Saturday, December 22, 2012

This is absolutely crazy!

Yesterday, my dad's close friend's son came to meet him. After talking about different things, the topic moved to me. He mentioned to my dad about my pic appearing in a recent newspaper in a story about NephroPlus. He then said, "But he started, right?" and gestured with his thumb to the mouth.

My dad did not understand. "What do you mean?", he asked.

He clarified, "He started drinking, right?"

My dad said, "No way!"

"Oh, then you don't know."

"Who told you?"

"I myself saw him."

"When, where?"

"During last year's HPS reunion, he drank and was totally out!"

My dad had two choices. One was to blast the guy for spreading false rumors about me and the second was to ignore the poor guy as he was going through some personal issues. My dad did the latter. Wisely, I would say!

For sure, liquor has never made me "out" but this rumor certainly did!

Wednesday, December 19, 2012

Gujarat Diary

The Modi juggernaut

I landed in Amdavad's Sardar Vallabhai Patel Airport expecting to be greeted with a blitzkrieg of election related publicity, large hoardings, huge rallies and more. I was surprised to find hardly any sign that elections were on. The only thing we saw were two small rallies taken out by BJP supporters. Modi, they say is all set for a third term. This time he is expected to get a bigger majority than last time which will put him firmly at the forefront of the BJP campaign for the 2014 general elections.

Though this will alienate a lot of voters and allies, I don't see how the BJP is going to avoid projecting him as their Prime Ministerial candidate. Ever since it lost power, the BJP has lost its way completely. Without a clear agenda, with no leaders of the stature of Vajpayee, complete confusion on important issues and the worst of them all, corruption among many top leaders, the party with a difference is no longer very different from the GOP of India politics. As I said before, Narendra Modi is at once the BJP's biggest blessing and its biggest curse!

Jalebi FafdaOshwal

We landed at around 9 in the morning. We were all hungry. Suggestions of idli and dosa were quickly shot down. We were in Gujarat after all! We should do a typical Gujarati breakfast was the general consensus. We called an acquaintance who recommended Oshwal. We reached the shabby looking place in about half an hour and took a table. We ordered Jalebi and Fafda. The food was priced quite high. Rs. 50 for four jalebis and Rs. 60 for a plate of fafda.

When the food came, we were delighted. The jalebis were some of the best I've had - thin, crisp and just the right degree of sweetness. The fafdas were served with grated raw papaya, fried chillis and kadhi - a first! Very delicious. We ordered more! We also ordered Methi na gota and Mag ni daal na bhajiya, both very well made, crisp exteriors and soft within. One thing that struck me was that every single thing we had that was deep fried! Welcome to Gujarat!

It was a great start to our short trip.

Chalo Bulava Aaya Hai...

It is said that no one can go to Shatrunjay without a call from Dada Adishwar! I experienced this first hand. Shatrunjay is the most sacred teerth for Jains. Many devout Jains in Gujarat make it a point to visit this teerth at least once a year. We, in the South are less fortunate and our visits are much less frequent. Before this trip, I had visited this great teerth a total of two times. Pathetic! This year, however, from the past couple of months, I suddenly had this strong urge to go there. I have no clue why. I don't know what triggered it. I started looking at options for flights. I checked if it was possible to go on one day and come back the next day so that I don't have to miss my dialysis. I did not want to miss more than one session. It wasn't looking possible.

Then, believe it or not, on my brother Prasan's birthday, his wife, Anjali surprised him with tickets to Amdavad to go to Palitana (the town around the Shatrunjay)! Prasan and his son Naman were to go. Prasan called me and asked my parents and me to join him. I hesitated for a bit. I would miss two dialysis sessions. But I felt it all falling in place. I agreed to go!

Aavyo Dadane Darbaar....

Our yatra went off really well. We got started around 7 in the morning. We reached up in about two and half hours. The number of pilgrims was extraordinarily high that day. We completed our pooja and the five chaityavandans and were back down by around 1:30 in the afternoon.

There were some people who were doing the chauvihar chhat with seven yatras - a feat that is beyond me. How can someone stay without food and water for two days and actually climb the mountain seven times during those two days. It is said that such people achieve liberation within three bhavs. An apt reward for a superhuman endeavor!

The next morning, I went off alone to the Jay Taleti and spend some moments of quiet solitude. There was considerable rush at that time as well but the peace in the early morning hours is unimaginable.

Sabarmati Ashram

We returned to Amdavad that day. We had a few hours to kill before it was time to get to the airport. My brother suggested we go to see the Sabarmati Ashram - the place were the Father of the Nation stayed for twelve years after returning from South Africa. The rest of us were not terribly excited by the idea but agreed nevertheless. I expected us to be the only people there but was surprised to see many people visiting the ashram. It was a motley crowd - some Germans, some Indian youngsters clad in shorts, some very typical Gujju families. It was a very peaceful place, well maintained, not the typical, picture perfect lawns but more natural greenery.

We saw the main ashram and then the modest house where Gandhiji actually stayed - the room he sat and spun the charkha, the kitchen, where he met people etc. The ashram led to the Sabarmati river which probably made for a very peaceful setting before industrialization led to the river being polluted heavily by factories. The ashram has still retained its charm oblivious to the dramatic changes that have taken place just outside its hallowed precincts.

Gordhan Thaal

Just before the Ashram, we went for lunch to Gordhan Thaal, Amdavad's famous thaali restaurant. They serve an amazingly delicious and elaborate thaali with very well made dishes, authentic Gujarati recipes in a very good ambience. My favorite item on that day's menu was the Rajbhog which was a saffron colored shrikhand. The other tasty items were the bajra rotla, the kadhi, the dal and the samosa. They have everything available in the Jain variants as well.

They don't serve any soft drinks but the helpful manager conceded to a request from my nephew Naman for a cola which he arranged from the neighboring kirana store! We were quite surprised by the price of the thali. Given the elaborate nature of the meal, we expected it to be in the Rs. 350 - Rs. 400 range. It turned out to be only Rs. 220. A steal by any standards!

It was a perfect meal to end our trip!

Thursday, December 13, 2012

Home dialyzors - don't let time bring complacence

It was about four years since I had started PD. My life was bliss. I was working full time, travelling with ease, gulping fluid like crazy, eating what I chose to. PD was working so well for me. I hadn't a care in the world.

I remember attending the Indian Society for Peritoneal Dialysis Conference that was being held in Hyderabad. Harish Natarajan, who headed Baxter India's Renal Division was a good friend. He managed to get me a pass to attend the conference. In the courtyard of the venue, Harish and I stood along with a few other executives of Baxter. Harish said to me in now what seems so ominous, "As you get more and more comfortable with PD, you tend to get a little complacent. Try not to do that. Be meticulous about sterile procedures and don't take any chances!"

He was so right. I had become complacent. I was taking chances. I would do two of my four exchanges at work. I did not even - hold your breath - wash my hands before those exchanges! It was a sure recipe for disaster.

Yes, the tsunami struck. Yes, I possibly got some infection. But I cannot deny that my taking chances with the sterile procedures most likely did contribute to my eventual loss of ability to do PD.

It happens with all. As you get more and more comfortable with the therapy, you start taking chances. This can prove to be disastrous. The therapy that gave me my life back, the therapy I loved so much, the therapy that gave me so much freedom was lost to me forever.

I regret it so much. Life would have been so much better with PD.

Those on home therapies always run this risk. Of complacence. On home hemo too, you run the risk of taking things for granted. My fistula got infected recently. I have tightened the screws after that episode. No chances at all.

Home dialysis gives us dialysis patients a shot at a normal life. The freedom is too precious to lose. We must never let anything under our control take it away from us.

Saturday, December 8, 2012

Act firmly against bullying

I was shocked when I read a friend's post on Facebook about a seventeen year old guy in the US state of Michigan who killed himself because of excessive bullying by his school mates. Bullying other people just because they're different in some way and don't fit into your narrow idea of 'normal' is truly abhorrent.

The whole issue lies in what people believe is 'normal'. Some whites believe people of any other color are abnormal. Brown people believe whites are abnormal. Some straight people believe gays are abnormal. Some Indians believe people from the North-Eastern part of India are abnormal. Some North Indians feel South Indians are abnormal. It goes on and on. Anything different is considered abnormal. This myopic view that many of us take must really change.

It is really sad that bullying exists in almost all schools and colleges. It is considered 'cool' to bully and it almost becomes a symbol of strength. The trauma that the target undergoes is too horrific to even be imagined. Your entire sense of self-worth takes a hit and the impact is often felt life-long. The mental torture that the victim undergoes leaves emotional scars that may take decades to heal and may actually never heal. These scars manifest in unimaginable ways and affect the individual's entire life, the relationships he or she has, the way he or she parents and deals with the normal pressures of everyday life.

Due to the extremely serious nature of the consequences, this kind of behavior must be considered deviant with some very strict laws and rules in schools to punish people who indulge in this. Exemplary punishments must be handed out to the guilty so that no student ever even remotely considers doing this again. Schools that do not do this must be punished severely by the law so that they take this important issue seriously.

Parents must watch out for their kids. They must talk about the possibility of being bullied and create an environment where they should be free to talk about the problems they're having in school. Without any outlets for their frustrations, kids often resort to what Josh Pacheco did in the story above and you really don't want that to happen.

Thursday, November 29, 2012

Have you registered for Aashayein Bangalore?

As you know Aashayein is being organized in Bangalore this Sunday. If you are on dialysis and stay in and around Bangalore, please attend this one day free fun and educational event at Hotel Fern Citadel near Anand Rao Circle.

There are going to be talks by nephrologists, transplant surgeons, dieticians and fistula surgeons apart from a lot of entertainment. There is also going to be an elaborate lunch as per the dialysis patient diet and many gifts for patients.

I am going to be hosting the event. I would love to meet you in case you're coming!

You can register for the event here.

Fistula infected

My fistula is infected now like never before. I have been put on very strong oral antibiotics. I have also been given an intravenous dose of a vancomycin, a very potent antibiotic. I was advised to avoid dialysis yesterday to give the fistula rest for a day. In fact the nephrologist was also suggesting that I might need to skip dialysis for one more day!

I will be having it checked again today and then we will decide about dialysis today.

I am quite worried about this. A fistula is like a lifeline for people on dialysis. It is the only way we can get dialysis.  With my fifteen years on dialysis, I am running out of options for fistulae. I cannot afford to lose this fistula.

That is why we cannot take any chances and have to treat this infection aggressively.

I am scheduled to go to Bangalore this Sunday for Aashayein. I am hoping this infection comes under control by then.

Sunday, November 25, 2012

Fistula troubling yet again

For the last few weeks, I have been having problems with my fistula. My venous site got slightly infected and I had to abandon it and develop a new site. (I use the buttonhole technique for my cannulation which means developing a tunnel by cannulating at the same site at the same angle for 5-6 times and then using blunt needles thereafter.) The first time I used a blunt needle for my new venous site, the next morning there was quite bad pain at the site and around it.

I skipped dialysis yet again - third time this week! This morning the pain is slightly better. But I guess I will have to abandon this site as well and develop yet another site.

Needling is bad enough with a fistula - buttonholes or with sharps. These kinds of problems I really could do without! This leads me to think about the convenience of using permcaths. No needles, no pain. The only trouble is it really is not permanent (despite the name). Permcaths, I am told last about a year. What is good cannot last long, right?

Last evening, I was really depressed, almost in tears. I went into the cycle of negativity. I saw people on the road on my way back and thought - these people are so lucky, they don't have to bother about these things! They have problems for sure - but all 'normal problems'. And here I am - saddled with this curse of a disease that dictates every breath of my life, that I have to live with every moment of my day, where all normalcy has been tossed out of my existence. I badly wanted to talk to someone, rest my head on a shoulder and cry.

As I said earlier, dialysis is something I can live with. But these additional problems are something I am getting fed up of.

Saturday, November 24, 2012

We are a corrupt nation

When I say we are a corrupt nation, I am not only referring to the corruption we see in government. I am referring to the corruption we see daily in life. The kind that you and me see everyday while going about our lives. The kind that you and me indulge in everyday.

Let us take an example. When I go to my doctor for a consultation, while paying the consultation fee to his secretary, I always tip him generously to ensure that when I need an appointment I get one quickly! 

Or when I need to get anything done for my house, let us say, I need to buy some electrical switches to replace some broken ones. There are two alternatives. Either I go myself and buy them or I give the electrician the money and send him to buy them.

Now I really don't have the kind of time or the energy to go and buy everything myself! So, I have no choice but to let the electrician do the job. I can say with a fair amount of certainty that the electrician over-charges me for the goods. The shop he buys from is, in all likelihood, in connivance with the electrician to ensure that the electrician always buys from him rather than go to any other shop.

If you look around you, you will find many such examples of small levels of corruption. We have become so used to this that we don't really care about it any more. We don't even feel guilty about doing this any more.

When you think about it, it shouldn't surprise us that the more powerful a person is, the larger the extent of the corruption. It shouldn't surprise us that the Union Government can actually argue that a scam of Rs. 1,658 crores is acceptable while a scam of Rs. 1.76 lakh crore is not!

Friday, November 23, 2012

Unscheduled skipping of dialysis session

I usually don't dialyze on Tuesdays. I used to skip Sundays but since Sundays are holidays and since we usually go out on Sundays, I would end up with more fluid than usual and Mondays would be slightly uncomfortable. So, I decided to go for a Tuesday-off routine since I am working that day and don't put on too much fluid.

This week however, we had gone out of town on Sunday and I was dead tired after returning. My fluid weight gain wasn't too much either. I just didn't feel like dialyzing. So I decided not to dialyze on Sunday.

I dialyzed on Monday, Tuesday and Wednesday. Monday night I did not sleep well. So, on Tuesday I decided to take a mild sedative. I slept well. On Wednesday night I decided to take the sedative again. Despite that I did not sleep well. So yesterday I was feeling quite tired and sleepy. When I got back home, I checked my fluid weight gain. It was about 1.3 kgs. Not much at all. So I thought I would not dialyze and get a good night's sleep.

When I am on dialysis, for the most part I have slept well. However it is not what you would call a 'perfect sleep'. It is about 80% perfect, if you know what I mean. When I don't dialyze, it is a perfectly sound, 100% sleep! So, yesterday, it was one of those ays where I felt like sleeping really well. So, I decided not to dialyze yesterday.

The best part about home dialysis and dialyzing daily is not only do you get better dialysis but you also get the flexibility and the freedom to dialyze according to your wish. You don't feel like dialyzing - don't dialyze! You need extra time, go ahead and do that!

Monday, November 19, 2012

Two girls arrested for FB posts: just where are we headed?

I was shocked and disgusted to read the news about two Mumbai girls being arrested by the police for making posts on Facebook that said that Mumbai should not close for Bal Thackeray's death. One girl made the post and the other 'liked' it.

Forget about whether they were right or wrong. What earthly reason did the police have, indeed, what possessed them to arrest the girl?

Further, what took over the court to actually - hold your breath - sentence the girls to 14 days imprisonment?!!! Just where are we headed?

I do not blame the Shiv Sainiks for what they did. What else do you expect from them?

What shocks me is the actions of the police and the court. I read some comments on the post that said that the girls were Muslims. So what? Please let me know what was illegal or inflammatory about a post that simply says the city should not be shut. People commented that many people did not know what Bal Thackeray did for Mumbai. Does that mean that someone saying that he did not do anything for Mumbai should be arrested?

Let us not accept this kind of blatant intolerance in our country. Hinduism is often praised for its tolerant philosophy. I am reminded of Evelyn Beatrice Hall's quote (often misattributed to Voltaire):

“I disapprove of what you say, but I will defend to the death your right to say it.”

Friday, November 16, 2012

The Parekh kutumb gene

When Saroj Bhagwanji Vora married Mohanlal Lavji Parekh many decades back, what hit her hard was that the Parekhs often ate idlis for dinner - "Aa loko to jamva ma idli le!" Brought up in a traditional Kutchi Gurjar household, she was used to a more 'sarkhu jaman' - sev tamata nu shaak and parathas, khichdi kadhi, bajra na rotla and ringna nu shaak and so forth. So this came as quite a shock to the teenaged girl. For her idli was something you only did for breakfast.

Little did she know that the clan of Gujarati businessmen who migrated from Gujarat to Bangalore took to idlis like a fish takes to water. They relished them so much that they wouldn't mind - in fact would love - idlis even for dinner! Saroj quickly adapted and became adept at making great idlis and even acquired the taste for idlis. As they say in Gujarati, "Ghar joine gotrej aave!" (I really cannot translate that but it loosely means that someone who marries into a house is usually like the members of the house!)

Cut to 2012. Scene: Poorna Tiffins. Naman, my nephew accompanied my brother Prasan and me one Sunday morning. He loved the idlis so much that he polished off 12! Now that is no mean feat for a skinny boy of 8 years. I couldn't help remarking, "That's the true hallmark of a Parekh kutumbi. It's strange how the Parekh kutumb gene manifests itself!"

We have surprised many people with this quirk. A few days back, Prasan revived the tradition of the dinner after the Diwali poojan. We had the entire kutumb that resided in Hyderabad gathering at Prasan's new company, Stone Plus. Guess what was on the menu? Of course, idlis! Some people were wondering why we had idlis. I tried explaining the gene to them. They did not understand.

Wednesday, November 14, 2012

Ban the bulk SMS from mobile phones

No, I am not talking about the 'pesky SMSes' sent by marketing companies. I am referring to the following flow:

1. Compose SMS
2. Choose from Contacts...
3. Select all
4. Type some cloyingly sweet message on the occasion of Diwali, Dussehra, whatever
5. Send!

So impersonal. So artificial. You don't even know who you've sent the message to! Whether that person is dead or alive. Whether you're still friends with him. Whether he celebrates the festival or not.

I find these messages very irritating. I get them from people I might have interacted once in my life and I forgot of their existence only to receive this SMS from them on a festival. Mind you, they've forgotten of my existence too. And what's worse, while I am reminded of their existence by the SMS they've callously sent, they are still clueless of my existence! Not fair!

That is why, getting the personalized message from Aditya is so heart warming! "Dear Kamal", it begins, "Wishing you and your family a very Happy Diwali! -Aditya." Very effective. You know the person has spent a few moments remembering you and has at the very least typed your name. The copy-paste feature of phones these days enables you to avoid typing the whole message again and again. But you're sure that at least your name was typed! So much better!

Monday, November 12, 2012

Diwali snacks!

My memories of Diwali are all of us going over to the "Jagat Pictures" office in the evening and having the traditional Chopda Poojan which was a simple pooja of the account books along with the Goddess Saraswati and Goddess Lakshmi. The pooja would be followed by snacks and a lot of socializing and then a visit to the temple.

Diwali would be preceded by a thorough cleaning of the entire house, preparing snacks and sweets for Diwali and buying new clothes. Those were innocent days!

When the "Jagat Pictures" office was officially closed down, the poojan was not performed for a few years. When however, my father took over the clothes shop "Adam n eve", he revived the tradition of the poojan and ever since then we have been having it! The ritual cleaning of the house is still done every year and my mother, who is a stickler for cleanliness insists on spending a few weekends before Diwali with the help of the maids to do a complete wash of the house.

Coming to the point of this post, the Diwali snacks. I just realized that every Diwali snack we make is deep fried. The Khari poori, the mori poori, the sev, the ganthiya, the ghooghras, the mathiyas, the cholafali, the chudwa and that mother of all deep fried delicacies - the pakwaan!

Snacks made at my house for this Diwali

To add to all this, you have a plethora of sweets that you get on the occasion.

The hours spent at the swimming pool and doing the strenuous yoga stretches must all be getting nullified in a matter of a few days! Well, it is Diwali, so I am not complaining!

Saturday, November 10, 2012

The Wearable Artificial Kidney - closer than you can ever imagine

When I first heard about the Wearable Artificial Kidney (WAK) by Dr. Victor Gura of Cedars Sinai-UCLA, I was a little skeptical. I thought it was good but it would be out in the market long after I was gone! These kinds of revolutionary treatments or devices usually take decades, if not more, to reach the common man, especially in countries like India.

For those who are not aware of what the WAK actually is, let me give you a small introduction. Dialysis machines currently are bigger than a typical washing machine. My machine is about 5 feet in height and about a foot and a half square. For my treatments, I need about 300 liters of pure water - water that has been treated by a Reverse Osmosis process. The water purification machine is also fairly large and I need a special storage tank to store the treated water. You can imagine how big the whole setup is. Not portable by any means.

A few years back, a machine called the NxStage System One was released. This was a true game changer. It reduced the size of the dialysis machine to about the size of a multi-function printer. It was also designed to be very easy to use so that patients could actually use it at home. This machine gave a lot of freedom to patients. They could now dialyze at home, they could travel with ease.

Bill Peckham with the NxStage System One

The WAK takes miniaturization to a whole new level. It can actually be worn around your waist like a belt. It is completely portable and does not require a water treatment plant. The power requirements have also been reduced to such an extent that the machine can run on batteries! 

The WAK received a huge boost when the FDA (authority in the US that must approve any new treatment or medication) included it in the Accelerated Development Pathway program which meant that the device would not need decades before it came to market!

I recently interacted with the man himself! Dr. Victor Gura and his company Blood Purification Technologies are now on Facebook! I sent him a message asking him about the time he estimates this device to reach active production and about his plans for countries such as India. He responded saying it should take 2-3 years and that they would try their best to ensure that the device becomes available in as many places as possible!

The trick will be to avoid being gobbled up by the companies for whom this device will not make sense. The money power of large corporations for whom profits are more important that saving lives is a real danger in the development of this device. More than the technological ability to develop this device, Dr. Gura will need some extraordinary management and strategy skills to help him ensure that the device reaches the intended beneficiary - the patient.

Friday, November 9, 2012

Aashayein to be held in Bangalore!

Aashayein, the day long fun and educational, free event for dialysis patients is going to be held in Bangalore! Its on Sunday, December 2nd at Hotel Fern Citadel near Anand Rao Circle from 9 a.m.

Aashayein is a great event for us dialysis patients. There have been two events organized in Hyderabad so far and patients have loved it. There are educational talks by nephrologists, transplant surgeons, vascular surgeons, dieticians and patients. There's usually some great entertainment as well.

One of the highlights of the event is the elaborate lunch prepared as per the dialysis patient diet. Usually, we patients have very limited eating options when we go for any such event. Most of the food is too dangerous for us to eat. This can be very frustrating. You see all the fancy food and people gorging away and you can only look! At Aashayein, the tables are turned. Patients get the fancy food while people with normal kidneys are served a modest meal!

Patients are also given a whole bunch of goodies.

Registration is mandatory and will close when the capacity is filled. So, I would register early! (I have already registered for the event and am really looking forward to it!)

For more details about the event and to register, please visit the Aashayein website.

Monday, November 5, 2012

Samiir, avid trekker, marketing head and on dialysis!

"It has been 11 years since both of (Samiir) Halady’s kidneys failed, when he was only 28. Since then, he has needed dialysis to survive. But still, Halady says proudly, he has managed to live life with few compromises.

An MBA from Narsee Monjee Institute of Management Studies in Mumbai, Halady now heads the marketing team of a digital agency, which manages advertisements on the internet. It was sheer courage, once his body started failing him, that kept him going. Halady’s condition means that he cannot ever cheat on his special diet, and has to undergo dialysis twice every week."

I am proud to say that Samiir Halady is a great friend. We've met each other only once! We share a lot. Both of us were hit by kidney disease at a very young age. There's one very important difference though. Samiir treks! Yes, that's right! He goes on arduous weekend treks around Mumbai with a group he founded called V-Hikerz.

Trekking is a very strenuous activity. Even many people with functioning kidneys would find it difficult. Yet, week after week, Samiir heads out on his weekend trips taking in the beauty of the mountains, the music of the waterfalls and the mystique of the forests, living his dreams.

On his blog, Samiir says, "Life with Renal Failure and hemodialysis is not so bad. There are ways to live a full life." Samiir shows us all how to do this!

Samiir's amazing story was featured in the latest issue of Open, a magazine from which the above extract is taken.

Sunday, November 4, 2012

Poorna Tiffins, this is your last chance

I don't remember since when I have been going to Poorna Tiffins. Its been a few years at least. Every Sunday morning, I religiously visit this joint about 12 kilometers from my house and relish piping hot idlis topped with ghee along with the coconut chutney. I have introduced many friends to this place and they have, without exception, absolutely loved the place. My friends and I have even had two idli-eating competitions here!

I have never had problems with the taste of the idlis here until now. They would always be very soft - they would almost melt in your mouth. However, for the last couple of times, the idlis weren't as good as usual. It was very disappointing. Now, they were better than many other places. But definitely not Poorna standard! The trouble is they have set such high standards that we have really been spoilt! Anything less and there's bound to be a lot of consternation!

I told the owner last week. He said they're having attrition! They're having to hire new people who are not as good as the original team! They're having to hire temporary people who don't understand quality! And we all thought that software companies are the only ones facing people problems! Imagine a critical function like making idlis being dependent on people rather than processes! Vikram Vuppala would not be happy at all!

Unfortunately I can't be bothered with Poorna Tiffins' internal problems. I want my idlis and I want them soft! Making the 24 kilometer (12 km, two ways) trip every week needs to yield good dividends. Otherwise, its just not worth it. Of what use is a pilgrimage if you can't get a darshan of the presiding deity?

I decided last week on my way back that I would give them one last chance. If they don't fix things and get the softness back into their idlis, it is going to be "Farewell, Poorna Tiffins". It would be a sad day in history. But I don't see any other way out.


UPDATE: The idlis were great! 

Friday, November 2, 2012

The unethical antipathy to PD

In the past few weeks I came across two patients - one who is actually related to me and stays in Mumbai and the other - a reader of my blog. Both had very thin veins because of which repeated attempts at making a fistula in their arms had failed. This should have been clear in the first attempt itself. Despite this, the patients were made to undergo the torture of a failed surgery again and again. Both had residual renal function. Both did not have an issue of not being able to afford the cost of treatment. Despite this, Peritoneal Dialysis (PD) wasn't even mentioned to them as an option!


Why this antipathy to PD?

I find it extremely frustrating that patients are not even told about it. Its like it is a bad word! I know I keep talking about this again and again but when I hear about these kinds of cases, my guts revolt. I feel helpless and angry at the powers-that-be in the dialysis industry who spare no thought for the plight of patients and can think only of their own selfish, commercial interests.

While chatting with my fellow dialysis patients while undergoing dialysis in hospitals, we used to often say that this is such a horrible disease that we would not wish it upon our worst enemies. But when I get to know about such cases where there is scant regard for basic human values, I find myself hoping that these people who take such decisions should get this disease. Only then will they realize what it means to suffer like this. Only then will they realize what it means to be denied a chance to decide for yourself. Only then will they realize what it means to be condemned to a life of hemodialysis when there is a better alternative. Really, they should experience this first hand.

We really need to move to a system of healthcare where the treatment is decided devoid of any commercial consideration whatsoever. Doctors must strictly be on a salary. In fact, I would go to the extent of saying that a part of their salary must be based on the outcomes of the patient they treat. If a doctor's patients live longer and have a better quality of life, he or she must be rewarded. Currently, our healthcare system is so horribly flawed that it is commercial gain more than anything else that dictates many decisions.

The Medical Council of India (MCI) had a while ago banned the giving and receiving of gifts and trips by corporates to doctors. This remains mostly on paper. This corrupt practice is far more dangerous than the multi-crore rupee scams carried out by politicians. They are actually playing with human life. This is the most base, the most sickening form of corruption.

Saturday, October 27, 2012

New look for blog

Obviously you've noticed the new template. But I am not sure if you are aware of some of the things you can do here. For example, if you move your mouse to the right of the page, a panel slides out where you can click to see things like the tag cloud, archives of previous posts, links to the "My story" sections and a link to subscribe as well.

Another cool feature in this template is the different modes you can view this blog in. Most likely you are viewing this blog in the Classic mode because that is the default mode I have set it to. On the top left, just below the title of the blog, you should see the word "Classic" written. Move your mouse to that area and you should see a menu slide down that has different options like Flipcard, Magazine, Mosaic etc.

You can click on any of those options to see different ways of viewing the blog. I like the Magazine view. But I set the default to Classic because that is what most people are used to.

Then there is the Search on the top right. This is a vastly improved Search which filters results as you type (AJAXified, for the programmers out there!).

By the way, I am meeting Rajat Srivastava, my classmate from HPS this morning for breakfast! Rajat is currently a practising doctor in London. I will be meeting him after 19 years. I am hugely excited!

Have a great weekend!

Wednesday, October 24, 2012

Change the pitch of video karaoke songs on your Mac!

Ok, at the risk of sounding boastful, let me say that my singing is above average! At the very least, I like to hear myself sing! When my friend from engineering college, Vinay Mantha, told me about karaoke sites where you could download the music minus the lead vocal track so that you could sing along, I was really excited! I visited the site he recommended (Make My Karaoke) and bought a few songs.

There are basically two types of karaokes available - audio and video. Audio karaokes have the entire music minus the lead vocal track. Video karaokes have whatever the audio karaoke has plus on the screen they play the lyrics and shade the part that is to be currently sung! So, video karaokes are really great if you don't know the song too well. Audio karaokes need you to know the song completely.

I downloaded a few of both.

Recently, on my trip to the US, my friends and I had a karaoke night at Dinesh's house in Seattle. There I realized that You Tube had a large number of karaoke tracks available!

I downloaded a few of them and played them. I found one problem however. Some of them had a pitch higher than what I was comfortable with! I was wondering how I could fix this as using those karaoke tracks, I wasn't comfortable at all as my voice would really need to stretch for the high pitched parts.

Google, as they say, is your friend! I looked for solutions and found it. Here's what I did:

- Opened the downloaded mp4 file that had the video karaoke in QuickTime Pro

- Extracted the audio track out of it by clicking on File -> Export -> Choose 'Audio only' in the Format drop down in the resultant dialog

- Launch Garage Band, create a new project and add a basic track (Track -> New Basic Track). Follow these steps to change the pitch of the song (from Brian Tychinski's comment to this post):

-- Click your imported track to make it the active track.
-- Click the i in the circle on the right of the interface.
-- Click the EDIT tab. You’ll see Noise Gate, compressor, and 4 empty slots.
-- Click one of the empty slots & change it to AUPitch.
-- Click the orange and yellow picture next to AUPitch. This will bring up the AUPitch dialog box.
-- Make sure your effect blend, smoothness & tightness is at 100%
-- To change a key up a whole step add +200, down -200. Half step, 100.

- Once you're done, click on Share -> Export song to disk... 

- Make sure Compress is checked and in the drop down choose AAC Encoder is chosen. Click on Export. Choose a name and location and save the file.

- Now open iMovie, create a new project. 

- Import the original mp4 file by clicking on File -> Import -> Movies...

- Click on Clip -> Detach Audio. the audio clip is now shown as a separate track. Click on the track and hot the Delete key on the keyboard.

- Now from Finder, drag the new file you just saved in Garage Band and drop it right at the beginning of the clip.

- Click on Share -> Export Movie...

- Choose the size, name and location and you're done!!

Sunday, October 21, 2012

Finally got my bread recipe right!

I have been baking bread at home for the past year or so. My parents got me a bread maker back from the US. Now, this bread maker had an option to make instant bread - yes, there is something like instant bread - it takes only an hour to make compared to the three plus hours it takes to make regular bread. Can you believe it?!

For the 60 minute bread, you need a special kind of yeast. In India there are very few people who bake their own bread. So the yeast that you can use to bake bread is not available easily in supermarkets. My parents brought back yeast that could be used with the bread maker.

I started trying the recipes that came with the bread maker. All of them tasted really good and would have excellent texture. There was only one problem - they rose too much and caved in during the baking cycle! This did not happen with the instant bread though. It happened only with the regular recipes that took more than three hours. Instant bread though convenient was not as fluffy as the regular bread.

I did some very preliminary research on the internet a few months back but did not find much help. A couple of weeks back, I looked some more and found what sounded promising. On a forum for people who baked bread at home, there was the mention of checking the type of yeast you used. Bingo! That was it! I was using Instant yeast but the recipe called for Active Dry Yeast!

As it turns out, the Instant Yeast is meant for the Quick Rise recipes (that take an hour) whereas the regular Active Dry Yeast is used for the traditional recipes (that take more than three hours). There were multiple suggestions on how to replace the regular yeasts with the instant yeast. Different people suggested different substitution formulae ranging from taking 80% to 25% of the quantity specified for the active dry yeast if you were using Instant Yeast.

I decided to try it that day. I took half the quantity. No luck. The Italian Herb Bread I made caved in again!

This morning I decided to try with a third of the quantity specified. I tried the Cinnamon and Raisin Bread. I was a bundle of nerves as I waited patiently for the bread maker to go through the two kneading cycles and then the final baking cycle. Lo and behold! A perfect loaf of bread was ready! Here's a pic:

Saturday, October 20, 2012

Sitting in the cabin versus being 'on the floor'

I have been a manager for the last many years apart from the time I spent at Grene. I have seen a lot of managers in the software field and outside it and differing styles of management.

Some managers I know are very aloof. They believe in sitting in their cabin, calling for updates, calling for meetings, getting things done. Their team members are more in awe of them, have a lot of respect and there is often at least a small element of fear.

On the other hand are the hands-on guys. They believe in being a part of the team. They believe in actually being 'on the floor'. When it comes to software, they will actually take up a bit of the coding to understand where the problems actually lie, what the problems on the ground are. Their team members are more comfortable with them, they are usually at-ease when they are around and there is no fear.

I am not saying which is right or wrong. Both have their positives and negatives. One thing which I am fairly certain is that most managers have one of these traits built-in. It has a lot to do with the personality. You can't learn one or the other. You are one or the other.

Being on the floor allows the manager to get insights that are otherwise impossible to get. Real issues come out much sooner and can be addressed immediately rather than waiting for reticent team members to come out with them.

On the other hand, a small element of fear is often needed to get people to put in a little extra effort and get things done.

Personally, I tend to like the 'on the floor' approach more.

Friday, October 19, 2012

Myths about Peritoneal Dialysis

Peritoneal Dialysis (PD) is a form of dialysis that can be done at home, has fewer diet and fluid restrictions and offers an excellent quality of life. If you were to ask me which dialysis modality I would prefer, medical constraints notwithstanding, I would say Peritoneal Dialysis without thinking about it for even a second.

Unfortunately, this therapy has been badly neglected by the nephrology community. I have often thought about why nephrologists do not even mention PD to their patients when discussing dialysis. I wrote an article for Nephron Power on giving us, the patients the choice. I asked that patients be informed about all the options and then involved in the decision making process. Currently, the nephrologist makes all the decisions which is extremely unjust, unethical and unfair!

When I talk to fellow-patients about PD, I find that many of them have not even heard about it! Those who know about it have many misconceptions about it. Here, I am going to try to dispel the most common myths I have heard about PD.

People fear that with PD, the chances of infections are high. They have been told that they need to maintain their room in extremely hygienic conditions otherwise they can get infected and it can often be fatal. While it is true that hygiene is important, it is not at all difficult. Basic hygiene is all that is required. Simply keep your room clean. Basic sweeping and swobbing. The room does not have to be sterile!

The risk of viral infections on Hemodialysis is much more pronounced and with much more severe consequences! And what's worse, with Hemodialysis you're entirely in the hands of poorly qualified technicians and nurses. Whether you get infected or not totally depends on these people. Scary! At least, with PD, you are in control! Bacterial infections that are possible with PD are mostly treatable. Most viral infections that can be acquired in hemodialysis units have no known cure.

Some people also believe that PD is far more expensive than hemodialysis. Not true. These days, the cost of PD has dropped significantly. It is on par with the cost of hemodialysis. Most PD companies also have attractive loan-based schemes which makes PD very convenient without hitting your finances.

Some medical professionals also say that PD can only be done when you have some residual renal function or urine output left. False. After my transplant failed, my renal function was close to zero. I still managed beautifully on PD for six years. While it may be true that PD works better when there is some residual renal function, it is definitely not true that it can only be done when there is some residual renal function.

The six years on Peritoneal Dialysis were the best in my entire life with kidney disease. When I see unsuspecting patients being denied access to this wonderful therapy for financial reasons, it deeply saddens me. I feel helpless that unscrupulous and unethical elements at work in the medical industry put money above everything else and condemn patients to a life of hemodialysis without as much as a thought for the pain they have to endure.

Sunday, October 14, 2012

The curse of unhealthy lifestyles

Two of my very close friends have been hit by Hyperlipidemia in the past couple of weeks. They are both around 30 years old. Both had quite a few things in common - software jobs, no exercise, unhealthy diet and stressful and long work hours.

It is quite alarming that at such a young age, they have been diagnosed with a condition for which they will need to be continuously on the watch throughout their lives. We have all started taking our lives so much for granted that we forget the big picture. In this rat race for earning money, especially people in the IT sector have really forgotten what they are working for. It has all become so driven by peer pressure that each individual simply ends up doing what everyone around him or her is doing. No one does what he or she truly wants to do. No one does what he or she truly enjoys doing.

I really feel that the work we are doing is primarily responsible for this. It is the root cause. We become so preoccupied with it that it takes precedence over everything else. We forget that it can be ruining our lives. Because of work, we don't eat good food. Because of work, we don't exercise. And work is a huge contributor to the stress in our lives.

We must never forget that work is only a part of our life. Let us not make it our entire life.

And now a word of caution for those leading similar lives. If you do any of the following:

- Work at a software company
- Put in long hours and work on weekends regularly
- Don't exercise at all (no, sex doesn't count as exercise, don't go by what the studies say)
- Eat meat at most meals
- Smoke and drink regularly

then stop and think. Do you want to die of a heart attack before you turn 40? Think of the unfinished things in your life. The most ironic thing about heart disease is that unless it is genetic, it is mostly our doing. It is totally preventable. Here's how you can prevent it (most of it is common sense and what you've read hundreds of times!)

- Don't let work rule your life. Remember that it can actually kill you. Restrict the time spent at office. Don't bring work home. Change your job if it doesn't allow you this.

- Exercise regularly. Play a game. Find a partner to exercise with so that you can motivate each other.

- Restrict fried food, sweets, red meat. If you really must have this, restrict it to once in a way. Definitely not every day.

- Reduce alcohol consumption. If you must drink, restrict it to social occasions and never binge.

- Quit smoking. No relaxation here!

- Get tested regularly. Get the following tests at least once a year - Complete Blood Picture, Lipid Profile, Complete Urine Examination, Liver function tests, Fasting Blood Sugar and anything else your doctor might want to add based on your medical condition and family history. It is a small price to pay for catching early warning signs and treating effectively.

I often think about my life. I honestly did not have a choice. I did not get kidney disease because of something I did. It came out of the blue. All of a sudden. I did not have a chance to correct anything. You really are much luckier. You have a choice. Most of us think - 'this cannot happen to me'. My two friends did too. It happened to them. It can happen to you too. Don't be smug. Take corrective action. Now.

Sunday, October 7, 2012

Ye duniya agar mil bhi jaye to kya hai

Sorry to start the Sunday on this note but this song came to me this morning after reading my email and I had to post it:

Here are the lyrics in Hindi (Taken from

ये महलों, ये तख्तो, ये ताजों की दुनियाँ
ये इंसान के दुश्मन समाजों की दुनियाँ
ये दौलत के भूखे रवाजों की दुनियाँ
ये दुनियाँ अगर मिल भी जाए तो क्या है

हर एक जिस्म घायल, हर एक रूह प्यासी
निगाहों में उलझन, दिलों में उदासी
ये दुनियाँ हैं या आलम-ए-बदहवासी
ये दुनियाँ अगर मिल भी जाए तो क्या है

जहा एक खिलौना है, इंसान की हस्ती
ये बसती हैं मुर्दा परस्तों की बस्ती
यहाँ पर तो जीवन से मौत सस्ती
ये दुनियाँ अगर मिल भी जाए तो क्या है

जवानी भटकती हैं बदकार बनकर
जवां जिस्म सजते हैं बाजार बनकर
यहाँ प्यार होता हैं व्यापार बनकर
ये दुनियाँ अगर मिल भी जाए तो क्या है

ये दुनियाँ जहा आदमी कुछ नहीं है
वफ़ा कुछ नहीं, दोस्ती कुछ नहीं है
यहाँ प्यार की कद्र ही कुछ नहीं है
ये दुनियाँ अगर मिल भी जाए तो क्या है

जला दो इसे, फूंक डालो ये दुनियाँ
मेरे सामने से हटा लो ये दुनियाँ
तुम्हारी हैं तुम ही संभालो ये दुनियाँ
ये दुनियाँ अगर मिल भी जाए तो क्या है

Saturday, October 6, 2012

ACE Inhibitor versus an Angiotensin Receptor Blocker

Ever since I was diagnosed with Left Ventricular Hypertorphy secondary to my kidney disease, I was put on Carvedilol (6.25 mg twice daily) and Ramipril (5 mg once daily). My Blood Pressure was controlled really very well. My normal BP currently is between 90/60 to 100/70. Many dialysis technicians are worried about my low BP, especially those who see me for the first time (usually happens when I am on a holiday!)

When I went to my cardiologist, a few years back, he said, "Lower the better" when I asked him about my unusually low BP. For my heart, undoubtedly, lower was better! Within a year of starting daily nocturnal home hemodialysis, my Ejection Fraction (a measure of the function of the Left Ventricle of the heart) bounced back to normal! My Carvedilol & Ramipril dose was reduced to half about a year back due to the low-ish BP.

For the last few months, I have been having recurrent coughs. It usually is dry. I try a ton of home remedies to no avail. I then take a course of antibiotics and it seems to go away only to return in a couple of months.

During my last consultation with my nephrologist, I told him about the recurrent coughs. He immediately asked me to stop Ramipril. My BP went up and I had these bouts of stress and headaches. I called my nephrologist and he suggested I take Coversyl. I blogged about this here. In a comment on that post, Dr. Avinash Ghimire (I am presuming he is a nephrologist) suggested that Coversyl was very similar to Ramipril (both are what they call 'ACE Inhibitors'). The thinking, I assume was that Coversyl would continue to cause cough if the cough was due to Ramipril. He suggested using an Angiotensin Receptor Blocker (ARB), another class of anti-hypertensives which do not have the side effect of cough.

This morning, I checked on this with Dr. Anuj Kapadia, my classmate at HPS and now a Cardiologist at Care Hospital. He confirmed this and suggested that I take Losartan, an ARB. Both these classes of drugs (ACE inhibitors and ARBs) are considered really good for BP control with other good effects as well. But each of them has a set of possible side effects as well. So, the therapy really needs to be individualized.

I will check with my nephrologist about this one last time and then start off on Losartan. It has a side effect of possible hyperkalemia (increasing the serum potassium levels) and I need to be a little careful about my potassium since I take a phosphorus supplement that has potassium in it!

Yes, it is a tough life with CKD!!

Closing the loop

What would you do if someone sends you an email inviting you over for a meal, a movie or whatever and you cannot go?

Here's what I would do: thank him for the invitation and then regret my inability to make it.

Some people however choose silence! I really don't mean any offense to them but I cannot understand this. Why would they do that? Why not respond and end the suspense? If you don't do that, the host and all other guests are left wondering what to expect!

We must all really 'close the loop'! End the suspense. Respond. 

Thursday, October 4, 2012

Increasing BP and stress

Last evening, as I was returning from work, I felt weird. My head was heavy and my heart was pounding. I was feeling unbelievably stressed. I had never felt that way before. I sipped some cold water when I reached home and lay on my bed for some time taking deep breaths. I also turned off Wi-fi and 3G on my phone.

I felt better in about half an hour. I had dinner and when Zia the guy who helps with my dialysis came home, I got him to check my Blood Pressure. It was about 30 points more than my normal blood pressure.

About ten days back, I had gone to visit my nephrologist. I told him about the recurrent coughs I was having. Every two months, I would get cough and would try to treat it with simple home remedies without any luck and then would need antibiotics. He asked me to stop Ramipril, an ACE inhibitor I was taking. He said that often causes cough.

Ever since, I have been having some symptoms of an elevated blood pressure like headaches and a feeling of stress. Yesterday, it happened to be a very hectic day at work. Tons of things to do and lot of urgent stuff to finish. Nothing extraordinary or unlike some previous days however. I guess stopping Ramipril and the stress at work probably combined to cause the symptoms.

Another thing that possibly added to the problem was that I did not dialyze the night before. So. fluid had also accumulated (I was up about 5 liters!) and this also caused a further increase in the blood pressure.

I called my nephrologist last night and checked with him about this. He asked me to start another drug - Coversyl. Hopefully this should help alleviate the symptoms soon.

I usually keep the Wi-fi on my phone one at night. The first thing I do in the morning when I wake up (even while still on dialysis!) is to reach out for my phone to see what email I have! This is one of the most disgusting habits I have which I must learn to give up. It is email, for God's sake! Not a call! It can wait until I have properly woken up and settled into the day! I kept the Wi-fi off last night.

Since I was pulling off a lot of fluid, I woke with cramps twice at night. Both times, I stood next to my bed for a few seconds and the cramps subsided.

This morning, I am feeling much better.

Sunday, September 30, 2012

What a birthday!

On 28th of September, I celebrated birthday number xx. God, that number makes me feel sick! So, I masked it. Anyway, in what has now become a routine, the NephroPlus folks barged into my room at midnight as I was undergoing dialysis. They brought cake and played the guitar and sang for me!

I went to three of our centers in the city one by one and they had the cake cutting ceremony at all three centers!I was planning to go only to the headquarters but the other centers would have none of it. One of them threatened that they wouldn't leave the center until I came! At the other center, they were upset that I was spending only a little time with them! They almost locked me up in the cabin to prevent me from going anywhere else!

I went out for lunch with my fellow-directors at NephroPlus to Indijoe's. Dinner was with the family at  my favorite restaurant, Little Italy.

All in all I had an unbelievably great birthday! Honestly, when people shower so much love on me, it is quite humbling. I feel really touched. Mohsin, one of our technicians once remarked, "Khuda ne aapki kidney le li, lekin uske saath itne chahne wale diye!" (God took away your kidneys but gave you so many people who love you!) This makes me wonder. If I did not have kidney disease, would I have got so much love? Well, I really don't know. But truth be told, I would prefer healthy kidneys over all the love! hehehehe....

Here are some pictures from the day:

NephroPlus team at my house at midnight when I was on dialysis

NephroPlus Founding Team at midnight

Banjara Hills Center pics:

NephroPlus Directors

ESI Sanathnagar Center pics:

With Mohsin, Lead Tech at ESI center

Family Dinner at Little Italy:

With nephew Naman

Sister-in-law Anjali made my favorite Mishti Doi garnished with a lotus flower!

On the left: My grandmother, Dr. (Mrs.) G. Fernes, my mother, my father. On the right: my niece Nidhi (making the face), Naman and Anjali

Thursday, September 27, 2012

I miss writing software!

The last serious work I did in software was a project for the Jain Dialysis Trust where their coupon distribution system was automated. I remember I had deployed the software and reached their office a little late on the day it was about to be used. I wasn't very worried because it was tested thoroughly by Ankur, my former colleague from Effigent (and a brilliant tester). As I entered their office, I noticed patient beneficiaries carrying papers that seemed familiar. A closer look revealed that those papers were coupons generated using my software! I was so thrilled. It felt really great! I almost had tears in my eyes!

For months, the trust did everything manually. Writing out coupons by hand, painstakingly collating data into registers, tallying cash against the coupons. Now everything was automated. The coupon distribution system that would involve 10-12 different people could now be handled by 2-3 people in the same amount of time! This whole project was coded by me! I never felt so ecstatic! Software gives you this kind of high.

I gave up my career in software to a full time job at NephroPlus in October last year. I have not done any coding for about a year now. I miss it!

There are things I did not like about software - the deadlines, the hurry to get something out there even if it was not perfect, the tension that comes with a production app having problems and so on. But the high you get when you see something that you have produced being used by users and actually making a difference like it did in the Jain Dialysis Trust project is unparalleled.

Even in my career in software, the period that I worked for Grene was most satisfying. My work at Effigent was mostly managerial. Managing teams of people writing software. Managing software teams never gave me the high I got from coding! My work at Grene was pure coding. I was the only developer on iOS and WebObjects. I was the only guy working on what I was producing. I thoroughly enjoyed that work. Of course, most software jobs would not be like that (unless of course, you are Jayadeep!). You generally work in a team in which you write a small part of the whole product. In Grene and the Trust projects that I did, my code was basically the whole code! So, I guess the satisfaction was that much more!

Wednesday, September 26, 2012

Politically, these are depressing times

For the first time in ages, we saw the government do things right. The measures they have taken to revive the economy, the way they did not bow down to Mamta Bannerjee's dictats, the Prime Minister's speech are all things that should have been done much earlier. But then, by now we are used to the Congress doing things that are "too little, too late".

However, the series of scams with no parallel in the country's history, a trademark of Congress regimes, has left little doubt on how they are going to do in the next elections barring a dramatic change in the way this government functions.

Unfortunately, what is the alternative?

The NDA looks like it is in a terrible mess. Nitish Kumar has already given enough indication that his allegiance is up for grabs. Narendra Modi is at once the BJP's biggest asset and its biggest problem. Project him as PM and they will lose out on Nitish and many others as well. Without Modi as PM, there is no one who has the charisma and capability to win a general election. And then there is L K Advani who is still threatening to run for PM.

This leaves us with the horrible prospect of a third, fourth or what-have-you front cobbling up a majority which has no single big party calling the shots and will be about as stable as the joke of a government we had run by the likes of Deve Gowda and others during the period between the Narasimha Rao and the Vajpayee governments.

Unless the Congress shows extraordinary courage and takes some bold decisions which bring the country back on track and acts really tough on the corruption issues dogging the country today and brings to book the culprits (which looks extremely difficult given the people alleged to be involved) or the BJP gets its act together and decides on one leader and projects him or her starting immediately so that the nation respects their leader like it did Atal Bihari Vajpayee, the next general election is going to end in an unmitigated disaster.

Tuesday, September 25, 2012

The trouble with doing things every other day

I take 30 mg cinacalcet every other day. It is a very useful drug to bring the level of Parathyroid hormone (PTH), a very important hormone in the body whose chief function is to control the level of Calcium in the blood. I need to test the level of PTH in my blood regularly to figure out whether I need to modify any medication doses.

The trouble is I take cinacalcet every other day. So, it seems like the level of PTH might be going up and down depending on whether I have taken the drug or not. I am not sure of this. It just seems that way. There should be a few hours in the day after taking the drug when the level of the drug in the blood should be higher than otherwise. Which means the level of PTH should be lower during these few hours than otherwise. How do I figure out when I should be drawing my blood sample to ensure that I get a correct reading of my PTH level?

Similarly, I have recently started dialyzing with a high flux dialyzer every other day. I use a low flux dialyzer otherwise. High flux dialyzers give much better clearances and are also good at removing the so-called middle molecules which are known to cause severe problems in long term dialysis patients. Now, I draw my blood samples for regular tests every month. Should I draw the sample on the day I have dialyzed with the high flux or the low flux?!

Samples drawn after the high flux dialysis are bound to contain less toxins than those drawn after low flux dialysis!

I really have no clue about the answers to these questions.

If, on the other hand, I was taking cinacalcet every day or was dialyzing with the same dialyzer every day, there was no problem because every day is like any other day. Drawing blood on any day would give you the same result.

Any suggestions?

Monday, September 24, 2012

Writing for myself versus writing for people

I once mentioned to Srinivas that I write whatever I write on this blog for myself. Because I enjoy writing. I don't care whether people read or like what I write. I write purely for myself.

Yesterday, when I published the survey, he appeared surprised because the survey was a way to gauge people's reactions to my short stories. He asked me why I was interested in knowing whether people liked my short stories when I wrote simply because I enjoyed writing and I wrote for myself.

This set me thinking. What he pointed out was true. Why did I want to know what people thought of my short stories? Wasn't it enough that I enjoyed writing them?

Creative pursuits are often meaningful only when appreciated.

Though a painter might enjoy painting stuff, he will probably feel completely satisfied only when people who view the painting appreciate his work. A musician might enjoy composing a piece but he will derive much more satisfaction if his composition is heard and applauded by an audience. Similarly, though it is true that I thoroughly enjoy writing, I feel really good when someone leaves a comment on one of the posts or when I see the hit count on this blog increasing.

If I was truly writing only for myself, then I would not publish it on a public blog, right? So, I guess, I do not write only for myself. I write for people to read. I hope people appreciate what I write. I hope what I write interests them and intrigues them enough to keep coming back.

Sunday, September 23, 2012

How Facebook saved my life

Life? Well, no, not exactly. But read on...

A few days back, right in the middle of Paryushan, I felt feverish in the evening after the pratikraman. When I checked, it was 100.4 degrees. I took a Dolo 650 mg and got on to dialysis. The next morning, though the temperature was normal, I felt weak and had aches all over. I decided to take the day off.

I sat at home and slept and watched episodes of "The Big Bang Theory" that Rohit, my colleague at NephroPlus gave me. I felt a little better by the evening. I got on to Facebook and posted the following: 

"Spent the day at home. Had fever last evening and was weak-ish this morning. Spent the day seeing four episodes of The Big Bang Theory and sleeping! Feeling much better now."

Guess what? This post got 6 likes, 10 comments and I got call from a friend! I was so thrilled! One of the comments was from Adil Asim, a friend from school who I have not met or spoken to for the last what - twenty one years??! This is what Facebook can do!

It feels really nice. Some people criticize the interactions we have on Facebook calling it artificial and what not. I couldn't agree with that. Facebook gives me moments like these where it feels nice to know that people whom I barely interact with in real life have written a "Get well soon" message for me. 

Its not like I do not have problems with Facebook. Their privacy features suck. I also get bugged by people who suddenly log on to their accounts after days and post like a gazillion pictures that have gyaan inscribed on them probably posted by someone else on their timeline or that they have received in their email as a pathetic forward. Gyaan once in a while is ok. Not when it is in a flood all of a sudden that clogs your timeline with crap. Good thing is you can block all this and some poor unsuspecting souls have received that treatment from me over the last few days. Serves you right!

Saturday, September 8, 2012

Wednesday, September 5, 2012

Teacher's Day memories from HPS

Today, September 5th is celebrated as Teacher's Day all over India. At The Hyderabad Public School, Begumpet where I studied, Teacher's Day was huge!

The morning would start with students doing what the teachers did at the Morning Assembly right from the prayer to the announcements. Classes would then begin albeit with a difference. The senior school students would take classes for the junior classes! The teachers would get to relax the whole day! It was after all, their day!

The afternoon would usually see an entertainment program put up for the teachers by the students. This usually included a whole lot of comedy and live music.

I had the privilege of being a part of our school beat group. Our group was hugely popular among the teachers and students alike.

One Teacher's Day, we did Pink Floyd's "Another Brick in the Wall". The song is a little irreverent to teachers but what the hell, this was HPS! Our teachers really enjoyed the song. In fact, our principal, Mr. S. K. Bose was seen snapping his fingers to the song! Here's a You Tube video of the song:

To all my teachers who shaped my thinking, helped me hone my talents and made me what I am: a BIG thank you! Here is a list of teachers I can remember from my school days:

- Mrs. Kanthi Rajan
- Mrs. Korobi Mukherjee
- Mrs. Prabhakar
- Mrs. Swadesh Sridhar
- Mrs. Deepa Chandra
- Mrs. Usha Bhargava
- Mrs. Shanti Sam
- Mr. G. Jayanand
- Mr. Govindrao Deshpandey
- Mrs. Akamma Koshy
- Mrs. Leila Parker
- Mrs. Roopali Mansukhani
- Mrs. Kamala Jagadeeshan
- Mr. M. A. Bari
- Mr. Devadattam
- Mr. Chandrashekhar
- Mr. Krishnam Raju
- Mr. Maruthi 
- Mrs. Suzy John Mathai
- Mr. Ramanachary
- Mr. Punna Rao
- Mr. Srikanth
- Mrs. Nirmala Abraham
- Mrs. Geetha Shyam Sundar
- Mr. Suresh Sharma
- Mrs. Kamala Jagannathan
- Mr. Sai Sunder Rao
- Mr. M. S. S. K. Subramanyeshwar
- Mr. P. Narayan Rao
- Mr. Sathyanarayana
- Mr. Dennis Powell

and one special teacher whom I can never thank enough - my English teacher for five years from Class 8 to Class 12 - Mrs. Marien Oommen. It would not be an exaggeration to say that any success I have achieved in my life is due to her. I got to be a part of NephroPlus only due to my blog and I give the entire credit for my blog to her. Thank you ma'am!

Wednesday, August 29, 2012

The morning after I don't dialyze

I take most Tuesdays off from dialysis. The swimming pool I go to is closed on Wednesdays. When I don't dialyze, the next morning, I don't swim because my body has a little excess fluid and swimming is a little difficult on these days. Earlier I used to take Sundays off but because of this I used to miss swimming two days of the week. By coinciding my dialysis off day with the swimming off day, I now need to miss swimming only on one day of the week.

I have noticed one other side effect of skipping dialysis. The morning after I don't dialyze, my bones feel stiff. I have no idea why this happens. When I was travelling abroad recently, I was dialyzing only every other day and I found that this stiffness of the bones turned it some very uncomfortable bone pain. It reminded me of the time when I had severe bone pain and it was attributed to the abnormally low Calcium level in my dialysate.

I got quite scared by the end of the trip on this account. I thought the bone pain was back. However, a few nights of long hour dialysis and the bone pain disappeared.

This sort-of ties in to the stiffness I experience on the days after I don't dialyze. What could be the reason? Could it be the Calcium that my body is getting during the night-long dialysis sessions? Is my body missing the Calcium during my nights off?

Another thing that hit me was that I do not take my phosphate supplements when I don't dialyze. Most people on dialysis need phosphate binders because their phosphorus levels are too high. Daily nocturnal dialysis removes a lot of phosphorus and due to this I need to take a phosphorus supplement. When I don't dialyze, I do not take the supplement. I am not worried about too high a phosphorus though. I am more worried about the Potassium because the phosphorus supplement is actually a Sodium and Potassium Phosphate.

Could my phosphorus level be low enough to cause this stiffness? During my trip abroad also I did not take the phosphorus supplement and my nephrologist felt that the phosphorus level might have been low enough to cause the bone pain.

As in most things related to dialysis - more so daily nocturnal dialysis, there is no definite answer to this question. I will have to try different things to check why this might be happening. I should probably take the supplement on the non-dialysis day to see if this helps in abating the symptoms.

Monday, August 20, 2012

I really don't need any studies to tell me whether more frequent dialysis is good for me or not

I keep seeing references to the Frequent Hemodialysis Network study on and off on the internet.

This was a study to study the effects of increasing the frequency of hemodialysis. By looking at the link above, it seems that they did manage to prove that increasing the frequency of hemodialysis does improve heart function that is often impaired in patients on dialysis.

I couldn't care less.

I honestly don't need studies to tell me whether more frequent dialysis is better for me. I have experienced it first hand. I was diagnosed with Left Ventricular Hypertrophy in 2006. My Ejection Fraction (one of the measures of heart function) was 30% which was fairly low. This is a common complication in dialysis patients where the heart function is compromised due to the increased volume of blood in the body (mainly due to the excess fluid in the blood that most dialysis patients have). I was put on some medication for this by the cardiologist. Around the same time, I started daily nocturnal dialysis. After a year when I went back to my cardiologist, the Ejection Fraction had rebounded to 60% which was a perfectly normal value. The cardiologist was surprised and said that they don't normally see such dramatic improvement due to the medication alone. When I told him about my switch to daily nocturnal dialysis, he said it was most likely due to that.

Daily nocturnal home hemodialysis has given me many other benefits. My Restless Legs Syndrome disappeared. My blood pressure control is much better. I need to take Phosphorus supplements (to increase my Phosphorus) where most dialysis patients need to take phosphorus binders (to reduce their Phosphorus)! My blood counts are almost normal. I am on a very small dose of Erythropoietin.

One very important benefit of this dialysis frequency has been practically no diet and fluid restrictions. I eat what I wish and I drink as much fluid as I want. This helps a great deal psychologically as well. I am also able to work full time, exercise and travel. This has been possible only because of the increased frequency. Yes, there are people who do all this even on the regular dialysis regimen of twice or thrice weekly. However, I know myself. I would never be able to take that. I am physically and mentally weaker than them. I need the liberty that comes with increased frequency dialysis.

The point I am trying to make is for me daily nocturnal dialysis does not need to be proved by a study or a clinical trial to see its benefits. I have literally lived the benefits. I do understand however that many doctors need to see these results before recommending this to their patients. That is the most unfortunate truth that is present in the dialysis world today. Thousands of patients who could benefit from this wonderful modality are being deprived because of the lack of a definitive theoretical recommendation in its favor. Sadly, common sense is not enough!