Thursday, March 29, 2012

Bangalore Diary

Andhera Pradesh?

I had to take the 8:35 a.m. flight to Bengaluru. Seems like a reasonable time. However, for someone on daily nocturnal dialysis, it can be a little uncomfortable. You need to leave for the airport by around 6:45. Which means you need to wind up dialysis by 4:30 a.m. which gives the tech time to reprocess the dialyzer and the bloodlines (yes, I reuse, can you believe it?!) To make things worse, the authorities decided that the denizens of Balamrai, where I stay, should wake up every morning by 6. So, they decided to cut power from 6 to 7 a few days back. Now, we are not yet into those days of the year where it is bright enough by 6. And the light in my room that is connected to the inverter decided to fuse a couple of days back and I had not changed it. So, I had to get ready in the dark!

So, it was with not-so-heavy a heart that I said, "Goodbye, for a couple of days, Andhera Pradesh!"

The Detective Cabbie

The cab ride from home to the airport is usually interesting. Last time there was an oblivious cabbie. This time, there was a detective cabbie. Within a few minutes into the ride, he asked me, "Aap doctor hai?" I was shocked. Was he also teasing me like my friends did? I denied the allegation. He then explained his faulty conclusion. He had seen my car which had the NephroPlus logo at the back and the logo had a red plus sign in the middle. Deduction, eh? I remembered the scene from Pink Panther 2 and felt like asking him how the weather was in Balkampet that morning? And then pithily add that the red sand below his chappals was found only in Balkampet in the city! I refrained.

Kannada and Telugu

It is amazing how similar the two languages are. Many of the letters are written almost exactly alike. Many words are also common. In fact, I strongly suspect that Kannada was derived from Telugu. Of course, true blue Kannadigas suspect that Telugu was derived from Kannada! When I was travelling with some friends from Bangalore to Coorg a couple of years back, we were lost and needed to ask for directions. The people on the road knew only Kannada. I advised my friend who spoke good Telugu to speak Telugu like he was drunk (in a blurred manner, if you get what I mean). The trick worked. Blurred Telugu = Blurred Kannada!

Vidyarthi Bhavan

The dosas in Karnataka are very different from those served in Andhra Pradesh and Tamil Nadu. Karnataka dosas are much thicker than those served in AP or TN. Despite this, they are crisp on the outside and very soft on the inside. I wonder how they manage that.

A few months back, when I went to Bangalore, I got a chance to sample divinity in the form of Idlis at Brahmin's Coffee Bar at Sankarapuram. This time my friend Sandeep suggested I try Vidyarthi Bhavan at Gandhi Bazaar. I secretly wished I could do both but time is never your friend on a trip as rushed as this. So, I reached Vidyarthi Bhavan around 8:45 in the morning and found myself in a place that had a sparse setting.

I settled down on a table which had a couple of other strangers already munching away greedily on some crisp, deep brown dosas. Recounting everything that I ended up eating would be gross. Suffice it to say that I had at least one dosa. It was truly heavenly. Thick like a genuine Kannadiga Dosa (if there ever was such a thing!). Crisp, deep brown on the outside, very soft on the inside, practically soaked in ghee! They served only one chutney with it. No sambar. That was a message basically to focus on the dosa! I did not complain.

As I left, I looked back at the spartan hall of Vidyarthi Bhavan. I couldn't help remark to myself, "Truly, it is in places such as these that India resides."





Sunday, March 25, 2012

Do you use a pill box?

Someone on dialysis usually takes a lot of medicines! For the longest time, during life with CKD, I never used a pill box. I had a big plastic box in which I had all my medicines and would take them as per my prescription which was stored in my head. Every now and then, some medicine would finish and then I would call my dad and he would arrange for it to be bought. After a few days, another one would finish and then another call to my dad and that would be arranged as well. Yes, my dad spoils me totally (even at this age!)

At one point, I started ordering medicines for the entire month. I would open this plastic box and then lay out all the remaining strips and then calculate the number of each tablet I needed, write it on a piece of paper and give it to my dad who would have the whole lot brought. Mostly, unless there was a change in prescription or I calculated wrong (which rarely happened!), I would be good until the beginning of the next month.

However, sometimes, I would get delayed in my stock checking exercise and this would result in me running out of a medicine suddenly and then frantic phone calls to my dad.

The first time I saw a pill box being used in India was when my aunt bought one for my grandmother who being diabetic, took a lot of pills as well. She kept forgetting her meds and this helped her never miss her dose. Great idea, I thought!

At Aashayein last year, we gave out pill boxes to all the patients and I took one for myself as well. Ever since then I have been sitting every Sunday morning after my customary visit to Poorna Tiffins and refilling my pill box. It has 21 sections for seven days a week, three compartments for each day - for morning, afternoon and night.

This has helped greatly. It serves two purposes. One, I need to remember or refer to my prescription just once a week while filling. And two, when I am going to run out of a med, I know on Sunday morning itself rather than in the middle of the week and I can make arrangements immediately to get them.

Here is my pill box after I filled out this week's medicines:


Tuesday, March 20, 2012

Study says more is not better: what crap!

The trial pundits are at it again! A recent study claims that more dialysis does not show any real benefit in quality of life. I say to them: Buzz off!

I honestly don't need any randomized control trial to tell me that daily nocturnal dialysis or more frequent, longer duration dialysis is better or not better for me. I have lived it, goddamn it! If it wasn't for daily nocturnal, I would have been dead long back. I simply could not work full time or live a normal life on conventional dialysis. Yes there are people who do. But sorry, I cannot!

And isn't it logical? Dialysis replaces kidney function. Kidneys work 24x7. So, you should get as much dialysis as you possibly can. Why is it so difficult to see? The study judges the subjects on numbers - a common mistake many researchers make. Numbers don't mean everything. The subjects who were given more frequent dialysis said they felt better. But this factor was ignored and condemned as 'perceived'. So what the subjects felt was simply what they perceived. What the numbers showed was the ultimate truth!

I do not care for such studies personally but I am worried about the people who will stay away from such great therapies by looking at such studies and be deprived of a chance at a normal life.



Saturday, March 17, 2012

Have I found my calling?

This is one question we all must keep asking ourselves. Have I found my calling? Have I found meaning in my life? Am I doing what I really want to do?

Finding your calling really makes you feel good. You look forward to your day. Life becomes a pleasure. Since most of our waking hours are spent working, it is extremely important that we do what we enjoy doing and what we feel satisfied with.

When you are working on something you do not truly love and are working on it simply for the money you are making, life becomes a chore, a burden, something you are doing day after day without really living it.

Your calling does not always have to be something spiritual - a higher good. It can be material. To me, it is doing what you enjoy doing the most. For example, I know that music is Timothy Marthand's calling, developing software is Kartik Thum's calling and painting is Venkateswara Rao's calling.

My calling came to me in the form of an email from Vikram Vuppala with the subject "Request for a brief meeting". Vikram had chanced upon my blog and then sent me an email asking to meet up. At that time, of course, I was firmly into software and had no inkling of how this was going to take over my life. I actually thought I would grow old banging away at the keyboard churning out software code! It started with one small step - informal advice. I slowly started enjoying it so much that I took up a formal role and now am doing this full time.

I often think what my calling would be had I not fallen sick? I feel it would be something to do with food!

There are many people who can go through life without ever finding their calling. That is a real pity. There are some websites that give advice on how to find your true calling. I am not sure that is a good way to do this. I believe that if it is a true calling, it will itself come calling! Like mine did!

Monday, March 12, 2012

If you can't practice, preach

Sorry for upturning the dictum but I have found this to be true in many cases. If you are unable to practice something you should, if you start telling everyone around you how important it is, it often goads you to do the same yourself!

This works, trust me!

Ever since I stopped swimming due to the infamous Porphyria Cutanea Tarda, I have been bad at exercising. I started walking close to home every day but ended up stopping that as well. There would be some reason or the other. No time. Have a cough. Need to rush to work. Did not dialyze yesterday, so have extra fluid in my body, so cannot exercise. I would use a new excuse everyday to not exercise and all of them worked!

Then yesterday I met a friend over dinner. The topic of discussion moved to exercise and eating habits. I started lecturing him on the importance of exercise, about how thirty minutes every day could save him from heart disease. A little into the conversation it struck me. Was I exercising? Oops!

This morning when I woke up, I had all the excuses ready. I had a sore throat. I had to rush to work. I did not dialyze yesterday. But I made a firm decision. No matter what, I was going to do something today. I went for a walk despite all the odds. At the end of it, I felt really good and decided to continue this no matter what!




Sunday, March 11, 2012

Key to a perfect dialysis session

When I would dialyze in a hospital, I would always hope that I would be able to sleep through most of the  session. When you sleep through, it is a great way to get rid of the time that it takes. It can be horribly boring otherwise. Many people suggested watching a movie or reading a book or ugh, working! These things never worked for me. The main reason for this was that the rate at which blood was being pulled out of my body, was being cleaned and was being returned made me feel like a small piece of cloth in a washing machine. It was as if I was being tossed and thrown around, squeezed and then twisted again and again.

Except that it wasn't! I just felt that way in the head. So, to watch a movie and all was impossible. I just never felt like doing anything. I would just hope the damn thing would finish soon. That is why, when I would sleep for at least  a 2-3 hours on the session, I would feel really good. That much less time to kill!

A perfect dialysis session in my opinion therefore is one where you can sleep through most of it. When I see someone asleep on dialysis, it feels really nice. I feel like making sure that there is absolutely no noise around so that this blissful state is not disturbed at all. Of course, many people not on dialysis do not realize the importance of this. So, they go about their daily chores without a care. They will shout out loud to their colleagues. They will wake the person up just to find out if he is feeling all right, not realizing that he was feeling good until they woke him up and now chances are that he will not feel as good as he was feeling!

My advice to anyone who is dealing with dialysis patients: if someone is sleeping on dialysis, unless you have a compelling reason to do so, DON'T WAKE HIM UP!


Saturday, March 10, 2012

Ignorance about basic dialysis concepts

A dialysis patient came to meet me a couple of days back. She has been on dialysis for a couple of years now. She came to ask me about my opinion on Peritoneal Dialysis. Those who've been reading this blog for a bit now probably know my bias towards PD and I explained that dialysis modality is strictly a matter of personal preference and I preferred PD.

We got around to discussing a number of other things. I was appalled at her lack of awareness of basic dialysis concepts. For example, though she probably knew that she must drink less fluid, she had no idea about ultrafiltration that happens during dialysis, why she cramps during sessions and the concepts of fluid weight gain. She had been thinking she must eat less to reduce her weight gain between sessions as advised by the technicians. Poor girl! She was emaciated!

This really goes to show the abysmal level of education being provided by our doctors and medical professionals to dialysis patients. I was bemoaning the lack of options being provided to us. That is much more to ask for than basic education. Better education, I can guarantee will improve compliance.

You, my dear medical professional, have no right to lecture us on fluid weight gain and non-adherence to the renal diet when you don't so much as goddamned care about letting us know what we should know!

Thursday, March 8, 2012

Today is World Kidney Day!



NephroPlus is organizing an awareness program for World Kidney Day.

There's going to be the launch of a book called "Protect your Kidneys" which has been co-authored by Dr. S. Krishnan, Medical Director of NephroPlus, East Marredpally Center. Dr. Gopal Kishen, Father of Nephrology of Andhra Pradesh is going to launch the book. There is also the launch of a new website on kidney disease in Telugu.

There will be talks on how to prevent kidney disease and on encouraging organ donation. There will also be a talk by a patient on dialysis (not me!).

There will be a nice dinner after this.

So, please do come and join us this evening! 

Wednesday, March 7, 2012

I TALKED TO PRATEEKA!!!

I am so elated this evening. For months (years?) now I have been a loyal listener of RJ Prateeka on Red FM, the radio channel in Hyderabad. I have posted about her here and here before on this blog. Her show has become so popular in the city that solely due to her following, the channel has now become the number one channel in the city.

So, when we at NephroPlus decided to do a radio campaign for our Hello Kidney initiative, there was no discussion about which channel we would go for. It was obviously Red FM. We chose the same channel for all our subsequent campaigns - Aashayein, Enpidia and now World Kidney Day. I have been co-ordinating the radio campaign. And Vikram, who knows what a huge fan I am of Prateeka suggested I write to her email id and let her know about our story. I did that this morning through our contact in the channel.

This evening, suddenly I got a call from the contact in Red FM that Prateeka was on the call and would talk to me! And before I knew it, I was talking to Prateeka! I gave her a brief background about me and what we're doing at NephroPlus. I talked to her about Aashayein. The best part about it was that she was genuinely interested in what we're doing. She asked the right questions. She also remembered all our campaigns and appreciated the way we treat our patients and the things we do for preventing cross infection etc.

To be very honest, the ten or fifteen minutes I was on call with her were like a dream. I still can't believe it happened! And she invited me over to her studio! Things like this happen very rarely. You listen to the voice for such a long time on radio and the voice occupies a place very high in your mind. When you actually end up talking to the person like this, it almost seems like a dream, like it never happened! I don't know how I will react when I actually meet her!

Tuesday, March 6, 2012

Finally got rid of Behenji, only to get Netaji!

So, finally the UP election results are out. Mayawati has been ousted. The systematized loot of the state's coffers for shameless self-aggrandizement will finally come to an end. Putting up a living person's statues and that too by the person herself was surely a first even in an India used to sycophancy.

The biggest scare was when there was a remote chance of her becoming PM. It was a few years back when the Third Front had a realistic chance of forming a government at the center and her name was doing the rounds for the top post. My heart really had that sinking feeling when I read that. Mayawati as PM? Then fall India!

But then that dance called democracy that plays out every five years in our country came to the rescue and stopped the plunder. What is going to happen to the statues in the park? Of Mayawati, Kanshi Ram and those humungous elephants? I am sure they're not going to be untouched.

Which brings me to the alternative. The Samajwadi Party and Mulayam Singh Yadav. The person who has plundered the state, albeit in a less shameless fashion, five years back. God, what is going to happen to Uttar Pradesh? When is it going to get deliverance from these two sets of thugs?

Yours truly makes an appearance on Pediatric-Nephrology.com!

See this page.

Thanks so much Dr. Sethi! Appreciate it!

Monday, March 5, 2012

Coronary Artery Disease - the silent killer

A very dear friend's father passed away last week. The reason: Coronary Artery Disease (CAD). Indians have a genetic predisposition to CAD. Thousands of years back, there was severe famine in this area. This resulted in the body adapting to the situation as it always does and over the years started storing fat within the body rather than allowing it to burn. This tendency has caused many people in this region to have CAD.

The recent trends of leading sedentary lifestyles, sitting all day in front of a computer, not having time to cook healthy, nutritious food and as a result relying on processed, junk food multiplies the risk manyfold. 

The time to act is now. Everyone is at risk. Some more than others. The best part - we can do something about it! And we must start NOW! Tomorrow is too late.

You really need not look anywhere for magic solutions. It is all very simple. Something we have heard hundreds of times. Exercise and eat healthy. Stay away from alcohol and smoking. Tension nahin lene ka. Get enough sleep. Etc. Etc. Nothing new at all. The trick, however, is to find innovative ways to do this. All of us procrastinate on these things. Exercise? "I will start from the 1st." Giving up fried food? "After my cousin's wedding."

On exercise and fried food, a great motivator is to stand nude in front of a mirror. Most of us will need no greater motivation! On stress at work, remember one thing - most of us are working to earn money so that we can lead comfortable lives or to achieve something. By getting stressed about the work, we are putting our health so much at risk that we may not be around to enjoy what we have worked for! Isn't this the supreme irony of our lives?!

The frightening part of this is that these days age is not a factor. People in their twenties are also at risk. So, stop thinking that you don't have to worry. 

As I said earlier, we must start NOW. Tomorrow is too late!

Thursday, March 1, 2012

Thank you Jayaram!

Yesterday was Jayaram's last day with me. Almost six years back, when I was desperate for a renal replacement therapy better than conventional in-center hemodialysis, Dr. Girish Narayen, my nephrologist had suggested daily nocturnal home hemodialysis. The whole magnitude of doing something no one in the country was doing was quite disconcerting.

At that point I was dialyzing in the KIMS dialysis unit where Jayaram was the Lead Technician. I had become very used to him cannulating me. Whenever he would be away on some other work, I would be totally scared about the cannulation. I would rarely let any other tech cannulate me. The confidence with which he went about his work was striking.

I immediately checked with him if he would come home and dialyze me. Thankfully, he agreed!

It was new for him as well. But he was not overwhelmed. Confidence was always his biggest asset. I depended on him heavily for the initial setup as well. And then we started home treatments. At first we did only short daily dialysis. Within a few weeks, we moved to nocturnal. There were issues at times. He handled all of them with ease. Blood leaks, machine problems, cannulation problems. Apart from his experience and skill, it was his self-belief that aided him.

Slowly, he became a great friend. We shared a lot. He soon taught me everything about dialysis - priming, cannulation, starting a session and eventually closing a session. Many times when he would get delayed in his day job at KIMS, I would start off on my own. At one point I started dialyzing on Sundays as well, doing everything from start to finish on my own. This was thanks wholly to Jayaram's teaching.

I in turn passed on to him my love for all things Apple. Today, he owns an iPhone 4 (which he bought before me) and a MacBook.

Jayaram is leaving because his duties at KIMS are now taking up a lot of his time and he is unable to come in time and he feels I am being put to inconvenience. He feels I should get someone else to help. Fair enough. I now have a couple of technicians from NephroPlus who will be assisting me with my dialysis. I doubt if I will ever have as close a relationship with any technician as I did with Jayaram.

Thanks for everything Jayaram!