Saturday, May 17, 2014

The rare opportunity that Narendra Modi has been given and why it must not be squandered



Very rarely in recent Indian politics has a single party got a majority in the Lok Sabha. The mandate that India has given to Narendra Modi and the BJP presents an opportunity so rare that the last time this happened was post Indira Gandhi's assassination. That was thirty years back! For the last 25 years, we have always had a fractured mandate where the large parties would have to depend on a number of small parties to be able to run the government. This meant that the ruling party could never act totally independently, do what it thought was right without fearing if it upset someone. One decision taken without consulting these allies and the government could fall!

The credit for this victory goes completely to Narendra Modi. The man was bigger than the party. His modest background, his track record in Gujarat and his earthy speeches connected with the people like no one else could. People like L K Advani and Sushma Swaraj would do well to recognise this fact and accept that this verdict is more for the man than the party.

It is now very important for Narendra Modi not to squander the opportunity he has been given by the people. India may not see such a decisive mandate again for a long time. There will be no alibis of 'coalition dharma', no excuses of not enough numbers. He will be judged solely based on his performance. India has seen a policy paralysis for many years now. Modi must show that he is truly the decisive leader that he says he is. There are a number of sensitive issues that have been left languishing for too long that must be addressed.

Now that he is going to be Prime Minister, Modi, I am confident will prove that he will be the Prime Minister of the entire country. This post is saddled with too much responsibility. He should make sure that the apprehensions the minorities have against him are addressed. No one can now recount the Gujarat riots. This mandate has clearly given the message that India has moved on.

This election campaign has seen the level of debate fall to dismal levels. There is a lot of bitterness among the political rivals. It is very important that Modi takes steps to ensure that everyone forgets the bitterness by making some reconciliatory gestures. For the last few years, we have seen Parliament being disrupted repeatedly causing some very important legislations to be either blocked or passed without debate. This is something that needs to be stopped immediately. Modi will need to be the first to blink.

The people have very high expectations from this man. He has the capability to measure up to them. Let us all hope that he will.

Wednesday, May 14, 2014

Am uremic, will travel!

A few days back, I got an email from Sachin Patel of Pune. I am posting excerpts here:

Hi Kamal,

[....] Ever since I have been on dialysis I have been apprehensive of going on long vacations. After reading your blogs I realized that my hurdle is only a mental block that can be overcome, which I did.

Last month I went on a tour of North India covering Delhi-Agra-Mathura-Dehradun-Haridwar-Rishikesh-Mussoorie-Dhanaulti over a duration of 14 days. I got dialyzed twice at Delhi and thrice at Dehradun. I and my family had great fun and we owe you a lot for inspiring me to do it. [....]

I have also been avoiding official tours which I am now taking up. This month-end I am going to visit Hyderabad for a week. [....]

Regards,
Sachin Patel

Travel is something that really invigorates you. It gives you  a change from the routine of everyday life. You feel completely recharged after a holiday. Your mind feels like it has got a cold shower on a hut, sultry day!



That is why it is so important for everyone, including those on dialysis to travel. And it is possible! These days, you have quality dialysis options in many great places. Most places would be willing to accommodate you in their schedules. Dialysis unit staff generally are very encouraging of dialysis patients wanting to travel.

I have been to many places after getting on to dialysis. The high point was, of course, the seven day cruise to Alaska! I recently had a fantastic time in Rishikesh, rafting and swimming in the Ganga. This month end I am off to the cool climes of Nainital for a week-long holiday with my parents.

Since I am used to daily nocturnal, travel is a little bit more of a problem than those on conventional thrice weekly in-centre dialysis since I am used to more frequent, long hour dialysis and during these trips, it is not only inconvenient but also impractical. So (and this is the part I hate most) I need to restrict my diet and fluid while I'm on a holiday! But the fun of going on a holiday easily outweighs this bit.

For those on dialysis, I would strongly urge you to consider going on a holiday. It will really make a huge difference to your life. Don't worry too much. Choose a quality dialysis centre, make sure you watch your fluids and Potassium and you will really enjoy the experience.

In fact (unabashed pitch alert!), NephroPlus has a very convenient Holiday Dialysis program where we take care of everything from your travel arrangements to hotel bookings to dialysis and you can travel hassle free along with your family and friends!

So, don't let dialysis hold you back. Take that trip you've been wanting to all these days. You will not regret it!

Tuesday, May 13, 2014

Mending my buttonhole ways after the fistula infection

I recently had an infection in my fistula near the puncture site. It started off with pain, some swelling and then eventually a small discharge of puss and fever.

I use the buttonhole technique and there have been studies that have linked this technique with a higher infection rate. It is however much less painful than using the regular sharp needles. Some proponents of this technique say that improper technique is the cause of the infections among those who do buttonholing not buttonholing itself.



Well, I have been having recurrent infections ever since I started buttonholing. I have been getting an infection almost every year. I take a course of antibiotics and the infection subsides.

This time however, the infection returned in about eight months. This was worrisome. I looked up the vascular access management group's paper from the Global HHD forum I am a part of and found some things that I have been doing wrong. I also posted on the Home Dialysis Central FB page and got some very useful tips from the buttonholing veterans there! I then added some common sense to what I learnt and here are some changes I have made in my technique:


  • 'Double prep': Someone on the FB group suggested that I 'double prep' my sites. Generally I do only a 'single prep' - clean the sites with a disinfectant only once (before removing the scabs). The suggestion was to clean before and after removing the scabs. I've started double prepping now.
  • Scab removal: With buttonholing, you need to remove scabs that form after the last dialysis on the puncture site. I used to use the same needle to remove both the arterial and venous scabs. This could be a potential cause of infection. So, I now use two different needles to remove the scab.
  • Lignocaine injecting: I need to inject a little lignocaine (a local anaesthetic) before I cannulate. I would use the same insulin syringe to inject at both sites. I now use two different insulin syringes to inject the lignocaine - one for each site. I also clean the top of the lignocaine vial with some disinfectant before taking the lignocaine.
  • Different pair of gloves for closing: I generally cannulate myself and the tech who helps with my dialysis does the closing. I would use a sterile pair of gloves and we would preserve that for closing. Tch tch. We now use a different pair for closing.
Some of these things might seem obvious to you. However, for whatever reason, I did compromise. Part of it was cost saving (I pay all my medical expenses out of pocket). Part of it was laziness. Part of it was plain inertia. I realise now that the price to be paid is heavy for these compromises.

Hopefully I have learnt my lesson and will not take any chances now. A fistula is a dialysis patient's lifeline. We must protect it at all costs!