Friday, April 30, 2010

Sureshot iPhone reset

One evening, a few days back, suddenly, my iPhone went totally dead. Nothing I tried to do would fix the problem. I held the power and the home button, like forever. No luck. Google to the rescue I thought. "iPhone won't start". Nothing beyond the "Hold Power and Home together until you see the Apple logo" and "Give it back to Apple for an exchange". The first didn't work. The second wasn't possible here.

I then handed it over to a colleague at office who knew someone who knew someone who could fix iPhones. This was my last hope. It might cost me a bomb but that would be less than what a new iPhone would cost. I switched my sim card and started using the most basic Nokia model that my office had provided for official use. The next few days were traumatic, to say the least. It was similar to driving a Hyderabadi auto-rickshaw after being used to a BMW for years. Nothing short of torture.

My friend gave the iPhone to the so-called Mr. Fixit. For two days, nothing. No news at all.

Then yesterday, my colleague told me that Mr. Fixit went out of town. He had not yet figured out what the problem was. He would return on Monday and would try again. In the meantime, he had brought the phone back. My heart sank. Is this it, I wondered?

I took the phone back, thinking that I would return it on Monday. In the meantime, I thought, let me give it one more shot on Google. This time I typed a more drastic search phrase - "iPhone dead". I got some results. I went through the links one by one. The first few did not show anything helpful. Then there was this link from Fixya. I went through it. There was a solution for the problem which was different from what I had read so far:

"You need to reset your iphone. To do this toggle the switch above the volume back and forth two times, then hold the main button along with the top power button for about six seconds or until you see the Apple icon displayed on your screen. The main menu will appear shortly thereafter. Oh and if you did any charging during this blackout period it is accounted for when your iPhone comes back to life. Hope that helps :)"

Hope that helps??? Heck, sure, it did!

Before the promised six seconds, I saw the Apple logo on the phone. Kitne taras gaye thhe mere baawre nain ise dekhne ke liye!

The iPhone was up and running. I was so relieved!

Wednesday, April 28, 2010

Never use cinacalcet too soon

All too often, cinacalcet is used to treat secondary hyperparathyroidism in patients on dialysis. This can prove counter-productive. I believe cinacalcet suppresses the PTH in a sort of artificial way.

Let us take a moment to understand the dynamics here.

The level of Calcium in the blood is very important. Too little Calcium and the bones don't form correctly; your nerves will also not function properly. Too much Calcium and the Calcium starts getting deposited on the walls of your veins and arteries leading to vascular calcification which can be fatal if not corrected in time.

The body realizes this and has a small gland called the Parathyroid gland (4 of them actually) to produce a hormone called the Parathyroid hormone whose sole purpose of existence is to regulate the amount of Calcium in the blood. When the Calcium level in the blood becomes too low, the glands produce more Parathyroid hormone that causes increased absorption of Calcium from the store house of Calcium in the body - the bones. When the Calcium becomes too high, the glands produce less Parathyroid hormone which reduces the amount of Calcium absorbed from the bones into the blood.

So, the amount of PTH being produced depends (inversely) on the amount of Calcium in the blood.

For people on dialysis, the amount of Calcium in the blood is related, among other things, to the amount of Calcium in the dialysate that is used during dialysis. This is in direct contact with the blood (through a membrane). So, too much Calcium in the dialysate causes Calcium coming into the blood from the dialysate. Too little Calcium in the dialysate causes Calcium to move out from the blood into the dialysate. All this affects the PTH directly.

So, when the PTH goes too high or too low, I feel the dialyzor and his or her doctor needs to check the Calcium level in the dialysate and tweak that around.

Many people opt for cinacalcet, touted as a wonder drug for PTH. While it may be true that Cinacalcet is a wonder drug, it must be used only when the body's natural mechanism of producing PTH in relation to the Calcium level fails completely. In my case, that mechanism is alive and kicking. By reducing the Calcium level in my dialysate, my PTH shoots up. Increasing the Calcium level in the dialysate cause my PTH level to fall.

I shouldn't have taken Cinacalcet at all. I did, however. If only I had understood this earlier!

An accident

This afternoon, as my driver was backing out my car, he accidentally hit another car. The owner of this car was wild with rage. He started arguing my driver and insisted on me being called. I was inside my office working. My driver came to call me and I went out.

The owner was probably in his late thirties. He insisted that I was responsible because it was my car that hit his car. Fine, I said. So? So, he insisted that I pay the damages. I told him that our insurance companies would figure it out. He said he did not think they would pay the full thing and he would have to go through the hassle of taking his car to the mechanic and all the trouble that this entailed.

I told him that I understood and I was sorry for that. He asked me for my card. I gave it to him. He asked me for more details like my house address and an alternate telephone number. I was ready to give that information to him but added categorically that I wasn't going to pay for anything out of pocket. He protested angrily. I told him that he could go to the police and let them take whatever action they thought was appropriate. He said he would do that.

He spent the next half hour in arguing with my driver that he should bear the expenses of the repairs to the car. I couldn't help thinking that the time he was spending arguing with my driver was worth much more than the cost of repairs of the car (given that he had a house worth at least a couple of crores in the colony in which we were at that time!). My poor driver couldn't even dream of bearing the repair cost with his meagre salary.

When you have a vehicle, there are bound to be accidents. Sometimes due to your fault and sometimes due to the fault of others. That is the very reason why third party insurance exists. You have to be practical, exchange insurance papers and move on. Not waste your time and the time of others. Well, there is the added hassle of taking your car to the mechanic. Well, I will have to do that as well. My car suffered some damage too. Poetic justice, if you will!

Monday, April 26, 2010

Active and inactive Vitamin D supplements

I went to meet an Endocrinologist, Dr. Rakesh Sahay, on the advice of my nephrologist, Dr. Girish Narayen on Saturday. After listening to everything and looking at my reports, Dr. Sahay suggested that I take Rocaltrol 0.25 mcg twice a day (this is the active form of Vitamin D3) and Calcirol granules (the inactive form) once a week.

I asked him about the possible hypercalcemia that is a side effect of rocaltrol. I also wondered about the PTH that Vit D supplements suppress. My PTH was already low. He said I should try this for a week and then check my Calcium, Phosphorus and PTH and then we could decide the further course of action.

I called Dr. Girish Narayen and told him this. He was also concerned about the hypercalcemia and the PTH. He had a chat with Dr. Sahay and they agreed to try it for a week and then take a call. I was also asked to use a low Calcium acid solution to try and prevent the Calcium from going too high.

I really don't get it, though. The purpose of Vitamin D in relation to the bones is to improve Calcium absorption from the gut. If I am being asked to reduce Calcium in my dialysate, what purpose is it going to serve to increase the Vit D?

I am trying it anyway (what choice do I have?). It is frustrating to have an undiagnosed problem and suffer continuously not knowing where you are heading. At least if I had a firm diagnosis and was getting some treatment, I would have the consolation that there is a clear end in sight. Currently I have no clue what the problem is and what I could do to help it.

Thursday, April 22, 2010

Bad patient or bad process?

Dr. John Agar, a firm believer in the benefits of more frequent, longer dialysis posted in response to a thread on the Home Dialysis Central forums about 'non compliant' patients. Dr. Agar hits the nail on the head when he says, "It is much easier to blame the patient for non-compliance than to grapple with the concept that the treatment that is being delivered may be inadequate, too short, too 'bazooka', too blunderbuss, too brutal ... or just wrong."

For years, the medical team has blamed the patients for things that are beyond their control. Patients do not come back fluid overloaded because they like to do it. They are not out to trouble their medical team. They do not enjoy being breathless!

The inadequacy of their treatment and the far from optimal dialysis that they got in the last session causes insatiable thirst. Thirst, as Dr. Agar so rightly puts it is "is a primal, irresistible primitive survival mechanism for all living organisms".

... the acute volume contraction of 'bazooka dialysis' (fast, hard, unsympathetic, short-hour, low frequency dialysis) results in a raging thirst.

… again - remember - thirst is a primal, irresistible, basic instinct. None of us can resist it ... when activated, it is all-consuming!

… and so, at the end of the all-too-short dialysis, the intravascular volume having been tightly contracted, the patient is discharged home (usually with a parting admonition at the door) with a raging thirst and their primal, irresistible survival mechanism fully switched on.

… surprise, surprise ... the patient drinks excessive fluid! Who wouldn't? I would! You would! Thirst is a mechanism that preserves the organism. Few (if any) can resist it!

… and, fearful and guarded now of the next 'berating', the patient fronts up for the next dialysis - too heavy, too much fluid on-board, too much weight gain - but, never having stood a chance!

… at the door, to greet, an angry yet poorly understanding dialysis professional

... another berating, another session of angst, anger, resentment, distrust.

… and ... what happens? Another short dialysis with an even higher UFR

... and yet another irresistible thirst cycle is switched on.

Dr. Agar has years of experience, a lot of it with patients on nocturnal dialysis. He is an untiring advocate for longer, more frequent dialysis. His genuine concern for patient well being is truly amazing. Despite his extremely busy hours, he somehow makes time to answer questions on this forum.

Monday, April 19, 2010

Will a bone biopsy provide any answers?

My bone pain is getting worse. It is now in the shoulders and fingers as well apart from my back, ribs and feet. I was surprised with the difficulty I had in climbing down a flight of steps during the last couple of days. It was really terrible. I had to climb down one step at a time by resting both my feet on each step. If I did one step with each foot like any normal person, I had pain in my feet.

This bone pain has become my most significant problem. The worst part is I am not currently doing anything to address it. The pain is most likely due to the low Calcium dialysate I erroneously used for months due to which, I suspect, Calcium was being leeched from my bones. I corrected this in the last week of January. I switched to a slightly more-than-normal Calcium. Due to this, however, my PTH plummeted to about 5 which is very, very low. The normal PTH for people without kidney disease is between 7 and 53 pg/ml. For people on dialysis, the PTH should be between 250 and 500 pg/ml. Mine was 5 pg/ml.

When I was on the low Calcium dialysate, my PTH had touched 1000pg/ml! The moment I corrected the Calcium, the PTH fell to 5. This can be dangerous in other ways. It can cause something called Adynamic Bone Disease which is equally harmful. So, I had to reduce my Calcium in the dialysate immediately. What did this mean?

I wasn't doing anything to put back the Calcium into my bones! That's how it is even today.

My Phosphorus continues to be low despite me taking a ton of Phosphate supplements and gorging on dairy products.

So, I was beginning to panic. I posted a question about this to Dr. John Agar, the expert on nocturnal from Australia. When I had figured out the reason for the pain, Dr. Agar had warned that the changes that had happened might just be permanent. I had hoped he was wrong. So, the questions I asked him were, "Is this bone pain likely to last long?" and "Is there anything at all that can be done about it?".

Dr. Agar responded that a bone biopsy would be the way to go. It would tell us what exactly the problem is. My nephrologist, Dr. Girish Narayen, had talked about a bone biopsy a few weeks back. The problem was it is not done in Hyderabad, the city where I live. I would need to go somewhere else to get it done. They first give you an injection of tetracycline and after three weeks, give another shot and then do the biopsy.

I am planning to discuss this with Dr. Girish Narayen soon.

Saturday, April 17, 2010

Be the change that you want to see: Leader

I saw 'Leader' again today. I was moved beyond words - again. It is really an awesome movie. Starring debutante Daggubati Rana, Shekhar Kammula's film is about the son of a deceased Chief Minister who decides to be the next Chief Minister and clean the system.

Arjun (Rana) returns to India on learning of a bomb blast in which his father, the Chief Minister (CM) of Andhra Pradesh is seriously hurt. The CM, while dying asks his son to become the next CM. On being goaded by his mother to take up the responsibility, clean the system and give the people a ray of hope, Arjun decides to throw his hat into the ring.

How he becomes the CM by playing the politicians' own game and then turns the tables on them eventually managing to flush out Rs. 1 lakh crore from the black money system forms the rest of the story. While one can argue that the story is hardly practical and such individuals rarely succeed, let us remember that this is a film.

Many of the scenes are so overwhelming that they cause goosebumps and you are moved to tears. You desperately want Arjun to succeed in his ernest endeavor to clean the mess that the politics in the state have left governance in.

The music is superb. The performances are excellent - Rana will find it difficult to live up to this film.

If you haven't watched Leader yet, I would highly recommend that you go watch it before it leaves cinemas.

Friday, April 16, 2010

I finally got to feel it!

The iPad, I mean! For weeks now, I have been dreaming about this. Ever since Steve Jobs announced the magical new device. This afternoon, around 1:30, I got to actually touch and feel it. And what can I say except that the experience was - well, magical!


No, it wasn't mine. Unfortunately. My boss, a self-confessed fanboy got one from the US through a friend. He called me to show it. These fanboys are so sweet! Give them anything with the Apple logo on it and they will rave about it. Talk to them about something from Apple not having this or that and they will go, "Why would anybody need that?"

Coming back to the iPad, it was very light. Now, we all know it weighs less than 700 grams, 698 to be precise. But you have to hold it to feel how light it is. The device itself is absolutely stunning. The display is ethereal, the animations extremely appealing.

The apps that come by default are the standard ones. iTunes, You Tube, Address Book, Mail, Safari and iPhoto.

Ah, iPhoto! This app has got to be the best on the iPad among the default set. The gestures that allow you to open an album and then close it are a treat. You simply pinch out on an album and the pictures open up. Pinch back in, the pictures go back in the album.

People rant about what is not there in the iPad (camera, Flash, a refrigerator, whatever). I like to focus on what is there. Killer looks, great apps, the ultimate user experience. My brother Karan will turn 23 on May 5th this year. Perfect occasion to get myself an iPad!

Thursday, April 15, 2010

Flexible office timings

There are two different schools of thought on office timings. One is the old school - fixed timings, say 9 to 6 with an hour for lunch in between and Sundays are off. No matter what. Then there's the new school - no fixed timings. Flexi-hours. If there's no work, go for a movie. If there's work, you have to work your ass off - weekends and late nights.

After being through both and seeing this through the eyes of the manager and the managed, I am still at a loss as to which is 'right'. There may be no 'right' actually.

Let's take the old school. Finish off what you can in those fixed hours. What isn't finished is done the next day. If you don't have work for the day however, you stay put on that seat till the clock strikes six. View the IPL on the internet, chat with friends about the new restaurant in town, whatever. But stay in office.

Then there's the new school. Everything depends on the amount of work. If you have no work for the day, leave. If there's work that needs to be done, it needs to be done, no matter what the time is. This works, in my opinion, only the wrong way. There is never 'no work'. There are plenty of instances, however, where there is a lot of work that stretches into the night or weekends. This can play havoc with your personal life.

Ideally, I would like regular fixed timings with an occasional stretching or compression of my day.

Wednesday, April 14, 2010

Internet is equal to Google?

Try to beat this.

We have an AutoCad programmer in our office. An IT guy was setting up a computer for him. He requested internet access on his machine. The IT guy said it was set up already. To show him, he launched Internet Explorer. The MSN site came up by default.

"There you go!", the IT guy said.

The AutoCad programmer was a little confused. He said, "I want the internet!"

The IT guy asked, "What exactly do you want?"

"Google", the programmer said!

During the entire time he spent on computers, the browser probably had Google as the default site. This led him to assume that Google was actually, the internet!

Though this incident might be dismissed as a one-off thing, what is important to note is that this guy was an AutoCad programmer. To the vast majority of people who use their computers primarily for email and the internet and to edit the odd document, this could ring even truer.

The way Google controls so much of our lives - think of how much we rely on it - is sometimes scary.

Sunday, April 11, 2010

Dr. John Agar answers questions at the HDC forums

Dr. John Agar is a pioneer in the field of nocturnal dialysis. He is associated with The Geelong Hospital in Australia. He is also the author of the website http://www.nocturnaldialysis.org/.

For some time now, Dr. Agar has been answering questions on hemodialysis at the Home Dialysis Central forums. Along with dozens of other members, I have greatly benefited from these discussions. Dr. Agar brings with him years of experience in nephrology and dialysis and has an extraordinary zeal for patient welfare as evidenced from the detailed, extremely well-thought out responses to patients' questions on the various aspects of their dialysis treatments and kidney disease in general. You can visit Dr. Agar's forum here.

Dr. Agar has also hosted some extremely useful webinars where he has presented important topics to the community. Though these webinars have been hosted by Home Dialysis Central, they are applicable and useful to the dialysis community at large. You can check the webinars here.

Even if you're not on home dialysis, I strongly recommend you visit the forums and take a look at the webinars. There is a wealth of important information there which everyone on dialysis must know. You don't even need to be a member to access that information.

Saturday, April 10, 2010

Seashore - image editing for the rest of us (with Macs)

I have been struggling for the last few months with Photoshop. My image editing needs are pretty basic. Making changes to existing images, making the background of images transparent, combining multiple images into one and so on.

I just cannot seem to get the hang of Photoshop. To do simple things, I would have to ask some Photoshop guru to help me. It is just not intuitive enough. Well, it might work for professionals; it probably is designed for professionals, but not for a novice like me.

This afternoon, I had a similar need - some simple image editing to do. I launched Photoshop on my MacBook. I struggled as usual. I quit the app for the nth time in the past few months without saving any of the changes I made. I was frustrated. For such simple things, I hate asking anyone else. Heck, I was a developer. I should be able to make such small changes to my images, shouldn't I?

I then remembered Seashore, which someone had suggested some months back, which I had installed and then forgotten all about. I launched it. A very simple interface. Basic options. Not intimidating like Photoshop. And within a few minutes I figured my way around and got my thing done. I struggled to do the same with Photoshop.

And the best part of it all - undo in Seashore is the familiar Cmd + Z. Always. In Photoshop, for some strange reason, that works only the first time. From the second time onwards, you had to do Cmd + Option + Z!!! I got to know this only this evening when I was discussing this with the Photoshop guru. I always thought Photoshop had only one level of Undo and that really, really sucked.

Why in the world would anyone design it that way??

Powered behind the scenes by GIMP, the image editing program from GNU, Seashore is really good for people like me who want to do some basic stuff with images. Its Mac only, however.

Friday, April 9, 2010

Farewell, Prateeka!

'Tummuchasal, Yemannasal!'

I got hooked to these two words from Prateeka, the RJ of the show Full2Bindaas on 93.5 Red FM, the radio show in Hyderabad, every evening. I have been listening to the show for about a year now. It used to play every evening from 6 to 7. She then also did a morning show and is currently doing the show from 5 to 8 in the evening.

Prateeka's shows are complete stress-busters. She is truly a bubbly young girl who can leave you in splits with her 'counters' and typical Telugu dialect of the region. I remember the days a few months back, when I was a little depressed. It just took a few minutes of her show to make me cheerful again.

And I wasn't the only one. Hundreds of listeners vouch for her ability to bring a smile to their faces. She would receive a barrage of text messages and calls from them day after day. People loved to respond to her 'topic of the day' which would be hilarious. She also had this knack of cooking up silly yet funny rhymes from people's names. Whenever it was someone's birthday, she would sing the birthday song on air!

Prateeka is moving to the US to do her Master's in Media Management and this Saturday will be her last show. Ever since this was announced by her in yesterday's show, the station has been flooded with calls from heartbroken listeners who cannot come to terms with the fact that they will not be listening to her any more. Many people actually broke down on air!

I am sad too that I will not be listening to Prateeka any more. But I guess, we have to respect her decision to move on in life for better career prospects. Wherever you go, dear Prateeka, keep up your spirits and light up the lives of the people around you, just like you lit up ours day after day on Red FM. All the best!

Wednesday, April 7, 2010

Phosphorus value continues to baffle

I got my Phosphorus tested a few times over the last few days. It continues to remain a mystery. My pre-dialysis value was 1.5 mg/dl. Post dialysis, it was 2.1 mg/dl. On Monday night, before dialysis it was 2.2 mg/dl. Which is kind of totally crazy. Dialysis is supposed to remove Phosphorus while in the time between sessions, it is supposed to increase because you are eating food, most of which has Phosphorus. It is exactly the other way round for me!

I went and met with my nephrologist yesterday with these values. He was as perplexed as I was. He suggested that I take a huge amount of Phosphorus orally. He asked me to try Joulie's solution or double my Neutraphos dose from two packets a day to four packets a day. He has also put me on carnitor and calcirol granules.

The bone pain is not getting better. Its been about seven months since it started and about two months since I started the regular calcium acid solution. The suspicion is that the chronic hypophosphatemia may have a role to play in the bone pain. We did toy with the idea of getting a bone biopsy but it is an extremely complicated thing and is not even done in the city.

For me, personally, the bone pain is getting very frustrating. It is causing me to limp quite badly and every movement I make, I can feel the pain in my back, ribs and feet. It is not a severe, unbearable pain, but it is a constant nagging pain. It gets worse as I get more tired through the day and is bad in the evening. It gets better when I swim in the morning, possibly due to the stretching.

Good news from Sai Karthik

I just heard from Sai Karthik's family. There is some good news at last. For the last 5 days, they have not needed to do any dialysis and his creatinine has stabilized at 1. They have also stopped plasmapheresis and are watching. They are still at Vellore and the plan is to watch for a few more days and then remove the PD catheter if he continues to show these good signs.

This is excellent news. Looks like the HUS is in remission.

Well, there are chances that the HUS may flare up again. But at least, they will be better prepared. Possibly start plasmapheresis immediately. This was really close.

Tuesday, April 6, 2010

Its official: Dialysis centers can make a difference

At a recently held Renal Physicians Conference at Baltimore in the US, Dr. Allen Nissenson spoke about an interesting study done at University of California, Los Angeles. Gary Peterson of Renal Web says: "They found that you can take two facilities with the same case mix, Kt/V, time on dialysis, albumin levels, etc – all the usual biochemical and treatment measurements – and the outcomes can still vary as much as 39% In the past, it was reported that they were looking at over 150 variables such as personnel issues, communication patterns, patient education, facility environment, staff morale, etc. to explain these differences."

This is very significant. This means that dialysis units actually have a large role to play in outcomes of dialysis patients. While this might seem obvious at first sight, it is important to realize what they are saying. Apart from the medical basics like proper sterile techniques and actual dialysis procedures, they are now including things like personnel issues, communication patterns, patient education, facility environment and staff morale.

Units where patients are better educated, where the ambience is more cheerful and the staff is more positive lead to better outcomes. Dialysis units must take serious note of this. (That is, of course, if they want better outcomes! How many units in India are seriously concerned about outcomes? Death on dialysis is something that our dear friends have become so used to that not a hair on their heads is stirred when it happens. Sad, but true.)

Managements of dialysis units must strive to make their units more cheerful places. The staff must be trained to make the experience of patients more pleasant. This must be a part of staff reviews and appraisals.

Which leads me to think - why can't someone have a system of rating dialysis units? First, establish a registry of dialysis units in India. Make the units record the statistics of every dialysis session. Keep a detailed history of every dialysis patient. Then, a central agency evaluates the statistics every year and notes how dialysis patients are doing. They publish the ratings of the units. This will give the units an incentive to do better. There will be healthy competition between units for better patient outcomes. They will strive to improve.

Who will benefit the most from this exercise? Of course, the patient!

Monday, April 5, 2010

Let numbers not be the be-all and end-all of treatment

During the days when calcium was being incessantly leeched from my bones, my blood levels of Serum Calcium were normal. Always. Not once did they fall below normal. Yet, it is an undeniable fact that there was something terribly wrong. The wrong calcium level in my dialysate has caused me so much harm, it is today the single biggest challenge in my life. Every step that I take, every movement that I make, I am reminded by the jabbing pain in my back, ribs and feet, of the mistake I made by taking this easy.

My Calcium level was normal. There should not have been any problem. My Calcium level is normal even now. Theoretically, I should have no problem.

Medical science has made great advances. But the mysteries that are hidden in the human body have not yet been solved. Will they ever be solved? I doubt it. As of now, at least, we should all be wiser than to simply take the values shown in a lab test at face value and treat ourselves based on that. There is a lot hidden behind those numbers.

This puts an additional burden on doctors. Doctors cannot afford to treat their patients based on lab tests alone. Careful study of the patient's history, keeping abreast with the latest that is happening and tons of common sense are inevitable to truly try and address the patient's problems.

Doctors must treat individuals as individuals, each of who is different. The numbers are there merely to serve as guidelines, not to dictate the ultimate course of treatment. The numbers are different for different people. And it is not possible for each person's 'normal' range to be clearly established. This makes medicine more of an 'art' than an exact 'science'. What needs to be looked at more closely is how a patient is 'feeling' than what his or her lab tests are showing.

Patients should be more proactive in their own treatment. They know their own bodies best. They know when they feel well and when they don't. They are the best interpreters of the numbers. Patients need to do their research and help the doctors help them.

Sunday, April 4, 2010

Compliment!

I went for a swim late today. Around 11. I saw Neerav Modi, my senior from school with his kids in the pool. I had run into Neerav a couple of times before at the pool last year. This is how our conversation went today:

"Hi Kamal!"

"Hi Neerav!"

"You're still coming every day huh?"

"Yes. Sundays I come a little late. Otherwise I come around 7:45 - 8 in the morning."

"Hmm. So, that's how you've kept in shape!"

I almost hit the ceiling in elation!

Saturday, April 3, 2010

Can't wait for the iPad

The iPad is going to be in people's hands today. For a change, they say it will be available in India sometime in April too. My initial reaction to Apple's new product announced in January this year was wait-and-watch. My current feeling is can't-wait-any-more!

It is going to solve a few problems for me.

When I get back home, I am generally very tired. I want to lie on my bed and watch a movie or browse for some medical stuff. My laptop is too heavy and inconvenient to use in this position. The iPad would be ideal. It weighs about 700 grams!

Every time I visit my doctor, I have to lug around huge files that have all my reports. I have all the reports in an Excel file. Problem is it is too clunky to take a laptop to a doctor and open it in front of him and show the reports. An iPad would be great. Small, light, convenient.

My journey on the way to office and back is often very boring. When there is a lot of traffic (which is on most days), it can be quite dreary. An iPad would be ideal to watch a movie or listen to music. In fact, if I can get myself a 3G model, I can actually browse the internet on the way!

Above all, the device looks extremely sexy. It would be really cool to have one of them with me.

Friday, April 2, 2010

What about per capita downloads?

Outlook has an interesting article where they say that India has the largest volume of illegal internet downloads in Asia and the fourth largest in the world. While that is probably true, it is unfair to just compare the volume of downloads and blame the country for not buying content legally.

What would be a more 'fair' statistic of comparison is the 'per capita downloads'! That is the volume of downloads per person. India has a huge population. Anything you talk about is bound to be huge. What makes more sense is to talk about the average download volume per person.

You might argue that that is also unfair because a large percentage of the Indian population does not even have access to computers and the internet. How then can you include them while calculating the average. Agreed. How about using the number of people with internet connections? Makes more sense?

One important thing to remember while discussing these statistics is that the cost of online content is very unfair in India. Especially that of software. Most companies simply multiply the cost in dollars by the exchange rate, add taxes and sell at that price. This is only going to increase piracy. What should be done is to apply the Principle of Equivalents. What can you get in a dollar in the US? Take those things and calculate how much it costs to buy the same things in India. It will be much less than Rupees Forty five.

Then again, the downloads are often for music and movies. In the US, you can buy a song from iTunes for 99 cents which is not a whole lot. To encourage legal purchases online, the cost has to be made more justifiable and content has to be easily available. Only then can any such comparison be considered fair.

Thursday, April 1, 2010

Yours truly features in the 'Grand Rounds' of Pediatric Nephrology website

I am happy to report to you that an article written by me titled, "Peritoneal dialysis as modality of choice in kids" has been featured in the "Grand Rounds" of the website Pediatric Nephrology maintained by Dr. Sidharth Sethi, Pediatric Nephrologist at AIIMS, New Delhi.

In the article, I suggest that in kids with renal failure, Peritoneal dialysis, rather than Hemodialysis should be the modality of choice, all other things being neutral. An excerpt from the article:

"The whole exercise of undergoing a session of hemodialysis is quite traumatic to the strongest of adults. For kids, it can be living hell. The process of cannulations and then seeing your blood outside your body, the fatigue at the end of a session, it is all too much for a child to bear.

Peritoneal dialysis is an excellent alternative medicine has given us.

...kidney disease is often a lifelong affair, something that the playful little boy sitting in
front of you is going to have to live with for the rest of his life. Every little step you take to help him bear this cross will make life a little less difficult to live."

You can find the entire article here.