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?!

Wednesday, August 21, 2013

Pushing the envelope: Bill Peckham dialyzes on a raft!

Bill Peckham, who has been an inspiration for many dialyzors - he has dialyzed in many countries and has taken 'living a normal life on dialysis' to an entirely new level - recently went on a holiday to the Grand Canyon. He took his NxStage machine with him. Along with some friends, Bill took a rafting trip down the Little Colorado river. Bill actually got two dialysis sessions aboard the raft on the shore! Here is a link to his blog that has some details of the trip and here is another post from his blog that has a video of him talking about this.

Bill Peckham getting dialysis on the raft (Source: Bill Peckham's blog)

Of course, Bill does things that many others, even with the NxStage, do not do. No doubt about that and hats off to him for that! But I believe that this machine has allowed Bill to really push the envelope. Bill has travelled to many countries on dialysis but things like doing a rafting trip down the Little Colorado become enjoyable thanks only to this little machine.

People on dialysis can go on holidays even without the NxStage machine. One major problem with this is that you need to watch your diet and fluid intake! For people like me who are on daily nocturnal, this can be a horrible mood dampener. Who wants to watch your fluid intake while on a holiday???

Another equally horrible thing to contend with is the fact that you need to get your dialysis in a dialysis center. The four hours of boredom, the drained feeling after the session, the mood swings of the techs and nurses - it all comes back to you! Home is such a good thing!

That is why, time and again, I say that the NxStage machine has been a true game changer in many ways. It has offered true freedom to dialysis patients. I so badly want this machine to come to India. I so badly want access to this machine!

Friday, August 16, 2013

Working for a big company versus working for a startup

My entire working life has been spent working in startups - my brief stint at Suma Computers, followed by Effigent, then Grene and now NephroPlus. When I was in Effigent, I visited the Infosys campus in Hyderabad. I was so amazed. The whole place had this college campus-like feel to it -huge grounds, large food courts, gyms, a beautiful swimming pool. I was truly mesmerized.

Infosys, Mysore

I promised myself that if I ever I decided to leave Effigent, I would come and work in this company. Obviously that never happened.

A few days back, I visited Max Hospital in Patpargunj, Delhi. My colleague Rahul and I walked down to the cafeteria to grab some coffee. I felt the same buzz there as well. Of course, the campus was much less ambitious than the Infosys campus but that whole feeling of being part of a huge community had something about it.

This reminded me of my school days. HPS was very similar. A gigantic campus with a lot of people trooping in every morning, going about their day and then going back. People congregating in a dining area at lunch-time, chatting away about myriad things.

Granted, there are many advantages while working in a startup for sure. No denying that. The growth that you can get in a startup, the amount of learning that happens, the feeling of being a part of an entity right from the start are all unique to the startup experience. Also, things are much less bureaucratic in a startup. In a large company, everything must move according to the rules and this can, at times, be frustrating. Processes and protocols triumph over all else. Startups, on the other hand, offer more flexibility at work.

I guess the thing I miss the most is being a part of a large community. For example, nothing can beat what Infoscions feel when they are watching a movie at the large open-air auditorium with hundreds of others right in the middle of their campus!

Am I romanticizing this a bit too much? My friends at Infy probably do not connect with this at all! I am not sure. They are all so busy working, putting in long hours, working on weekends, that they often say they have no time to enjoy the campus and the life it offers. This is quite an irony.

Tuesday, August 13, 2013

A good fistula plan is so important

I was on the Operating Table. Dr. Prem Chand Gupta and his assistant surgeon were operating on my left upper arm. They were creating an arteriovenous fistula - basically connecting a vein and an artery to enable my vein to carry blood at high pressures that would make it suitable for hemodialysis. The surgery was to take only about 45 minutes to an hour. We were about an hour and a half into the surgery. I could sense that everything was not all right. Dr. Gupta and his assistant were talking about some problem in the vein.

After a while, Dr. Gupta said, "Mr. Shah, there seems to be a block in the vein and we will have to do something else. So, please bear with us for some more time!"

"Sure, Dr."

The team then basically grafted a part of another vein and created the fistula at the end of three hours.

When I went back to my nephrologist and showed him the surgery notes, he remarked that if it was any other surgeon, he would have given up at the first instance.

I thanked my stars that I had Dr. P. C. Gupta operating on me!

The whole trouble with fistulas is that there are a limited number of sites in the body where they can be made. Once a site is used or even attempted to be used, it can no longer be used again! That is why, it is so important to preserve sites for fistulas very, very carefully.

Unfortunately, many doctors today don't treat this with the importance it deserves. There are some simple things that can be done to ensure that we preserve sites for fistulas well. For example, before selecting a site, check all available options and if necessary, do a scan to check the size of the veins. Many fistula surgeries have failed because of insufficient size of the veins.

Once a fistula is made and a problem is discovered, all attempts must be made to rectify the problem rather than hurry into a new fistula! I have heard of many patients being subjected to a new fistula at the slightest hint of a problem with the existing fistula! This is ridiculous. The site is precious. Only after all attempts at restoring the current fistula have failed should a new fistula be attempted.

The trouble with our country is the lack of good vascular surgeons. We have very few as skilled and committed as Dr. Gupta. This makes the few that are available very busy. This means that some kind if intervention to save a fistula would be delayed by weeks if you want to get it done by an expert. Letting someone with less experience take a shot may not be effective!

Yes, yet another problem Indian dialyzors have to deal with! But at least, if we are aware of the problem, we can think of ways we can overcome it. Many patients are not even aware of the importance of the limited number of fistula sites. Three of my four possible sites are already used up. I must make sure I preserve the current site as well as possible. I need many, many years of service from my fistula!

Friday, August 9, 2013

Delhi Diary

When I got back from the US a few days back, I had intended not to travel for at least two weeks to get enough time to recoup from the trip. Recoup, did I say? It was mostly fun, wasn't it? Yes, of course! But don't be so harsh on me. What I meant is to recoup in terms of the dialysis; to settle in to to my nocturnal routine so well that I no longer felt drained after my dialysis.

Despite that, in less than a week of my returning, I found myself on a cab in the early hours of the morning on the way to the airport enroute to New Delhi on work!

Oh hygiene!

As we stopped at a signal, the cabbie did something with his finger that made me make a mental note of not handing him my credit card at the end of the trip. I instantly remembered an incident at Heathrow on my recently-concluded trip.

The terminal generally has a sprinkling of Indians. You walk past the odd Sardarji or two once in a way. When your flight is announced and you go to the gate of departure, you hear ONLY Telugu! You look around you and see so many familiar faces. You immediately get the feeling that you've already landed at Hyderabad. People who haven't even met each other are conversing animatedly in Telugu discussing Telangana like they never might have before (the decision was announced just a couple of days back). To be among your own can be a welcome relief, I guess!

The guy in front of me had his hands full. He had the boarding pass in his hand and was asked for the passport by the white lady behind the counter. He thrust his boarding pass between his lips and reached out for his passport. The lady was aghast. After checking the passport, she wouldn't dare touch the boarding pass. She requested the guy the place it below the scanning device. The guy sheepishly complied!

All pervasive technology

When I got into the cab at Delhi, I told him where to go. He did not seem to know. Seeing my iPhone, he asked "Usme kyun nahi set karte?", referring to my Google Maps app. I smiled in response, did that and he happily followed the directions that the lady inside the phone sweetly offered at every turn. I especially loved the way she pronounced "Shantipath"!

I was amazed at our reliance on Google Maps these days and wondered how we ever managed to find any place all those years before Google Maps?!

Two Delhis

As we left the airport, we soon entered what is called Lutyen's Delhi. We passed by all the embassies and then the houses of all the ministers. We also passed by the Congress Headquarters on Akbar Road. All these houses were huge, had extremely well-manicured lawns, very well laid out roads in front of them and a beautiful feel to them. Once you cross over to the rest of Delhi, you have a very crowded, dirty and filthy city. It is no wonder that politicians hanker after power so much! Life can be good in the better part of Delhi!


The traffic in Delhi, like many other metros in India today can get nauseating at times. The traffic is not even disciplined like in Mumbai but is a tad worse than even Hyderabad. People don't follow the lane system, cut across all the time and do not hesitate before driving on the wrong side. I saw a line of cars get on the footpath at a particularly busy intersection. I was staring with amazement when a speeding motorcycle got onto the same footpath and jumped off the other side - the motorcycle and the rider were airborne for a good few seconds!

Chole Kulche, Chole Bhature

We went to the famous Bengali Market for lunch to sample the Chole Kulche I had heard so much about. We went to a place called Nathu's. The Chole Kulche was good. I wouldn't say it was extraordinary. The hype probably killed it! The Chole were good. The Kulche were passable. I did not understand the big deal about it!

For dessert, we ordered Jalebis. What came was disaster! Jalebis have to be crisp and piping hot. We guessed that these were probably an older lot which they simply put back in hot sugar syrup! Not for nothing is the "Dilli ka thug" famous!

The next day, we decided to go to Haldiram's at Cross River Mall close to Vivek Vihar. The Chole Bhature was good, better that the Nathu's version. We also did Chawal with Dal Makhani and Sweet Lassi. All these were good.

However, to be honest I was disappointed with the food in Delhi. I found my answer when I was talking to a local. When I told him about where I ate, he almost berated me. He said, in Delhi, you get the best food on the streets! "Well", I promised him, "next time I know who to ask for advice!" 

Tuesday, August 6, 2013

Denver Diary

Missed flight!

When we reached LAX airport around 7 a.m., I saw this huge queue outside the terminal. I went up to the door and said that I had already check-in online, I just needed to drop my bags and go. The guard at the door said, "Please go all the way back to this line!" I made my way to the end of the queue. After about 45 minutes, I was able to get inside. To my horror, there was another queue to check-in! I got on to that queue. I saw a sign on the check-in counters that said, "Check-in cut-off 45 minutes" I was already past that cut-off. I asked another security person about this. She said I would need to re-book on another flight!

For the first time in my life, I had missed a flight!

I waited in the re-booking line and after an agonizing wait of about another hour, I was put on the 1:05 p.m. flight to Denver! This put paid to all my plans for Denver! I would barely have a few hours.

16th street

I reached Denver around 4:30 p.m. Chittu, my childhood buddy from school picked me up from the airport and took me to Denver downtown and we spent some time at the famous 16th street. The weather was awesome. A slight drizzle and a gentle breeze - just my kind of weather. We walked for a while on this street, had dinner at a place that had outside seating - I had wanted to do this again (after Spacca Napoli in Chicago) and we headed back home.

Dialysis at Denver

Dialysis at Denver was pretty uneventful. I pulled off 3.5 liters again. No problems whatsoever. On my way out, I remember that no one had asked me for the payment! I went back and told them that I was supposed to pay for the treatment. All hell broke loose. They were not sure how to handle this. They were not used to collecting money for treatments. After all, no one in the US pays for dialysis out of pocket! They then checked some stuff and collected my money order.

Dialysis & flight on the same day - not good!

I had to rush to the airport after my dialysis via Chittu's house. I was feeling quite drained. I ate something at the airport and then boarded the flight. The two and half hours were quite bad. I was feeling very weak and the cramped seats on the plane made things worse. I was just waiting for the flight to land. Once the flight landed, I had to go to another terminal to catch my flight back to India.

All this was quite a task. I can handle all this on a non-dialysis day or even on a dialysis day when I am at home doing nocturnal. But a regular four hour session just saps me of all my energy and then to take a long flight can be very difficult. These are things which people with healthy kidneys so take for granted! Not so when you're on dialysis!

Home sweet home

Anyways, I am now back home, slipping in slowly into my daily routine. I still sleep off for long hours at weird times and wake up at 3 a.m. every day! Hopefully, that should settle down soon.

I am very relieved to be back to my daily nocturnal sessions. But the extent of damage done by regular four hour sessions is evident when I realize that I just don't feel normal after my sessions these days. I feel very drained, tired, weak and need a few hours to recover. I remember when I switched to nocturnal for the first time in 2006, it took me some time to feel well enough after dialysis to be able to swim and do other things immediately after dialysis. Four regular sessions have been enough to set me back on this!


Monday, August 5, 2013

Los Angeles Diary


When my best friends from Engineering College and I said our goodbyes at the end of four years of being together and having loads of fun, we made a pact that we would meet after 10 years at our college at 10 a.m. on Jan 1st! That never happened though! Two or three of us would manage to meet up but never all four of us. Finally, last year, after a whole 20 years, we met up and how! We did the cruise together.

Again this year, I sent them an email when my plan for Chicago was firmed up asking if we could meet at some place. Miami, Las Vegas and Hawaii were thrown up as possibilities. Finally, however, we zeroed in on Oceanside, a place about an hour and a half from Los Angeles.

We all reached LA between 9 and 10 on Friday night and met at the Baggage Claims area of LAX airport. From there we took the shuttle to the place where one of us had booked a rental car for the weekend. After a really long wait, we took the car - a cool, red Mustang convertible and headed out. After having dinner at a Denny's on the way, we reached the resort that we'd booked at around 2:30 a.m.! The suite was like a small apartment - with two bedrooms, two baths, a living room and a small kitchen! Our balcony overlooked the beach.


The next morning, we walked down to the town and had breakfast and then headed out to the beach. Dinesh was very keen on doing some boogieboarding. So after getting our feet wet (literally) we got some boards and tried this. Dinesh and Kamal (my namesake) were fairly good at it while Chetan and I struggled! We spent some more time in the water, swimming and generally playing the fool and then went back to the resort swimming pool followed by the jacuzzi.

After showering, we went to a Mexican restaurant for lunch. We then took the car and went for a drive around the area, packed some Indian food for dinner and then headed back to the resort. That evening was spent over dinner and drinks (I drank Coke!) discussing, as is usually the case in such meetings, a lot of philosophy, religion, college days, the girls in our college (when will you get over this, Dinesh???) and similar very important topics.

Redondo Beach

The next morning, we checked out of the resort and drive back towards LA and stopped by for lunch followed by a visit to Redondo Beach. This place had a huge marina where there are thousands of boats. We hired a boat and drove into the water and then did what we love to do, sang songs in the middle of the water.

Dialysis at Santa Monica

The next day, my brother Karan picked me up from the hotel in LA we were staying at and took me to a place called Urth Cafe where we had breakfast. My dialysis session was scheduled for 5:15 p.m. that day. I was a little jittery because I had got dialysis about 3 full days back! I had done a very good job of controlling my fluid intake but three days is three days! I called the center to check if they could take me in earlier. They called back saying they could take me immediately! Great! So I had my brother drop me off at the center.

The staff was really good at this center. They had me on very soon. I targetted to pull off only about 3.5 liters because when I was trying to pull off more (4.5 liters) the last couple of times, I was having really bad symptoms (my mouth started cramping badly in Chicago - and I was alone there!). And anyways, due to all the saline they would push in to control the Blood Pressure, the nett weight loss would only be about 3.5 kgs! So, I thought might as well aim for that without all the accompanying drama!

The session went off fairly well.

The next morning, I was headed for Denver. My flight was at 8:15 a.m. My brother said, we should be good if we left home around 6:45 a.m. That proved to be a miscalculation.

Friday, August 2, 2013

Chicago Diary

Rich Berkowitz & Giordano's

I took the British Airways flight from Hyderabad to Chicago via London on the 23rd. I reached Chicago on the 23rd evening local time. Rich Berkowitz, an old friend from the internet - I have exchanged dozens of emails and had many Skype calls with him - picked me up from the airport and showed me around the city. It was the first time I was meeting him in person! Rich is on nocturnal home hemo in Chicago and along with Bill Peckham was one of my go-to experts on home hemo when I was just starting out in 2006!

Rich took me to a great pizza place called Giordano's and we had some great stuffed pizza. During the meal, we chatted a whole lot about what else - dialysis! Well, suffice it to say that I am not the only person on earth who is fed up of dialysis!

Dialysis in Chicago

The next morning I had dialysis scheduled at 11:30. I took a cab and went over to the dialysis center. When I checked my weight, I was surprised to see that it was about 6 kgs over my dry weight. I realized however that when I weigh myself at home, it is in my skimpy little boxers and T-shirt! Here, I was wearing heavy denims, a thick T-shirt and shoes. However, there was no way to tell the actual weight. I guessed and decided to pull off about 4.5 kgs! Not a good decision. About three hours into the session, I started feeling dizzy. My Blood Pressure had plummeted to 82/43!! The machine was set to a minimum UF, saline was infused and the BP rose to a respectable 90/50. In the process, however, I lost only about 3 kgs.

The dialysis center I went to had one really experienced nurse who was from Philippines. The Filipinos are the American equivalent of the Indian Malayalees! They are very good as nurses in healthcare, have a thorough knowledge of medical protocols and most importantly, are very caring and compassionate.

The nurse I was treated by had one problem though. She used the same silly jokes with all the patients - she called all the male patients "Boyfriend" and she would say something on the lines of, "I am going to return all your blood because I don't want to owe you any blood!"

Global HHD Forum Meeting

That evening I met with Dori Schatell, who runs the Home Dialysis Central website. Dori is also someone I have been in touch with over email and calls from 2006! I was very excited to be finally meeting with her in person. Dori, Paul Bennet, a Hemodialysis professor from Australia and I formed the sub-group that dealt with Psychosocial Factors in Home Hemodialysis.

At the pre-meeting dinner, I got a chance to meet with some of the stalwarts in home hemodialysis from around the world. I had a long chat with Dr. Robert (Bob) Lockridge, one of the legends in the Home Hemodialysis world!

One problem I have with foreign travel is the food. My Indian palate is used to spices and a certain style of cooking. The pre-event dinner had an elaborate spread - most of it was non-vegetarian though! For me, they had some vegetable stew. I hungrily ate up the entire bowl. Within half an hour I was thoroughly nauseated! This was just not my kind of food! I went back to the hotel room and took an anti-emetic and went to sleep.

The next day was the main meeting. Dr. Christopher Chan, another great name in home hemodialysis introduced me to the rest of the participants. I was very thrilled with the attention! The meeting went off very well.

I felt that this was a great opportunity for me to give back, in whatever way I could, to the modality that has given me my life back.

Spacca Napoli

I had heard a lot about Chicago's pizzerias. When I looked up the internet for recommendations for the best Neapolitan pizzas, Spacca Napoli kept popping up. Once we were done with the meeting, I asked Google Maps for help and successfully changed two trains and walked right up to Spacca Napoli and had the Margherita pizza (Neapolitan style). It was the best pizza I had ever had!

Navy Pier

I then took the trains and a bus to the famous Navy Pier and took a boat ride that showed you Chicago's Skyline. It was a good ride! Here are some pics from the boat that I took. By the way, this was probably the first time that I did anything like this on my own. During my last trip to the US, I was always with family or friends. On this trip to Chicago, I was on my own. I walked the streets, asked around for the location of the train stations, got advice on the tickets and more. This gave me a true flavor of what the city is like! Chicago is really a very beautiful city!