Monday, March 31, 2014

Dakshin Diary

I had finished my tour of the North of the country when I visited most of our North Indian centres. This month, it was time to tour the South! So, I headed off to Chennai one Tuesday morning rescheduling my dialysis so that I would get a full night of dialysis on Tuesday which is usually my weekly off. That's one more advantage of home hemo. You choose when you want to or do not want to dialyse.

Hot and humid

Chennai was hot. I  mean, really hot. The humidity made it worse. I found myself getting uncomfortable the moment I stepped out of an air-conditioned area. I went for an early morning swim at the hotel I was staying in. The water in the pool was also very warm. This was quite a contrast from the pool I go to in Hyderabad. This made the whole experience much less pleasurable. These days, in Hyderabad, when I get into the pool, the entire time I spend in the pool is so good. The cool water against your body can be a welcome relief from the heat.

NephroPlus Chennai First Anniversary

Our Chennai centre at the reputed Bharathi Raja Hospital in T Nagar was celebrating its first anniversary. We had a small celebration in the unit where our Nephrologist partner cut the cake and we all had a team lunch. Many of our patients also participated and were all very excited that the unit was one year old! We are growing really fast in Chennai and recently took over another four units making our Chennai presence the largest across the country in terms of the number of units per city.

I got two short dialysis sessions at our centre in Bharathi Raja Hospital. Earlier I used to be very conscious of the entire staff collecting around my bed to watch me self-cannulate. I have now gotten used to this. For them it is mostly a first. They have never seen a dialysis patient self-cannulate. At Chennai, however, I got very uncomfortable when after cannulation, one of the staff members was continuously staring at me in disbelief - 'did you really just do that???'

Murugan Idli Shop

Chennai is home to the famous Murugan Idli Shop. The chain has grown by leaps and bounds over the past few years. I visited two of their outlets - one on North Usman Road that serves meals at lunch time and the one in T Nagar which serves regular 'tiffins'. The fare served at both joints is amazing. The soft rice idlis, the vadas, the dosa along with a delectable array of chutneys and sambar make Murugan a must-visit during any Chennai trip. Luckily our dialysis centre is very close to both the joints!



Former colleague on dialysis

When I was in Chennai, I got an email from a former colleague of mine. He mentioned that he was diagnosed with CKD a few months back and was on dialysis for the past couple of weeks. He stays in Bangalore and coincidentally I was to travel to Bangalore the next day. I scheduled a meeting with him. On Sunday, we met at a coffee shop and chatted about his diagnosis. He was the first person I knew as healthy who was now on dialysis. It was weird listening to him talk about fluid restrictions, lying on the dialysis bed for hours during the day to get dialysis and the fact that he had a fistula on his arm! He will be getting transplanted in a few months and I am sure will be ok after that. It is IgA Nephropathy, only IgA Nephropathy and after all, IgA Nephropathy!

Idli Hopping in Bangalore

I had got some recommendations for good Idli places in Bangalore. I started off with the tried and tested Brahmin's Coffee Bar in Basavangudi. The idlis and vadas were out of the world.



I then went to the street market at Nagarathpet. I had heard so much about these 'bandis' at Nagarathpet. It is a street full of shops in the busy Raja Market. The shops close by dusk and numerous little 'bandis' serving piping hot 'tiffins' line the street at night. I sampled the idlis at one 'bandi' and the 'thatte idli' at another. Good but not as good as I had expected based on the hype.

On Sunday morning, I went to Veena Stores which sells masalas during the day and 'tiffins' in the mornings. The idlis were even better than Brahmin's but I would rate the vadas at Brahmin's better.




I was also advised to try the dosas at Janardhana near Race Course Road. I told my aunt who recommended this place that I was not much of a dosa guy! She said after eating dosas at Janardhana, I would become a dosa guy! So, I took up the challenge and went there on Sunday evening. The dosa was one of the best I have ever eaten. I still firmly remain an Idli guy but yes, the dosas were really excellent!

I also went for dinner to a place at Malleshwaram called Halli Manne. I was looking to try some authentic Kannadiga cuisine. We went to an upper floor where they were serving the meals. The trouble was the meal was a mix of Kannadiga and North Indian. So you had the ragi roti jostling for attention with a kulcha and a traditional dal competing for some love with a paneer curry! I was quite disappointed. Who wanted to eat Punjabi in a place like this?



I guess the locals don't want traditional Kannadiga food. So, while they probably started off like that, they were forced to modify the menu to cater to the local clientele. I guess Punjabi cuisine has this bad habit of bastardising all cuisines!

Thursday, March 13, 2014

On World Kidney Day, take a step back and think about this



Today is World Kidney Day.

Last year, on this day, I posted a few simple tips to keep your kidneys going for long. I am not going to repeat them. When you see the steps, it is not rocket science. The same old stuff. I guess that makes it really boring! Eat healthy, exercise, drink a lot of water etc. etc. etc. Isn't it the same to prevent almost all diseases? I guess the fact that you need to do the same things to prevent a lot of things makes it a dull read and no one takes much notice.

However, take a step back and look around you. Look at people who have been diagnosed with kidney disease and are actually battling it day after day. Look at how their life has changed after this diagnosis. You will realise that the consequences of taking this advice lightly!

I encounter such people all the time. They were racing through their lives. There was no time for anything. Work, family, holidays occupied their mind completely. There was no time for exercise. There was no effort at eating and living healthy. And then suddenly, one day, it all came crashing down.

We all go through our lives smug in the belief that this cannot happen to us! There is no rationale behind this thinking. It is just there. Everyone thinks the same way.

The sad truth is that kidney disease is spreading like an epidemic. Almost everyone knows someone who is on dialysis these days. The worst part is it is not reversible. You need to live with it your entire life. Ask someone on dialysis about what this means. Your life changes so dramatically that you would never have imagined that this could ever have happened. Dreams are shattered. Plans go awry.

The best part is you can prevent it. Its really not that difficult. All it needs is a conscious, consistent effort. You simply need to make small changes to your life to accommodate these steps.

This is coming to you from someone who has lived with kidney disease for the last 17 years of his life. Almost half my life has been spent battling this disease. Trust me, it is not pleasant. You do not want to go there. Take steps to prevent this - today!

Wednesday, March 12, 2014

Is a court verdict enough to absolve Narendra Modi of the 2002 riots? Should we even care?



There are two types of people who support Narendra Modi.

The first type consists of ardent fans. They don't care about the 2002 riots. They don't care if Modi did not do enough to stop the riots or if Modi was actually the reason that the riots actually happened. In fact they actually started liking Modi after those riots. Here was a man that stood up for Hindu rights, they felt. This article describes one such lady.

Then there is the other group. They like the way Modi operates. They like his decisiveness. They like his vision for the country. They like his support for industry. They are a little uncomfortable with Modi's role in the riots but they are satisfied that the courts have not found any evidence against him and as such, they believe he is innocent.

I think the second group was looking for an alibi and they found the perfect alibi in the court's verdict. Honestly, if you think rationally, you cannot genuinely believe that Modi had nothing to do with the riots. It is fairly obvious that he caused the riots to happen. I am not even going to agree that his role was limited to not doing enough to stop them. I truly believe that he was instrumental in the riots happening. He egged the rioters on, encouraged them and provided state support to them.

The lack of evidence does not mean the crime has not happened. You may not get punished because of the lack of evidence but you cannot say the crime never happened. I think every individual in this country who has the ability to think clearly and logically would agree with me that Modi is definitely responsible for the 2002 riots.

Now if he is really responsible for the riots, should he be in the reckoning for the PM's post of the country? This is for you to decide. You could say that the riots are a thing of the past and Modi has now realised that this can never happen again. You could forgive him if you think what happened was wrong. Or you could argue that such a man should never lead the country. It would be too dangerous. It would also be an insult to the people who were killed in the riots.

One huge problem for people who do not want to support Modi is the lack of a credible alternative. Who do we have against Modi? Rahul Gandhi? Arvind Kejriwal? A bunch of regional players who have no hope in hell of providing a stable government? Vishal Dadlani put it well when he tweeted: "Stuck between a moron and a murderer....what now, India!?"

I think what's working really well for Modi is the lack of any opposition. Even though the BJP may not get the numbers on their own, the tie-ups with others might get them past the 272 mark in the elections. What might have been interesting to see is the presence of a good leader in the opposition. How Modi would have fared in those circumstances might have been a surprisingly different story!

Tuesday, March 4, 2014

HDU Diary

When I saw the speaker list on the Hemodialysis University 2014 (HDU) website, I was really excited! Some of the top nephrologists in the world were going to come to Hyderabad, my home city. Some of them were John Daugirdas, Andrew Davenport, Suhail Ahmad and believe it or not - Victor Gura, the man behind the Wearable Artificial Kidney! I would definitely attend! At NephroPlus, we also decided to have a booth at the event.

Packed house

One of the striking differences between this and some other conferences I have attended was that most of the sessions were completely packed. The main hall of the Marriott Convention Centre is a gigantic space and despite that, almost every chair was taken for most sessions. The other conferences that I have attended rarely see this happening. The sessions were all very useful and interesting to a majority of the audience.

Dialysis frequency - more is better!

John Daugirdas started the conference with his session on adequacy. Daugirdas is the author of the famous Daugirdas equation that is used world-wide to calculate spKt/V, the measure of the dialysis dose delivered over one dialysis session. Daugirdas made some rather startling remarks about frequency and quoted some studies and the rather controversial FHN trial that questioned the benefits of more frequent dialysis. Honestly, I don't agree with those conclusions. I have experienced the benefits of more frequent, long duration dialysis first hand and I don't need a randomised controlled trial to decide about this!

Thankfully, most of the following sessions extolled the virtues of more frequent and long duration dialysis.

Networking, networking, networking

One of the best things business school teaches you, they say, is how to network. More than the actual content you learn during those years is the ability to network with ease. I have not attended business school but I spend so much time with MBAs and consultants these days that their skills have started rubbing off on me! So, I found myself reaching out to a lot of people during the breaks between the sessions. I rather enjoyed it! From nephrologists to vendors to dialysis professionals, they were all  there at HDU!

Question time

I got a lot of my doubts regarding dialysis cleared at this conference. I have had these questions for a long time now and this was a fantastic opportunity to get them answered by the leading thinkers in this field who have spent years on these subjects and who better to answer these questions reliably than them?

Questions about the benefits of high flux dialysers, whether an antiseptic is helpful while removing needles, benefits of citrasate, clearance of middle molecules - all these were doubts I have had for long and got cleared in this conference!

Victor Gura!

For me, the highlight of the conference was that I got an opportunity to meet Victor Gura, the man behind the WAK. Until a few days back, I would have considered myself lucky if I was able to be in the same room as he was and breathe the same air that he did. Today, I have not only done that, but I have also met him, talked to him about the WAK one on one and got a picture with him! By that measure alone, HDU was a stupendous success for me! Here is the prized pic: