Tuesday, April 23, 2013

Aashayein this Sunday at Agra!

Aashayein, the one day, free, fun and educational event for dialysis patients is being held at Agra this Sunday (28th April) from 9 a.m. at Hotel Moti Mahal Delux, Gandhinagar, NH2, Agra.

If you are on dialysis and stay in or close to Agra, please do come for this event!

There will be some great talks by nephrologists, dietitians  vascular surgeons and patients. There is also going to be an elaborate lunch prepared as per the renal diet. There's also going to be a whole lot of entertainment and games! To top it all, there's going to be splendid gifts for every patient apart from the "Best Fistula Contest"!

To register, please click here.

Saturday, April 20, 2013

The irresistible urge to pull off the very last drop of fluid

Yes, I always have that. So do most people on dialysis. When we go in for a session, we want to pull off every bit of excess fluid. Even if it means cramping a little or feeling weak after the dialysis session.

What is the necessity to remove more fluid than you actually have? This is something only people on dialysis will get!

The crux of the matter is we are better off pulling off more than less. We never want to get off dialysis with any extra fluid. To make things more complex, it is very difficult to tell for sure how much above our dry weight we really are. There are a lot of factors involved. The amount of food we have had in the past few hours, the kind of food, the overall increase or decrease in dry weight over the past few day and other such things.

There have been attempts by the medical community to develop tools to determine exactly how much excess fluid is there in a patient's body and hence accurately determine how much fluid to remove. However, these tools have still not gained wide acceptance, at least in India.

So, where does that leave us?

All we have is subjective measures of the fluid weight gain. The dry weight is not assumed to have changed unless some symptoms are noticed. For example, if a patient cramps during dialysis regularly, it is assumed that too much fluid is trying to be pulled off and that the dry weight has increased. If the patient has breathlessness or a high BP, then it is assumed that too little fluid is being removed and that the dry weight has probably decreased. Again, there are multiple other reasons why the above two symptoms can also happen due to, so the game becomes all the more difficult.

This leaves the person on dialysis always wanting to err on the side of caution. Remove every single possible drop, that is! If we do not reach our known dry weight, we will feel so horrible. Like we have been cheated! Like we have undergone the horrible thing called dialysis and all the fluid wasn't even removed! The main problem with this is that now until the next dialysis session, we will have to restrict our fluid intake even more than usual because there is already some fluid left behind in our body and not restricting this would lead to all kinds of horrible symptoms like breathlessness, swelling in the feet etc.

What unholy crap!

Sunday, April 14, 2013

Chennai Diary

Mistaken Identity

As I landed at Chennai Airport, I quickly queued up at the Pre-paid taxi counter and booked myself on a cab to my destination. I took the receipt and headed out of the airport. When I got into the cab, I found the driver unusually polite. People who are not from Chennai have some really bad tales to tell about Chennai cab and auto drivers. This guy was a far cry from those in the horror stories! He also had a charger available that had cables for almost every phone you could imagine!

He was talking to me in broken English about the weather, the traffic and myriad other things.

After a few minutes, I understood why. He asked me, "Which country?"

I was surprised! This was the first time I got asked this! I said, "Hyderabad, India only!"

He seemed shocked and disappointed at the same time. "Hindi aata?"

Whatever little conversation we had after that was all in Hindi.

He probably thought I was from a foreign land because of my new goatee. Whatever misconceptions about Chennai cabbies were cleared in the first half of the ride were built up again in the latter half!


Whenever I go for the first time to any of our dialysis centers, I am filled with a sense of apprehension. How would the staff react to me? How would the patients react? Chennai was very pleasant on both counts. The staff were really thrilled to meet me! They had seen very few patients who had survived so long and were very motivated with my talk to them about the NephroPlus philosophy and culture. The patients I interacted with were quite surprised that I was actually on dialysis. They asked me a lot of questions they had. I answered some of them and suggested that they ask their nephrologist about some of the medical ones.

One thing I see in NephroPlus centers is that the patients love the staff. Many of them have dialysis centers close to their homes but they still travel long distances because they like our staff so much that they cannot think of leaving them and going elsewhere!

When you see patients feeling happy when they come for dialysis, laughing and chatting with the staff, you feel a sense of warmth in you. When patients commend you for changing the unit and providing many conveniences that makes life much simpler for them, you feel a sense of unbound happiness. This is really what dialysis should be like. Something you do not really have to dread, something you are comfortable with. I can never do anything else for a living after this!

A Gourmand's Delight

Chennai is a place I love for its food. The rice idlis made here are like nowhere else. Luckily for me, our dialysis center, the hotel I was staying in and my favorite eating joint - Murugan Idli Shop were all very close to each other. I went there for all my meals! Why go anywhere else? I got to sample the idlis (of course), the vada, the uttapam, the mini meal and the full meal over the course of four different meals.

The idlis really are something else. I have yet to eat a rice idli that is better than this. The vada is also really excellent. Most times in the past, I have had only 'tiffins' - or snacks like idli, vada etc. This time I got to try the mini meal and the full meal as well. The mini meal was good.

The full meal was a revelation however! They serve a bowl of steamed rice and then one by one, a waiter comes along with various accompaniments - each better than the other! The only trouble was I was totally uninitiated. I had no clue on how many such accompaniments were there and did not know how to plan my meal to make sure I did justice to all! This was definitely one of the best 'South Indian Meals' (that's singular btw!) I have ever had!


Staying with Murugan, as I walked into the outlet serving the meals, my eye caught a small little section at the mouth of the outlet that was serving some delicious looking drink called the 'Jigarthanda'! This means something that cools the liver! I promised myself the treat on my way out.

It was a difficult task given the sumptuousness of the meal itself. But no meal can fill a dialysis patient enough to say no to a good looking drink! Trust me on this!

I ordered the Jigarthanda and relished every drop of it. The sweltering Chennai afternoon made my task much easier. I could actually feel my whole body (including the jigar, of course) become real thanda!

Wednesday, April 10, 2013

Heating water in an electric kettle versus on the gas stove

I have a cup of Darjeeling tea every morning. I make it by heating water in an electric kettle and then pouring it into a bowl which has the tea leaves and let it brew for five minutes before I pour it out into a cup and add sugar.

For the past few weeks, there is a power cut in our area every morning from 6 to 7:30 which means that the electric kettle cannot be used. I have started heating the water on the gas stove in the kitchen instead.

There is one startling difference in using this method to heat the water. When I used the electric kettle to heat the water and poured the water into the tea leaves, at the end of five minutes the tea leaves would still mostly be at the bottom of the bowl. However. when I heat the water using the gas stove, after pouring the water into the tea leaves, at the end of five minutes, the tea leaves are all over the water - right from the top of the water to the bottom!

I am very surprised. The water is the same, the tea leaves are the same. The water is taken to a boil in both cases. Only the method used to raise the temperature of the water is different. While it is electricity in one case, it is LPG fuel in the other.

Why then this difference in behavior?

Sunday, April 7, 2013

The Tiramisu-Bhindi controversy

Does Tiramisu have bhindi?


This was a question that took up a significant part of dinner I had with some friends last evening. It all started when two people ordered Tiramisu for dessert. Pushkar, one of my friends suddenly asked all of us in a very authoritative tone, "Did you know that Tiramisu is made out of bhindi?"

The two people who had ordered the Tiramisu stopped eating it. Somehow the image of the bhindi does not sit well with Tiramisu.

I protested strongly. "Tiramisu cannot contain bhindi! It is impossible." The table was quickly divided into three groups - those for the motion, those against and the rest who were not really sure or care. We all argued.

"How can Tiramisu contain something like bhindi?" said one.

"The stickiness of the bhindi is actually quite ideal for the Tiramisu. They probably use it for the consistency", offered another.

I asked Pushkar what his source was. "Google!" he responded.

I asked him whether everything thrown up by Google was right. "No, but you can check this. I am sure about it."

Thank God for 3G! A young lady pulled out her smartphone and quickly pulled up a recipe for Tiramisu.

She read out the ingredients:

1 1/4 cups white sugar
1 1/4 cups mascarpone cheese
1 3/4 cups heavy whipping cream
2 packages ladyfingers

We were all shocked for a moment. Ladyfingers? How could it possibly be?

It was then that it struck us! In India, bhindi or okra is called Ladies Fingers! The ladyfingers referred to in the recipe were light and sweet sponge cakes roughly shaped like a large finger often used in dessert recipes!


We all burst out laughing!

Pushkar also confessed that he was told about this by his boss a while ago. I shudder to think what would have happened to people who mistook the ladyfinger to be the Indian bhindi and actually went about trying to make the Tiramisu!

Bhindi / Okra / Ladies fingers

Saturday, April 6, 2013

The circus is in town!

The IPL is back. For the next two months, many people around me will be fully hooked to their TV sets following the happenings. The IPL has really changed cricket in India completely. It is more entertainment than sport, really - the short matches, the whole carnival-like atmosphere, the involvement of Bollywood.

It doesn't work for me though!

For starters, I am one of the very few in our country who is not crazy about cricket. Its not that I hate it or something. Its just that I am not crazy about it. If there's an India-Pakistan match or a World Cup semi-final or final in which India is playing I will watch. But I am not one of those guys who will watch a replay of a West Indies-Australia match and get excited about the goings-on.

My father and brother are both big followers of cricket and the IPL. They even go to the stadium for a match or two during the season. They know the names of all the players. They know which match is on today and would be excited about it. For me, one of the problems about IPL is you start cheering for people you've been against all this while. It confuses the heck out of me. Ponting and Tendukar opening together? WTF? And people on Facebook had goosebumps! Double WTF!

The funniest part about this IPL for me was the TV coverage. Once a match was over, the folks at the studio would analyze the match like any other match. Which is fine. But every time they were about to show special features like some successful batsman's fours or sixes, the camera would pan to a group of scantily clad white girls who would jig to Bappi Lahiri's "Ooh la la" song from "Dirty Picture". This was totally hilarious!