general surgeon (abscess / fistula / something else?), I finally underwent surgery for a fistulectomy which got rid of the pain.

The next few months were bliss. Until October. I developed bone pain at that time. My PTH was also high since May. It was treated using Cinacalcet. It is now normal. My Vit D levels are however low. So, I am on Calcitriol for this. The bone pain is quite bad now. It is the most troubling problem for me at this time.

The transplant question popped up from time to time. So did the question of marriage. Both are so similar. So difficult to decide either way. I swayed from one side to the other again and again. Ruled them out at one point, was totally in favor at another point. I have been able to finally decide on only one of them until now. Hopefully, 2010 should see a decision on the other.

My work has been quite rewarding both intellectually and financially. I got into Mac OS X (Cocoa) and iPhone development. I built my first iPhone app from scratch and it is now on Apple's App Store! The app was quite a fun app to do. The fact that I did it entirely on my own has made me really happy. The job at Grene is very different from my job at Effigent. Here I am a full time programmer. In my previous job I hardly got to do any programming. Programming gives you a high that management simply does not offer. I guess I have written a lot about this. So, I will not repeat this here.

On the friends front, Chetan and Pavithra came down in the beginning of the year and were here for a while. I would have liked to spend some more time with them but I understand that the arrival of a son, Tejas does add some responsibilities to parents and there is no denying that their son is the highest priority in their life right now! Yogita also visited India with her daughter Niharika. Dinesh could not come. Many of my school friends are visiting India right now and I got a chance to meet many of them - some after about 17 years!

I always enjoy the company of my friends thoroughly. The few hours spent with them transport me to another world. In October, I did a trip to Vizag and Araku with my friends. I really had a blast!

All in all, like most other years, 2009 was a mixed bag. Here's wishing you a great 2010!

Wednesday, December 30, 2009

Update from the swimming pool

Its quite cold in Hyderabad these days. The minimum temperature touched 11 degrees centigrade a few days back. Generally, when I get up in the mornings, it is quite cold. It is another matter that I am waiting to get out of bed because I am unable, for some reason, to sleep beyond 5:30 and I try to make sure that my dialysis finishes at least by 6 so that it is only half an hour of waiting! It is funny how half an hour can become such a long wait.

Anyway, once I finish my morning routine of Darjeeling tea followed by checking emails, Facebook, Twitter, some dialysis related forums and the newspaper, I go to the swimming pool for a swim. On the way, I invariably see almost everyone on the road wearing a sweater, a muffler or one of those ear pieces every second Hyderabadi has these days. It sits tight on the back of your head and its two arms cover the ears securely. I wonder whether I am being foolhardy swimming in this weather when everyone else seems to be trying to escape the cold in some manner.

When I reach the club, I amble along from the parking to the pool, almost limping due to the bone pain in my feet. There usually are less than two people in the pool. Mostly there is no one. The water is crystal clear. I change, take a hot shower (this, I believe helps me bear the cold water in the pool) and then dive into the pool.

My diving has considerably improved over the past few months. After I learnt the knack of diving from the coach, Irfan, I have consistently improved. For a long while, I would always land on my stomach or below and get hurt in the process! I persisted however. Today, I can dive reasonably well, head first, at a good almost 90 degrees and within a couple of seconds almost touch the floor of the pool. I have also realized that focussing on the dive helps me take my mind off the cold water. It is really cold!

Quickly I swim a couple of lengths in the pool and this helps a lot in adjusting to the cold water. I used to put in about 14 lengths a couple of months back. But ever since this damn bone pain has started, my capacity has reduced. Today I just did six.

Swimming is important for me in may ways. One is it helps me stay in reasonable shape. My body is slowly beginning to resemble John Abraham's. Ok. Ok. That's not true. Let's just leave it to "stay in reasonable shape". Another thing is swimming is said to be good for the bones. So, I'm hoping it will help limit any damage to my bones that is due to the 'effects of long term kidney disease' (oh, how much I hate that term the docs use to describe everything that happens to my body these days!). And most important of all, I really enjoy it.

So, you see, it is good in all ways. I really hope I am able to continue swimming for a long, long time to come.

Monday, December 28, 2009

Rudy learns the ropes at Ferndale

Yesterday, we played Taboo again. Nisha and Rudy (Anirudh) had come down from Hong Kong and all of us got together to play the game. We had played last in April and I had described Rudy's reaction to our generally boisterous demeanor - 'What a family!', he had said.

Yesterday, things were a tad quieter thanks chiefly due to the absence of the younger siblings - Karan and Aditi. But Prasan, Nisha and I quickly made up for the lack of noise.

The interesting thing was Rudy, who last time was extremely accommodating and 'fair' actually started showing shades of the Fernes gene. Months of staying with Nisha has actually begun to bear fruit. His voice was louder than last time. He was more aggressive than last time. And some of us were quite shocked to see that he was actually fighting over a point! Unheard of until now!

So, Rudy is finally learning how to deal with the family. He has probably realized that being soft spoken doesn't get you anywhere. You have to be equally rough and shout as loud to have even a remote chance of getting heard in all the din. Welcome to Ferndale, Rudy!

Thursday, December 24, 2009

The T tangle - what's the way out?

We have the state on boil again. What is the way out? The government's flip-flops along with the flip-flops of the political parties are literally causing the state to burn. In my humble opinion, (which I realize does not count for too much!) this is a way out:

1. Start the process of forming a separate Telangana state immediately. It is not true that a resolution is required to be passed in the state assembly. Please correct me if I am wrong. The centre can do this independently. The cause is genuine. There is no doubt in my mind about this. Please read this (albeit patiently!) to understand the history behind this demand. The people of the region have a genuine grievance and it must be addressed. Hyderabad must be the capital of the Telangana state while Vijaywada or Visakhapatnam can be made the capital of Andhra Pradesh.

2. Put the state under president's rule for a while. This is important because the government under Rosaiah has failed miserably in performing its most important duty - that of maintaining law and order. It is also an open secret that K V P Ramchandra Rao is the one who wields the baton in the home ministry. There are a number of vested interests in the government who are acting against the interests of the people. To bring back the state to normalcy, it is important that there is a neutral government.

3. Bring in the army to ensure peace. The moment you announce that you forming the state, the Andhra region will erupt (stage managed, if you will). This must be quelled forcefully and decisively. No nonsense must be brooked. The government of India must send a stern message to all that the nation cannot be held to ransom by a bunch of hoodlums. What is the problem for the people of the Andhra region to concede a Telangana? What do they have to lose?

4. TRS must cease to exist. I don't say this. They themselves have promised (apparently) that they will merge with the Congress once the state is formed. It will be dangerous to have KCR and his ilk running the state of Telangana. They will loot and plunder its resources like never before and this will sour the dream of the people of the region.

5. Form the 2nd SRC. The moment you announce a Telangana, umpteen other demands will be raised. All those must be examined. The center must constitute the committee to look at these demands in a time-bound manner and the center must refrain from knee-jerk reactions like in the Telangana issue.

I understand that things are not as simple as this. But I feel this might offer a way out of the mess that we have got ourselves into. Mulling on this issue for many days, I have realized that there cannot be a united state for too long. The situation is worsening every day and some decisive action must be taken soon. Some of this might not be palatable to some. This cannot be helped. In a country like ours, you cannot please everyone all the time.

I write this as a neutral person - neither from Andhra nor from Telangana. I write this as a silent spectator who yearns for normalcy in the city he has lived in all his life.

Wednesday, December 23, 2009

Debilitating bone pain

My bone pain is getting worse. It is a big problem. I find it difficult to walk down a flight of steps. There is too much pain in my feet. I have to walk down like an old man - step by step - planting both my feet on each step. I feel crappy.

I did all the relevant blood tests. Its been a month since I started rocaltrol to treat the Vitamin D deficiency thought to be the cause of my bone pain. The PTH is normal now but the bone pain has become worse. The neph feels it could be due to the low phosphorus. It is only 1.1 post dialysis. The normal level is 2.5 to 4.5. I have started adding a phosphate additive to the dialysate to try and reduce the amount of phosphorus being removed from my blood during dialysis.

I was also asked to get some X rays to see the status of my bones. I am going today to get these done.

Tuesday, December 22, 2009

Life expectancy

I have been thinking really hard about this for the last couple of weeks. It started with me having to decide about a pension plan. My bank sent an executive to suggest some investments and I thought it might be a good idea to start investing in a pension plan. Every year I would need to put in some money and when I retire, I would have different options, one of which would be to get a monthly income to take care of my expenses. I asked for a plan that would allow me to retire at around 50. The numbers came.

At that point I started thinking about it, asked a few experts on the dialysis forums and also talked to my nephrologists about it. How much longer can I hope to live? That is a loaded question. No one wants to answer it straight. I understand that. But it is a very important question for me. From a very practical standpoint. If I were to live till 60 or more, investing in a pension plan makes a lot of sense. That is because when I am about 50, I may not be able to work and earn enough to meet my expenses - medical and general. Now, when I am able to work, I should save some money to take care of this.

If, on the other hand, I am not going to be around after just a few more years, what's the point in investing in this kind of a plan? I might as well spend the money. I don't have any dependents to take care of. So, without sounding depressed or worried about this, I needed an accurate answer. Now, I totally understand that no one can give me an accurate answer. I also know that each individual is different and that statistics are made up of extremes and you cannot really rely on statistics to arrive at this answer.

I understand too that people without any chronic conditions could get run over by a bus or die in an accident. No amount of planning can avoid these kinds of things. Nevertheless, I believe that I really need to keep this in mind while deciding about how to go about my life in the next few years.

Bill Peckham quoted some statistics related to the US population which said that the life expectancy of a person on dialysis at my age would be about 11 years. This could be the average of extremes. When I think about my condition, I have almost all the co-morbidities associated with dialysis and more. So, should I consider myself close to one of the extremes?

These things can be really depressing. No, please don't leave a comment about how not to worry about the length of life; live each day to the fullest and all that. I usually do that.

Thursday, December 17, 2009

Thankfully, its not osteoporosis

I took the day off from work today to try and get a handle on the bone pain. It has been bothering me a lot recently. It has been a month now since I started calcitriol for the Vit D deficiency and it has not helped at all. It has in fact, become worse. I have been advised on the dialysis mailing lists and forums to get a bone density scan. This is done to check if someone has osteoporosis.

So, today I got a bone density scan, also called a DEXA scan. It cost me a whopping 4000 rupees. I was made to lie down on a bed and there was a machine that scanned me. The report was normal. So, at least its not osteoporosis.

So, now the question is what is causing the bone pain? I was asked to repeat my Calcium, Phosphorus and PTH levels again around this time and go for a review. So, that's the plan at least for now.

The bone pain is really my biggest concern at this point. I find it difficult to do my daily activities. My feet hurt when I walk. My back and ribs hurt when I am lying down and want to turn. Any sudden movement hurts too. I really have no clue about what the reason could be.

Wednesday, December 16, 2009

Had I been given some more time to live my life fully

I was diagnosed with kidney disease at the age of 22. Yes, too young. Sometimes I wish I had some time before lightning struck and changed life as I knew it. I wish I would have known a few years before this was to happen. I would have at least done a few things I cannot now do. Well, its not as if I cannot do these things. But its a whole lot more complicated and difficult. Almost impossible.

The main thing I would have done was travel. I would have made a trip to Switzerland and seen the Alps. I would have stayed for a few days at one of those secluded houses which I heard about from my mother and brother who have been there; in the middle of nowhere, with no human being in sight for miles. Where it would be so cold that you didn't feel like getting out of your bed from under the rug in the morning except to the smell of chocolate.

I would have travelled to the US and done a cruise. I have always wanted to do this. Staying on a luxurious ship and just enjoying myself the whole day. If I was not in the swimming pool on the deck, I would be luxuriating in the jacuzzi or sampling the exotic food that was on offer. I would love to jump into the ocean or curl up in my bed looking at the ocean from inside amazed at the humungous volume of water that was all around me.

I would also have planned to spend a few weeks with some sages to try and learn the secrets of peace - something I would really need in the days to come. I would spend a lot more time on religion. I would try to understand the scriptures and learn the languages in which they were written. They would provide me the strength to face the tribulations ahead.

Oh, how I wish I had known in advance. It all happened too soon. My life was snatched from me in one fell swoop. I had no time to prepare. This wasn't fair at all.

Tuesday, December 15, 2009

New Indian website on Pediatric Nephrology

Dr. Sidharth Sethi, a pediatric nephrologist has started an excellent website on pediatric nephrology. It is really great to see doctors in India take to technology. The blog features the latest in the field of pediatric nephrology from around the world.

I have a special interest in this field because my primary disease Hemolytic Uremic Syndrome is usually a pediatric disease. Mostly children are affected by this disease. Adults are only rarely affected.

So, a lot of work in this area has been done by pediatric nephrologists. The genetic defects associated with this disease, I would assume, are similar in children as well as adults.

Do check out Dr. Sethi's blog! I have a little article there too!

(Update: Website URL updated on 28th November 2016)

Friday, December 11, 2009

Vijaya Diagnostics - too good!

I recently had to get my Vit D levels tested (I had got the 1,25 levels tested a few weeks back, this time it was the 25 levels - more about this in another post). I was asked to get it done in Vijaya Diagnostics. Now that's a name I had heard a lot in the past few years. I would always be told - get this test done either in Vijaya Diagnostics or something like Apollo or Yashoda. I would typically choose something like Apollo or Yashoda for no particular reason.

This time, I wasn't given a choice. I was asked to get it done in Vijaya Diagnostics. I knew their main branch was somewhere near the Skyline Cinema. But I had this feeling that they had a branch close to my office. I had probably chanced upon their board or something. I did a quick Google maps search and sure enough, found a branch about half a kilometer from my office. I called them and asked them if they did the test. They said they did.

I went over to the branch. It was a nice, new premises. Without much ado, I paid the bill and gave my blood sample. I then enquired about when the report would be ready. They said it would be ready after 8 p.m. that day. I asked if I could get it around 6 because I leave my office at that time. They said it would not be ready until 8 because the report had to come from their main branch. I then told them I would collect it the following morning in that case.

Then came the biggest surprise.

They said I could check it online. Online, I asked, half in disbelief?

They showed me the id and password on the bill they had given me some time back and said I could go to their website and check my report online in the evening.

I was so impressed!

That evening I checked my Vit D level online. The website was great. Easy to use. No fuss. Within a minute I had my value with me! (It turned out to be normal, by the way.)

Thursday, December 10, 2009

Is this the way such important decisions should be taken?

While I am not going to argue about whether the decision to form a separate state is right or wrong, I strongly feel that the sequence of events that led to the decision to form a separate state left a lot to be desired.

Forming a separate state is not a small decision. To take such a decision under pressure of the failing health of a man who is nothing but a selfish thug who has shown no signs of morality and dedication to anything is wrong. If anything, this decision should have been taken without any pressure from anyone.

I do not think the protestors from Osmania University and other places did anything wrong. They believed in a cause. They fought for it. It is for the government of the day to deal with the situation. It should not be forced into anything it does not believe is good for the people, the state and the country at large.

Some people might argue that the decision is right and eventually, it was the pressure that forced the government to act. Pressure is not the reason a government should act. If the reasons behind forming a state were genuine, this should have been done long back, not because of the pressure.

To what extent is the government going to go now? What about Hyderabad? Is it going to become a Union Territory? Joint capital of both states? What about demands for other states? Is a fast and agitations by university students the formula for getting a new state? Every demand for a new state has justifications. There are many regions in the country that have ben neglected. How is the government going to handle these demands?


Monday, December 7, 2009

Telangana - different perspectives

I was home alone. My parents had gone to Chennai on work. I was chatting online with some friends after a long time. Suddenly, I heard a lot of commotion outside my house. I caught only one phrase - 'Jai Telangana'. I rushed towards the front of my house. Through a window I saw about a hundred people with pink flags walking past my house sloganeering and shouting. Chants of 'Jai Telangana' rent the air.

I watched, not worried at all. They were not there for me, nor did I have anything to do with them. Suddenly, I heard a noise which sounded like a mild explosion. It was clearly just a few feet from the window I was at. I realized it was from inside my house. I was horrified. It was either a bulb which had broken or a stone that had hit a glass window. Immediately however, some people within the crowd shouted at one of the others. "Eh, Eh!" The crowd moved on.

I breathed a sigh of relief. Whatever it was, it had passed without much damage. For a moment however, I was petrified. I was dreading that more could come. Thankfully, it did not.

Mobs are not rational, right? Who could explain, indeed who would have an opportunity to explain to them that I had nothing to do with this. That I was not even from the state. The concept of Telangana and Andhra was completely alien to me.

***

On Saturday evening, I was returning from a hospital where I had gone to discuss something with a doctor. We had heard there that Section 144 was imposed in the city because there was some violence in Ameerpet and Punjagutta areas.

I passed by the Paradise bus stop. I saw about a couple of hundred people who had gathered at the bus stop. It was not an unruly crowd. It was an eclectic mix of the old and the young, men and women, children and adults. There was one thing common among them. Worry. They were all waiting for buses to take them home. Buses had been withdrawn because some unruly hoodlums had broken some buses during the violence that evening.

They had no means of getting back safely to their homes. Autos were either absent or were charging unaffordable amounts. They were all waiting anxiously hoping some bus would come and take them home.

I felt really bad for them. I have no idea how they went home. No buses plied that day.

***

Kartik is a software programmer. He has one major grouse. He says, "The only complaint I have had is that my Telangana dialect is not accepted by anyone around me, and as for the film industry they have come to brand it as a rogue dialect which saddens me." The Telangana dialect is spoken only by villains and comics. Never the lead actor.

It is this attitude which bugs the hell out of people from the region. Nobody likes to be made fun of. Too silly a reason for a separate state? Well, depends on which side of the divide you are on. There are other reasons too.

Two of South India's largest rivers flow through the region but the large parts still do not have access to proper drinking water. The basic reason for separate statehood is that the powerful Andhra people have systematically exploited the region and promoted their own kin. The rightful owners of the region's bounties have always got a raw deal. You can read more about the history of the demand for a separate state here.

Saturday, December 5, 2009

Healthy people - never take your body for granted

When you are diagnosed with a condition that is going to last your entire life, it can come quite as a shock. Most of us go about our lives smugly thinking that these kind of things will never happen to us. Then one day, boom, all of a sudden, our world comes crashing down. Ask anyone who has been through this and you will hear something similar. 'I never imagined that this could happen to me!'

That is why I want to say to all you healthy people out there - never take your body for granted. You have no idea what's in store for you. Live a healthy life. It is fairly simple to do. You don't have to go looking for 'nirvana' where your health is concerned. It is common sense.

The problem is many of us go about our lives without thinking about the 'big picture'. Cliched, I know. But, seriously true. We get so caught up in our daily routines that we don't really stop to think about our lives and where we are going. This is true about our health as it is about anything else in our lives.

If you take some time out and think about what it is about your life that is not healthy, you will easily be able to identify a few things which you must change. It is never too early. Don't think that I am too young to not do this or start worrying about my health. Remember that chronic conditions are hitting the young at an alarmingly increasing rate.

There are simple things you can do. Eat healthy food. Don't eat processed food. Don't smoke. Drink within limits. Exercise. Work normal hours. Get good sleep.

See, no rocket science there. Simple common sense.

By taking a conscious decision NOW about living a healthy life, you will really feel better and reduce your chances of getting hit by lightning when you least expect it. Once you are diagnosed with a chronic condition, there is little you can do about it except keep your chin up. The key is to prevent it. And its not that difficult. If you take it seriously.


Thursday, December 3, 2009

Used a new site, used a sharp, slept well after a long time!

Yesterday I had written about the severe pain I had during dialysis that night and that I had to close the session early. I was worried the whole day about cannulation. I decided to abandon the buttonhole sites I have been using for my arterial site and use sharps to cannulate on a fresh site. I dumped in a whole lot of lignocaine and used a sharp. Cannulation was fine. The real test would be after about 15 minutes when the effect of the lignocaine would wear off.

There was very mild pain for a while. Too mild to keep me from sleeping! I drifted into a really peaceful sleep.

Beep, beep, beep, beep....

I awoke only in the morning to the sound of the machine signaling the end of treatment! After a long time, I slept till the end of the treatment. For the last many days, I would invariably wake up an hour or so before the treatment was scheduled to end, my arterial site paining, sore from the needle, waiting in frustration for the minutes to pass by. Not so today.

I feel so good. Rested. Pain free. Cheerful!

Wednesday, December 2, 2009

Arterial pain back

For the last week or so, my arterial sites have been paining. I have been using a local anesthetic before cannulation. So, the cannulation is all right. However, a few hours into dialysis, the arterial sites have started paining. I am unable to sleep properly too.

Last night, around 3 a.m. the pain had become quite severe. I tried carrying on. I was unable to sleep. I woke Jayaram, the tech and told him about the pain. I actually asked him to close the dialysis session. The pain was that bad. But I had got only about three and half hours of dialysis. So, he suggested that we push in a little local anesthetic. He did that and there was immediate relief. But that would only last about 10-15 minutes. So, he gave me an IV painkiller - trammadol. This allowed me to pull along for another hour or so. Around 5:15 in the morning, the pain was quite bad again. I woke him up and asked him to close the session immediately.

My arterial sites have always been problematic. I had written about it here, here, here, here and here. The last week has been quite bad. I am planning to use a sharp needle and change the arterial site today. Let's see how it goes.

Monday, November 30, 2009

Flexible code versus less code

I recently came across an excellent post by Wil Shipley that talked about making code small versus making it very flexible. We've all had to make that decision at some point or the other, right? You have to add this piece of functionality somewhere. And then we think, it might be useful to others too. So, why not make it generic enough so that it not only serves our purpose but also the legions of developers who might need this feature decades down the line!

Though the goal above is not wrong by any means, we tend to overestimate the usefulness of this strategy. This practice is good in an ideal world. Probably when you are at a stage where you're writing software for a doctorate. Probably not when you're writing software that needs to ship or when you have a customer breathing down your neck for a release that is already one sprint behind schedule!

Let's face it. It is difficult to conceive every possible way the method/class/feature is going to be used, design for it and code it in the shortest possible time. It is much easier to bang away a solution that fits your current needs and then sit down and make it 'flexible'. And that time is often not really available easily. Well, the perfectionist may argue, 'That time is time well spent. It will actually result in a net gain over time.' Point well taken. But are you really sure? What if you spent a week trying to add the 'genericness' and no one really uses it in the next seven and half months?

I have had enough experiences in Effigent and in Grene where I have seen overenthusiastic developers, in the name of making a framework 'future-proof', make things so fucking complicated that they screw up many people's presents. Take for instance, the case where a colleague decided to use hexadecimal for representing the customer id. I asked, "Pray, why hexadecimal?" He said. "We really need to make this future-proof. Tomorrow when we implement this solution across the country, we may have so many customers that merely decimals will not be enough!" I wanted to say that when we have as many customers that 'decimals will not be enough', you and I will be dead and long gone to worry about this. Well, in theory, it was a noble goal. But it made things unnecessarily complicated (for the paucity of space, I will not go down that road now)!

Shipley has some really sensible rules in his company about this which I reproduce here:

- We don't add code to a class unless we actually are calling that code.

- We don't make a superclass of class 'a' until AFTER we write another class 'b' that shares code with 'a' AND WORKS. Eg, first you copy your code over, and get it working, THEN you look at what's common between 'a' and 'b', and THEN you can make an abstract superclass 'c' for both of them.

- We don't make a class flexible enough to be used multiple places in the program until AFTER we have another place we need to use it.

- We don't move a class into our company-wide "Shared" repository unless it's actually used by two programs.

Follow them at your own peril. They make a lot of sense to me for sure. The developer I was referring to has probably learnt his lesson though. In the next version of the same framework, he quietly switched to decimals! I asked him, "Why not hexadecimals?" He had a sheepish grin on his face. I did not probe further.

Thursday, November 26, 2009

You're probably really famous but...

Sample an email I received this evening:

Hi Kamal,

How are you?

Srinivas

The 'from' in the email also just said Srinivas. Now, which Srinivas is this? I know like a hundred Srinivases. In fact, statistics show that every third person in the state of Andhra Pradesh is called Srinivas! Well, ok, not every third. But probably somewhere close.

What I really fail to understand is why some people do not put their last name in their 'From' field while setting up their email. Heck, some people do not recognize me when I sign as Kamal Shah. They know me as Kamal D Shah and they wonder who Kamal Shah is!

And you actually have people who sign off with just their first names! I can understand if you have a name like Seewoosagur Ramgoolam. If he signed with either his first name or his last name, anyone who knew him will instantly recognize him because there probably is no one else on earth with that name!

But Srinivas? Nah!

One year at Grene

Yesterday, I completed a year at Grene. A good year. The best part of this year was the return to active development. Return, did I say? Well, I wouldn't call it return exactly. I was hardly ever in active development. Circumstances forced me into management a little too early in my career. Apart from the first few months of my career, I did not do a whole lot of coding.

This year has pretty much been all coding, which I have thoroughly enjoyed. The joy of actually building something that works, the thrill of seeing people use something you have built, the high of receiving praise for something you have done are all indescribable!

Management is somehow not as satisfying. The primary reason for this is it is your team who is doing all the work. Yes, somewhere down the line, what you have done is the sum total of what your team has done. But still, despite that, the feeling of personally having accomplished something was never there.

This is what I like about my current job. I can see what I have done. I can identify a problem, very often, the moment I see one. I am totally hands-on. When I see what I have done it feels good. Because I know that I have built that, line by line, class by class, screen by screen.

There are some really good things about Grene. I have been given a good amount of freedom. Features were discussed and arrived at. There was no sales guy dictating how the product should shape up. It was all a joint effort. Everything was collaborative. My managers also have been very visionary in that they had a fair idea about what they wanted in terms of the high level qualities of the product. They gave me complete freedom in how to achieve those high level objectives. Very often, there would be a review meeting. I remember leaving those meetings all charged up and excited, unable to wait to get down to implementing those ideas!

Let's hope I continue to enjoy my work in the months to come!

Tuesday, November 24, 2009

I will at least know if there is a ray of hope

My native kidney disease is Atypical Hemolytic Uremic Syndrome (aHUS). My first transplant - my mother was the donor - did not work out because they suspect aHUS recurred in the transplanted kidney. Subsequent examination of the slides of a biopsy of the transplanted kidney revealed that it could have been cyclosporin toxicity too.

The problem with aHUS is that there is a high risk of recurrence of the disease after a transplant. At the time of my first transplant in 1998, I had done a lot of research on the internet about this disease. Many papers referred to Dr. Bernard Kaplan of the Children's Hospital of Philadelphia. I got in touch with him and sent him the biopsy slides. My mother also met him later in a trip to the US. He suggested that I get my blood checked for some genetic defects that have been associated with aHUS. There was a Dr. Tim Goodship in the UK (Newcastle upon Tyne) whose lab was doing this study.

I got in touch with Dr. Goodship's lab. They offered to test for the genetic markers implicated in aHUS. Basically, I assumed, that if they did not find the genetic defects in my blood samples, I would consider a second transplant. They agreed to do it without a charge. I sent the samples. After a few months, the reports came back negative which meant that they could not find the genetic defect that was implicated in aHUS. Further study however revealed that the genetic defects they had looked for were only in a small percentage of the population with aHUS.

Recently, there have been some more genetic defects that have been associated with aHUS. There has also been a lot of research that I have found on the internet. There is also a drug called Eculizumab that has been successfully used in a lady with aHUS after her transplant. Most of the work in this area refers to a Dr. Giuseppe Remuzzi of the Mario Negri Institute in Bergamo, Italy. I sent him an email a few days back giving him a brief history of my problem and asking him what he thought about another transplant. His team got back to me and said we should perform some more tests to determine if the additional genetic defects that have identified in the last few years were present. After that they would recommend the course of action. They have offered to do the tests for free.

I have to send some samples of my blood (after some complicated processing - I have started the process of inquiring who in Hyderabad can do the processing) to Bergamo, Italy. The samples have to be packed in 7 kgs of dry ice in a thick thermocole box and must reach Italy in a maximum of two to three days. I am checking with Fedex if they can do this.

The end of this whole exercise is not a functioning, healthy kidney. The end of this whole exercise is simply to know if I should even try to get a functioning, healthy kidney.

Sunday, November 22, 2009

Treating Vitamin D deficiency

I went to my nephrologist a few days back to discuss my Vitamin D deficiency. He wasn't as alarmed as I had expected him to be. Now, he is a guy who doesn't hide his emotions. For example, when I told him my feet felt numb a few months back, he exclaimed, "Oh, no!" Not very comforting to hear your doctor say that, is it? He thought it could be early signs of a stroke. In the end it turned out to be peripheral neuropathy, which is not even half as worrisome as a stroke!

Anyway, he wasn't worried at all. The test which I got done indicated the level of 1 alpha 25 dihydroxy cholecalciferol (1 Alpha D3), which is the active form of Vitamin D. The Vitamin D that we take in as part of food and the sun is basically an inactive form which the kidney processes to form 1 Alpha D3 which is used by the body to increase the absorption of Calcium from the food we take in. So, basically if there is a dip in this level, Calcium is not absorbed enough by the body and the bones become weak and brittle and then pain.

The test that is generally done, at least in Hyderabad is for the inactive form of Vitamin D which is not an accurate marker. The test that was done at Yashoda hospital was for the active form which is a more accurate indicator.

So, my neph put me on Calcitriol 0.25 micrograms a day. I was asked to take this for a month and then check my Calcium and PTH level. The problem with Calcitriol is that it causes Hypercalcemia and Hyperphosphatemia, basically increased Calcium and Phosphorus levels in the blood. My Phosphorus has been consistently low ever since I started daily nocturnal dialysis. So, this will be a good side effect for me!

The levels of Vitamin D are also linked to the levels of PTH in the body. My PTH has been really high for a few months now and I have been taking cinacalcet for this.

There are a couple of other drugs available now (not sure if they are available in India though) - Zamplar and Hectoral which are supposed to have lesser side effects than Calcitriol. I must check and discuss them with my nephrologist.

Either way, let's hope the bone pain settles down soon.

Thursday, November 19, 2009

Adding multiple items to svn in one shot

If you're using subversion or some other version control for your code (if you're not, then you're really doing something wrong unless you're the only developer on the project and even in that case, there are some really good reasons you should be using some version control, even if it means SourceSafe. Well, I was kidding about SourceSafe. Heck, even Microsoft does not use SourceSafe! Any version control except SourceSafe!) chances are that you have been in a situation where you just added a bunch of files to your project and were now faced with the arduous task of adding the whole goddamned bunch to the repository.

I added about 35 images to my project this morning. I was for a moment, wondering how I could avoid adding each image, one by one to the repository. I did not, for the life of me, want to do:

svn add imageFileName

35 times over.

I wasn't using Eclipse which would have probably done this for me in a breeze. (When is there going to be a Cocoa or a Cocoa Touch plugin for Eclipse, btw???)

Google, as you know is my friend. I googled and found stuff. But beware - the first hit in Google does not give you a method that works. The second does, which I reproduce here for you: Open a terminal and navigate to your folder and type:

for i in $(svn st | grep "?" | awk '{print $2}'); do svn add $i; done;

and katakatakatakat.... all your files will be added to your repository in a jiffy!

What's the big deal about this? Not too big. Anybody with a rudimentary knowledge of shell scripting or the Unix command line could have figured this out. Well, true! But how many people do?

You might ask, if you feel all programmers should know shell scripting, why did I need to Google this? Why could I not do it myself. Good question. Next question.

Wednesday, November 18, 2009

Low Vitamin D level

My Vitamin D level report is back. The value is 3.2 pg/ml. The normal is 19.6 to 54.3. So, it is really, really low.

I am going to my nephrologist with the report tomorrow. I am really worried about this. There will be a supplement which I will be prescribed. So, it should settle down soon.

But what worries me is the larger picture. How long has this level been low? I noticed something wrong when my bones started to pain. I wonder what other damage this has caused.

What if I had tested my Vit D levels earlier? This could have been avoided. How many other things are happening in the background? Why wasn't I told about this?

Saturday, November 14, 2009

400 posts and counting!

Ok, this is post no. 400! Wow! That's quite a lot.

Its been more than two years of blogging and 400 posts. I remember starting off inspired by Akbar's blog. To start with, I would write every once in a way. The frequency of the posts slowly increased. I had much more to say. I began enjoying the process thoroughly. Blogging was my manna for the day.

I was going through some of my older posts. I noticed that along with the frequency of posting, the average length of my posts has also gone up. Here's a link to my first post which is incidentally about ten years with kidney disease. Those ten years have now become twelve and a half!

No great surprise - my favorite posts are centered around my favorite things.

At one point I started a series on food. The posts mostly started with "In search of the perfect" and described a particular dish. I loved doing these posts! Unfortunately, I have exhausted the list of my favorite foods.

Then there were the series of posts on the story of my life. I eventually gathered all the links and put them on the top right corner of the page. These posts helped me describe the major events in my life.

I loved doing the posts on funny, little incidents in everyday life. My brother complains that I haven't done this kind of post in a long, long time. But then that's how this is. Nothing terribly funny has happened recently! You can read some of those posts here, here, here and here.

I have always enjoyed reading comments to the posts. Comments on the post reinforce the fact that there are people who are reading the blog and are reacting to it. I have received a few nasty comments but by and large, they have been encouraging and warm. The post about a family game attracted the most comments (10) followed by the story of my diagnosis with CKD up to the transplant (8).

What makes me blog? What is it about blogging that I like so much? For one, I love to write. I love to put my thoughts on paper (or keyboard!). But what really keeps me going is you, dear reader, who have kept reading this blog! I really thank you from the bottom of my heart for this!

Friday, November 13, 2009

Lidocaine - to use or not

Lidocaine is a local anesthetic. It is used extensively in surgeries to make areas of the body numb before making an incision. It is often used before dialysis to make the area where the needles are going to be inserted, numb.

Many people do not use lidocaine. The argument is the lidocaine itself is painful while injecting. So, why bother? I used to use lidocaine every day but was advised by many people not to use it. I then stopped using it without too many problems.

For the past few weeks, however, despite using buttonhole needles, cannulation had become painful. I dreaded the whole process. Even the venous sites, which were generally really trouble-free for months, started paining. And it was not the angle that was wrong. I was cannulating myself everyday, so I couldn't get the angle wrong.

A couple of days back, I decided to use lidocaine after I read on the 'I hate dialysis' forums that others too, had similar problems. I somehow believed, for the longest time, that I was the only person in the world who couldn't bear the pain with buttonhole needles. Pain with buttonholes? Nah, don't be a sissy! The needles are blunt, for God's sake! I could almost hear fellow dialyzors from the US say. But then I read this thread on the forums that had people say that the buttonhole needles pained too.

I started using a little lidocaine - just a tiny bit - in both the venous and the arterial sites. The pain is Z-E-R-O. As simple as that. Well, there are possible side effects of using lidocaine. I really can't help that. It just makes my life much simpler to deal with. So, for now, I am going to continue using lidocaine and have painless cannulations.

Thursday, November 12, 2009

Bone pain

For about a month now, I have been having pain in my bones - mainly in my ribs, my back and my feet. When I sit for a little while and then get up, my walking is a little painful. The pain is not unbearable but it is uncomfortable.

I have had a high PTH for a few months now and have been on cinacalcet. We're still trying to arrive at a 'correct' dose. My PTH is around 640 now. I have also had a low Phosphorus since I've started nocturnal.

I saw my neph a couple of days back and he suspects that the Vitamin D levels are off. I used to take Alpha D3 capsules before I got onto nocturnal. The plan is for me to get a Vitamin D supplement if the level is low.

I posted this problem on the Home dialysis central forums and the 'I hate dialysis' forums. There are others who have had a similar problem and Vit D supplements did help. Maybe I should start off on it right away. But then the blood test might show a wrong value. So, I will wait till the test is done.

In one of the responses to my question, I was told that people on nocturnal should not take cinacalcet. Or so the responder had heard at a conference a while back. I am trying to look this up on the internet. I have not heard of this before. And neither have my treating docs.

Wednesday, November 11, 2009

If only someone else could worry on my behalf

Like I said a few weeks back, if it was only the dialysis I had to deal with, it would be really all right. Its the whole set of side effects that puts me off. At one point, it just becomes too much to deal with.

Take PTH, for instance. Many people on dialysis have secondary hyperparathyroidism - the Parathyroid Hormone (PTH) levels increase in the blood. This is associated with many side effects. It also affects the levels of Phosphorus and Calcium in the body. Each of these have their own effects.

My PTH levels skyrocketed a few months back to over 1000 (the normal is less than a tenth of that). My nephrologist started me on cinacalcet, supposed to be a wonder drug for secondary hyperparathyroidism. Within 6 weeks, my PTH levels were normal. But my nephrologist said that for people on dialysis, it should be a little above normal. So, he asked me to stop cinacalcet. And then take a reduced dose.

Happily, the PTH level rose again, first to 353, after which I increased the dose further and yesterday it was 642. Yes, I know, increase the dose again, you would say. But it can be quite tiring to keep thinking about this. Especially when there is no standard protocol for most of these conditions. Every human being is different and there are no established patterns for many of these co-morbidities.

It would be so nice if my doctors would worry about these conditions, read up on the internet and then confidently prescribe whatever is necessary. It would be so nice if I did not have to bother about the long term effects of having low phosphorus and high PTH levels. It would be so nice if I could leave everything to my doctors and be cocky that I am in the best hands!

Friday, November 6, 2009

These are a few of my favorite things

Yesterday, Dori Schatell, posted the five things she couldn't live without on Facebook and asked her friends to list theirs. That set me thinking. It didn't take too long actually. Within a minute, I could list the five things I couldn't live without.

Well, these do not include silly things like air, food, water, dialysis etc. Rather, these are things that I actually love and make life meaningful and enjoyable for me. So here is my list, in no particular order:

1. Darjeeling Tea

I have a cup of black Darjeeling tea every morning. This is usually the first thing I do in the morning after I wake up and get off dialysis. I put water to boil in my electric kettle, measure out about one and half tablespoons of Darjeeling tea and then brew the tea for 4 minutes. I add about 2 teaspoons of sugar and then sip the heavenly concoction sitting by my lawn slowly taking in the purity of the morning air. This really gives a serene start to my day.

2. Idlis

I have always been a huge lover of idlis. For nearly two years now, I have been going to a place called Poorna Tiffins, a 11 kilometer drive every week to have really good idlis. I love good idlis and I don't mind going any length to try good idlis. A taxi driver, once remarked what it was about idlis that made me hitch a ride in Chennai, one rainy morning in search of the famous Murugan Idli Shop which has really good idlis. I had no answer! Idlis are another example of how the best things in life are the simplest.

3. Swimming

I go for a swim every morning. Even in winter. Swimming is what keeps me going. It is what has helped me keep fit (and won me many compliments!). The best part about it is that it is good for the body! When you enjoy something that is good for you so much, what more can you ask for? My half hour swim every morning is the best part of my day. I really love the feeling of being totally inside cool water. Have you looked at the surface of the water from inside the water? Or seen the rays of the morning sun dance on the ripples on the water's surface? No? You should. These are the simple beauties of life that must be experienced.

4. My MacBook Pro

I love my Mac. It connects me to the rest of the world. It helps me keep track of my life. It helps me earn a living and have fun, all at the same time! I got hooked to the Mac about 9 years back (thanks a ton Obul!) and have never got over the obsession. I can never switch to another platform now. The ease of use, the great user interface and the exceptional development environment has no match anywhere else. I actually have a T-shirt that says, "Hello, I am a Mac" with an Apple logo!

5. Travel

I love to travel. I love exploring places I have never seen before. Every few months, I like to head off somewhere or the other and take a few days off from the mundane routine of daily life. Unfortunately, I am not able to travel as much as I would have liked to because of the restrictions that dialysis imposes on me. Dialysis centers are available only in major cities in India and these centers do not as yet offer nocturnal dialysis. I am waiting for the day when portable hemodialysis machines are introduced in India. I will be able to travel unfettered then.




Wednesday, November 4, 2009

Quiet working spaces

Software programming is primarily a mental job. Your entire work is done by your brain. Whatever your brain thinks is eventually typed by your hands on your keyboard to form the code that forms the software you're working on.

Now, the brain can process seven plus or minus two chunks of information at the same time. It is important for the software programmer to utilize as many as possible of these seven plus or minus two chunks of information on the work he is doing. That gives him the best results.

Now, imagine a scenario where there is a programmer in a room where there are other programmers, sales people, managers and what have you. To an extent, it is all right to have other programmers who respect the need for peace and quiet. But heaven help the programmer who has sales folk and managers in the same room. The primary job of these two categories of people is to talk. Often without thinking. But that's an entirely different story.

So, when you have these myriad people performing different roles in the same room as programmers, it is a sure recipe for disaster. Well, maybe not disaster, but definitely a lot of wasted man hours. A few chunks of the seven plus or minus two are taken up by the various conversations going on in this room. This greatly debilitates a programmers ability to do a good job at what he's doing.

Even if companies cannot afford to give programmers individual, enclosed rooms, they should seriously consider giving a group of programmers separate rooms where peace is guaranteed.

This will tremendously increase overall productivity in the company.

Tuesday, November 3, 2009

Hemodialysis starting kit - shortage all around

Ever since I have started home hemo, I have been using a small little sterilized kit that has a small plastic tray, six cotton balls, 6 gauze pieces, a paper towel and a sheet to place the cannulated arm. This was very convenient because you did not need to sterilize these things manually. These were available from a couple of suppliers.

To start with, I was using the dressing packs I had left from my days on Peritoneal dialysis. Subsequently I started procuring the special hemo kits. I used to get them from Universal Biomedics in Chennai. Subsequently, however, I found another supplier based in Vijaywada. For the last couple of months there has been a shortage of these kits.

I now have only about 5-6 left. I use one per day. I have tried Universal Biomedics and they have stopped dealing with these kits. The Vijaywada supplier also claims helplessness.

Anyone who might have any idea about where these kits might be available, please leave a comment or send me an email. I shall really be thankful.

Monday, November 2, 2009

Touched

I played tennis in the same center as Sudhir. This was when I was in school - around 1986 to 1989, I think. He was a friendly guy and he came home to spend the day with my brother and me a few times too. Then, as it happens so many times, we lost touch.

About three years back, I heard about him through a cousin of mine. Both of them were colleagues and they got talking about tennis and then realized that they both knew me. Sudhir was keen on meeting me and we finally met at my cousin's wedding. We spent a whole lot of time together that day reminiscing about the tennis days. He has a fantastic memory and remembered minor details about those days.

We've kept in touch ever since.

Sudhir has kept up with tennis. He is now a very good player and has won a few tournaments held in his company too. Tennis is his passion and he never misses an opportunity to play.

He drops in usually on Saturday mornings and we chat for an hour or so. He got to know about my kidney disease some time back (before we met after many years). He is quite concerned about my medical condition. He tries to understand as much as he can. A few weeks back he chanced upon the videos of my dialysis sessions and called me to say he was quite alarmed that I underwent that procedure every night!

A couple of days back, the bell rang around 8:30 in the night. It was Sudhir. He had dropped by to say Hi. A little later my tech came. I excused myself and said I needed to go and start my dialysis session. He asked if he could see it. I said, "Sure, provided you are comfortable watching needles and blood!" He said he was ok with that.

He sat through the next half hour or so patiently, saw me cannulate myself and eventually start the session, trying to understand the whole process. After that, he sat next to me and further discussed what dialysis was and how it worked.

I was really touched. It felt really good that someone was concerned with what I was going through and tried genuinely to understand the procedure. I undergo this procedure every night. It is harrowing - for me at least - to cannulate myself every night and then sleep while being hooked to a machine. All this, to try and live a life that is close to normal. It really feels good to see someone try to understand what you're undergoing and empathize with you. It reemphasizes to you that you're not alone in this world and there is someone you can count on for support in times of distress. Thanks Sudhir!

Saturday, October 31, 2009

Blood drops keep falling on my bed...

Well on the floor, actually. But that didn't rhyme with the song! Ha ha ha.

What happened was - this morning, when we (the tech and I) got up as the machine signaled that the treatment was done, we noticed that the bucket that is placed below the dialyser had blood in it. Well not a whole lot, but there was blood. Blood has this nasty habit of looking quite gross. The bucket usually has the saline that is used for priming the dialyser and tubes. Even a few drops of blood in that saline can look quite scary to the uninitiated.

The cap of the dialyser was probably not screwed on well enough. It probably was not in line with the threads. As a result blood kept slowly dripping out of the dialyser into the bucket. Drop by drop. Through the night.

My calculation based on my weight which I measure before and after a session was that I lost around 200 ml of blood.

There is actually a device called the Dri-sleeper which has a sensor that is connected to a beeper. Many people on nocturnal dialysis use two of these devices. One is taped onto the arm near the cannulation sites and one is placed below the dialyser. I have used this device for my arm in my early days on nocturnal when I used to ooze quite often from my cannulation sites. I have however, stopped oozing and hence, stopped using the device ever since I started tying my hand to avoid movement of the cannulated arm.

I have never used the device below the dialyser though. This kind of leak from the dialyser has happened only once before and at that time too, the quantity of blood lost was much less than that I lost last night.

I have found the device. I am going to try it out today by placing it below the dialyser.

Some might say - these kind of risks are not worth taking. Maybe you should reconsider nocturnal dialysis. I don't agree.

Nocturnal dialysis is what makes my life worth living. Yes, there are risks. But there are ways to minimize them. I can never imagine myself undergoing in-center again especially now that
I am used to daily nocturnal at home. Without panicking, I have to take adequate precautions so that these kinds of incidents don't repeat.

Thursday, October 29, 2009

Hot water to help reduce amount of water consumed

I have found drinking hot water instead of cool or cold water helps in drinking less water. People on dialysis need to restrict the amount of fluids consumed. Water is probably the most commonly consumed fluid. So it is important to restrict the amount of water consumed.

When I drink water at room temperature or water that has been cooled, I find it easy to gulp down a lot of it. In fact I need to gulp down a lot of it for my thirst to feel satiated. There is a region in the throat that needs to feel the water for some time for this happen.

I switched to drinking hot water instead of cold water a few days back. I found that I could manage to drink much less than I needed to drink with cold water. I felt satiated pretty soon - with a couple of sips. I can't gulp down hot water - it's hot - I can only sip it. And that's the key. Sip the fluids.

In the end, I drank much less than I usually do.

Tuesday, October 27, 2009

The clock starts ticking

For the last three and half years, Jayaram, a dialysis tech has been coming home every night around 10 to help me start my dialysis treatment. Once the session starts, he sleeps in the same room on a mattress. If there is any problem, he wakes up and takes care of it.

Jayaram is an excellent tech. He knows the ins and outs of a treatment. He knows what to do if any problem comes up. I have complete confidence in him. When he is around, I am not at all worried. Even if anything goes wrong, I know he will be able to handle it.

Once in a way, he cannot come. He sends his brother, who is also a dialysis tech to fill in for him. This guy is not half as good as Jayaram. I am a bundle of nerves when he is there.

Jayaram is in his mid-twenties. Of marriageable age. Probably very eligible in his circles. I have been thinking about this for a long time. When Jayaram gets married, obviously, he will not be able to come home for my treatments. Then what?

I have been wanting to learn the treatment myself. I did actually. For a few months I would start the treatment myself entirely. Jayaram would come often after the treatment had started. But then, there were a couple of incidents where some complications arose. My family and I got a little nervous after these incidents. Ever since, I have been waiting for Jayaram to come and start dialysis. (I do the cannulation myself, however.)

This morning Jayaram mentioned that his family had a girl in mind for him and he was going to see her today. I realized that the process had started. Sooner or later, he would find a suitable girl and get married. After that, what?

I realize that I need to get trained in starting and stopping my treatments and handling any complications that might arise. There is just no other way. Fresenius has been talking about home hemo training in India. I have no idea when that is going to materialize.

I am too used to nocturnal home hemo and its comforts to even consider in center hemo. I will have to find a way to get trained really soon. The problem with me is I think about all these things only on weekends. The moment Monday mornings come, I get so busy with my work that I don't have the time or the energy to think about the other, more important things in my life.

Monday, October 26, 2009

Yippee, finally figured out how to disable app updates in Facebook

For a long, long time, I have been wanting to disable getting updates about how my friends were doing on the different applications and quizzes on Facebook.

I couldn't care less about an ugly duckling (or a black sheep or a lonely cow) that appeared in X's farm in Farmville and could do with a new home. Or what Mystic Meg predicted for Y. Or who Z was going on a date with.

To start with, I had a few friends and the app craze hadn't quite caught on. Gradually, however, the number of friends I had on Facebook increased. And unfortunately, their fascination with crap like Farmville did, too.

The result - every morning, when I would religiously access my Facebook news feed, I would be inundated with updates like these. The real updates I was interested in - more important stuff - what A had for breakfast, for example, or some what B did during the weekend would be lost in the junk. And since Facebook showed only a limited number of updates (you have to click on the "More" to see more), I would lose out on all the good stuff.

Checking FB twice a day solved the problem for a few days. But my friend list grew and again, the app craze did, too.

This morning things became a little too serious. About 70% of the updates on my news feed were crap. Farmville, Mystic Meg, Anita, the psychic and what have you. No way I was going to let this become worse.

I went to Settings. I went to Edit Options. I went to every possible link to see how to Disable App updates from Friends. No luck. Google too did not help. There was some stuff about how to do this on Firefox. I use Safari. I wasn't going to let this trivial thing make me switch browsers. I then noticed a small little "Hide" link next to every update on the feed. I clicked on it.

Aha! I found it!

There was a "Hide Farmville" link inside. Cleverly tucked away inside a menu. So that nobody could find it! But I am cleverer than they think I am.

I hit my laptop trackpad quite hard while clicking on the link, actually. It was a victory of sorts. I then went ahead and disabled every freaking application. Farmville, Mafia Wars, Dates, Meg, Anita. All of them.

Now, my Facebook feed looks so much better. Almost like its had a nice shower. Only the important stuff. No chaff.

Sunday, October 25, 2009

Free dialysis - coming soon to a center near you

The Andhra Pradesh state government is extending the Aarogyasri program for dialysis. Very soon, 111 new dialysis centers are going to be operational. People with Aarogyasri cards can avail of dialysis thrice a week at these centers free of cost.

This is truly revolutionary.

So far, dialysis under the Aarogyasri scheme was limited to existing centers with their limited facilities. Very few people could undergo treatments. Also, the coverage was only for twice-a-week dialysis, clearly inadequate by any standards. The new scheme increases the coverage to thrice a week dialysis - of course, still inadequate, but an excellent step ahead, at least by Indian standards.

Is this utopia? Far from it.

There are two basic problems when you talk about dialysis in India. One is the dialysis providers, the cost of treatment and the payment model and the second and more serious problem is that of knowledge among the patient population. Patients and their caregivers (family) do not understand that dialysis is solving a problem - that of kidney failure. They treat dialysis as the problem. This mindset causes a large number of problems.

For example, when I tell a fellow patient (and even some doctors) that I dialyze every night, for seven hours each night, they are shocked. Why?! Do you need that much dialysis? That is the common refrain. They do not understand that the more you dialyze, the better it is - both in the short term and the long term.

I have people tell me that their doctor has asked them to dialyze thrice a week but they feel all right with twice a week dialysis. Why should they go thrice a week? The cost of dialysis and the fact that most people have to pay out of pocket for their treatments has a huge role to play in this "Why more" mindset.

Hopefully with the state providing for thrice a week treatments, we will see better compliance with the increased frequency prescription.

Thursday, October 22, 2009

Arterial buttonhole

I have been using two pairs of buttonhole sites for the last couple of months. The venous sites are always well-behaved. Not much pain. The tracts are well formed. The needle goes in smoothly. The arterial fellows are usually badly behaved. They give me trouble every night. Almost.

I don't know what the problem is, really. The needles do go in for the most part. But there is a stinging pain. I used to inject a little lignocaine which would make the actual cannulation comfortable (even if the lignocaine itself stung for a few seconds!). But I was told by many people to avoid using lignocaine. So, I tried that and have been avoiding it for the last few months.

A couple of days back, the arterial needle just wouldn't go in. No matter what I tried. Touch cannulation, rotating the needle slightly, pushing and tugging. Nothing worked. I then switched to a sharp needle and started the treatment.

The next night I used the alternate site and everything was fine. Last night, back to the troublesome site, I used a sharp again. I have no idea where this is going. But for the last couple for weeks, the thought of cannulation has me all worked up towards evening.

Sometimes I think, what the hell, just use the lignocaine, never mind the side effects. But then I think what if there are some really bad long term effects? So, I am trying to avoid it for now. Let's see how it goes.

Saturday, October 17, 2009

Lighting up a life - the story of Diane Franks


Diwali is the festival of lights. In millions of homes all around the country, people light 'diyas' or lamps to celebrate the festival. The lamp symbolizes light in a dark world. Just like Diane Franks.

Diane Franks is a healthy individual living in the UK. She is currently undergoing an evaluation to determine whether she can donate one of her kidneys to someone who needs it. The amazing thing is she is going to donate the kidney to an unknown person, someone she will never meet, someone she has no relationship with.

Giving a kidney to a loved one in need is the best gift anyone can give. My mother gave me one of her kidneys and I can never thank her enough for that. We see many examples of people donating to their parents, children, siblings, spouses etc. And each one of them is an act of genuine sacrifice. Each of them deserves tremendous appreciation. It is not easy to agree to undergo a major surgery and giving away a part of you even to a person who is so important to you.

Diane Franks takes this to an entirely new level.

She is going to be donating a kidney to someone she doesn't even know!

What do you say about this? Why is she doing this? What prompted her to decide on this?

In Diane's own words, "...I do not like the thought of people struggling, wanting help and not getting it. I know the emotional pain and depression it can bring and believe me, no one should have to go through that. If I can give help to someone, I will – and God willing, I hope that is what I can do in this instance."

Diane will not be meeting the person her kidney goes to. She will not even know how the person is doing. It will be, as she says, an "emotional hole" for a while. I really wonder why this is so. Wouldn't it be great for a donor to be in touch with the recipient and see the difference she has caused in someone's life? Wouldn't it be fulfilling to see the change she has been a part of?

People like Diane Franks reaffirm our faith in humanity. They are like the lamps of Diwali. Bringing light in an otherwise dark world. Read her story here.

Friday, October 16, 2009

Are white lies used by managers really beneficial in the long run?

Let me tell you about a little incident from my days as a manager at Effigent.

I was managing a project with a small team. We were working on a particular feature which the customer had asked for. I had a call with the customer one morning and discussed the schedule and by when he would like the feature to be deployed. The customer said he would like it by next Monday. It was Thursday. We had about 8 working days.

I came out of the meeting and called my team. I told them that the customer wants the feature to be deployed in a week! Without cringing one bit! I had developed quite a knack at telling 'white lies'. Lies that did not do any great harm but were lies nevertheless.

In my defense, I knew by then that most software tasks take more than what you budget for initially. So, I thought if I gave 5 days, it would eventually get done in 8 days and we would meet the customer's expectations. If I gave 8 days to start with, the task would get completed only in about 11 or 12 days and we would lose face with the customer.

There is a flaw in the reasoning above.

The amount of time taken to complete a task is assumed to vary based on the time at hand. This may be true in some cases, especially when your team is comprised of people not diligent enough. I couldn't say that about my team. They were all conscientious and sincere. But, this was a problem of habit. I was habituated to shortchanging my team on deadlines.

Now, on the other side of the fence, I get irritated when my manager says, "We have a demo tomorrow. This really needs to get done today!" And then we work hard, stretch and get all tense by evening and complete the task for the demo, possibly even jeopardizing the product in the short term. And then next day, no demo happens!

What has happened? By creating an artificial deadline, the work has actually been increased. The quality of the product has been compromised. Our manager has lost our trust. By doing this a few more times, we could have a 'cry wolf' syndrome at play!

That is why, after all these years in the software industry, I strongly feel, management of software teams really needs change. More common sense. Less processes.

Tuesday, October 13, 2009

No dialysis for 2 days - how it felt

When I went for the trip to Vizag and Araku, I did not dialyse for two nights in a row. I have done this very rarely. Only twice before, I think. This is a classic problem. If you want to do a meaningful trip, you have to go for atleast two - three nights away from home. That inevitably brings up the question of whether to try and get dialysis at a hospital or skip a session or two.

I have been dialysing at home for the last three and half years. Daily nocturnal mostly. I do not dialyse on Sundays. That means I am without dialysis only for one day at most. The problem with dialysis outside home is that first of all, no one allows you to dialyse for more than 4 or 5 hours. And they do not have night sessions. I am used to seven hour sessions at night. This means that I would have to spend about 5 to 6 hours (including time to get to the unit and back and the startup and close up time) of my waking day on dialysis. Not a very good thought when you're on a holiday!

Another thing which bothers me about dialysis away from home is the cannulation. Many centers do not even know about buttonholes or self cannulation. So, I have to explain to them that I do my own cannulation and I use my own needles. Last time I dialysed in Goa, the tech called the neph and explained that I wanted to cannulate myself and use 'different' needles. Thankfully the neph agreed. What if he hadn't?

On the other hand, not dialysing has its own share of problems. You have to watch your fluid intake. It is difficult to control sodium too. Most places will not oblige you with salt-free food. Since I was at a place where I was for the most part inside water - a beach, a stream etc., I did not have a problem. But if the place was less conducive to restricting fluids, I would probably had a miserable holiday - fretting about fluids all along!

At the end of the day, I put on very little fluid weight until I got back home. But then, when I knew I was close to my dialysis machine and that I would get on to the machine in an hour or two, I kind-of took it easy and gulped a little more than I should have. I put on 6.2 liters over 3 days and 2 nights. Which wasn't too bad!

Sunday, October 11, 2009

Friday, October 9, 2009

Trip to Vizag and Araku - 3

We reached the Haritha Valley Resort at around 1:30 in the afternoon after an excellent journey through fog and greenery. We checked into our rooms and had our lunch. We then headed out to Chaparai - slippery stone in Telugu. This was about 14 kilometers from Araku.

A few kilometers on our way, we stopped to take a look at a stream that was flowing below a bridge. A group of village women who were carrying bundles of sticks, probably transporting it somewhere on foot, had stopped on the bridge to take a break. Srinivas asked them how far Chaparai was from there. They said it was very far. We were quite surprised. One of them then said, "If you go by car, it is not very far, but by foot, it is very far!" A very telling comment on the different perspectives different kinds of people have. For us, 14 kilometers was nothing. For these women however, 14 kilometers meant probably many hours of walking.

Chaparai is basically a perennial stream that flows over a sheet of rock. The stream gushes over hard rock and forms a shallow bed where you can walk over to the other side where there is a natural water slide! You have to walk down a flight of steps to get to the bank of the stream.



On reaching the place, we quickly changed into our swimming gear and ran down the steps to the bank. Initially we were a little hesitant to get into the water. There was a guide who offered to help us across the stream. Slowly, he held Srinivas' hand. We held each other's hands, formed a chain and trudged through the stream. We had to be careful because we couldn't see the rock below through the water. There were crevices which could hurt us and we had to avoid these by simply guessing their location by looking at the patterns of the flow of the water! The guide, of course, knew where the crevices were and he warned us in advance.



At one point, there is a small bridge, about 2 feet long. This was to help cross a deep gap in the rock. There was this old man standing at the corner of the bridge who told us that we would have to pay Rupees Three per head to cross the bridge. This was a riot! We agreed, of course.

We made our way to the middle of the stream where there is a portion of the rock where there is hardly any water and you could stand there safely for a while. The atmosphere was almost like a festival. There were quite a few people there. Many people had started sliding down the natural water slide on the side of the stream. The water was gushing really hard there and we were a little nervous about trying the slide.

There was also a point in the middle of the slide where people 'bumped' up before continuing. It looked like there was a piece of rock there below the gushing stream. Srinivas and Laxman, brave-hearts that they were decided to give it a shot. One by one they took the slide. They looked like they had fun. They told me that the point where the slide ended had sand below so it did not hurt at all when you landed.



I couldn't resist the temptation. I slowly made my way to the top of the slide. Note that the whole area is covered by the gushing stream and there is hard rock with crevices below which you cannot see. There was this guy at the top of the slide who was playing the good samaritan. He was helping people take a good start with correct positioning of the feet. If you don't position your feet correctly, the water can actually sweep you down the slide. Not life-threatening, but scary nevertheless.

I took position. Looking at the water forcefully make its way down the slide from top was quite unnerving. For a moment, I had second thoughts. I almost turned back. But then the thought of sliding down with the force of the water got to me. I gave in.

Whoooooosh, bump, whoooooosh, whooooooosh, splash!

Within a few seconds I landed into the pool of water above the bed of sand. For a few seconds, I lost control and was being dragged away by the stream. Thankfully, there was rock ahead and I held on to it. But it was great overall. I did sustain a bruise but the exhilaration of going down the water made it worthwhile. No slide in a water park can offer the thrill that this natural slide offered.



We played around for a while in the stream taking pictures and then walked back to the bank of the stream, more confidently this time. We dried up and changed and then got back to our resort.

We had dinner at another resort.

The next morning, we started back for Vizag. On the way back, the weather was quite different from what we had experienced the earlier day. We were really lucky the previous day.

All in all, we had a great trip, memories of which we will carry for a long, long time to come.

Thursday, October 8, 2009

Trip to Vizag and Araku - 2

We started at around 9 in the morning for Araku. The weather was perfect. There was a slight drizzle. As we got out of the main city, the surroundings became more and more beautiful. The lush green countryside and the forested hills with the clouds perched on top were a treat to the eyes.



After a while, we began our ascent of the hills. The view of the valley below on one side of the road was really good. Terraced plantations and a lone cottage here, a sleepy hamlet amidst green fields there, we soaked in what that moist October morning had to offer with amazement.

We encountered our first stream about an hour into the journey. Like happy schoolboys, we played with the water, washed our faces and climbed the rocks through which it flowed. It was like a mini-waterfall. We encountered more such streams on the way, one of the advantages of taking a car to Araku rather than the train where you have no control of where you want to stop.



The moist morning caused a lot of fog which made the whole experience ethereal. The dark green cedars almost touching the sky with the fog around them looked beautiful indeed. At one place, near the Ananthagiri coffee plantations, hawkers had set up small roadside shops where they were serving coffee. Sipping the piping hot coffee in those foggy surroundings was really magical.



To get to the Araku valley, we had to go down the hill eventually. We were wondering if we had just completed the best part of our trip. We hadn't.

Wednesday, October 7, 2009

Trip to Vizag and Araku - 1

It is the time of year when the travel bug really gets to me. I just have to go somewhere. So, I quickly checked with my friends about doing a quick Vizag/Araku trip over the 2nd October long weekend. Everything fell into place pretty quickly. Kartik, A Srinivas, Murli, Laxman and I. There was, however, incessant rain in many parts of the state and all our families were concerned with us making the trip. We were undeterred.

We reached Vizag on the 2nd October morning. My first thoughts were, "What a beautiful place!" Vizag has hills on one side and the beach on the other. It had also been raining a little. This gave the whole place a fresh, clean kind of look which accentuated the whole experience.

After a sumptuous breakfast at the Dolphin Hotel, where we were staying, we headed out for the Yarada beach. I had heard so much about this beach. It was about an hour's drive from our hotel. You have to drive up a hill and then go down to the beach. The first glimpses of the beach from atop the hill were truly magical.

We took the entrance through a private resort to the beach. The beach was lovely. The water was cleaner than any beach I had seen in Goa. We quickly changed into our swimming gear and hi the water. The water was a little rough. Some of the waves tipped us over!



We then went over to the left side of the beach where there were rocks jutting out into the sea. We sat on the rocks for a while feeling the powerful waves lashing at us. One wave was so strong that it displaced me from my seat.



We showered and then started back for our hotel after grabbing a bite at the resort restaurant. Back at the hotel, a couple of us decided to hit the pool - no, we had not had our share of water for the day!

The next morning we left for Araku.

Thursday, October 1, 2009

Going back to the bay area - Bay of Bengal that is!

I am off on a brief holiday to Visakhapatnam and Araku tomorrow with a few friends. I am back on Sunday evening. We plan to visit the much talked about Yarada beach in Vizag and then go over to the picturesque Araku valley.

I would like to visit the Ketki falls and Chaparaya where apparently a river runs over sheets of hard rock.

The weather promises to be fun. Rains have been predicted in the area through the weekend. Let's hope the weatherman is right for once!

The last time I hit the Bay of Bengal, a tsunami was triggered. I really hope the sea is more kind this time!

Wednesday, September 30, 2009

My friend, the bachelor

I am quite surprised to find the number of bachelors I have among my friends. I thought I would do them a little favor and try and fix them a match. So, here goes - the list of the most eligible bachelors in town:

1. Mr. Nice - he is the essence of correctness. The guy whom every girl would love to take home to her parents. Take all the good things in this world and put it inside one human and you get Mr. Nice. A genius. An excellent techie. A wonderful human. I could go on and on.

2. Mr. SCDAFF - this guy can do anything for friends. If you're in a horrible mess, with insurmountable problems, unable to figure out what to do and need some support, no matter what, call him. If you hook him, you will get a best buddy for life and that sometimes, is more than a husband.

3. Mr. Dialysis Tech - this guy dialyses me. He has no formal education in dialysis but is better than most others in his field. When I was in-center, I would refuse to undergo dialysis if he wasn't there to cannulate. I probably would not have started home hemo if it wasn't for his support. I am probably doing myself a disservice by looking for a match for him because, the day he gets married, I will be on my own with the dialysis machine.

4. Mr. Masti - I have known him for 28 of my 34 years - my oldest friend. We've been friends since we were toddlers in primary school. Behind the intemperate exterior is a genuine, caring heart. He will not make it evident. But I can feel it. That's the beauty of this guy.

And last, but not the least, yours truly. If you are a young girl on dialysis, looking for a hunk on dialysis with a huge - well, fistula, drop me a line and we could - well, dialyse together into the sunset!