Thursday, December 29, 2011

Can I please have my news channel back?

I suddenly realized that news channels are not the same any more. Earlier we had news bulletins at 8 p.m. and 9 p.m. that gave you 'news' as in 'news' not 'news' as in discussions to death about every happening of the day!

Every single bit of news has to have a discussion associated with it. And there always are the so-called resident experts giving their much more than two cents.

When I watch the news, all I want are the headlines and a quick summary of the main news of the day. That's how it used to be. 30 minutes of crisp, objective reporting of the incidents. Not opinions of every party involved and more.

Now suddenly, every channel has a debate after every news item! And some panelists are asked to stay on for all the news stories. Like they are experts on everything. Think Renuka Chowdhary.

I wonder why this change has come about. Is there any English news channel that does news in the good old format?

Tuesday, December 27, 2011

Trying to figure out the Effigent bond

On 25th December this year, former 'Effigentians' had the second reunion. It was great fun. We had some games, lunch and a whole lot of catching up.

When I look back at the gathering and also the years in Effigent, I wonder what it was about Effigent that brought everyone so close, what it was about Effigent that gives many people goosebumps even today, what it was about Effigent that was so magical?

I had written about this during Effigent's last few months here.

I still do not have any perfect answer.

I just leave you with the video that I put together when the consulting division was sold to another company:

Thursday, December 22, 2011

Steve Jobs - the book

I just finished reading Steve Jobs' biography by Walter Isaacson. It is a brilliant book. It takes us right through  Jobs' childhood up to the time just before he died. It brings us perspectives from Jobs, his family, colleagues, adversaries and many others. I read it entirely on my iPad and iPhone. The beauty of the seamless integration between the devices championed by Jobs was evident from this one fact: when I left the book on the iPad after reading for a while and then took it up a little later on the iPhone, the book on the iPhone opened up exactly where I left it at on the iPad!

Isaacson was called by Jobs to write this book. Jobs knew that books would be written about him after he was dead. They would not be able to get his side of the story. He wanted to correct that.

Jobs has often been portrayed in the media as someone who easily rubs people the wrong way, can be brutally frank and critical and tells it like it is. He can also be insulting. The book confirms this. However, this, in conjunction with the 'reality distortion field' led him to inspire people to do better and make such great products.

People have also criticized Jobs for the 'closed' nature of Apple products and the fact that Apple controls the entire eco-system around its products. The thing to realize is that this is the only way the experience while using these products can be seamless and enjoyable. The little thing I described in the beginning of this post is only possible if the devices are 'closed'.

I have a MacBook, an iPhone and an iPad. I never have a problem with crashing or hanging computers, viruses, transferring my music and books between devices and so many other things people around me working on Windows, Linux, Android and what-have-you complain about. iCloud is also such an amazing service that it takes this whole syncing business to an entirely new level.

There is no doubt that Steve Jobs has made a dent in the universe. Thousands of people around the world have experienced pure joy from the many products (and movies) that he has produced. He will be remembered for a long, long time.

Wednesday, December 21, 2011

Wanted: An Anna Hazare for the medical industry

Anna Hazare has stepped up the pressure on the government to bring about an effective Lok Pal Bill in the winter session of Parliament. People asked why Anna Hazare was assuming that the bill is not going to be passed and was planning an agitation. I kind-of saw reason in those arguments. But now, when I think about it, had the pressure been eased even if just a bit, the bill would never have been brought in this session. Well, I am still not sure if the bill is going to be a reality because our politicians are so thick skinned and devious that they may still find a way out.

Anyway, coming to the topic, we really need a crusader similar to Anna Hazare to check corruption in the medical industry. It is so widespread that it is a bigger danger than the administrative corruption that he has been fighting against. This is because it directly affects the life of the citizen. If administrative corruption is not checked, the worst that can happen is that someone's house may not be built, someone's pension may not be released or some corrupt ministers may get away after thieving the nation of a few thousand crore rupees.

What is happening due to medical corruption? First, what do I mean by medical corruption? Medical Corruption is basically when doctors and hospitals treat a patient for considerations other than the patient's health. For example, a doctor prescribing a brand of erythropoietin simply because that company sponsored  a foreign trip for him and his family. Or a doctor eschewing a particular brand because he was not sent on such a trip! In these cases, clearly, the patient's condition has become secondary. What became important is what the doctor gained from the transaction.

Referral fees is another huge area of massive, brazen corruption in the medical industry. Doctors are given huge referral fees for almost every service. Doctors, for the most part, send their patients to the service providers that offer the largest cut.

There are many such areas where corruption has become so deeply ingrained in the industry that it is no longer seen as 'corrupt' and yet it is nothing short of corruption. Shameless, absolute corruption.

It is more important for this corruption to be fought, in my opinion. For it is not merely money that is being lost, it is often lives that are put at stake.

Tuesday, December 20, 2011

The problem with monks who sell Ferraris

I had heard so much about the book that I finally bought it and read it. I actually heard the audio book first (much to the disgust of my driver who had to put up with an accented voice talking nonsense for hours on end instead of hearing the latest chartbusters) and then thought I would go ahead and read the book because the audio was abridged.

It was a good book. Good messages, a good style of writing, overall simple to follow, not too weighty. I was blown away when I read it at first.

However, what was new? Nothing much, IMHO.

We all know what's being said. We all know that we are spending way too much time in things we don't like. We all realize that we need to take a step back and see where our life is heading and then take corrective action. But how many of us actually do that?

I don't find myself having made any change or practising any of the steps mentioned there. I suspect that a vast majority of the readers of the book haven't either. Well, there are definitely a few who have but those are really very few.

Things like Art of Living and Landmark courses are similar. People are highly impressed at first, especially when they read the material or do the course. The key to making it work though and see any perceptible difference is continuous practice of the concepts involved.

Yes, there is nothing wrong with these courses or books per se but they are not like some magic wands that are suddenly going to make us feel very happy and contented. It requires much more than reading the book or attending the course. And at the very base, all of them are very similar in content.

So, stop and think hard before selling that Ferrari.

Monday, December 19, 2011

A fundamental question - Is the treatment giving a better quality of life?

I had written about dialysing our elderly here a few days back. I reflected on that deeply a few days back while discussing the treatment options of a patient with her son along with a nephrologist. The lady was 70+ years old. Her son was as committed as ever. I could tell that the option for withdrawing treatment had not once crossed his mind.

The nephrologist made a very important point. The question she asked was, "Is the treatment doing anything to improve her quality of life or is it merely prolonging her suffering?"

It was easy to see that the dialysis session was nothing short of torture for the patient. Within a few minutes of starting, she would ask for it be closed. She was also not totally aware of what was happening around her. For her, it was a strange surrounding even though she had been there a few times. In her mind she was probably wondering why she had been brought there.

The family was considering PD as one of the options to make it easy on her. The nephrologist did not feel it would benefit her.

The nephrologist asked the family to consider this question and answer honestly if they really thought the treatment was benefitting her.

Once the conversation wound up, the son went over to her mother and gently stroked her head asking her if she wanted to eat anything. He could hardly hold back his emotions. Neither could any of us.

Sunday, December 18, 2011

The Second Annual Ex Effigent Reunion

Second Annual Ex Effigent Reunion

Date: 25th December 2010
Time: 9 a.m.

Venue: A farmhouse on the outskirts of Hyderabad (same place as last year)

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 yet again taking the initiative!)

Thursday, December 15, 2011

Try not to change your nephrologist

Many people on dialysis keep changing their nephrologist. Every now and then. This is not a good thing. There is a lot of undocumented history that resides in a nephrologist's mind. This can never be substituted by anything.

Why do people change their nephrologist?

Mostly, it is because they hear something good about some other nephrologist. "He is very good, why don't you try him?" kind of a thing. Remember one thing. Once you're on dialysis, things happen. It is often not due to the nephrologist's fault. Chronic Kidney Disease lends itself to a host of co-morbidities (conditions that occur alongside the primary disease itself). This is part of the game. The nephrologist can often not do anything to prevent it. So, do not blame your nephrologist for everything that happens to you.

Some people do not find the time given by the nephrologist to them adequate. This is a valid concern. Some nephrologists do not spend enough time with their patients. It is not their fault. They have to see so many patients in a limited span of time. But what does the patient do in the circumstances? This is something that I have no solution for. But think hard before changing the nephrologist.

The time the nephrologist spends with you is very important in your overall treatment. A lot of thought goes on in his or her mind that gets stored in his or her brain. This cannot be replaced by any amount of documentation.

Think about how the human brain works. There is a lot of processing that goes on before arriving at a decision. Things that can never be substituted by books, journals and documents. The decision is arrived at based on a lot of experiences of the past, the dozens of cases the nephrologist has dealt with in the past and the results of so many different treatments and their outcomes that are stored only in his brain.

I am not saying NEVER change the nephrologist. But you must have a strong reason to do so. Don't do it just because the patient in the next bed at the dialysis unit asked you to.

Rolling stones, they say, gather no moss.

Tuesday, December 13, 2011


I was recently chatting with an elderly gentleman of my 'sangh' (the community of people who belong to the same temple). He asked me what I was doing these days. I said I was working at NephroPlus, a chain of dialysis centers.

"Oh! so you have dedicated your entire life to this cause?"

I immediately clarified that I was getting a salary and this was a for-profit organization.

Yesterday's Business Line also attributed a lot of things to me that are not entirely true. They said that I started NephroPlus after years of fighting kidney disease. It was actually Vikram Vuppala who started NephroPlus. I was with him in spirit from Day 1. But it was totally his baby. I supported him. I officially joined part time last year and full time a few weeks back. To Vikram's (and the other co-founder Sandeep's) credit, they involved me right from the beginning so that they could get the patient's perspective while setting this up.

I loved the time spent there as this was very close to my heart. I finally answered my calling and joined the company. But this is a for-profit organization and I get a salary and sweat equity. So, its not like I have sacrificed anything for this or am giving up anything for this. So, please don't accuse me of these honorable things!

Monday, December 12, 2011

ISN Conference at Hyderabad

This year, NephroPlus put up a stall at the Annual Conference for the Indian Society of Nephrology. I attended all the days of the four day event. It was a great experience.

First of all, I saw everything 'nephrology' around me. Erythropoietin stalls, Iron stalls, Dialysis machine stalls, Dialysis center stalls. Kidney was probably the most used word around the conference!

There were a lot of very good sessions by stalwarts from round the world. And there were a lot of people attending the sessions - something contrary to what I was given to believe.

More than anything, however, I got the feeling that it was a great opportunity to network. For nephrologists, for corporates, for vendors, for everyone in the Nephrology industry.

I met with a lot of nephrologists, some of them pioneers, from around the country.

I ran into my own nephrologist, the man who has been treating me for the last fourteen years, Dr. Girish Narayen. He introduced me to his friend. While introducing me, he said he was not sure whether he should refer to me as his patient or his colleague (because of my current job at NephroPlus)!!

The most interesting meeting was with a doctor formerly associated with AIIMS, New Delhi. He came to our stall along with another doctor and started writing his name in our Visitor's Register. I was dumbstruck for a second as I saw the letters form. It was Dr. S. C. Dash. Dr. Dash is a very senior and respected nephrologist. When I was initially diagnosed with atypical Hemolytic Uremic Syndrome, a kidney biopsy was done to confirm the diagnosis. Due to the extremely rare nature of this disease, the biopsy slides were sent to Dr. Dash to confirm the diagnosis. This was a major step in my treatment.

I introduced myself to the doctor and told him that he had seen my biopsy slides years back! He of course did not remember that (he has probably seen thousands of biopsy slides!). But he gave me a playful box on my stomach and said he was very happy to see me like this, meaning, in good shape.

It was an excellent experience overall. When I moved to healthcare, specifically nephrology, from something as different as software, I never thought these things would happen. It has brought me close to many people I never imagined I could even be in touch with.

Sunday, December 11, 2011

In search of the perfect Baklava

Albert Einstein, while describing relativity said, "Put your hand on a hot stove for a minute, and it seems like an hour. Sit with a pretty girl for an hour, and it seems like a minute. THAT'S relativity.”

You might wonder what relativity has to do with finding good Baklava. Bear with me for a bit.

So, there I was, returning from the Indian Society of Nephrology's Annual Conference after winding up the last day this morning (NephroPlus had a stall and coming up is a post on the happenings), I took the short cut from Hi-tec city to Banjara Hills that goes through the road that houses "Sweet Nirvana", a place where I was told you get great Baklava.

Baklava is something I have been dying to eat from many years now. My yearning began when my grandmother returned from the US and Canada after a visit to her son and daughter. Apparently, my uncle, her son, makes great Baklava. My grandmother is very well read and has a flawless command over language. She described the whole process by which my uncle made the Baklava. He laid out the sheets of 'flow-dough' and then brushed it with syrup and then put crushed walnuts and then another layer of 'flow-dough' and another round of syrup and walnuts. And then he baked it at such and such temperature for so many minutes. The whole description caught my fancy and I have been dreaming of eating the Baklava since then. This was at least fifteen years back.

I have eaten what people thought was Baklava. I have eaten what people called Baklava. But I don't think I ever ate what was actually Baklava! Weddings, restaurants, no place served the real Baklava. Note that I had never eaten the real thing to actually know what it was supposed to taste like either. But I had made a mental note of what it was supposed to taste and look like and always compared it to that!!

So, I stopped at Sweet Nirvana and asked for some Baklava. I was told there was only one slice left. I asked how much it cost.

"Two fifty"

"Two hundred and fifty rupees?"

"Yes sir!"

"Ok, please pack it."

I was asked to sit at a table and wait. Rs. 250 for one slice of Baklava? I started thinking about how I will explain this to my mother!

In a few minutes I was on my way home. The container was opened and my parents asked me what it was. I told them. The slice was fairly big. We all took a portion. My parents said it was 'ok'. I kind of liked it. It was the closest it had come to my mental image and taste.

Then came the tricky part.

"How much did you pay for it?"

"You won't believe it! This thing usually sells for a couple of thousand. But I got it for six fifty!"

"What? You paid six hundred and fifty for that?"

"It is not at all like the Baklava we bought from Dubai. That simply melted in the mouth. Tell me the truth."

My mother was fairly sure the stuff she got from Dubai was better. Especially since this was six hundred and fifty rupees!

After a few minutes of this charade, they were convinced that it cost Rs. 650.

Then I told them, "I was just joking. It actually cost only two fifty."

"Don't tell lies Kamal. I am sure you paid more."

"I swear. Do you want to see the bill?"

"Yes, show us the bill"

I darted to my room and brought the bill and gave it to my mother.

"Hmmm. Rs. 250."

She was actually quite happy!

I said a mental thank you to Albert Einstein for his theory of relativity and took another piece of the Baklava. I promise that this time it tasted exactly like what I had in mind.

Thursday, December 8, 2011

Hitler gets angry about 'Kolaveri di'

A friend posted this from YouTube. I found it hilarious! This scene is very popular for such spoofs.

Wednesday, December 7, 2011

Bone pain rears its head again

For the last few weeks, I have been having bone pain again. I had severe bone pain towards the end of 2009. At that time I had realized that it was due to multiple factors - the low Calcium level in my dialysate and the low levels of Vitamin D in my body.

The problem with things that develop gradually in the body is that you are not sure until it becomes bad. For the last few weeks, I had pain on and off but I did not do anything about it. I was always wondering if it really was serious or was it just a passing phase? For example, joint pains can happen once in a while without indicating anything important, right?

But for the last few days, the signs were unmistakable. The only difference from last time was the areas in which the pain was there. While last time, it started mainly in the feet and back, this time, it is in the shoulders and back. It is quite bad in the morning. In fact so bad that I invariably get up at around 4 - 4:30 with the pain!

A few days back, I concluded that something was definitely wrong and got a battery of tests done including those for 25 hydroxy Vitamin D3 and 1,25 dihydroxy Vitamin D3 apart from Calcium and PTH. Both the Vitamin D3 results came back low. Especially the 1,25 test was shockingly low. The report says it was less than 1.6 pg/ml whereas the normal is 19.6 to 54.3! They don't even give a value. Just less than 1.6, they say. So it could practically be 0!

I went over to my nephrologist yesterday and he put me on Calcitriol 0.5 mcg once daily. Hopefully, this should correct my problem.

Monday, December 5, 2011

Unfairly condemned Creatinine

Ask any dialysis patient worth the little salt he eats which is the blood test he would most commonly associate with kidney disease and chances are that the answer would be creatinine. From the time you get diagnosed, everyone talks about creatinine. "How much is your creatinine?" is a question I have been asked the most, even more than, "What is the secret of your good looks?"

I have talked a lot about Creatinine in a recent post here.

However, a very interesting perspective about Creatinine was offered by Dr. Ashwin Aiyangar at the patient meet we had at NephroPlus recently. What he said was that Creatinine is a product of the breakdown of a certain compound in the muscle. So, if your muscle mass increases, your Creatinine increases.

Many people on dialysis in India have a huge malnutrition problem. Many nephrologists do not impose any diet restrictions on such patients. Heck, they are not even getting the basic nutrients; what is the point in asking them not to eat this or that? Many dialysis patients are so malnourished that their potassium and phosphorus are below normal!

So, in this context, the Creatinine is a good measure of how well you are eating. This is true for those dialysis patients that are on maintenance hemodialysis or those with End Stage Renal Disease. (Note that the end stage is not end stage as in end stage of life but end stage of kidney function!) These patients need not worry when their creatinine is too high. All that means is that they are eating well and they don't need to worry about being malnourished. These patients should check their creatinine only to serve as a marker of nourishment, never as a marker of kidney function.

In patients who are in the early stages of kidney function, the creatinine serves as a marker of kidney function and they should be worried if their creatinine is going high.

Sunday, December 4, 2011

One way not to proselytize

For the last few months, every Sunday morning at 6, an autorickshaw roams around in our locality and on the loudspeaker begins a sermon in Telugu. The voice is not pleasant. The sermon lasts about twenty minutes and then some music is played for a couple of minutes. The intent is obvious.

I have nothing against any religion. To each his own. However I am dead against this intrusive attempt to proselytize. The worst part about it is that it is entirely ineffective. Who would be willing to listen to a horrible voice trying to thrust religion down your throat at 6 on a Sunday morning? Anyone thinking about converting would have second thoughts!

Religion is a highly personal thing. It should never be worn on your sleeve. I wrote about this here and here earlier too. It has now spread to almost all religions. Its almost as if they are each trying to outdo the other in being 'heard'!

I doubt if any religion was like this a few centuries back. They have all evolved so much. Most have moved into becoming more external rather than internal. More about show, less about reality. More about competition, less about inner introspection. The clergy are often to blame.

Even my own religion has fallen prey to this trend.