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 http://geetmanjusha.com/)

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.