Wednesday, August 9, 2017

Fresenius acquires NxStage: what this means for those who want Home HD in India

In a surprise press release, Fresenius Medical Corporation announced the acquisition of NxStage, the company that produces the world’s only portable hemodialysis machine. I just wrote about NxStage completing ten years a couple of days back.



This acquisition could be good news for patients in India looking to have access to home hemo infrastructure. Why did NxStage not come to India? As I said in my last blog post, this was primarily due to the lack of a large number of patients who would be able to afford a machine like the System One and more importantly the per-session cost of the consumables.

How can that change with Fresenius coming in? Fresenius already has a well-established presence in the country. They are the country’s largest dialysis machine suppliers and they have a decent penetration when it comes to consumables for dialysis as well. Add to that their solid service infrastructure which consists of well-trained engineers and you have an end-to-end dialysis solution. The Fresenius team can theoretically make the NxStage machines available pretty soon in the country. They would need to figure out a way to manufacture the NxStage specific consumables at a lower cost. They can easily get their Indian engineers trained in the NxStage machine. All this would actually make it possible for Indian patients to get access to the NxStage machine!

However, all this is assuming that Fresenius would want to bring the machine to India. That is quite a big assumption. It is rarely the case that patients like me can gauge the real reasons for these multi-billion dollar acquisitions! We might never get to know the real reasons behind the acquisitions. Press notes are drafted to make the right noises. People might make guesses about the real motive. However, no one apart from the people right at the top would know the real reasons.

Anyway, I am strongly hoping that Fresenius will find a way to bring the machine to India and will want to do so. The large population here does have people who will want the convenience it offers. So, to those Indians on dialysis who want better options: don’t lose hope yet!

Sunday, August 6, 2017

NxStage System One completes ten years, no signs of coming to India

The revolutionary portable dialysis machine that has enabled home hemodialysis for many patients in the US has completed ten years. More than a hundred patients recently celebrated their ten year anniversary with the machine. Despite criticisms of the machine by renowned experts especially with regard to the high blood flow rates (necessitated by the low use of dialysate to make it portable), this machine has really changed life for many. 

When you think about it, though home hemo in itself is a huge life-changer, the added convenience of a portable hemodialysis machine takes this freedom achieved due to home hemo to a whole new level. 

For me personally, the inability to travel without the shackles of a fluid and diet restriction is a major killjoy. Who wants to have these sickening restrictions on a vacation? In fact, when you’re used to not having any restrictions at home, having them on a vacation actually makes the outing sometimes feel torturous!

The fact that not one company has been able to come out with an alternative to the System One is quite astounding. Ten years is a long time. Though there are many companies that have a machine in the works, not one has been able to hit the market. 

And what keeps the System One from India? Are we more than ten years behind the US? This is a really sorry state of affairs. I complain about the lack of Soliris to enable me to have a kidney transplant. I have stated in the past that I will stop complaining; just give me the NxStage machine!

Saturday, August 5, 2017

Watching streaming video

I recently got myself an Amazon Fire Stick. It is a very simple device that plugs into the HDMI port in your television and connects to a power socket. Using Wifi and various apps available for it, it can stream a lot of content from around the world.

I have watched a lot of stuff since I got the device - House of Cards, Silicon Valley, Inside Edge, The Crown. Its an amazing device with the simplicity of any Apple product. 

I remember reading about television content that you could watch at your own convenience long, long back in a book. To me, at that time it seemed almost impossible. And here I am actually using such a device. The pace at which technology is progressing is almost mind-numbing. I recently was told about a blog called Wait, but why? In it the author writes some really amazing stuff about how technology is changing our world and the rapid pace at which this is happening. I am going to write a complete post about that some other day.

Back to five nights a week

I have been dialysing for six nights a week for a long time now. I did dabble with various other routines and settled on six nights a week. That worked well for me. For the last year or so. I have been having Carpal Tunnel Syndrome which did not allow me to sleep beyond very early in the morning and I would get up with severe numbness in my left hand. Strangely, on dialysis nights, I could sleep up to 5 am. So, it kind of made sense for me to do dialysis on more nights!

Recently, I got operated for  Carpal Tunnel Syndrome on my left hand and my right hand is getting better with a device under clinical trial. So I am able to sleep till longer. I thought recently that I should try to do five nights instead of six nights and see how it goes. I have been doing that for the last two weeks and find it going quite well. I will be continuing this for some time now.

What, you might wonder, do I like about my nights off-dialysis? Well, who likes to dialyze? Who likes their fingers to be tied with a string to prevent the hand from moving too much in the night so that the needles don’t come off? Who likes needles in their arm, isn’t the first place? Not me! I also like the fact that I am alone in my room. I feel free. Honestly, it is difficult to describe.

I have been putting on less fluid weight recently and that has helped to make this decision. If I know me well enough, the less fluid weight gain is not going to last long. In that case, I will switch back to six nights a week. That is the whole damn advantage of home hemo. You can choose when to dialyse and when not to. You can choose when to start your session and when to end it. You can dictate your treatment without worrying about schedules, about timings, about so many other things. I am so grateful that I have access to this wonderful modality. I so wish many others could do this as well!