Tuesday, June 30, 2009

Did you attend the asyw agm? Shit, I missed it too!

In fact a whole lot of people missed it. In fact just about 28 people attended. The 28 members.

Recently my Facebook home page was flooded with messages about the asyw agm. WTF was that I wondered? I first thought it was some auto show which the whole of Hyderabad was attending. Then I wondered why there would be an "AGM" for an auto show. I took the trouble of clicking on the asyw that was helpfully linked in the messages.

You know what it turned out to be? Agarwal Samaj Youth Wing. You have never heard of this? Come one, ASYM - Agarwal Samaj Youth Wing - the second most important institution in the world - after the UN. Like, everyone just had to know what it stood for. They had their Annual General body Meeting (AGM) recently. Billions of blue blistering barnacles! What a hue and cry! And how many members does it have? All of twenty eight! Why call a meeting of 28 people an AGM? Heck, our family get to-gethers have more people!

Well, I am just kidding. In all likelihood, the group in question probably does a lot for charity. Once a year, they probably have their fun in a five star hotel. Nothing wrong with that.

This goes to show however what Facebook can be. A few years back, one would have thought what was the use of anyone knowing what they were up to? For example, why would I be bothered if Akbar saw a sandwich called The Obama or if Rishit breathed a sigh of relief and it is Dot Net (ugh!)for Rajesh. And no I am not interested in which Simpson's character you are like or which color defines you. No, I couldn't care less about when you will find true love. The quizzes really get to me. And people take them like their life depended on it.

In spite of all this (or is it because of all this?), I check Facebook religiously thrice a day and many times on my phone in between. I am totally addicted to it!

Friday, June 26, 2009

Two great things from the government in one day - too much for me to take!

You usually don't get to hear of too many good things from the government, do you?

So, yesterday was a shocker of sorts! Two path breaking announcements from the government. In one day. Please Dr. Singh, do this to us more often!

The first is Kapil Sibal's education reforms. The HRD minister announced his intention to do away with the stress-filled board exams among a host of other welcome measures in the sphere of education. It is a well-known fact that Indian students have to undergo extreme stress during their board and other entrance exams. The pattern currently being followed mostly encourages learning-by-rote.

He plans to replace the percentage-based system to one based on grades. This one step alone will do a lot of good to the student community in general. He also plans to replace the different syllabi being pursued by students in different states with one national syllabus.

He will face stiff opposition for sure. We have already heard the Left-ruled states reject his plans. Trust the antediluvian Left to oppose anything good for the country. Even a Congress ruled state like Andhra Pradesh has expressed some doubt.

I strongly hope the minister holds his own in this attempt. It is high time we bit the bullet on education reforms in this country.

This brings me to the second piece of news. The decision which will bring in better accountability and transparency in implementing social welfare schemes in the country. Nandan Nilekani, a co-founder of Infosys was given charge of implementing National IDs. This huge effort could not have had anyone better than Nilekani to head this.

The important thing here is that a corporate leader was given such a major responsibility. This is significant. The involvement of such competent people in government could be the harbinger of more efficient implementation of government schemes ensuring that the benefit of government expenditure reaches the intended beneficiaries. This has been the most cruel problem of government spending in India. Less than 10% of it reaches the intended recipients.

Nilekani's appointment (and his acceptance) offers hope to all Indians that the days ahead are bright. We might just see better governance, better accountability and better implementation.

The Congress government has got off to an excellent start. You can literally feel the enthusiasm among most of the ministers. They have the mandate of the people. They do not look like they are going to waste it. We cannot ask for better.

Can 400 ml make such a difference?

A couple of days back, I decided to get over my obsession with fluids. What helped was that the antibiotic I was taking for my infection left a foul taste in my mouth. Due to this water tasted quite bad. Other food and drinks did not taste bad at all. It was only water.

So, day before yesterday, I put on only 2 kilograms between treatments which was a record of sorts! I was at 80 kg in the morning. By night I was only about 82 kg. I pulled off 2.5 liters of fluid during my night session of dialysis. I thought I could go to about 79.5 kg which I assumed was my dry weight.

The next morning when I checked my weight, it was 79.6 kg. Not bad, I thought.

For the first few hours everything was all right. However, after that I felt totally weak. I could not do anything. I felt like I was going to pass out. I was at work. I did feel better after I had lunch but not normal at all. I took off early, got home and slept for a while. But I did not feel normal even after waking up. Before my treatment, I had put on 3.4 liters because I had had a lot to drink due to the weakness.

This brings me to the need for having some mechanism other than weight to know the amount of fluid gain. The changes in dry weight can play havoc with the amount of fluid being removed. This happens rarely but it does happen.

Wednesday, June 24, 2009


Recently, if I have had a light breakfast, around mid-morning, I suddenly feel totally weak. As if I am about to faint. My head feels giddy. My feet start feeling numb. I also break into a sweat.

It has happened twice in the last week.

I need to eat something immediately. The symptoms gradually reduce on eating something. But I do not feel totally normal for about two hours after this even if I eat.

This is very similar to the symptoms I have heard diabetics describe when they say they are hypoglycemic.

I am not diabetic.

The problem is by the time I realize I am getting close to this, it is too late to do anything. I just need to quickly eat something to prevent collapsing and then wait for a couple of hours to feel normal again.

The key is to have a heavy breakfast and then keep eating small amounts every now and then. This is really difficult to do especially when you are working regular hours. As it is, my colleagues joke about my 'three-course-lunch' and my evening snack! I will probably need to add a morning snack too. They will now have a ball. Not that I care!

Sunday, June 21, 2009

Being proactive in your treatment

I was with a doctor yesterday. He was putting me on antibiotics. Low grade antibiotics for a long duration. This was to cure an infection which is generally difficult to eradicate. He told me to take the tablet after dinner.

Now, the normal thing I would have done is to say thanks and walk out and take the drug every night for the next 6 weeks as advised.

What would have happened?

The infection would have had no chance in hell of getting cured.

Why? Read on.

I get dialysis for 7 hours each night. Dialysis removes toxins in the blood. The dialysis would have removed the antibiotic from the blood as well leaving close to nothing to deal with the infection.

What did I do?

I asked the doctor about this. He said "Yes, we need to check that." To his credit, he called his associated nephrologist to check on this. The neph confirmed this.

The doc changed the prescription so that I would take the medicine after breakfast instead.

I am not blaming the doc in question. After all I am probably the first nocturnal dialysis patient he is seeing.

The point is it is so important for people like me to be completely knowledgeable about their condition and to be proactive in their treatment. The word of the doctor is not the last one. We need to think through all aspects of the treatment.

Having a doctor such as the one I visited is very helpful. They have no egos and they like patients who are well informed and proactive.

Saturday, June 20, 2009

How doctors keep abreast

Recently, I met a senior urologist in the corridors of a hospital. He had performed a surgery on me a few years back. We wished each other. He asked me how I was doing and how my dialysis was going. I said I was dialyzing at home in the night, six nights a week.

He was shocked! He asked me why I 'needed' so much dialysis. I was at a loss for a few seconds. This, from a senior urologist!

I explained that the kidneys worked 24 X 7. Dialysis was trying to replace kidney function. So, obviously, more the better.

Hmmmm. I could see the look on his face. Amused. He asked me if I felt better. I said yes.

It was obvious this doctor had not heard about daily dialysis, about nocturnal dialysis, much less about buttonholes or antegrade cannulation. Though he was a urologist, he was also playing the role of a nephrologist for many patients. Many people did not see any other doctor for their kidney disease.

The advances in medicine totally elude these kind of doctors. They have no clue about what is happening in the world outside their hospitals. They are dedicated to their profession, no doubt. But they are too 'old-world' to keep in touch with the latest by getting onto the internet.

The field of medicine is constantly changing. The internet is possibly the only way doctors can keep abreast. Journals are not a substitute.

Tuesday, June 16, 2009

Home hemo coming to India!

Thiagaraj, the Chief Clinical Co-ordinator of Hemodialysis at Fresenius, India recently visited Hong Kong to train on home hemo administration and training.

They are planning to get more people onto home hemo in India. He has undergone training himself on doing this. He is going to train more technicians on the nuances of home hemo and enable them to train dialyzors who would like to do home hemo in India.

They are planning to arrange for the importing of buttonhole needles from Korea. They are also going to arrange for the other safety devices to be brought over. Thiagaraj is coming to Hyderabad in the first week of July to spend some time with me and fine tune the procedures I follow. He is soon going to start training others on this too.

This is no ordinary event.

This could see widespread adoption of home hemo in India. The number of young people on dialysis is steadily increasing. Most young people will hate regular in-center hemodialysis. Many do not like PD. They will want a modality that enables them to work and have a more fulfilling life. There cannot be a better answer to this than home hemo.

Juxtapose this with the fact that daily nocturnal home hemo actually costs almost the same as regular thrice a week in center hemo and you have a win-win situation for all. Only the initial setup cost is to be taken care of. If Fresenius can work out some kind of a loan scheme, maybe with the help of a bank, then that will literally open the floodgates.

Exciting times ahead!

Monday, June 15, 2009

Home hemo program in South East Asia

I was recently visited by Thiagaraj, Chief Clinical Co-ordinator, Hemodialysis for Fresenius in India. He had visited me a few months back to see my home hemo setup.

He told me about his visit to Hong Kong to train on home hemo administration and training. Hong Kong and many parts of South East Asia have a very mature home hemo program. There are many people doing hemodialysis at home.

They have a three week training program where dialyzors are taught how to self-dialyze. This is followed by a one week monitoring session at home. After this they are on their own. There is regular monitoring by the center. They also use the buttonhole technique using needles manufactured in Korea.

The government bears all the expenses provided the dialyzor works full time. This was an interesting piece of information. How much the individual earned was immaterial. The only requirement was that he or she worked full time.

He also took some pictures and videos of two people starting dialysis on their own. These people were fairly at ease with the process. They were however not very computer or internet savvy and did not have an online presence.

I asked him if he could arrange nocturnal dialysis for me if I wished to visit that part of the world. He said he could definitely arrange that! That was really good to know because I would like to go to Phuket after hearing my friend Aditya raving about it.

I was surprised to hear about the home hemo program in South East Asia from Thiagaraj because I haven't heard anything at all about it until now. If its not on the internet, I guess, we tend to assume it does not exist!

There was another very exciting development about which I learnt during Thiagaraj's visit. More on that soon.

Saturday, June 13, 2009

Rain drops keep falling on my head...

Yesterday, I had a really tough day at work. I had to go to this construction site where we are going to be installing our software. It was quite hot and there was no air conditioning. By evening I was totally drained. I got back home and was lying down, the air conditioning vents blowing cold air directly on my face.

Just then, the weather became stormy and it started to rain heavily. My dad was about to go to the gym at the club. He asked me, "Want to go for a swim?" For a moment, I hesitated. I was too tired. And I had gone swimming that morning too. He said, "You don't have to drive!" The thought of swimming in the heavy rain was too tempting. "I'm coming!"

I got ready in a jiffy and we left for the club. My dad dropped me near the swimming pool and went to the gym. I got half wet merely getting to the changing rooms. The rain was so heavy. I changed into my swimming trunks and jumped into the pool. At first I felt a little cold. I quickly swam a length. This did me good. The length was a little strenuous though because I had about 3 liters of excess fluid on me.

After that I just stayed put at one side of the pool taking in the atmosphere. The heavy rain pouring in to the pool, the twilight setting, the cool breeze, the warm water of the pool. For the next hour or so, I simply stood there doing nothing. The entire exhaustion of the day was washed away. I felt rejuvenated. Exhilarated.

Wednesday, June 10, 2009

A question of dependence

I started nocturnal home hemo about three years back. I hired a dialysis tech who came home every night, started my treatment and then closed it in the morning. He did everything.

About a year and a half into home hemo, I started learning the ropes. I first learnt how to cannulate myself (putting in the needles), then started preparing the bicarbonate solution, then learnt how to prime the dialyser and the tubings and then eventually connecting the needles to the tubes and starting the treatment.

I was doing everything on my own for about 6 months. Then, I changed my job. The new office was very far from my house and I would be exhausted by the time I came back home in the evening. I was too tired to start my treatment. Around the same time, I had two incidents (this one and this one) while starting dialysis that scared me.

My family and other friends (including some people who left comments on this blog) really felt I shouldn't take chances. They felt I should let the tech come and start the treatment instead of me doing it myself.

On the one hand, I saw people in the US taking complete responsibility for their treatments. On the other hand, I realized that they have undergone a formal training program and they are also using a simpler machine meant for home use.

So, I relented. For the past six months, I have not been doing anything except cannulation and that too in the tech's presence.

Recently, however, the tech has been having some professional problems - politics at work - due to which he has been coming late. The last two days I was on the machine well after midnight. This is causing me to undergo shorter sessions. This is not likely to end too soon either.

I have two choices - start treatments myself again or wait for him to come and get shorter treatments.

I really like the independence that I get when I start treatments myself. I can start whenever I feel like. There are risks however. There is an hour of work involved. But I do not have to wait frustratingly for the tech to come. I must decide on this quickly.

Sunday, June 7, 2009

We need our own Jay Leno

Jay Leno was funny. I often watched the Tonight Show on TV. He's left the show and has been replaced by Conan O'Brien. The first episode that I watched (not the first of O'Brien's) wasn't half as good as Leno's. But I guess it is too early to pass judgement.

I am an ardent follower of politics and I find humor involving politics quite funny. India has more than its fair share of jokers in the political circus!

Shekhar Suman did a fairly good job as our own desi Jay Leno a few years back. He imitated Atal Bihari Vajpayee and Laloo Yadav very well. Vajpayee himself had remarked that he found Suman's imitation of himself funny! The show itself was a complete rip-off of the American version. But it was good.

The level of political satire reflects the maturity of a nation. Until a few years back, we couldn't imagine making fun of politicians on television. Politicians were only prostrated before on dais. They were worshipped. Today, when you see people joking about the things that some politicians have done or Karan Thapar ripping them apart in interviews, you are not startled.

This is a good sign. Probably reflected well enough in the results of the elections where performance was rewarded without consideration for caste, religion or irrelevant jingoism. Well, almost!

Now that Shekhar Suman has lost the election (he contested from Patna Sahib against Shatrughan Sinha), maybe he should consider getting back to this! It will be interesting to watch his take on politics after being a part of it, briefly at least!

Saturday, June 6, 2009

Diagnosis and alternate medicine

The importance of diagnosis in any medical condition cannot be over emphasized. I have been grappling with pain for the past couple of months, all the while thinking it was hemorrhoids. I have been taking Ayurvedic medication for it for the last month or so wondering why something that worked so well last time was not working now.

Guess what? It was not hemorrhoids after all!

Yesterday I went to a surgeon and he examined me thoroughly and said it was not hemorrhoids. He asked me to get an ultrasound scan done. The scan showed prostatitis. That was the reason for the pain all these days. So, now I have started heavy IV antibiotics along with Bactrim to take care of the infection.

Which brings me to diagnosis. To diagnose the problem, there is simply no alternative to regular medicine (what we call allopathy). However effective alternate therapies may be (even if you find an authentic practitioner), they are no match to the conventional methods of diagnosis.

All these weeks I have been taking the Ayurvedic medication for the wrong problem. Obviously it wouldn't work. That, I think, is a major problem with alternative therapies. They do not have the tools or the procedures to properly diagnose the problem. They have to rely on conventional techniques.

Thursday, June 4, 2009

Can I take the afternoon off?

I find myself asking this question quite often these days. And to my manager's credit, he has always agreed cheerfully. Ever since I joined this new company, I have been plagued with hemorrhoids which refuse to go away.

I have tried different therapies suggested by different doctors. Nothing seems to give me permanent relief. The most promising seemed the medicines prescribed by Dr. Dharmalingam, a practitioner of the Varma stream of Ayurveda. It almost got cured but unfortunately a month back, it recurred. I am trying his medicines again. So far, not much relief.

Coming back to my work, this problem has been an on and off thing. I have often gone to work taking a strong pain killer. Often it is a choice between taking the pain killer and working or not working at all. It is a tough decision. How often can you stay at home? How often can you take the pain killer?

The only pain killer that works for me is Myospaz Forte which has a load of Potassium which is bad for me. So, I cannot take it too often. During the first bout of this problem, I was taking this pain killer twice a day, every day for a long time. I really hope this has not caused any other problems.

So, I cannot take this drug every day and go to work.

I try to balance things out. Take an afternoon off once in a while, once in a while take the drug and go to work. Sometimes, just bear the pain. How long can this go on? I have no clue. And neither does anyone else. I am really at a loss.