Thursday, December 30, 2010

My article gets published in the American Journal of Kidney Disease!

Well, you must excuse the pompousness but I am really thrilled!

My article, titled "Taking the Uncharted Path", got selected and published in the American Journal of Kidney Disease's (AJKD) January 2011 issue!

It all started with an email from Dr. Sidharth Sethi, Pediatric Nephrologist at AIIMS, New Delhi in July this year. He told me that AJKD was inviting "essays of fewer than 1,600 words that illustrate some facet of kidney disease through a personal story".

I then wrote this article where I described how I got on to daily nocturnal home hemodialysis. The article went through a series of edits, some suggested by the editorial team at AJKD to make it make more sense to a global audience which is unfamiliar with the Indian nephrology context.

Finally, about a couple of months later, I was told that the article was selected! And now it has finally been published!

This is the link to the pdf version of the article which actually appears in the hard copy of the journal and this is the link to the online version of the article. This is the link to the online version of the journal's January issue. My article is under the section "In a few words" towards the bottom of the page.

Wednesday, December 29, 2010

NephroPlus launching second center

NephroPlus launches its second center tomorrow. This is a big step. So far, we had one center. All efforts were focussed on that center. Suddenly, now things become more complicated. Managing operations in two centers will bring more challenges. Catering to patients in multiple centers, making sure their every need is fulfilled, making sure the best possible care is given to them. 

The founders of a company are usually very passionate about what they are doing. The challenge is to make sure the same passion percolates down to everyone else in the company. The top management is rarely the face of the company for its customers. So, it is important for the management to make sure every single individual in the company works with the same motivation and zeal and has the same amount of passion for the job as them. This will be the main challenge for us at NephroPlus as we expand to truly become a 'chain' of dialysis centers. 

Tomorrow, the 30th of December at 10 a.m. Please do come and grace the occasion. We would be more than happy to have you!

Sunday, December 26, 2010

Does a chronic disease really change perspective?

I met with a few friends from engineering college a couple of days back. We had a great chat and caught up. I was meeting two of them for the first time after college, more than thirteen years later! One of them had undergone a heart transplant a few months after passing out of college. I was intrigued by his story. Here was a real fighter!

Vinay, one of those at the dinner mentioned how he thought that guy and I were really inspirations to him and how both of us looked at life in a very different way. We looked at the big picture and were not bothered by the little problems in life. He asked us if that was true. I nodded hesitantly. I wasn't so sure! It wouldn't of course, be politically correct to say it was not true. We are supposed to be really strong people. We were supposed to be the courageous ones. We couldn't care less about the petty things in life. Right?

I am really not too sure!

I thought about that on and off over the last couple of days. I realized that, at least in my case, that was not completely true. I still bother about the small things in life. I still worry about what others would think if I did this or that. It was much worse until a few years back however. I was constantly doing things others expected me to do. I had set certain standards for myself and I was constantly trying to measure up to them. Even though I was not enjoying it. Just because people expected me to live up to them.

Then I had dinner with Chetan, my best friend, my guru, my bro. I can hardly forget that day. At the bar in Taj Banjara. I was sipping a mocktail and Chetan, a beer. I told him about how suffocated I felt living this life. And then he told me those words. The words that changed my life. "Kamal", he said, "live your life like you are the center of the universe. And as if everyone else is revolving around you." He gave me an explanation too on what that actually meant.

I thought hard about this after and it made so much sense. Why was I constantly seeking approval from others? I must 'get a life', so to speak!

I was a changed man.

Monday, December 20, 2010


There is a legend about Queen Victoria offering a reward of 100 pounds sterling to anyone who could deliver to her the fresh mangosteen! It is such a delicacy.

I first ate a mangosteen at a wedding. It was one among many other exotic fruits being served at the dinner. I loved it at once. The waiter would slice through the outer rind of the fruit and then open it up and serve and we took a small spoon and scooped out the pulp. It had a sweet and slightly tart taste and was delicious.

I tried getting the mangosteen in many fruit shops in the city but nobody seemed to have it. The next time I got to have it was at another wedding! After a few such weddings, I was crazy enough about the fruit to actually walk up to the caterer for the wedding and ask him from where he got the fruit. He told us he imported it from somewhere. I asked him if he could sell some to me. He said he would when he got them the next time. Of course, he forgot about it soon.

A year or so back, I checked at Pure 'o' Natural, the fruit shop opposite L V Prasad Eye Institute in Banjara hills. They did have some. I was excited. I bought a bunch of them (they were terribly expensive) and rushed home to feast on them. As I opened the first one the way the waiter did, I was thoroughly disappointed. It was rotten. The next and the next. Almost all of them were rotten. Only one of them was good. My enthusiasm for the fruit disappeared.

A few days back, however, my parents went on a holiday to Dubai. There they saw some Mangosteens at a mall. They bought some for me. Coincidentally, that very same day, I saw some at Q Mart at Banjara Hills.  I bought a pack of 9 for Rs. 500! Very expensive! But what the hell?

They were delicious. Every one of them was excellent. I was thrilled!

When my parents got back a couple of days back, I got to feast on them again. Heavenly!

Here is a video on how to eat the fruit.

Sunday, December 19, 2010

What I am up to these days

I recently switched to an arrangement at Grene, the company I have been working for, for the last two years, where I would be like a contractor. I would have flexible timings. I could work from home when I wanted to but would come to the office as required. I would make sure all the work I needed to do would get it done in a timely manner.

Around the same time, I took on an official role at NephroPlus, the chain of dialysis centers I have been informally involved with right from its inception.

My life has changed dramatically.

When you are not an employee, there is a remarkable change in attitude towards work. Even though I am making significantly less money than I was until a couple of months back, life is much better professionally and personally. I find myself enjoying my work much more. I do not perceive my work to be a chore, to be done day after day. Suddenly, I find it very stimulating.

And then there is NephroPlus. I am enjoying my role there thoroughly. For the first time in my life I am working for a non-software company. The whole dynamic is very different from a software company. The goals are different. The working style is different. Well, obviously, you might say! But you only realize the extent of difference when you actually experience it. In a software company, despite all the complaints about the chaotic nature of the work and the schedules, there is a semblance of a plan, a structured team, defined deadlines, goals, deliverables.

In a startup chain of dialysis centers, there is no 'deliverable' as such. It is a continuous process of improvement, of catering to patient needs. There is no 'end point' as such. You have a few problems. You deal with them. Then the next set of problems comes up. There is not much scope for gratification at the end of a project like you have in software. After the successful execution of a project, there is celebration, a sense of catharsis, a time for relaxing. No such thing here.

What then is good about this?

Whenever I visit the center, I go over to chat with the patients that are getting dialysis there. I talk to them about how they are doing, how they are feeling and if they are having any problems. We usually have a heart to heart chat. I talk to them about the problems I might have had recently similar to theirs and how it got resolved. They give me tips about how they are dealing with the disease. I share my experiences. There is an immediate connect, an immediate feeling of empathy from both sides. I really like the time I spend with them.

There is one thing for sure. Only a dialysis patient can understand what another dialysis patient goes through. Not a nephrologist, not a technician, not a nurse, not a family member, not a best friend. Irrespective of any claims made by these people.

Friday, December 17, 2010

Mixing business with family

I strongly believe that you should never do business with family. I try to avoid doing any transaction that involves money with a family member or a close friend. I try to avoid getting into any business or hiring a family member or a close friend for a business. I also try to avoid working for someone who is family or is a very close friend.

Money is a strange beast. However professional we are or try to be, money can corrupt. Us and others. I don't claim to be unaffected by it, either. It is the very character of money. Due to this, our minds play havoc with the relationship and many times, a good relationship is soured due to this.

Some would argue that is is actually good to involve family or close friends in business because it is very good to have someone you can trust. That is really a call you have to make. Are you ready to risk spoiling the relationship?

The converse is also true. Never make someone you have a professional relationship with as close as family. Never get too close with someone you transact financially with. It can mess things up.

When you are paying for some services or products and the expectation is not met, you need to have the comfort to be able to talk about it. This comfort is compromised when you have a close relationship. It works the opposite way too. When you provide services or products in return for money and you have a grievance, it is difficult to air it with someone close.

I am writing this from experience and have seen both these aspects play out badly in the past.

Tuesday, December 14, 2010

Worst ever cramps

As you know, I have been trying to figure out my dry weight. I really should have figured this out sooner. Yesterday shouldn't have happened.

I was about 4.2 kgs above my dry weight. I had not got enough dialysis the previous night. So, there was some fluid from the previous day that I had to remove. So, I told Jayaram to set the UF to 4.5 kgs to account for the half liter of water I usually have at night and keeping in mind that I had just had dinner, so about 300 grams was probably food.

As usual, for the first few hours, everything went well. Around 4:20 in the morning however, I started cramping. The familiar sensation of the calf muscles contracting involuntarily causing my feet to get pulled was mildly disturbing at first. These days, in the rare occasion of cramps, I don't wake Jayaram. I simply press my feet downward and it usually takes care of the cramps. That is what happened yesterday as well.

But a few minutes later, the cramping worsened. The pain was severe and my left calf muscles contracted really badly. No amount of pressure on the feet would release my calf muscles. The pain become unbearable quickly.

I started screaming. I woke Jayaram up and shouted out that I had bad cramps. I asked him to push my feet to release the muscle that had contracted so stubbornly. He tried and it worked. But only just. Within a few seconds, the muscle contracted again, this time worse than before. With every passing second, the pain was becoming worse. I was shouting out with pain.

Jayaram immediately opened the saline clamp and let some saline into my blood. It did not help. By now I was sitting up on my bed. No help. I asked Jayaram to give me more saline. He reopened the saline clamp and pumped in about half a liter of saline. I also stood up simultaneously, something I have never done on dialysis. There was immediate relief. The saline was giving my blood some volume which was loosening up the muscles.

In a few minutes, the saline helped relieve the cramps entirely. I settled down in my bed and slowly went back to sleep.

Dialysis ended about an hour after. I was feeling quite exhausted and drained. My fingers were feeling weird. The left calf was also very sore. I went back to sleep after Jayaram closed and left.

This was probably the worst incident in terms of pain that I have had while on dialysis. The blood loss incident was probably more dangerous but I did not have any pain or trauma. This incident was like going through hell for that short period of a few minutes.

Jayaram remarked that he had never seen anyone have such severe cramps ever. I thought how lucky I was that this happened when Jayaram was there. I have no idea what I would have done if I was alone that night.

Monday, December 13, 2010

The First Annual Ex Effigent Reunion

First Annual Ex Effigent Reunion

Date: 25th December 2010
Time: 9 a.m.
Venue: A farmhouse on the outskirts of Hyderabad

Click here and register asap so that arrangements can be made accordingly.

A voluntary contribution towards the expenses would be appreciated! Link available in the site above.

(Acknowledgements: M V Krishna for taking this excellent initiative!)

Saturday, December 11, 2010

Figuring out my dry weight

Yesterday, as I was on my way from Grene to NephroPlus, I felt a familiar sensation. My head suddenly felt cold and I could feel tiny droplets of sweat on my head. I felt slightly giddy and weak. It wasn't very bad. But I knew it could get worse if I didn't do anything about it.

I asked my driver to go to a snack center nearby. I rushed in and ordered an Idli. It came pretty fast. I quickly ate the Idli and could immediately feel better. Not totally normal, but definitely better.

I then got dropped at NephroPlus and sent my driver to bring me a soft drink. I then sat down in a chair, set the air-conditioner to a comfortable temperature and took a few deep breaths.

Slowly, I regained composure and felt normal.

What was this? It could have been one of two things - hypoglycemia or hypotension. I cannot say for sure which.

Hypoglycemia is a condition where the sugars in the blood go down suddenly and you have exactly these symptoms. Diabetics experience this sometimes if they have taken too much of the sugar-lowering drugs.

Hypotension, on the other hand, is something which people lucky enough to be on dialysis sometimes have. Let's say you have been eating well and eating healthy food like sweets and fried food. Your weight increases. Now, when you go for your next dialysis session, this can be misconstrued as fluid weight and the good folks (aren't they all?) at the dialysis unit try to pull it off. Now, this results in the amount of water in the blood actually going below what it should be. This causes thickening of the blood and reduces its pressure.

This can result in the symptoms I had, as well.

So, knowing your 'dry weight' is key. I knew my dry weight had gone up a little but I was in a little bit of denial. I somehow wanted to convince myself that my daily swim is helping me reduce weight. What I did not realize is that my regular cola binges are not helping matters. Hence, the hypotension.

But then, if it was truly hypotension, maybe, I shouldn't have felt better with the Idli. But then, I did have cramps in the last hour of my dialysis and I also had a little bit of a cramp in my hand that afternoon.

So, I am really not sure what it was. All I can say is I really enjoyed the full bottle of Thums Up that morning!

Tuesday, December 7, 2010

The evolution of the humble khakhra

The khakhra is a Gujarati snack. It is probably one of the simplest foods ever. It is basically a chapati that is roasted as crisp as a papad. It is typically made of wheat flour, a little salt and a little oil. A dough is made with these ingredients and then made very similar to a chapati. This is then roasted in a tava by applying pressure with a wooden utensil. Ghee can also be used while roasting the khakhra to make it a little tastier.

The most a good cook would experiment with the khakhra would be by adding a little jeera to the dough to add a touch of flavor to the otherwise bland recipe. A few years back, however, people started experimenting a lot with the khakhra. They started making masala khakhras - basically adding turmeric, chilli and other masalas to make the khakhra quite tasty.

Most people would have the khakhra for breakfast with milk, tea or curd. Some people would also have it as a tea time snack, sometimes with a little pickle. But due to the plain nature of the snack, it would always need an accompaniment like curd or tea. With the masala-isation, however, the khakhra took on an independent identity and people started relishing masala khakhras plain.

Recently, people have started taking experiments with the humble khakhra to another level. You now have a large variety of khakhras. The mangroli khakhra, tomato khakhra, bajra khakhra, bajri-methi to even pani puri and pav bhaji khakhras! You also get a dosa khakhra which actually is dosa batter made into a khakhra!

As people started becoming more and more watchful about what they ate and how healthy it was, the khakhra adopted too. So, you now had seven-grain khakhras and khakhras without ghee!

There are entire stores in Mumbai and Ahmedabad that are devoted to khakhras and allied items.

Take a look at this picture of a variety that I recently saw:

The khakhra is shaped like a mobile phone, complete with a keypad on the packing and is called SMS khakhra! It is ideal for people like me for whom the khakhra forms a great 5 p.m. snack at work. Easy to carry as well. The interesting thing about this khakhra is it is labeled 'whole wheat bran diet and health' but at the bottom says 'Ghee sada'! Pray, how can a khakhra that has ghee be branded as a 'diet' khakhra??

Saturday, December 4, 2010

Does this ad inspire any confidence?

Recently, a new hospital opened in the city. They've probably got a really bad PR agency! Look at this ad that they have in many prominent places in the city.

Who is the guy in the ad? Is he a doctor? Why is he wearing a sherwani? I read somewhere that he is a ghazal singer. Hmmm. An unknown ghazal singer on the ad for a hospital! It's not even as if he is handsome or something. Seriously, what were they thinking? This is even more silly than the dick who had his pictures all over the city for a famous club in Begumpet.

They have also flooded radio channels with ads with some guy talking about the hospital. The voice is so sick and he talks like he is being very gentle and caring. This may serve to drive patients away from the hospital rather than to it!

A good PR agency is so key!