Monday, February 28, 2011

Have you tried Google's App Engine?

Recently, MVK, my friend, told me about Google's App Engine. Call me disconnected but I had no clue about this fantastic service from Google. They have this whole infrastructure where you can run web applications on their servers. And this is not just simple static websites but full featured applications! 

They have a choice of two development environments you can use - Java and Python. They also have a persistent store that your apps can use. So, you can pretty much have everything on their server. And like most things Google - the basic service is free! You can also serve the application from your own domain name.

I was really thrilled when I got to know this and explored it a little. It is a pretty decent service. Well, they have a few restrictions but what the heck - its free! Nothing problematic at first sight. But I am guessing you can't use it if you are going to have hundreds of users hitting your app every hour. For anything from simple to medium complexity and traffic, you should be able to use this.

I haven't yet done anything significant with this so far. But I do plan to take it for a spin soon. I have a requirement that I have been trying to have a decent solution for, for some time now. This should be ideal.

The only thing that worries me is the extent to which we are all dependent on Google!

Sunday, February 27, 2011

Alvida Afsar saab

Ghulam Ahmad Afsar is no more. Afsar saab, as I used to call him, came thrice a week in the morning to NephroPlus for hemodialysis. I used to interact with him almost every time he was there. He was a man who had seen life in its various hues and shades, the darkest of which were probably his last. He switched to another center a few weeks back for some reason. I got to know a few days back that he passed away.

Afsar saab was an unlikely loser in the game of life. He would not take no for an answer when he thought something was not being done right. He would raise his voice and fight for what he believed was correct. He took very good care of his health. He was proactive and totally in control. He would do a little bit of exercise every day too. He maintained excellent control over his diet. I am at a loss as to how this happened.

To think that someone I met only a few days back and had no sign of any complications is no more is very difficult to come to terms with. This is the nature of this disease. The disease will never kill you but the co-morbidities that it brings along with it will. Its almost as if each of us is sitting on a time-bomb that is ticking away. Nobody knows when the timer will run out.

Whenever I get to know that someone on dialysis has died, I get very uncomfortable. My heart becomes heavy, like lead for a while. I become a little scared. John Donnes' lines are so true:

No man is an island,
Entire of itself.
Each is a piece of the continent,
A part of the main.
.......

.......
Each man's death diminishes me,
For I am involved in mankind.
Therefore, send not to know
For whom the bell tolls,
It tolls for thee.

Saturday, February 26, 2011

The mellifluous Suprabhatam

I remember the Suprabhatam from my childhood. In the apartment where I lived, one of my neighbors used to play it every morning. At that time, I was not very spiritually nor very musically inclined especially not Vedic Religion or Carnatic music! But it stayed with me somewhere at the back of my mind.

Some time back, I somehow got this urge to listen to it. I asked around and sure enough, got a copy of M. S. Subbulakshmi's excellent rendition of this masterpiece. I have been listening to it almost every day for the past few weeks. It leaves me spellbound!

Who is it that sang this with the legendary MS? Was it Radha, her foster daughter? MS and her mystery companion have sung the verses with flawless pronunciation of the rather difficult Sanskrit words. Hours of practice have probably gone in before such a divine performance. All the verses are sung by the two voices in perfect sync. The other voice matches MS note for note, letter for letter.

There is something about the Sanskrit words, the simple, rhythmic tune and the way MS has sung it that really mesmerizes you. When I was looking for more information about the Suprabhatam, I found a remix by A. R. Rahman. How was it? Pathetic! Nothing can match the MS version.

The verses themselves are invocations to the Lord to wake up. You can read the entire set of verses here along with English translations.

Here is a You Tube video that has the audio with images from Tirumala and the verses as subtitles:







Thursday, February 24, 2011

Are your shoes cleaner than mine?

Most dialysis units in India have a sign outside them that asks people to leave their footwear outside. This is to make sure that dirt does not enter an otherwise supposedly clean and hygienic area. So, patients and their attenders religiously follow this and leave their footwear in the designated area and only then go into the dialysis unit.

People who manage the unit however, do not follow this instruction for the most part. Hospital management, staff, dialysis technicians and nurses barge in to the unit almost always with their footwear on. Why this discrimination? Are your shoes cleaner than the patients'?

If regular footwear is not allowed, it should be not allowed for everyone. If it is allowed for hospital staff, it should be allowed for patients as well.

I have never understood this. I thought this was restricted to one or two hospitals. I was wrong. This is prevalent in many hospitals.

I dare not point this out too. Already, my being proactive has landed me in some trouble. I can do without more!


Tuesday, February 22, 2011

Make sure you do not lock unnecessary attributes in an entity in a WebObjects EO model

One more mistake many people doing EOModelling with WebObjects make - unnecessarily locking attributes.

In the EOModeller tool, all new attributes come with the locking option set to 'on'. I have no idea why. This really should have a default of 'off'. The locking attribute is used when an update is being made to the database. During the actual update, the attributes that are set as 'locked' are used in the 'where' clause of the update query being sent to the database.

Typically, you would only need the primary key when you are updating a single row. Now, if you have set another attribute to be locked and you are trying to update that same attribute, you will get a 'GeneralAdaptorException'. That's because, you set the attribute to be locked and you are trying to update it!

The problem is the tool sets everything to be locked by default. What I have started doing is to set everything to unlocked except the primary and foreign keys which you never ever update in WebObjects. That has worked well for me.

Does anyone have any more insight into this?

Monday, February 21, 2011

Beware of the reverse relationship in WebObjects EO modelling

I have made this mistake more than once in the past.

In WebObjects, when you create a relationship between two entities using the EO Modeller, the tendency is to create the reverse relationship as well. Let me give you an example. Let's say you have two entities - Programmer and Project. One programmer can belong to only one project and a project can have many programmers (unless of course, the programmer is Shravan Kumar Mahankali, who usually can finish off entire projects, especially WO ones, single handedly!)

So, here, we need to create a to-one relationship from Programmer to Project. In the process, you have an option to create the reverse relationship (a to-many) from Project to Programmer. The advantage of creating these relationships is you can get the desired destination object(s) of the relationships by a simple method call - programmerObject.project() or projectObject.programmers(). This can be a great convenience. Without this, you would have to manually write code that would create the fetch specification and then call it - a good few lines of code!

The reason behind this is in the good old days of WebObjects, when everyone and his uncle used Apple's EOModeller tool, the reverse would always be checked by default. For all you rookies who have started using this fantabulous development platform recently, the EOModeller tool that comes with WOLips has an option that you need to select manually.

Think hard before creating the reverse relationship. Are you going to ever need the reverse relationship? Actually, even better, are you going to be using the reverse relationship frequently? After all, if ever you need the reverse relationship objects, you can always write the code for a fetch specification and get them.

The reason I am stressing on this so much is that WebObjects gets the reverse relationships in anticipation of them being used, even if they are not actually ever used. So, if you get the project object at any point in your code, WO will automatically get the programmer objects as well if the reverse relationship is defined. This may be all right if you have a few programmer objects associated with the project. However, if the number of objects can get large, this could be a recipe for disaster!


Sunday, February 20, 2011

Make using cell phones during dialysis procedures a cognizable offence

In India, dialysis professionals do not refrain from using cell phones during procedures such as starting and closing sessions. I am not sure about other countries.

This is totally unacceptable. You may be an expert at what you are doing. But please spare a thought for the poor soul on the bed. He has had a life-changing diagnosis. He is trying to come to terms with this. The procedure may be painful. It is quite daunting for him. Is your call that important that it cannot wait until the procedure is over? Ok, it might be another patient. Even if it is another patient, can it not wait for a while, until the procedure is over?

Heck, using cell phones while driving a vehicle is banned in our country! Then why is it allowed to be used during medical procedures?? Isn't this much more serious? There is a life literally in your hands!

This is something that medical professionals should really take seriously. A blanket ban on cell phones during medical procedures. That is the only solution.

Saturday, February 19, 2011

Uremic minds

I wrote about the mental aspects of kidney disease earlier too here and here. I find myself thinking about this in the past few days again. There have been, undeniably, some changes in my mental make up all along my journey with kidney disease. Isn't it natural?

When my peers were busy completing their master's in this field or that, I was grappling with basic survival - my initial diagnosis and a transplant. When my peers were getting married, I was trying to get a handle on my life by switching to Peritoneal Dialysis and get some period of sanity. When they started having kids, I had to switch to hemo and then get my home hemo setup done. Now, when I see them planning their kids' futures, I am battling comorbidities of long term kidney disease. With all this, can anyone be surprised that there are mental changes in me?

What are these mental changes? I tend to react strongly to small things. Two swallows do not make a summer. For me, often, one is enough to conclude that its summer. One small incident and I tend to generalize that that is how things are always. Working full time has probably limited that to some extent. The more someone thinks about his kidney disease, the stronger this warped thinking becomes.

People who are dealing with people with kidney disease on dialysis should always remember this. Families of people on dialysis, doctors, nurses, techs - please remember this. Please give them some leeway. Do not judge them based on such actions. Needles take their toll. They cause bumps on the hand - and the mind as well.

Sunday, February 13, 2011

Back under the scalpel

I will be back on the operating table soon. I will be undergoing a minor surgery on Monday at 10 a.m. at Medwin Hospitals. This is unrelated to my kidney disease.

I trust Dr. M. G. Rama Rao, the surgeon who is going to perform the surgery. I have been seeing him for this problem for the last three years. He is a down-to-earth, gentle and kind doctor. Dr. Girish Narayen, my nephrologist recommended him.

The surgery in itself is not major. The thing that bothers me about these surgeries (and I have had more than my fair share) is the part where you have to fast the entire morning until well after the surgery. The other bothering thing is the part when you wake up from the general anesthesia. For a while, you wonder why the surgery has not yet started and then when you start feeling sore at the point of surgery, you realize that the surgery is over. Then you have to wait until they let you go. This wait is horrible. You are feeling sore, there is pain, you start feeling thirsty. But you have to wait for a few hours before they let you go.

At the point of the surgery itself, there will be this stabbing pain that lasts for a few days. They will put me on pain killers and antibiotics. Slowly the pain will start wearing off and hopefully, the original problem I have been operated for will be a thing of the past.

I am going to Poorna tiffins this morning as usual. I will have a few extra idlis, however so that I can bear the hunger the following morning with fortitude!

Saturday, February 12, 2011

Aashayein - in pictures

Here is a link to some pictures from the Aashayein event. The pictures really bring out beautifully the entire event. I especially liked the pictures that showed the smiles on the faces of the patients - true, genuine, full blown smiles!


Friday, February 11, 2011

Aashayein - from the sidelines

Here are a few incidents/comments/whatever from the sidelines of Aashayein:


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I was chatting with a fellow dialysis patient, probably in his late thirties, during the lunch break. We discussed the lunch and that it was great. I asked him how many salt packets he used? (The lunch was entirely salt free and patients could take a salt sachet and sprinkle it over whatever they chose.) He told me he took two sachets since he could not eat food without salt. He asked me how many I took. I told him I also took two. Both of us burst out laughing! "Namak ke bina khaana aur woh sab - doosre patients ke liye hai, hamare liye thodi hai!", he said. (All the salt free food advice is for other patients, not for you and me!)

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One of the doctors spoke in English. Vikram translated the key points of his speech to Telugu. One of the patients called me and complained about why the speech wasn't translated to Hindi. I said that we were trying to have a mix of all three languages so that everyone would benefit. He wasn't satisfied and felt we were being partial to the Telugu speaking audience.

A little later, the next speaker started speaking in Telugu. I requested her to switch to Hindi so that those patients would also benefit. Sure enough, within a few minutes, a lady called me and complained that they could not understand anything and that we should be more mindful of the Telugu participants!

I guess you cannot satisfy everyone together!


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After the dietician, Dr. Haritha Sham concluded her talk, this was a question asked by one of the patients: "Is kidney disease a life long thing?" Huh? Now what has that got to do with the diet??

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After one of the nephrologists concluded his talk, one patient got up to ask a question: It went something like this: What is Peritoneal Dialysis? What is Hemodialysis? What is the difference? What diet can a person on dialysis take? What exercise can a dialysis patient do? Can someone on dialysis eat horse gram? Can you please reduce the rate of Cresp?

All very valid questions. And I appreciate the patient's quest for knowledge. However, sir, you must understand that this is a forum where we have extremely limited time. These questions could take up almost half a semester of an MBBS nephrology course! We can't have a speaker answer these questions at the end of a 4 minute talk! To the nephrologist's credit, he gave a quick summary in about 3-4 lines!


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I ended up getting a lot of undue credit. It all started with Vikram mentioning that I came up with the idea of this event. Actually, to be very honest with you, it was his (or Sandeep's?) idea. I was definitely very excited when I heard about it. But the idea was not mine. Vikram and Sandeep have this habit of giving me credit for things I have not done!

Then Dr. Gopal Kishen took the bait and thanked me for doing this. The patients that were attending followed suit. By the end of the day, almost everyone in the hall believed that I was responsible for all this. That was ok, to some extent. The problem started, when in all the commotion, even I started believing that!! 

When you hear something again and again (even if it is not true and especially when you like what's being said!), you tend to start believing that it is true. But since you are reading my blog, I thought you should know the inside story. 

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In the end, of course, patients had a great day. We continue to receive compliments for the successful event. Of course, we intend to make Hyderabad Kidney Foundation what people expect it to be. May be I did not actually come up with this idea. I will, however, take it to fruition.

Thursday, February 10, 2011

Aashayein - a resounding success!

Aashayein, the first-ever exclusive event for dialysis patients was a huge success! At one point, a few weeks before the event, Vikram, Sandeep and I were worried about how we can make sure that there are at least a hundred people in all that turn up for the event. In the end there were more than 600! And half of them were patients! By any standards, the event was a hit.

For the first time, 300 patient with a similar set of problems gathered together under one roof and talked to each other, heard people talking about their problems and most importantly - had fun.

The event kicked off with Vikram's welcome address where he described how we came up with this idea. I, as MC of the event, introduced the Hyderabad Kidney Foundation (HKF), its objectives and the plans and then invited the father of Nephrology in Andhra Pradesh, Dr. Gopal Kishen and Joseph Rajshekhar, on dialysis for the last 18 years to formally launch HKF by lighting the lamp.



Then we had a few talks by Dr. Gopal Kishen, Joseph Rajshekhar, Dr. Sree Bhushan Raju, Senior Nephrologist at NIMS, Dr. Krishnan, Senior Nephrologist at Apollo Hospitals and Dr. Haritha Shyam, Chief Dietician, Apollo Hospitals.

We also had Madhur Deep, a transplant recipient who shared his experience on getting a transplant. Srinivas Perisetty, husband of Monadipa who is on dialysis gave his perspective on how the family of someone afflicted with kidney disease should cope with this. There was also a Yoga demonstration on some simple but beneficial breathing techniques.



Every talk was interspersed with some entertainment for the patients. There was a mimicry show by Mimicry Hari Kishen, himself a dialysis patient who had the patients in splits with his jokes relevant to people on dialysis, a definite first in India! There was a skit performed by dialysis patients called 'The 7 o' clock shift' which poked fun at the various little incidents that happen in a typical shift in a dialysis unit.



The 7 o' clock shift

We also organized some 'antakshari' type questions for the audience with a prize for each question.




Patient being given a prize for answering an Antakshari question

The lunch was an elaborate renal friendly affair. Patient could eat everything on the menu for a change without worrying about how much salt it had or whether the vegetables were leached. There was a role reversal of sorts. Caretakers had a very simple menu - biryani and raitha whereas patients had a very elaborate menu! After all it was their our day!


A sumptuous lunch for patients




A simple lunch for caretakers!

After lunch we announced the winner of the best fistula contest and had some patients come and present their talent. Some did songs, some did jokes. In the end we had two rounds of Tombola. Every patient was given out a bunch of goodies which included injections, a bag customized for dialysis sessions and other stuff mostly relevant to dialysis patients.



Winner of The Best Fistula contest

After the event, many patients came up to us and thanked us immensely for organizing this. For the first time, someone thought about them and this touched them deeply.

Dr. Reddy's sponsored this event along with NephroPlus and full credit to both the sponsors for making this happen.

Thursday, February 3, 2011

Aashayein - three days to go!

Its three days to go for Aashayein - the first ever event for dialysis patients. Am I excited or what? The tension is palpable. I can almost hear my heart beat. I can barely think about anything else. I am sure Vikram and Sandeep are in a similar state of mind! It is a huge event. The first time we are doing something on this scale.

The response has been overwhelming. We are already overbooked. People registering now are being put on a wait list. In case there are any last minute cancellations, they will be invited. The resources we have are limited. The space that we have is limited. So, there is no other option but to restrict the number of participants.

I took a few calls for registration. I could feel the excitement in the patients' voices about this event. It was the first time someone was thinking about them. There have been numerous events for doctors. None for patients.

The support by the nephrologists also has been excellent. All of them were very encouraging. I am hoping many of them will also come for the event, even if for some time.

Like any other event, there have been last minute surprises as well. Some changes in the speakers were also necessitated.

Yesterday, Sandeep and I went for a trial of the lunch. This was the first time the hotel was preparing food with leached vegetables and without salt. Today we are having a full rehearsal of the skit in the morning at the Banjara Hills center of NephroPlus.

Let's hope everything goes well!

And by the way - if you are a dialysis patient in Hyderabad, please come for the event!

Tuesday, February 1, 2011

William Kolff must have turned in his grave today

Today, a television starlet was invited for a press meet organized by a chain of quality dialysis centers to spread the word about a free patient event. The starlet, obviously not familiar with the work certain bean shaped organs in her body do, day in and day out, was briefed about this and what dialysis actually is. I was also a part of the briefing and we went through the usual rigmarole about me being on dialysis for thirteen years (it is close to fourteen, by the way) and all that.

Here is what the starlet told the press after the briefing (the emphasis is mine):

"I am very thankful to the organizers for inviting me to this event. Dialysis patients are generally very depressed when they are diagnosed with this disease. It is really great that this company along with this patient has invented this treatment called dialysis so that kidney patients can lead a normal life..... Patients can come to this center and get a cure for their kidney disease."

William Kolff, who performed the world's first dialysis in the 1940s would have been very upset had he lived through till today.

William Kolff: "Errr... it was actually me, ma'am!"