Sunday, December 29, 2013

Making following up on emails much easier

I was faced with a problem very often. I send an email to someone who needs to respond to me about something. That someone does not respond. I have moved on to other things. A few days later, when I need the information that I was supposed to receive, I remember that I never got a response!

This happened so frequently that I was desperate to look for a solution to this problem. A friend recommended Sanebox. With this, all you need to do is cc or bcc something like and you're done! If, within a day, you don't receive a response to the email, Sanebox reminds you by sending you an email.

And the '1day' needn't be just that. You could do things like 1week, 4hours and many other such time periods. You can also set it to remind you on a particular date and time.

This is so cool!

There is a trial version you can sign up for which is free and after that, if you like the service, you can sign up for the full version - available at between $3.25 to $24.92 per month for various amounts of emails.

I pay about $7 a month and have found this to be a really handy tool. I use this all the time!

Another feature that could be useful to some is the concept of "Sane Later" which is a folder you move any email (and the tool learns as you do this and automatically starts moving) to that is not important at the moment and can be seen later. In this age when we are all flooded with tons of email, this can be a very useful feature.

This feature however works only with IMAP and not with POP, which I use now.

These days, we're all grappling with an email overdose. Small tools like this really go a long way in making us more productive and making sure we're doing things that are important and not missing out on stuff that really needs to get done.

Saturday, December 28, 2013

Modi's blog: why nothing much changes

So we're led to believe that Narendra Modi was 'shaken to the core' by the 2002 riots. This contrasts sharply with the widely held belief that Modi had sanctioned the police inaction in the aftermath of the Godhra incident. Modi is supposed to have asked the police to let the people vent their anger. Modi, apparently is denying this.

My right wing family and friends should actually be disappointed by this blog. If they believe him, that is. What they liked about Modi was that he did not mince words, that he spoke his mind on issues especially pertaining to minority appeasement and that he unabashedly represented the right wing in this country.

Whenever I discuss Modi with this group of friends and relatives, I always take deep umbrage to their support for how Modi allowed the 2002 riots to happen. My argument is that sure, you can support Modi because of his decisiveness, his strong persona, his no-nonsense attitude and his having the gumption to do what he thinks right as opposed to the current 'dead-duck setup' we have in the name of a government in New Delhi. But you cannot support what happened in Gujarat in 2002. Every man is a shade of grey rather than being fully black and white. So, while you could support Modi's governance model, you cannot say that what happened in Gujarat in 2002 is right!

Now, if one were to believe that what Modi has blogged about has genuinely come from the heart (and I honestly doubt this), even Modi does not support what happened then! Why then are his ardent fans supporting this? Or do they also concede, albeit in hushed tones, that Modi does not genuinely believe this. It is merely an attempt at becoming more acceptable to a larger section of the population? If this is the case, then that takes away a major plus from Modi - that of him always speaking his mind.

However, they are all so mesmerised by Modi that they will continue to support him, no matter what!

This brings me to those belonging to the left wing among my family and friends. They continue to hate Modi. This blog hasn't changed anything at all. Some argue that he hasn't apologised for 2002. That, I can guarantee wouldn't have helped either. It would have been construed as affected. I am sure no one believes a word of the anguish he claims to have felt during those times. Their hate for Modi is so complete that nothing, absolutely nothing is going to change that.

What is annoying about the non-BJP political class is the way they have arrogated to themselves, the position of being the voice of the minorities. Each of them speak on behalf of the 'desh ki janta' and claim that the people have not forgiven Modi for 2002. The truth, I am afraid, is not so clear cut. Most people have actually moved on. Though they did not like what happened in 2002, they realise that Modi might actually provide a better administration than the current regime. Blog or no blog.

The Congress and its heir-apparent are so thoroughly confused on what to do and how to react that they have now become a joke. The way Rahul Gandhi ducked a journalist's question on Modi's blog was humorous to say the least. All he does these days is to backtrack on the Congress' official stated position on various issues.

The choice before me in 2014 is not a very happy one. No clear cut answers. No clear cut winners. And this makes the possible outcome only more frightening.

Monday, December 16, 2013

Cracking the whole wheat bread recipe

Ever since I have got my bread maker, I have been making different kinds of bread. One problem however was 100% whole wheat bread. I never got it right. All recipes in the recipe book that came with the bread maker worked really well. Except the whole wheat one. The recipe with half whole wheat and half maida (refined flour) also worked quite well. But for me the holy grain, oops grail, was whole wheat. We have it dinned into our heads by everyone around us that whole wheat is good, maida is bad!

One of the ingredients in the recipe from the recipe book was brown sugar. I had gone to Q Mart and found two types of brown sugar. One was light brown, the other dark brown. I picked the light one. The internet revealed that there are many more types of brown sugar and I was not really sure if that was the problem! In the US, UK and other countries, they have a wide variety of ingredients that are not available in India. I needed to research a lot to figure out the different types of flour, the different types of sugar and more!

This recipe resulted in some very dense, not at all light and fluffy bread. I tried some variations of that recipe - changed the quantity of water, the yeast, added some butter. To no avail.

I scoured the internet to find that whole wheat bread rose better and came out light and fluffy by the addition of gluten. Obviously gluten was not available in stores in India! I found Bob's Red Mill on the internet which seemed to be a good place to buy such stuff. I sent the link to a cousin who was coming to India late November and had her buy some and bring it when she came.

Yesterday, I finally got some time to try the whole wheat bread. All I did was to use the same recipe in the book - with two changes compared to what I had done the first time - use the darker version of the brown sugar and two table spoons of gluten.

I kept a close eye on the bread maker. The first kneading cycle. The first rise. The second kneading cycle. The second rise. Then the final baking cycle. The bread did look promising inside! It rose very well. When the three hours and forty minutes were completed, I took the loaf out with some trepidation. Would all the research and effort still be in vain?

Thankfully not! The bread was delicious! Here's a pic:

Wednesday, December 11, 2013

Dialysis in Wonderland

Thanks Bill Peckham for posting this! I can't imagine this was in 1979. I'd give an arm and a leg to be able to do this today!

Thursday, December 5, 2013

Juggling a right wing family and a left wing friends list

Last night, I was at my cousin's house. My extended family had gathered there in preparation for cousin Nishant's wedding. Someone mentioned that the exit polls predicted a BJP victory in the four states that went to vote for their assemblies recently. There was excitement all around. Someone switched on the television to watch Arnab Goswami analyse the poll of exit polls. There was cheering, laughing and unbridled joy on almost every face in the house.

All the excitement eventually and expectedly, led to next year's General Elections and discussions about who would win. The consensus all around was that Modi would win and win big-time! Never mind if the JD(U), the Biju Janata Dal, the Trinamool Congress and the National Conference, the four groups that supported the BJP the last time it formed the Government would not touch the BJP with a barge poll this time. But excitement and reason do not play well together, you see!

My family has always been unabashedly right wing. They now support Narendra Modi to the hilt. One of my uncles made a grand announcement that should Narendra Modi win the election, he would throw a big party for all!

I honestly believe that my uncle's money is safe, for now at least. I do not see how the BJP is going to be able to form the Government in 2014. Without support from the major allies barring the Shiv Sena, the Akali Dal and most probably the AIADMK, there is no way they are going to go anywhere close to the magic number of 272.

On the other hand, many of my friends (on Facebook at least) are strongly left wing. They abhor the Modi brand of politics, they can never forgive him for the Gujarat riots, they in fact hated the BJP even before the Modi phenomenon. During the last General Election, I decided to vote for the BJP and posted it on my FB wall. I was torn apart by my friends! I almost felt guilty for posting that! Even today, the minority among my friends who are Modi fans get a lot of flak for posting anything pro-Modi.

The trouble however is, what is the alternate to Modi? Rahul Gandhi? There is so much fun made of him and his speeches that anyone who has any online presence must surely be embarrassed to be supporting him.

After two terms in power, I would think it highly unlikely that the Congress would return to power. The large-scale corruption, the image of a meek, lame-duck Prime Minister and the lack of any tall leader who can inspire the people will work strongly against it.

This brings us to the worst part of the situation. The prospect of a third front Government led by someone like Mulayam Singh or Mayawati. This would be my worst nightmare come true. I might actually just decide to secede a la Arundhati Roy.

A week, they say is a long time in politics. We have 4-5 months to go before the next election. Let's hope things change and we do not have to feel embarrassed of our next Government.

Wednesday, November 27, 2013

Why no dialysis unit in every district, asks the Supreme Court

Acting on a Public Interest Litigation, the Supreme Court of India issued notices to the Union and State Governments asking why there should not be dialysis units in every district of the country to ensure easy access to dialysis for all. In some alarming statistics quoted by the petitioner, Sanjeeb Panigrahi, two people die every minute in the country due to lack of access to dialysis facilities!

I read this on the web on the Times of India site. Scrolling down, you can see some rather interesting comments. People say when there is no proper drinking water access or access to proper sanitation for people in many villages in India, dialysis units cannot be a priority. There is merit in that argument.

People who have been affected by kidney failure and the lack of affordable, quality dialysis facilities hold this cause close to their heart. However, when you look at the entire population and the problems the vast majority is facing, dialysis would rank very low on the priority list. How many people would actually need dialysis compared to the number of people who do not have even the basics like drinking water and sanitation?

The Government must really get its act together and find ways to get out of this mess. While it must focus on basic stuff, things like healthcare can be done by engaging with the private sector. Public Private Partnerships have worked very well and this could be the way forward. The Government does not have the means to provide quality dialysis at every district. It should engage with private players and let them provide the service at reasonable costs which the Government can pay for for people who cannot afford the service.

These kinds of models have been formulated and have succeeded to a large extent in many states in our own country. It is just a matter of replicating the success in other parts of the country. All it takes is some out-of-the-box thinking and some willingness to make the change.

We need someone at the national level to take such bold steps and do something about it. Maybe someone like Nandan Nilekani?

Saturday, November 23, 2013

Steps to setup POP access to Gmail from Mavericks Mail - Part 2 - Setting it up

Yesterday, I wrote about how POP was better than IMAP in at least some circumstances. Today, I will outline the steps to setup POP access to email on Mavericks Mail. I was surprised when I found that there was no straightforward option to do this. Mail assumed you would use IMAP!

I tried multiple things. I setup the IMAP account and then changed the incoming mail server to This was suggested by someone on the internet. This did not work. The syncing continued. Also, mail did not get deleted on the server after downloading. That meant that the account was still behaving like an IMAP account! Then I found this link on the internet which had the trick! Here, I outline the steps to do this.

So, navigate to Mail Accounts. It should open up the Internet Accounts section of System Preferences. In the right panel, click on "Add Other Account...".

Make sure "Add a Mail account" is chosen in the next screen. Now click on "Create...".

The nest screen is the tricky part. This is where Apple hid the feature that allows you to be able to go to the screen that lets you set the account type. If you enter your correct email address and password here, Apple cleverly, rather too cleverly, figures out that you are setting up a Google account and assumes it is IMAP and goes ahead without bothering to check with you. Arrrggghhh!

So, what you do here is enter some wrong email address and some wrong password and then hold down the Option key!

The "Create" button magically changes to a "Next" button! Click on "Next" and you are shown the screen that allows you to specify whether you want the account to be POP or IMAP!

In this screen, you click on POP and then enter for the Mail Server, your full email address for the User Name and your password. Click on Next.

In the Outgoing Mail Server Info screen, enter for the SMTP server and your full email address for the User Name and then your password. Click on Create.

Your account should be created as a POP account! In the Internet Account screen, the account description will show up with the wrong address you entered in the initial part of the setup. You can easily change that by clicking on the Details button on the right when the account is selected on the left and editing the Description field in the resultant screen.

I am now comfortably using my POP account and hopefully my email issues would be a thing of the past. I make sure I regularly backup my computer to prevent losing all my email in the event of a mishap. Yes, this problem is not there on IMAP. But then the other limitations make it worthwhile for me to take the risk!

Friday, November 22, 2013

Steps to setup POP access to Gmail from Mavericks Mail - Part 1 - Why POP?

IMAP has been the preferred way to setup email for a while now. When I started working back in 1997, we only used POP. Over the years, people gradually moved to IMAP and now, when you setup email on Apple Mail, there is no question asked. It is assumed you are doing IMAP!

I am sorry to spoil the party but IMAP sucks in certain circumstances. First off, for people using Gmail as their mail provider (don't most of us do?), even with a fancy custom domain name using Google Apps, the amount of space you have is a paltry 15 GB. Sooner or later, you're going to run out of space. And then your realise that you have to pay a bomb to upgrade.

The other problem is that in a bandwidth challenged country like ours, the whole concept of always staying in sync can get pretty annoying. When I used to look at my Activity window on Apple Mail, it would be constantly syncing!

Problems reached gigantic proportions when I upgraded my old laptop to Mavericks, Apple's shiny new OS. It didn't play well with Gmail. There were all kinds of issues. The issue was with Google's non-default implementation of IMAP and labels and what-have-you! I was stuck with mail that would mysteriously re-appear in my Inbox even after I had moved it to another folder, wrong unread counts and perennial syncing.

Then I bought the new MacBook Air and at this point, I decided that Apple Mail was the problem. So, I downloaded the new mail client that everyone and his uncle was talking about in Mac circles - Airmail. Heck, it was #1 in the paid apps in the Mac App Store! For $1.99, it was touted as a steal. About Rs. 120 poorer, I tried the new app that promised to be the solution to all my email problems. Setting up the email accounts was a breeze. I started using the app. Moved messages around. Seemed like nirvana!

Only, it wasn't. The messages re-appeared in my Inbox! What crap!

It was then that I thought I had had enough of IMAP. I don't want to sync forever. I want complete control of my messages. When I move them to a folder, it should happen RIGHT THERE, RIGHT THEN! Is that too much to ask???

POP seemed to be the solution. People talked about being able to access your email from multiple devices. I could still do that. The way I use email, if I am not in front of my computer, I just want to read the damned email. I don't want to move it anywhere. I don't want to do anything else with it. So, if I set up POP on my computer and IMAP in my phone and tablet, I should be good!

So, I did that. There were some issues with setting up POP on Mail. Apple Mail assumes everyone in the world has perfect internet speeds and everyone in the world has spare money to splurge on Google's upgraded email storage plans. Well, sadly, they're wrong. So, you need to use some tricks to actually setup POP on Mavericks Mail. That's coming up tomorrow!

Monday, November 18, 2013

Being put on dialysis has a mental impact as well

No, I am not saying we turn crazy! Its a more subtle impact. I have noticed this in myself and others a as well. I have changed a lot mentally. I used to be a very confident guy when I was in Engineering College. I am no longer that sure of myself. I am constantly looking for approval, for appreciation. I am filled with self-doubt.

All around me, I see people continuously projecting themselves, showing off their capabilities. I am not even sure of my own capabilities to show them off. In today's cut-throat world, this doesn't work. Being good is simply not enough. You need to let the world know that you're good and if possible, try to get them to think that you are better than you actually are!

When I think harder, I am not sure if it is dialysis in general or dialysis in my circumstances. When I was diagnosed, I was only 21 years old. When you get diagnosed at such a young age, your mind does tend to develop differently. So, is it young people diagnosed with kidney disease who have this problem? When I talk to adults on dialysis, this is not the case. For example, people who have got married, had kids, settled down in life, were working for years - basically had what you would call a 'normal life' and were recently put on dialysis. They don't seem to have the mental issues I have.

It is probably this, then - having what the world sees as 'normal' being taken away from you for no fault of yours. This probably causes the mental impact that I am referring to.

I do sound depressed, right? I am not depressed really. Its just that this whole mental thing comes back to hit me time and again. One small sentence uttered by someone is enough to make me feel like shit for days. I go into this vortex of negative emotions where - you will not believe it - I continuously convince myself that I need to give up and withdraw from dialysis! I feel that I cannot take it any more. I feel that I have had enough. And how did it all start? One small, probably unconsidered sentence from someone.

I really am not sure how to change this. I know I make a difference to at least a few people. I know at least some people love me. But this small trigger is enough for me to disregard all that and just start thinking my life is worthless. I start thinking of all the things I do not have. I start looking at people around me living 'normal lives' and feel bad. In these circumstances, even watching someone do something as harmless as gulping down a glass of water will set off a negative reaction in me, "Look at him gulp down that chilled water! I can't even do that!"

Is there a solution to this? I have no clue! I can't change people and what they think or say. I have to find a way to change the way I think. Not sure how, though...

Wednesday, November 13, 2013

Aashayein 2013 in Delhi

To be honest, I expected a low turnout at our first Aashayein in Delhi. Many reasons were given. Delhi patients don't come for these kinds of events. It was very cold. Very few people would venture out on Sundays. I was also apprehensive about the how the patients that would come would behave. I had heard all kinds of stories about 'Delhi patients'! They are rude, they are not pleased easily, they are very rough!

Thankfully, both my fears were unfounded. By 10:30 a.m., the hall was full. The patients and family that attended were excellent. All well behaved. All very curious. All very eager to learn more about their disease.

Initial glitches

When we reached the hall, we found that the arrangements were still incomplete. At the last minute we were told that the audio cable from the laptop to the amplifier was not long enough which would make playing audio from the laptop impossible. The way we were told, it seemed that there was no solution. However, I asked Mandeep, our BD guy from Delhi to talk to them and sure enough, the cable was arranged! All the initial glitches were fixed soon enough and we were all ready in time!

My Hindi surprised me!

I spoke almost entirely in Hindi. I am not very proud of my Hindi generally. However, I didn't do a bad job at all. The words came easily. I also used some fancy phrases. "Jahan na pahonche ravi, wahan pahonche kavi!" when I was introducing Dr. Madan, who did some poems and "Inhone bada hi madhur kanth paya hai" when I was introducing Asif, who sang some songs.

My entire talk as well was in Hindi and I was really happy the way it went.

Questions, questions, questions

We had two nephrologist talks, one dietician, one patient and one vascular surgeon talk about various things. One thing was common among all. Everyone had a ton of questions after every talk. All kinds of questions. One thing which you would imagine is that the questions ought to be generic questions and not about some individual condition. However, a lot of questions were very specific. This goes to show that patients just don't get enough time from their doctors. In a country with more than a billion people, there are only 800 nephrologists! How much time can a doctor spend with each patient?

Each patient is different with a specific set of problems. Nephrologists in our country are very, very busy. They don't have the time to look up specific issues and are forced to adopt a one-size-fits-all approach.

After every talk, we had a hordes of patients swarming around the speaker asking all kinds of questions! The funniest scene was patients gathering around the vascular surgeon pulling up their sleeves and asking the harried doctor to check their fistulae!


The lunch was usual Aashayein style - one counter for patients and one for the rest. The patient lunch had no salt and was made by leaching vegetables and not using other things forbidden for dialysis patients. As Sandeep and I made our way to the lunch counter, I headed to the patient counter. Sandeep wondered why I was going there. I don't have any diet restrictions despite being on dialysis because I do daily dialysis.

"To express my solidarity with the patients! They go through a lot!" Sandeep followed me there. He wanted to express some solidarity as well, I presume!

After my first helping, I moved to the non-patient counter. Sandeep asked me why? "Family members go through a lot as well. Might as well express some solidarity with them!" ;-)

A great experience

At the end of the event, I had many patients and their family members come up to me and thank us for organising the event. Many of them said that after seeing me, they got tremendous hope that they too can live long, productive lives. Until now, they thought that dialysis meant end of life as they knew it. But now, they were inspired that they have a shot at a normal life as well.

This was gratifying indeed. If all the effort you spent has made some difference to the people who you wanted to reach, it feels really good. In the middle of the run up to the event, I had got a little tired with the amount of effort that goes in to this and the enormous pressure that is there on all of us preparing for the event. I was wondering if it was all really worth it.

At the end of the event, I got my answer. A resounding YES!

Friday, November 8, 2013

Pune Diary

I have been a couple of times to Pune in the past. Both times it was en route to the hill town of Mahabaleshwar. Once it was on a holiday with family and the other time it was for cousin Pooja's wedding. The wedding was in the last week of December and I remember the nights in Mahabaleshwar were biting cold!

This time however I was actually going to Pune for the launch of our eighteenth dialysis centre. Vikram and I went to the airport together and from there hopped on to the Air India flight to Pune. I have heard many stories about the horrors of traveling by Air India. Thankfully, our flight was without any hitches if you do not count the old, less than beautiful air hostesses.

There are airports and there are airports

When we walked into Pune airport, we were quite surprised with it. Very old school, no modern facilities, very, very basic. Contrast that with our Hyderabad airport and a sense of pride fills you! Many people have rated Hyderabad airport as one of the best in the country. I am not a frequent flyer to give that kind of verdict but Hyderabad airport is definitely very good! Pune, on the other hand could really do with some modernisation. It is after all, one of the most important cities of the state of Maharashtra.

Jehangir Hospital

We drove straight down to Jehangir Hospital from the airport. The hospital was very well done up. Not five star but tastefully designed. There were wildlife pictures taken by its Chairman adorning the walls that added a cheerful flavour to the hospital's interiors. We made our way to the dialysis centre and were very pleased with the way it had come out.

We realised over the next couple of days that the hospital's entire team right from the Chairman, Sir Cowasji Jehangir BT and the CEO, Mr. George Eapen to the administrative staff to the clinical staff and right down to the ward boys, everyone had this warmth exuding from them which made our visit to the hospital very pleasurable. The hospital is known to have high ethical standards and we could feel this throughout.

They organised a dinner in our honour that night and the top management of the hospital attended. We got a chance to meet the Chairman, Sir Jehangir, some of the trustees and the nephrologists. First time a hospital partner did this for us!

Differing pooja styles

We have a small pooja during the launch of all our units. With eighteen centres across the country in  places as varied as Alleppey in Kerala down south and Agra in Uttar Pradesh up north, it is striking to see differing styles of the same pooja! I guess the basic pooja might still be the same - probably from the Vedas - but local flavours get added and the pooja keeps getting small modifications over generations. Over centuries, the final outcome looks entirely different in different parts of the country!

The Pune unit pooja happened on the 6th of November around 9:30 in the morning. We had Vikram, a senior member of Jehangir Hospital and our nephrologist partner Dr. Shrinivas Ambike sit for the pooja.

"... and I declare the unit open!"

The inauguration followed the pooja. So, we had the rather funny ritual of everyone inside the unit go out of the unit by bending to cross the inauguration ribbon! The unit was inaugurated by the Chairman, Sir Jehangir and the CEO, Mr. George Eapen. There was the traditional lighting of the lamp by Vikram and me and other Jehangir Hospital staff. Everyone present was thrilled with the way the unit had come out - bright and cheerful with the NephroPlus green doing its bit to add life to the interiors.

Home sweet home

Vikram and I took the evening flight to Hyderabad. We had received an SMS that morning that the flight would now take 2 hours instead of the planned one hour! We figured that they were putting us on a slower flight. When we enquired at the check-in counter though, we were told that it would take an hour and fifteen minutes. This brought some cheer!

I finally got home and was relieved to be home after a very tiring couple of days. When I am not on my routine home-office-home schedule, I tend to drink more fluid than usual. This happened this time as well. I was up by about 5 kgs at least. There was a feeling of chest congestion by the evening. I was very happy to get on to the machine and have the excess fluid removed. I really need to find a way to restrict fluid when I am traveling. It is not impossible. I did a fantastic job during my Oceanside weekend where I missed dialysis for 2 nights and managed quite well. Its just that since this is only one night, I take it a little easy!

Saturday, October 26, 2013

No, being put on dialysis does not mean that the end is near!

First, one piece of factual information. I was put on dialysis in July 1997. Its about sixteen and a half years. I work full time. I swim every morning. I travel. I lead an almost normal life! And I do not intend to change this for some more time.

I was shocked a few days back when I talked to the adult children of a 60-something year old lady who was recently put on dialysis. They went to a nephrologist of one of the more respected hospitals in Hyderabad and to their utter horror were told by him that the end was near! She did not have any co-morbidities, she was otherwise healthy but put on dialysis. Imagine the plight of the family!

When I was diagnosed in 1997, a general physician commented to my father, "There is no chance!" My father was shocked. Then, when we consulted my nephrologist, Dr. Girish Narayen, he dismissed the thought and assured my father that there was nothing to worry.

In this case, however, it is a nephrologist making the claim! This is quite shocking!

Today, with good quality, adequate dialysis, people live for decades. I personally know so many people who have been on dialysis for so long and they lead normal lives - work, travel, exercise, even trek!

Even among the medical community, there is a lot of misinformation about the prognosis once you are on dialysis. Naturally, among people who are not medically trained, this can be much worse. Once your neighbors come to know that you or someone in your family is on dialysis, they all think, "Khel khatam, dukaan bandh!" - the story is over!

Nothing can be farther from the truth.

Of course, there are people who die within a few months or a few years of being put on dialysis. But it does not have to be that way! It is up to the patient, his or her family and the treating nephrologist to prevent this. It is possible to live long, productive and fruitful lives after being put on dialysis. It is all a matter of getting good dialysis, enough dialysis and yes, have a positive outlook.

Friday, October 25, 2013

The WAK hits a funding roadblock - corporate interests at play?

I was horrified when I read this post on the Facebook page of Dr. Victor Gura of the Blood Purification Technologies, the developers of the Wearable Artificial Kidney:

Dear friends of the WAK,

In several past posts we had annonced, that the first WAK trial would be carried out sometimes in the fall of 2013.
Unfortunately, that will not be the case.
Last August,we had the promise of having sufficient funding available to us, that would have allowed us to carry out our first FDA approved trial in Seattle. We received a cash advance, and work started in earnest.
A few weeks later, the financial support for the trial, and also the continued developement of the WAK, were witdrawn by those that had indicated that they would support it. Thus, manufacturing of the devices to be used in Seattle were halted, and the trial will not be carried out until the study is funded.

The development of the WAK is currently at a standstill solely because of lack of financial support.

We are sorry to have to make this announcement. Now we must wait further until the funds, allowing us to resume work, become available. 
We will continue to work diligently, in order to make the WAK happen, and we wanted you to know that we are not giving up at all. ,

This is really sad. What could be the reasons behind this withdrawal of funding? This device holds so much promise for people on dialysis. It offers the freedom from being tethered to a giant machine lifelong! It offers a real chance at normalcy for us dialysis patients. Things were looking so good. The FDA even approved the device for the accelerated approval pathway and we were told that in 3 years from then (more than a year back), the device would be in the market!

I may be over-reacting here but I have read of a couple of instances where the big corporates have scuttled the development of such game-changing devices to protect their own business interests. The way this has happened - initially promising funding and then withdrawing it at a crucial stage - all points to some sinister conspiracy against the development of the WAK.

I have no clue on Dr. Victor Gura's plans to tide this crisis. All I can say is that the hopes and prayers of the entire dialysis patient community are with him and his team and we strongly wish that he overcomes this situation and succeeds in his mission to bring succour to the thousands of patients worldwide.

Thursday, October 24, 2013

Aashayein being held in Delhi!

Karnataka's PD pilot - what happened last year?

I was happy to read yesterday that Karnataka was launching a pilot project on Peritoneal Dialysis. The state would bear 65% of the cost and the rest would be borne by patients. As I thought about it, I felt a sense of deja-vu. I had read this earlier as well! Guess what a Google search for "Karnataka PD pilot" threw up? The second result was my blog dated February 6th, 2012 on this same topic!

The same proposal, the same institute, the same director! Well, I really wonder what has been happening on this proposal for the last one and half years? Anyway, I am not going to complain. We all know how things in the government take time. More so when it is really for the good of the people!

I really believe that Peritoneal Dialysis is an excellent alternative to hemodialysis. It requires no expensive machines, no expensive staff, not much infrastructure and it can be done in the convenience of home! What more can one ask for?

Despite all its benefits, PD has always been the step-child of nephrology, a bad word, something not talked about with respect, something not for real people. The big corporates have frowned upon any promotion of PD. It did not sit well in their grand scheme of things. Patients would have more power. Patients would be more normal. They would not need to come to the nephrologists as often. They would not need to come to the hospitals as often. All this was bad business! And isn't that what healthcare has become all about - business? Who cares about the patient?

When I was put on PD back in 1999, it was more expensive than hemodialysis. At least there was a valid excuse for patients to not be recommended PD. Over the years, however, it has become cheaper than hemodialysis. Thankfully, there are no businessmen colluding to keep prices high! However, despite this, the penetration of PD is still abysmally low. Who is to blame? I still see many patients who have not even heard of PD!

So, in all this gloom, when such a piece of news comes in the form of a Government scheme to promote PD, I cannot be anything but delighted! Doesn't matter if the scheme is a year and half old. The Institute of Nephro Urology, its Director, G. K. Venkatesh and the Government of Karnataka, all deserve to be congratulated!

Thursday, October 17, 2013

The Renal Diet need not be that bad!

When someone is put on dialysis, ideally they must see a dietician. A dietician who is experienced in seeing dialysis patients would assess your food habits, your blood investigation results and then customize your diet according to your needs. In India, however, many nephrologists hand out a one-size-fits-all diet plan and do not insist on a diet consult. This could be because the patient would see this as a waste of money.

The trouble with a standard renal diet plan is that a lot of unnecessary restrictions are imposed. This results in the patient getting extremely frustrated and often, going into malnutrition which is a bigger problem than eating the wrong food.

If someone is on regular, thrice weekly dialysis, they do not really need to restrict their diet so much. You need to know the basics of Potassium, Phosphorus, Sodium and fluid and you can actually bring in a lot of variety into your diet. Food can really be much better!

In fact, there is a very small list of foods that must totally be avoided. Everything else can be had in moderation. I once overheard a tech talking to someone who had been on dialysis for the last 3-4 years. The patient said he had not tasted a mango for the past 3-4 years! Yes, mangoes are very high potassium fruits but I am sure, by checking with your nephrologist or dietician, a small slice once in a way in the first half an hour of dialysis, especially if you're getting regular, thrice weekly dialysis, cannot be that bad!

The key is moderation! You obviously cannot binge on fruits but a little fruit once in a way cannot kill you. There are people who get so completely swayed by the not completely thought through advice on diet that they take things to other extremes. And an over-enthusiastic spouse or offspring does not help!

Once someone is on dialysis for a while, say a couple of years, they figure out, by and large, what works and what does not work. They have tried different stuff, stretched the limit, little by little and know their bodies well enough to actually disregard the diet chart given to them and do their own thing.

The way we humans think, it is better to have a small quantity of something in safe circumstances than to crave it so badly that it leads us to depression!

Tuesday, October 15, 2013

Is 2016 going be my year of liberation?

I was thrilled to read recently about a collaboration between a medical devices company in the US, Medtronic and Indian healthcare giant Apollo Hospitals to "bring an affordable and portable hemodialysis system to India." I have never seen the words "affordable", "portable", "hemodialysis" and "India" in the same sentence before. Naturally, I was excited!

What is striking about this announcement is that Medtronic chose to launch their device in India. I have no clue about their financial incentives to do this but it just seems too good to be true! For years now, we have had the NxStage System One available for dialysis patients in the US. There is no sign of it becoming available in India. Our country is not even on their radar. So, while patients go on rafting expeditions in the US thanks to this wonderful machine, my fellow patients in India and I must continue to be shackled to our mammoth machines and travel unhindered only in our dreams!

The announcement says, "The commercial launch of the product is slated for 2016." Oh my god! This is not even decades away. We have kept reading about wearable machines, about implantable machines the size of a coffee cup and many other fancy sounding, fantastic solutions for kidney failure. The trouble with all these machines, for patients in India is that these are many, many years away from us. Even the WAK, which they say would be out in the US in the next 2-3 years, would take a long time to reach India.

The Medtronics device is expected to be launched in India in 2016. Read that again. Digest its significance. 2016. India. And it is going to be portable and affordable. I am really not used to such good news!

If this really happens, I don't need to rush back to Hyderabad after 2 nights away.

If this really happens, I can travel to any place in the world and not worry about being close enough to a dialysis center.

If this really happens, I don't need to watch my fluid intake when I am on a holiday!

If this really happens, I don't need to feel the heaviness in my chest when I am on a holiday!

If this really happens, my family and I don't even need to look for a house to move to that has enough place for an RO plant!

The freedom that this kind of a machine offers is unimaginable! Seriously, only someone on dialysis can understand this!

Is 2016, finally, going to be my year of liberation?

Saturday, October 12, 2013

Fistula infection

On Tuesday, dialysis ended normally. Around 10:30 in the morning however, I felt pain in the venous puncture site. There was a slight swelling around the puncture site. I was wearing a formal shirt which had full sleeves and the cloth kept touching my puncture site and made the discomfort worse. One more reason for me to hate formal clothes at work!

By afternoon, I developed a slight fever as well and I decided to go back home. I called Dr. P. C. Gupta, the vascular surgeon who made my fistula back in 2005 and who is a wizard when it comes to matters of the vascular system in the human body and asked to see him right away. This had to be treated quickly. Luckily I was asked to come over immediately.

Dr. Gupta said it was infected and I would need to be put on antibiotics. Augmentin 625 mg twice daily. I thanked him and went back home and started the antibiotic. Being Tuesday, I did not have dialysis that day. The next morning the fever had gone up to 101 degrees F. I was feeling quite bad as well. I had some breakfast and took the antibiotic apart from some paracetamol. The whole day was quite bad. The fever touched 103 and wasn't coming down.

I had already skipped dialysis the previous night. So, I absolutely had to get dialysis on Wednesday night. However, dialysis cannot be started at temperatures above 100 degrees. Despite taking paracetamol, the temperature was just not falling!

I called Dr. Gupta in the evening and he advised to add Cifran 250 mg twice daily and also send the puss for a culture. Within two hours of taking the Cifran, the temperature started reducing. By about 10:30 in the night, the temperature was at 99.8 and we started dialysis.

The next morning, I felt even better. Though there was a lot of weakness (I was taking two very strong antibiotics at the same time!) and a horrible taste in my mouth, at least the fever had become normal and the infection was healing.

As I was leaving Dr. Gupta's room on Tuesday, he remarked that the repeated infection could be due to the buttonhole technique I was using. It was true that the buttonhole method was prone to more infections than the regular cannulation techniques. He added however that it was a small price to pay for the convenience and the long life of my fistula. That quite settled things!

Saturday, October 5, 2013

Yours truly featured in Home Dialysis Central!

When I got onto Daily Nocturnal Home Hemodialysis back in 2006, it was quite a challenge to figure out even the basics as I couldn't find anyone else on this modality in India. I relied primarily on the internet, mainly, Home Dialysis Central for information. There were some really helpful people there who answered every question I had. They had been there, done that and were ever willing to provide answers to newbies like me who were just starting off.

Today, I am proud to let you'll know that the site has added my story to their patient stories section! Here is a link to the page. Home Dialysis Central is one of the best resources to information about home dialysis you can find on the internet. It has some really useful information, links and videos related to all home dialysis modalities including PD and home hemo. It also has forums for various modalities where your questions can be answered. Another very valuable aspect is the presence of home dialysis experts like Dr. John Agar who also answer questions posted there!

Many thanks to Dori Schatell, the founder of that site and an amazing person!

Wednesday, October 2, 2013

Had a great birthday!

I turned xx a few days back. I had a party for the NephroPlus team at home the night before. My parents were very keen on having the clinical staff over. For the last three years Sandeep has been coming home to surprise me at midnight with a bunch of people from the company and I actually cut the cake while on dialysis! So, this year, my parents wanted to have a gathering of the whole team at home.

I sent out the invite to all a few days before hand. People were excited. The Center Manager from our Chennai center and one of our technicians from Mahbubnagar actually came all the way to Hyderabad just for my party!

On the day of the party, we had about eighty people attend the party and we had a fantastic time. We played a game of Antakshari as well apart from a whole lot of singing and dancing. We brought in my birthday at midnight and wound up by about 1.

I got a bunch of gifts as well. Many of them were personalized and I realized that a lot of effort had gone in in putting this together!

The next day, on my actual birthday, I had dinner at my favorite restaurant in town, Little Italy with my family. The good times continued on the 29th as well. In the morning, we had a huge family gathering at an aunt's house (not birthday related, but had a lot of great food and fun!). That evening, I met some friends over dinner at another good place - Olive Bistro.

So, it was an awesome three days of fun!

Wednesday, September 25, 2013

Know your dialysis: dialyzer type and needle gauge

Today, let us look at the last couple of things that are important about your dialysis.

Dialyzer type is a very important factor in determining whether you are getting good dialysis. As you know, this is akin to an artificial kidney where the actual filtering takes place. This is where the excess fluid and toxins are removed.

There are many types of dialyzers in the market today. The important thing to check is whether your dialyzer is low-flux, medium-flux or high-flux. High-flux dialyzers offer the best clearance among all variants followed by medium-flux and then low-flux.

The difference is the amount of surface area inside dialyzer available for the blood and the dialysate to interact. The greater the surface area, the better the clearance of toxins. High flux dialyzers have a greater surface area than medium and low flux dialyzers and therefore, are able to clear toxins much better than them.

High flux dialyzers are also able to remove more fluid easily compared to low flux dialyzer which have constraints in fluid removal. Though fluid removal is a setting on the machine, this is done by altering the Trans-membrane pressure (TMP) and low flux dialyzers cannot withstand a high TMP.

Clearance of middle molecules is something that everyone on dialysis must be worried about. Middle molecules do not have an immediate impact like potassium or sodium but over a long period of time, they can cause something called Carpal Tunnel Syndrome and other problems. So, it is important to make sure we are getting adequate clearance of middle molecules. The clearance of middle molecules is not at all satisfactory in low flux dialyzers. High flux dialyzers do very well in clearing middle molecules. However, dialysis duration plays a very important role in clearing middle molecules as well.

High flux dialyzers are unfortunately and expectedly, much more expensive than the low and medium flux dialyzers.

The gauge of needles is another important factor to consider while determining your dialysis prescription. Dialysis needles are thick! Who likes them? Thicker needles allow more blood to be removed from your vein than thinner needles, obviously. So, using a needle with a thicker diameter allows you to run your dialysis at a higher blood flow rate. Trying to run at high blood flow rates with a thin needle can cause your blood to hemolyze which can actually be fatal if not detected early. So, it is very important to choose the right type of needle with the right blood flow rate.

One thing to remember is needle gauges are reverse in order. The higher the gauge, the thinner the needle. 16 gauge is thinner than 15 gauge and 16 gauge is thicker than 17 gauge!

In India, most people use 16 gauge needles because we run at low blood flow rates compared to the US where most people use 15 gauge needles because they run at higher blood flow rates.

Your technician or nurse, totally devoid of ego and extremely well-versed with all these aspects of dialysis - some are so learned when it comes to dialysis, they actually have come up with a fascinating set of theories for different aspects like why the US runs at high blood flows - will generally make a good choice when it comes to which dialyzer and which needles would suit you rather than just use a default for all. However, it would do you a great deal of good if you discuss both these things with your nephrologist and arrive at a considered, well-thought out decision than just accept the default that is used for all!

Remember, medicine is highly individual. What works for one person will not necessarily work for all!

Tuesday, September 24, 2013

Know your dialysis: Blood flow rate and dialysate flow rate

As we saw in the last article of this series, the dialyzer has two compartments - the blood compartment and the dialyzer compartment. The blood flows through the blood compartment and a special fluid called the dialysate flows through the dialysate compartment. The dialysate is prepared by the dialysis machine by mixing three liquids - the acid solution, the bicarbonate solution and pure water in a certain proportion.

The most important part of our dialysis happens in this dialyzer. This is the artificial kidney which is performing the most important task the kidney performs - that of cleaning the blood of the excess toxins and water.

Since the cleaning happens in the dialyzer, it is important that more and more blood passes through the dialyzer from the body. There is a pump that pumps blood out of the body through the arterial needle. The faster the pump rotates, the greater the quantity of blood that is pumped through the dialyzer and the better the blood is cleaned.

Similarly, since the dialysate is the fluid that is surrounding the blood compartment, the volume of dialysate also impacts the amount of cleaning that happens. More dialysate means more toxins can be removed from the blood. The dialysate flow rate can also be controlled by the machine based on a setting.

If you are getting four hours of dialysis, thrice a week (and that is the bare minimum anyone with CKD on Maintenance hemodialysis must get!), the number of hours you are spending on the machine is limited to twelve per week. So, it is important for you to ensure that you get the best dialysis possible during those twelve hours. The blood flow rate and dialysate flow rate are by far the most important parameters that affect the cleaning of your blood of toxins. Ultrafiltration rate is not affected by these parameters at all. But the clearing of toxins is almost entirely dependent on these two parameters.

Generally, our extremely knowledgeable technicians and nurses who are totally committed to our well-being and would go to any extent to help us feel better, would be aware of all these finer nuances of dialysis. :-)

However, for those unlucky few patients who go to centers where they have clueless staff who will do everything possible to reduce their work and headaches, there could be a chance that your blood flow rate and dialysate flow rate is set to unreasonably low numbers. This is because low blood and dialysate flow rates means less chance of anything going wrong. Never mind if the clearance achieved is low. Never mind if this could spoil your quality of life and not allow you to feel your best. Never mind if this could actually reduce your lifespan!

One thing to be careful about is to make sure you don't go overboard with these changes since too high a blood flow rate could have some negative consequences as well. Make sure you discuss with your nephrologist before making any changes. The human body is very individualistic. Each one has its own quirks. What I have explained here are only general guidelines.

One thing is for sure though - the higher your blood and dialysate flow rate - the better your clearance!

Sunday, September 22, 2013

Know your dialysis: Conductivity

Yesterday, we saw how Ultrafiltration and dry weight are really important parameters to keep an eye on before your dialysis treatment. Today, let us look at another important parameter - conductivity.

Ever had to hear a scolding from your technician or nurse for coming back with too much fluid weight gain? All of us probably have! Now, guess what? Chances are that they are responsible for this! Seriously. Read on.

The conductivity setting in a dialysis machine controls how much Sodium is present in the dialysate. What is the dialysate?

A schematic representation of a dialyzer

Ok, let's get to some basics. I am sure you know that the dialyzer is the artificial kidney that does the actual work of cleaning our blood of the excess fluid and toxins. How does this actually happen? There are two compartments in the dialyzer - the blood compartment and the dialysate compartment. The blood flows through the blood compartment (what else did you expect?) which contains hundreds of 'hollow fibres' which are very thin pipe like structures which have many, many pores on their walls. All around these hollow fibres is the dialysate compartment through which a special solution flows. The excess fluid and the toxins flow through these pores from the blood compartment to the dialysate compartment.

A diagrammatic representation of how substances in solutions move from areas of high concentration (right in the picture above) to areas of low concentration.

Why doesn't the blood itself leak out of the pores? That's because the pores are very, very tiny and the size of the blood cells are larger than the size of the pores. The pores are designed so that only the toxins and water can pass through them.

Now, it is possible that things from the dialysate also pass through these pores and enter the blood. It all depends on the size of the substance and the concentration difference on the two sides of the pores. Any substance can only move from one side to the other if the concentration (the amount of the substance per unit volume) is more on one side than the other. If the concentrations are the same, no movement will happen.

Now coming back to Sodium. The dialysate must be ideally designed such that the concentration of Sodium in it is around the same as that of a healthy human body. This is around 135 to 145 mEq/liter. The dialysate, therefore must also be maintained around this level.

The dialysate is prepared by mixing three liquids inside the machine - the Acid solution (Part A), the Bicarbonate solution (Part B) and RO water in a certain proportion.

The conductivity setting of the dialysis machine directly corresponds to the level of sodium in the dialysate. A higher conductivity means a higher sodium level in the dialysate and vice versa. By altering the conductivity desired, we can tell the machine what sodium level we would like the blood to be exposed to. The machine does this by altering the proportion in which it mixes these three liquids.

As in anything related to dialysis, as indeed, in medicine, every individual is different and there is no one single number for conductivity that is suited to all. Generally, a high conductivity causes excess sodium to be present in the dialysate and as a direct consequence, in our blood while a lower conductivity cause lower amounts of sodium to be present in the dialysate and in our blood. Excess sodium causes excess thirst and causes us to drink more water while low sodium causes low blood pressure and cramps as well.

So, if you come back with excess fluid weight gain, it is quite likely that your conductivity setting was higher than you need it to be. Blame the techs or this! Not yourself!

But I am sure most of us are lucky enough that our technician or nurse knows all this and sets the conductivity that is suitable for our body. I am sure most of them understand the problems related to excess sodium and low sodium and most of us don't have to ever worry about this at all. Right? :-)

For the minority among us whose technician or nurse do not know about this, start with a conductivity of anything between 13.8 to 14 and then if you are getting cramps or low blood pressure, go up a point or two (0.1 or 0.2) at a time. If, on the other hand, you are feeling too thirsty and feel you can drink the water in all the rivers in the country and still not tire, try going down a notch at a time (0.1 o 0.2) and see how it feels! Always remember to discuss any changes you make with your nephrologist since he or she is the most aware of your overall condition. What is explained here is only a general guideline!

Remember, it YOUR health on the line. It is YOUR body that is being dialyzed. The least you can expect is that YOU be consulted on matters related to this. This will obviously make sense only when you are aware of these things.

Saturday, September 21, 2013

Know your dialysis: Ultrafiltration & Dry weight

For those of us lucky to be on dialysis, it is important to know some of the basic aspects of dialysis. As you know, the technicians and nurses looking after us during dialysis have so much time for individualized care and are so knowledgeable that we can completely trust our life in their able hands. They are totally devoid of ego and are so humble that they will listen to us if we tell them to set a particular parameter to some level. Right? :-)

So, coming to ultrafiltration. The lucky ones among us don't produce any urine. Yeah, think about it. No waiting in line for the loo during the interval of a film. Who wants to use those terribly unhygienic public loos? No pacing around impatiently on a long flight waiting for someone to come out. No need to take breaks during a long car journey. No bio-breaks during meetings. Yes, being anuric has its advantages!

When you're kidneys are not working as well as they should, they don't remove all the water you drink. Some or all of it stays inside your body. This water is partly in the blood, partly in the body's tissues and partly in between the tissues.

This has a number of undesirable side-effects - your blood volume goes up, your feet and hands may swell and you could also get breathless because the excess fluid could go and accumulate in your lungs. Not everyone will experience all these symptoms. Each one of us has his or her own favorites.

Dry weight is your body weight assuming there is not one drop of excess fluid that has not been removed by your kidneys. It is your weight assuming your kidneys were working. Now it is difficult to tell exactly what your dry weight is because your kidneys aren't working! So, that leaves it to our able and knowledgeable technicians and nurses to determine the dry weight!

Since there is extra fluid in your blood, the amount of blood your heart has to pump is not normal. The average human body has around 5 liters of blood. Even if you are one of the techs' favorite patients and are putting on a measly 2 liters between sessions, that's a whole 40% more volume for the heart to pump! This cannot be good. If you're more like me and want to make sure you're getting your money's worth on dialysis, you're likely putting on about 4-5 liters when you have a one day gap! That's a whopping 100% more! This is much worse!

Now, on dialysis, one of the most important things that happens is the removal of this excess fluid. So, you can drink again! The process of removing this excess fluid from your body by the dialysis machine is called ultrafiltration.

You can read here how the body is capable of letting go of fluid only at rates of 400 ml/hour or less.

So, if you are about 2 kg over your dry weight, you're removing fluid at 500 ml per hour - assuming you do four hours. If you're 4 kg over your dry weight, you would be removing fluid at 1 liter per hour. This is very dangerous for your body especially your heart.

So, it is very important for you to be aware of your dry weight, to know how you feel when your dry weight has gone up (because, maybe you've been eating well) or down (you've been exercising) and have complete control over how much water you are removing every session. Discuss your Ultrafiltration Goal (also called UF) with the person who is setting it and arrive at a number keeping all this in mind.

Remember - remove too much - and chances are that you could get a very low Blood Pressure and cramps; remove too little - and you will have fluid in your body when you get off - which means you cannot drink as much until you get your next session. What could be worse???

Sunday, September 15, 2013

The skewed importance of materialism in modern day Jain Dharm

Jain Dharm, or the Jain religion was historically an extremely non-materialistic religion. The desire for materialistic things was frowned upon. The only quest that was worth pursuing was that for moksh, or salvation - the freedom from the cycle of birth and death. Pure Jains went to the temple not to ask for material comforts - money, a good job, a good spouse, good health etc. In fact, the deities in the temples - the tirthankars, it is believed, cannot even give these things. They have already attained moksh showing us the path to it.

In recent times, however, many changes have crept into this religion. A lot of people have begun expecting material benefits from the religion. A religion that was totally anti-materialism is being used to promote materialism and this is really, really sad.

Take for example, the Mahavir Janm Vanchan day during the Paryushan Parv. On this day, there is this tradition of ghee boli. This is when representations of the fourteen dreams that Trishala Devi, the mother of Lord Mahavir had are bid for by the Jain Sangh. I will not go into the demerits of this here. You should visit this link where it is beautifully explained. What I want to highlight is the relative bids for the different dreams. Trishala Devi got fourteen dreams after conceiving the Lord. The fourth of these dreams was of Goddess Lakshmi. The bid for the fourth dreams surpasses all other bids. People bid for this dream many times more than the other dreams.

Isn't this entirely wrong? Isn't it obvious to all that people are bidding more for this dream in the hope that Goddess Lakshmi will bless them and get them more wealth? This is completely against the basic tenets of the dharm that Lord Mahavir propounded. It is completely against the very fundamental principles of the original dharm that Lord Mahavir and indeed, before him the other Tirthankars preached. And yet, year after year, the Jain Sangh continues this tradition in the garb of raising funds for the activities of the temple for the entire year. I say, STOP! Let us do less activities. Let us spend less. Let us not have so many swamivatsalyas or community lunches. It is better to do less than to do more by insulting our Tirthankars in this way.

The shameless 'pleasing' of Goddess Lakshmi continues even after the boli is completed. There is bidding for who will carry the her statue during the procession that is taken out after the Paryushan Parv is completed! People will request for the statue to be brought into their shops on the way of the procession. At every step, the Jain sangh is knowingly encouraging this blatant and completely wrong practice of giving Goddess Lakshmi more importance than the rest of the dreams.

The bid for Goddess Lakshmi is just one of the wrongs that is happening in the religion. There are multiple others like poojas and artis for devi-devtas, presenting 'navlakha haars' to devis, adorning the idols of the tirthankars with expensive ornaments, the list is endless! When did Jain dharm become such a showy and pompous religion? This was not what Lord Mahavir wanted!

I am really sorry to say, this entire exercise has the blessings of the Jain sadhu-sadhvis or the Jain clergy. They probably like to see high amounts being bid in their presence dropping hints that their presence has inspired the laity to bid increasingly high amounts! If the sadhu-sadhvis take a strong stance on this, it would be enough for this practice to be put to an end immediately. But will they? I would think not!

The only thing one should follow any ritual in Jain dharm for is moksh. Nothing else. Not more money, not to get rid of health problems, not to give birth to a child, not to ensure that your business does well. Practising Jain dharm for all these things is not only ineffective, it is totally wrong and I can say with a certain degree of certainty, that it is only making us attach bad karm to ourselves.

Some people argue that if we do not allow these changes to come in, Jains would turn to other religions to solve their material problems. I say, LET THEM! We should never compromise on the basic principles of our religion just so that people who do not understand it go elsewhere. What is happening, unfortunately, is that even people who understand the basic principles start indulging in this shameless quest for materialistic benefits from the religion.

What have we gained from this? What have we lost? These are two very fundamental questions every right thinking Jain must answer.

Friday, September 13, 2013

You have no choice but to be aware

For people that have kidney disease, in fact, any chronic condition, it is very important to be aware of the condition, the options available and the pros and cons of each. I see so many people on dialysis every day. Unfortunately, many of them rely on others to make their decisions. Some rely on their family, some rely on doctors, some rely on other patients with similar conditions. This is not good at all.

I would strongly advise you to read up as much as you can about your condition, become a member of an online group of people that has a similar condition and ask questions when you visit your doctor.

The internet is a great source of information. You should regularly look up your condition and keep abreast of what's happening in that field. Google Alerts are a great way to get a daily digest of the latest in any field right into your inbox! I have a Google alert set up on "dialysis" and "Atypical Hemolytic Uremic Syndrome" apart from other things. That way I am certain that the most important news on these subjects will always reach me in time. I also follow some nephrology blogs like those of Dr. Ajay Singh, Nephron Power and Renal Fellow Network among others. You should get a good RSS reader account like Feedly and subscribe to these blogs. This is a very easy way to keep up with the latest.

I have learnt some really important stuff simply by being part of online support groups. The simple fact of having dozens of others with similar problems like you can be heartening. Whenever I have a problem related to my home hemodialysis, I post it online and within hours, I get replies with how others have handled the same situation. Contrast this with having to wait for an appointment with my nephrologist and waiting to get his advice. Of course, you need to be judicious when you decide what questions are meant for a support group and what questions are only to be answered by a nephrologist. For example, a support group cannot help you decide which Blood Pressure medication you must take. However, a support group will definitely help you to feel better when you have just pulled off too much fluid on dialysis. And remember to contribute back to the group when you can! These days, there are many places where you have groups. Facebook also has groups for most things.

Some of us are lucky to have doctors who look beyond commercial factors while recommending treatments. Not all of us are that lucky. If you have a chronic condition, chances are that at some point in your life, you will run into doctors who ONLY look at the financial benefit they are getting while recommending something to you. Yes, the world is filled with cunts, right? But it is difficult to tell one from the other especially if your interaction is short. So, remember to ask questions.

"You need to get a fistula made for dialysis."

"Why do I need dialysis? What are the options within dialysis? What is the chance of success of a fistula surgery? Anything we can do to improve that? Who is the best fistula surgeon in town?"

You get the picture?

Ask questions. Understand your options. Understand the pros and the cons for each. Then make the decision along with your doctor. Never let the doctor decide everything. Remember, it is your life. You are the only one that will bear the consequences. Is it too much to expect that you be a part of the decisions?!

This is where education comes in as well. If you are well read about your condition and know the options, no one can take you for a ride. If you know nothing about it and rely completely on others, then no one can help you. The choice, really, is entirely yours.

Wednesday, September 11, 2013

Solving my hunger problem

First of all, sorry for not posting for such a long time! I was busy with religious rituals - the Jain 'Paryushan Parv'. Eight days of special rituals including the last day of fasting in some form.

Coming to today's post, I had a weird problem till some time back. I used to feel hungry all the time. I would have my breakfast at around 8:30 in the morning and would feel hungry by about 11 and I would need to have some snack. By 1 o'clock, I would feel hungry again. Lunch would happen then. By 4:30, I would get hungry again. I ended up snacking quite a lot. Most of these snacks would be unplanned and so, unhealthy!

Well, I could fix this by planning to have a snack every 3 hours and making it healthy. But then, doing that is not an easy task. Planning two snacks every day apart from your usual meals can be more difficult than you can imagine. And I am one hell of a fussy guy when it comes to food. I cannot eat the same things for more than one day at a time. If I snack on something one day, I need something else the next day!

Another problem was my reputation. My office has glass walls that are all see-through. Anything I do is visible to everyone. Taking out a box every couple of hours and eating is not at all good for your image. Believe me. At a previous company I worked for, I got told in an anonymous manner (in a Fishing Pond game) to give my mouth rest at least sometimes. And it was not from talking.

So, I had to find a way to control the frequent hunger pangs I was having.

I consulted the NephroPlus Chief Dietician, Akhila a couple of months back and told her about this problem. She suggested I maintain a food diary. I did so religiously for a week. She then studied it and suggested that I include more protein in every meal. Protein offers satiety and does not let you feel hungry too soon.

I started doing that. I consciously started including protein in my meals. It wasn't too difficult despite me being a vegetarian. Milk in the morning, dal in the afternoon and so on. This really helped. Whenever I manage to include adequate amount of proteins in my food, I find that I feel hungry much later.

This is good tip for those who feel hungry often. Include protein in your meals. Protein lasts much longer and hey, it also improves your albumin which is very important for your overall well-being and longevity!

Sunday, September 1, 2013

I wish I could wear a stethoscope

When I was a kid, I was very clear that I wanted to be an engineer. I did not want to have anything to do with medicine. I hated Biology and the thought of dissecting rats was not appealing. I did go on to become a Chemical Engineer in 1997.

Looking back, if there is one regret I have in life, it is not doing medicine. These days, I fantasize that I am a doctor, walking into a surgery wearing scrubs, a stethoscope around my neck, feeling the pulse of a patient and then going about the complicated procedure finally relieving the patient of his problems!

It must be so magical! Seriously! A doctor's work, to me, is unquestionably the most satisfying job that exists on the planet. When I met my classmate Anuj Kapadia, now a cardiologist, after many years, as a patient, I listened with amazement as he recounted his journey and how he spends time at the hospital from 6 in the morning till 10 or 11 in the night and then is sometimes called back for emergencies. Well, it seemed like a tough life. But his one statement after this summed it all up. "It feels nice!" Not many people can say that about their jobs!

The beauty of taking away problems related to health of a fellow human being can have no parallel. This can give you a kick like no drug can.

Even others in medicine, not only doctors, get a chance to experience some part of this satisfaction. Nurses and clinical technicians, for example. They get to do some of the stuff doctors would do and this can be great as well. Since not everyone gets to be a doctor, this could be a great alternative as well.

At NephroPlus, I do get a chance to watch all this from the periphery. But that is no substitute for the real thing. I think I am very clear in my mind. If I had to live my life again and were allowed one change among the decisions I have made, it would be my choice of career for sure. I would pick medicine without a doubt.

Saturday, August 31, 2013

LinkedIn Endorsements - don't!

I am not a LinkedIn kind-of guy. I rarely visit my profile. I created one because everyone had one. I keep getting requests. If I know the person or know someone that knows the person, I add him or her. Otherwise, I ignore the request.

Recently, I started getting email notifications from LinkedIn that such and such person has endorsed me for such and such skills. For a moment, I was flattered. Wow! He appreciates my skills in Agile Methodologies! Nice!

But then it strikes me. This guy has no clue about Agile Methodologies! How did he endorse me??? Well, by now, honestly, I have no clue about Agile Methodologies as well! But that's an entirely different matter!

I recently visited my LinkedIn profile after ages to accept a friend request. When I clicked on the name of a contact, a small notification came up on the top of the page exhorting me to endorse the person for some skills.


All you probably need to do is to click on the bright yellow button that says Endorse and I guess the person gets an endorsement for those skills. Never mind if I have no credentials to endorse someone for those skills. Heck, never mind if the person being endorsed also has nothing to do with those skills.

LinkedIn endorsements, in my humble opinion are really unnecessary. Nothing is achieved. Everyone, I am sure by now, knows that they don't mean anything.  Why even bother?!