Sunday, August 30, 2009

Wearable hemodialysis machine - what's in it for me?

Those on dialysis must have read about the wearable dialysis machine that made news recently. This is a breakthrough in dialysis technology. Many of the constraints of dialysis as it is known today will cease to exist.

The device will make it possible to get dialysis 24 X 7. However, as Bill Peckham says, "I can't see myself on dialysis, with needles in my arm, as I go about my day." The main challenge is to have needles in your arm continuously. I am not sure if it is physiologically advisable either.

What then is the advantage of this device over the NxStage System One, for example, which already offers portable hemodialysis today?

Complete portability, for one. The System One, though portable, is a little difficult to lug around. You also need the RO unit or fluid bags to be moved around. This new device is more like a belt that can be worn around the waist. It is much smaller in size and much lighter.

Another important difference is the power supply. And this is important for me considering that the US and India use very different power supply types. The NxStage has to be connected to a power outlet which means that for the machine to run in India, I would need a good device that can transform the power to suit the device.

The wearable machine, on the other hand, uses small batteries. This means it can be run anywhere provided you have the correct batteries.

The trouble is availability. The NxStage System One was available in the US a few years back. It is not yet available in India. This new device is a few years from being used in the US itself. When will it become available in India?

Lignocaine-free cannulation

Lignocaine is a local anesthetic. As I wrote here, it is quite an oxymoron. I started using a little lignocaine after cannulations began being painful despite using buttonhole needles. Everyone would ask me to try not to use it. No one ever told me why. They would simply say it was not needed.

The reason I used it was that the cannulation itself would be painless. The injecting of the lignocaine itself produced a sharp stinging pain for a few seconds. But I would still use it thinking that this would prevent a possibly deeper and more long lasting pain after putting in the dialysis needles.

Recently, however, I was visited by a team from Fresenius including one of their senior clinical coordinators. They said the same thing. "You should not need it". I had had enough. I decided to try it out. So, I cannulated without using lignocaine. It wasn't bad at all. Especially since I was using buttonhole needles.

A few days back however, I had to create a new buttonhole site since there was a problem with the old site. For this I had to use a sharp needle. Now, this was a different ball game. Buttonhole needles are blunt and you just have to push them through the tract that has been already created earlier (using sharps). But sharps have, well, sharp ends and can be quite painful. But I had some confidence from the previous few nights. So, I decided to go for it without lignocaine even for the sharps.

It was totally ok. I would say the pain with sharps is about the same as the pain of injecting lignocaine itself.

Day before yesterday, the new buttonhole site was also ready. So, now I am back to using buttonhole needles daily. I have two pairs of sites which I alternate every night.

Saturday, August 29, 2009

The mad, mad world inside a fan club

I recently saw Magadheera. Twice. The movie is phenomenal. S S Rajamouli has done a great job and Ram Charan excels.

I like to do different things sometimes. So after seeing the movie twice, I decided to join a fan club. I joined a Ram Charan fan club on the internet. At first glance, there was nothing very different from what you would expect. Collection figures of the film on the home page, a large number of fans, lots of pictures and links.

Slowly, however, as I explored the club, I started having a lot of fun. You have to read the posts to believe them. The world of Telugu cinema is dominated by a few families. So, you have legions of fans devoted to a family. You can pretty much divide them into those belonging to fans of the families of Chiranjeevi, NTR, ANR etc. So, in the Cherry (short for Ram Charan) fan club, you have people going to great lengths to ridicule Mahesh Babu, for example.

You also have some really interesting threads. Sample this gem: "Last person is the biggest fan of Charan". This means that whoever posts last on this thread is Cherry's biggest fan. In a couple of weeks, more than 4000 people tried to be the "last person". The thread is still going strong. Then there is this really hilarious thread where you have to compete to key in the letters in Charan's name in different posts without allowing anyone to interrupt you!

The polls are also really great fun. There was one poll that asked, "How did Charan act in Magadheera?" This question - in a fan club. I mean, what did the author expect? A bipartisan, objective analysis of his acting abilities?! (For the record, he's acted really well.)

But, you know what? Its all ok. I really like people who are passionate about something in life. Everyone should have something they look forward to outside work. I myself have been having a good time going through the posts in the fan club community. I have also started defending the actor and the movie in discussions at work and with other friends over never-ending email threads.

And I'm having a whole lot of fun!

Friday, August 28, 2009

Come clean Advaniji

Three of the five members of the Cabinet Committee on Security of the Vajpayee government have now gone public with the fact that L K Advani was aware of Jaswant Singh's trip to Kandahar to release the terrorists in exchange for the passengers of the hijacked Indian Airlines plane.

The other two members are Vajpayee and Advani himself.

Was Advani really lying? What other explanation can you have for this? Surely, the Home Minister would have been aware of such a major decision. Why then did Advani feign ignorance before the elections? If people of the stature of Advani resort to such blatant lies to save their 'image', what can we expect from lesser mortals?

The BJP would still like us to believe that Advani was speaking the truth when he gave that interview to NDTV. What was it? A communication gap, perhaps? A temporary aural failure? A visit to the restroom when the decision was taken? What really, was it?

Advaniji, you owe us an explanation.

Tuesday, August 25, 2009

A minor surgery

I went back to the surgeon on Thursday. I had taken antibiotics for a few days, got some relief and then the pain had returned. The surgeon said he would like to examine me under general anesthesia and if necessary drain a suspected abscess. He asked me to come empty stomach the next morning. I was quite surprised. General anesthesia? That was surely unwarranted!

I called my neph after leaving the place. The neph concurred with the surgeon.

So, the next morning, with my parents and brother in tow, I went to Medwin Hospital, fasting. Memories of my transplant and the delayed recovery from anesthesia came back. General anesthesia always had me worried.

I was asked to change into the hospital gown and wait for the surgeon to arrive. A friendly anesthetist discussed my medical history including the post transplant complications. I was given an IV line through which a sedative was administered. Soon, I was wheeled into the Operation Theatre. There, they put a gas mask on me and asked me to breathe deeply. This was to put me to sleep.

After a while, I was wondering why I wasn't able to sleep. I was breathing deeply. I was about to call out to a nurse to ask how much time it would take before I fell asleep. Just then I felt a deep pain. It was then that I realized that the surgery was over!!

I did call out to the nurse and told her about the pain. She gave me an analgesic through the IV line. I was in a daze. The effect of the anesthesia was wearing off slowly. My parents and brother took turns to see me. I was very thirsty. I asked for some water. They gave me a few drops.

The surgeon then came and met me. He said the pain was due to a chronic fissure and he had excised it. He said I could go home as soon as I was completely conscious. I could take oral analgesics for the pain and no antibiotics.

It is four days since the surgery. The original pain is gone but there is a small ulcer that has formed near the site of the surgery which the surgeon says should go in a few days. He warns however that the fissure could recur and I should eat a fiber rich diet to help avoid that.

Sunday, August 23, 2009

Has 'Micchami Dukkadam' become more of a social greeting?

Today is Samvatsari, the last of the eight day Paryushan of the Jains. The day of forgiving. A beautiful concept, indeed. Ask for forgiveness from anyone you have hurt during the past year, repent for the sins committed in the past year and forgive anyone who has hurt you in the past year. The caveat of course, is all this has to be genuine!

I have always found asking for forgiveness easier than forgiving someone who has hurt me. Forgiving someone who has caused me harm or bothered me is really a difficult thing to do. It is easier to go up to someone whom I have harmed and say "Sorry". It is more difficult to erase the bitterness from my own mind due to someone else's actions.

As with many other practices in the Jain tradition, and other religions as well, this act of forgiving and asking for forgiveness has now become more of a social greeting. Ideally, I must think about who all I have hurt and who has hurt me and clean my mind of the latter and have a frank chat with the former. This rarely happens. Instead, after the ritual pratikraman, everyone goes about greeting everyone else with the 'Micchami Dukkadam'. There are people whom I meet and greet only that time of the year. People with whom I have had no other conversation or interaction and yet I ask them for forgiveness. Really meaningless!

I must practice the true essence of Paryushan and Samvatsari by introspection and then genuinely forgiving and asking for forgiveness. Only then will the true benefit of this tradition reach me.

Tuesday, August 18, 2009

The fuss over Apple's closed policies

There's been a lot of consternation over Apple's closed policies especially with regard to the iPhone. At the surface, these feelings may seem valid. But for those used to the Apple experience for long - and I am not referring to techies here - these policies go a long way in making life easy.

I do not believe that Apple does most of what they do because they are evil, control freaks. You have to understand that a large percentage of people who use Macs are non-technical people. They are not from a software background. So, while it may seem ridiculous for a programmer to not be able to explore the file system on his iPhone, the average Joe or Ram does not even know (or care) what a file system means.

When people buy a product from Apple, they expect a seamless user experience. They want to be able to get things done. They do not have the time or the inclination, for example, to use a piece of software other than iTunes to sync their music. They typically want something that just works. They couldn't care less about the open source movement.

If Apple started supporting other music software, for example, they would get unnecessarily bogged down by the gazillion different pieces of crap available in the market. Why bother, when iTunes works for most people?

Even the app verification process at Apple, which has flummoxed many, is really more likely a process that isn't working than a display of Apple's paranoia. The clause that apps should not resemble functionality that Apple provides by default is well-meaning in my opinion. Most users don't like options and they don't even know this. Apple does and you can't argue with them when they have been providing unmatched usability in all their products for so many years.

Friday, August 14, 2009

Processes that don't scale

In the software industry, people, especially managers (who almost always don't understand a thing about software!) love putting processes in place. Processes for designing, processes for coding, processes for testing and even processes for incorporating new processes!

Unfortunately, things are easy to do when the team sizes are small. At that time you don't even need too many processes. When the team size starts increasing, that's when things get difficult. Processes are not understood and not communicated properly down the ladder. That's when things get messy.

Let me give you an example from my career. We were starting a big project (not the BIG project, just simply a big project). We wanted to make sure error messages were standard across the application. For example, if the user did not enter some important information while creating a customer, he got a message, "Fields marked * are mandatory". If he did not enter some important information while creating an item too, we wanted him to get the exact same message.

For that, we mandated that every error message goes into a common text file. Whenever you want to show an error message, pick something from that file unless it does not exist in which case add a new message which others will also use in the future. Simple enough, right?


For the first few weeks everyone followed this. As the team started growing in size, however, people simply used the error message file as a dumping ground for error messages. They would add whatever they wanted without bothering to check if an appropriate message already existed. As a result, the entire meaning in the process was lost! If anything, the program would run a tad slower than otherwise because of the overhead of picking up an error message from a file without the intended effect of consistent error messages!

So, as team sizes grow, it is very important to keep the processes being followed very simple with regular checks to ensure they are being followed in the manner intended.

Thursday, August 13, 2009

Patients as customers

"Good morning Kamal! This is Vikram calling from We-don't-really-exist Hospital. I just wanted to let you know that the report for the blood test you were expecting this morning isn't ready yet. So, please don't come all the way to the hospital. We'll call you tomorrow when it's ready."

How nice it would have been if I had got this call from Apollo Hospital on Saturday morning. Of course I didn't get it. And what happened instead? I went all the way to the hospital, about a 45 minute drive in the traffic. I went to Report Collection. They made me wait for half an hour checking all their stuff before telling me that the report had "not reached us". They didn't tell me if its ready or not. It has just "not reached us".

They asked me to check with the lab where I gave the sample. I called the lab. I was told it would take another day. I eventually got the report after two more days. Is it really so difficult to tell your client what you had promised to deliver on a particular date is not yet ready. We would be really taken to task if we treated our clients that way in the software industry!

A couple of days back, I had to walk about a kilometer through a veritable maze of buildings, flights of stairs and elevators to actually give my sample to the "Central Lab". Why, oh why, couldn't the hospital staff transfer the sample?

The way patients are treated by healthcare professionals at times is really shocking. Aren't patients clients at one level? Can we not expect better customer service? Especially when we are paying through our noses?

Monday, August 10, 2009

Scaling the summit

At the pool where I swim, there are diving boards. There is one slide, a spring board and two diving boards. When I was a kid, I used to jump a lot from these boards. For many years however, I haven't.

A few weeks back, I had this irresistible urge to jump again. However, I couldn't make myself do it. I needed company. How could I do it alone? It felt a little odd. Men find it difficult to be kids, right?

So, yesterday, I called my brother and asked him to join me because I wanted to jump from the diving boards. My brother came along.

First, both of us did the spring board to get warmed up. This was at a very low height and so was very easy. Then we went up to the diving board which was lower. My brother went first. He was hesitant to start with but then just ran and jumped. I was quite scared to be honest.

When you are standing at the edge of the board, the board, for some reason looks higher than it actually is! I couldn't bring myself to jump off it. I couldn't turn back either. People were watching! Its ok to turn back when you're a kid. Not when you're grown up! I did the next best thing. I sat at the edge like I was very cool. I then jumped. The moment of impact with water from a height was amazing. I touched the ground in a second.

Next was the summit. The equivalent of Mount Everest. The highest board. My brother used the same trick. He ran without thinking or analyzing and jumped right in. Next, it was my turn. God, this was tough. I went ahead. Took a look at the water. It was almost like I was on a plane and had to jump straight out. Was I crazy? Did I want to die so young? I tried the sitting trick. Tried to look cool. A group of onlookers smiled. I couldn't make myself do it. I got up, walked back and went over to the second highest board and jumped.

I was disappointed. I had to conquer the summit. After some banter with my brother, I went up again. I was determined. I was at the highest board again. I had two choices - run and jump or just jump. There was no third option. I just couldn't turn back. Running somehow did not appeal to me. So, I went up to the edge. I thought of the feeling of hitting the water from this height. Would be pure exhilaration. This did the trick. I jumped.

The contact was pure joy!

I had done it! I had scaled the summit!

Sunday, August 9, 2009

The magic of yoga

A few years back, when I was on PD, I had an irritating pain in my left knee. I visited a couple of orthopedic doctors who asked me to get an X ray. On seeing the X ray they said there was no cure for this and I would have to bear the pain for the rest of my life. They asked me to take pain killers if the pain was too bad.

After a few weeks, I started yoga. Note that I did not start yoga to help with the pain. I just started it for general well-being. In fact, I did not even mention the pain to the yoga instructor. To my surprise, within a month of starting the yoga, the pain was gone!

I also would always get a bad cough and cold almost every couple of months. I had to avoid cold drinks totally. Within a couple of months of starting yoga, this problem disappeared too. I started drinking cold stuff, starting having ice cold water and nothing would happen.

There are no two ways about it in my mind. Yoga works like magic.

The only problem is - it takes effort. You have to spend that hour diligently every day. Its not as simple as taking a tablet.

These days, though I get good exercise in the form of swimming which I thoroughly enjoy, my body feels quite stiff. I know yoga will help me a lot. But I simply cannot devote an hour to this every day. This is the classic contradiction in our life today. We know something is good for us. Its just that we cannot (do not?) devote the time for it.

Thursday, August 6, 2009

Medical update

I was being treated for recurrent hemorrhoids for a long time. It turned out to be prostatitis. Or so they say. I was put on a short course of strong antibiotics, followed by a long course interspersed with a 10 day course of really strong antibiotics which they injected into me post-dialysis (thankfully, those don't hurt as they use the needles already inside for the dialysis).

Where are we? Not an inch ahead.

The pain after going for a few days is back. Probably as bad as before. I say "Probably" because you can't measure pain, can you? Its not like the stock market index. You don't say the pain was 234 yesterday. Today its better, its around 200! Its all about perception. If you've had a tough day at work, the pain seems worse. If you've spent an hour with a pretty girl at a coffee shop, it seems less.

So, I went to the docs - wait a minute - why docs? Well, when your base problem is a nephrology problem, you almost always see "docs" rather than one "doc". That's because your neph has to sign off pretty much anything any other doc says.

So I went to the doc for prostatitis who asked me to stop the antibiotic and then get a culture done to identify the correct bacterium. "Well, doc", I wanted to say, "isn't it a little late in the day to be identifying the bacterium?" I controlled myself. I have had a cocktail of really strong antibiotics for about 2 months now and don't even get me started on the pain part of it. And they want to identify the bacterium now? Anyway, better late than never, I thought and fixed up the date and time of the identification.

I went back to my neph who asked that simultaneously we might as well also check for Tuberculosis. Sure. Might as well.

So, this morning, I gave a sample to test for the bacterium and Tuberculosis. The results are expected on Saturday after which I meet with the docs again to decide on the future course of action.

An interesting thing is the Tuberculosis report is going to take 2 whole months! They will give a preliminary report on Saturday but the final report is going to take two months. Of what use is a report that comes after two months in a condition like this?

In the meantime, I have been adding a Sodium Phosphate solution to my dialysate to help prop up my low Phosphorus. This has a side effect. It is increasing my Sodium which is causing increased Blood pressure and a heavy head. So, I don't know what to do. I will be checking my Phosphorus level tomorrow after dialysis to see if this is helping.

My PTH which had crossed 1000 a couple of months back is now at 72, thanks to a new drug called Cinacalcet. I started off with 30 mg per day for two weeks followed by 60 mg per day for 2 weeks. 72 is too low. So, I did not take any cinacalcet for a couple of weeks and am now on 30 mg every alternate day.

There's never a dull day with CKD!

Wednesday, August 5, 2009

Can you think of a longer method name?

I was introduced to real programming in the summer of 2000. Ah! WebObjects. I had done about 6 months of VB before that. Now, you know how VB is right? WebObjects (WO) was a refreshing change. True MVC. So well architected.

The problem was WO was my first real programming experience. And I was totally spoilt. Whenever I came across other technologies later, they seemed so badly done and so difficult to use that I never really let go of WO.

I still remember my first web app from the "Getting started with WebObjects" book. There was this simple app. One lesson I clearly learnt from that app was to use descriptive method names. There was a method name called (and bear with me on this):


Gosh, that was long!

It was a very handy method. For those of you familiar with object relationship modeling, you often have two sided relationships. For example, the class Developer may be related to the class Project. The class Project may also be related to the class Developer. Now, usually, while relating a project and a developer object, in code, you would need to manually set both sides of the relationship. WO (or rather Enterprise Objects Framework, WO's first cousin!) had this method that just did that saving the programming community roughly a million lines of code per year!

Just for kicks, if you come across a longer method name (in any language or framework, not your own program!) please let me know.

Monday, August 3, 2009

Being Telugu

It has been my endeavor for many months now to speak fluent Telugu. I have this fascination for all things Telugu - movies, songs, radio programs and what not. I am trying really hard to learn the nuances of the language. I try to converse with my colleagues and friends in Telugu and scrap in Telugu using the English alphabet on Orkut.

My success is limited. One thing which I need to get the hang of is the "sandhis"; Telugu makes wide use of them. Native Telugu speakers probably don't even realize the abundance of "sandhis" in their language. "Sandhi" is the joining of two or more words to make them sound like one word. To give an example from a recent Telugu song: "Preme ledhannaadee Mallanna". Now the second word is actually three words joined together.

"Ledhaa" + "Annaadaa" + "Ee" = "Ledhannaadee"

which basically means No + said + this. The whole line means "This Mallanna said there is no love"!

These "sandhis" add a whole new level of complication to newbies like me. When I hear a word, I first need to figure out if it is really one word or more words "sandhi"-ized!

To learn any new language we really need to first figure out the rules of grammar with examples and then learn the vocabulary. Vocabulary of any language can be like an ocean with literally thousands of words. But once you know the grammar, the vocabulary can be picked up slowly.

I am probably about 25% there with the grammar.

An important part of my quest to be a Telugu thoroughbred is Telugu films. I have meticulously got myself acquainted with Telugu filmdom - actors, their sons, their brothers, their brothers' sons; that's the way it is in Tollywood, you have entire families working in films. I hear (and now thoroughly enjoy) Telugu music. I can even identify many of the songs as soon as they start.

I naturally try to show off my knowledge about Telugu films and music. For example, the other day a colleague started playing the title track of Oy. I immediately started singing along. What a proud moment! Everyone around me was mighty impressed. I beamed with pride!

I've had my share of embarrassment too. The other day, I mentioned to one of my colleagues, "I am really dying to see Magadheera! Ram Charan Tej has done a phenomenal job, it seems." My colleague nodded and added, "I am more eager to see how well Rajamouli has done."

I shot back, "Yeah! She looks really hot in the banners."

Everyone around me burst out laughing. As it turns out, Rajamouli is the (male) director of the film. I thought that was the actress' name!!

But I am undeterred. I don't give up so easily, you know!

Sunday, August 2, 2009

Yaari hai imaan mera, yaar meri zindagi

Today is Friendship Day! I have always been a little skeptical about all these "days". Father's Day, Mother's Day, Doctor's Day, Valentine Day and what have you. But Friendship Day is special. That's because I have always considered my friends to be my most valuable asset.

I have had, what you might call, quite a tumultuous life. Time and again I have turned to my friends for succor. There have been many times when I was down, depressed and sad. My friends have always come to my rescue, pulled me out of the morass and made me cheerful again. The best part is I did not even need to tell them that I needed this. I simply had to call them or meet up with them. That usually did the trick.

I connect to friends at a different level. I can talk to them about anything under the sun without being judged. That can be a huge relief. The human mind is inherently quite dark. To have someone who understands you and supports you in times of need is reassuring.

Thanks all of you for being there for me! I leave you with a classic from Bollywood that really portrays the epitome of friendship.

Waiting for my turn at the doctor's

Doctors have different ways of calling in patients.

The best way is when they give you an appointment and see you at that time. There is not much waiting. There might be a delay because some patient took more time to see but pretty much you get to see the doc around that time.

The other most common way is when the doc is available during a particular time period and you have to go around that time. The problem is the amount of time you have to wait depends on how many people reached before you. This is the worst form. You have no idea when to go. And usually you have to wait for atleast an hour. If you want to be the first to see the doc, you have to reach about an hour before he is expected to come and if you don't reach before he comes, then there are enough patients before you that will easily take up a whole lot of time!

At a famous corporate hospital, one of the docs I visit has absolutely no rules or system in place. Its literally a free-for-all. There is a lady who tries to bring in some order but she is not firm enough. Maybe she's just not interested enough. You have to just barge into the doc's room. There is no appointment, no order in which you came. Whoever has the gumption to go in gets his turn. At times, I have seen as many as three patients storm in at the same time and the doc having to ask two of them to wait outside! Is it really that difficult to put a system in place?

The cake, however, goes to a senior neph who is now no more. He would come out after seeing every patient to the waiting room and see who all were there. Then he would, at random, pick one patient and call him! No order, no appointments. For some reason, whenever I came alone, he would call me in as soon as he saw me. But whenever anyone accompanied me, he would call me after making me wait for atleast an hour!

The eccentricity of genius? Search me!

Saturday, August 1, 2009

Having a life outside work

Work occupies a majority of our waking hours. Most people are defined by their work. Our work provides us with our identity. It is important, however, to realize that work is not life. It is a part of our life. Yes, an important part. But only a part.

I believe there is a lot to life apart from work. I like to pursue other interests in my life apart from work. I try not to miss my swim every morning. I try not to miss my Sunday morning idli breakfasts. I try to catch up with friends every once in a while. These are simple pleasures that make life more complete.

Its not like I don't enjoy my work. The truth be told: I am enjoying my work like I never did in the past few years. iPhone application development is a happy pursuit. But I make sure I enjoy the other things in life too.

Becoming obsessed with work is common. Forced or volunteered. This happens a lot in the software industry. It is all right to put in long hours and work on weekends for a short period of time when there are tight deadlines or an upcoming delivery. To make this a regular affair over months is disastrous. I would never want to get into this irrespective of the financial dividends.

I do not believe that we need to work more than 8 hours a day on an average. Dhirubhai Ambani had once said, "People who say they work more than 8 hours a day are either not smart enough or are lying!" My mind becomes saturated after 8 hours. I cannot think creatively. My body too is fatigued. Especially in a job like mine, it is important for my mind to be well-rested and fresh to be able to put in my best. This is impossible by working long hours and over weekends.

Are the number of hours more important or the quality of work done? I am glad my manager realizes that it is the latter.