Wednesday, January 23, 2019

I finally made the switch to the dark side

I finally made a long term permanent move to an Android phone from the iPhone. Tim Cook has Sunil Mittal to blame though.

It started with Airtel having really bad network coverage where I stay. Like everyone and their uncle, I decided to get a Jio connection because they had good coverage in that area. I planned to port my number to Jio. However I was told that the Jio network also sucks in some areas and cities. So the only way out was to use both sims. But two phones is too much to carry. So I needed a two-sim phone. The cheapest two-sim iPhone costs almost one lakh rupees!

So what did I do? I went and bought myself a Xiaomi Note 5 Pro which costed about Rs. 12,000. I kept my iPhone SE handy just in case I wasn’t comfortable with Android. I had two experiences in the past when I had switched to Android phones and went back to the iPhone within a week. So, I thought maybe the same thing could happen this time as well.

Its been more than two weeks now and I don’t see myself switching back. The Android OS has improved a lot compared to earlier. I am fairly comfortable with it now.

I still believe iOS is the better OS and the iPhone is a better phone. It’s just that iPhones are too damn expensive. And I don’t mind a slightly inferior experience if I am getting a phone at roughly 10% of the price of an iPhone. 

Tuesday, January 22, 2019

We will miss you, Bill Peckham

“The light has gone out of our lives.” - Jawaharlal Nehru

Bill Peckham is no more. He passed away a couple of days back. I knew Bill from the time I was considering home hemodialysis (HHD). He was a regular on the Home Dialysis Central Forum always giving tips to newbies like me on how to make HHD work for you. Bill was one of the reasons I got the confidence to begin HHD. An untiring advocate, Bill fought relentlessly for dialysis patients and their rights in the US. He worked in various positions in the Northwest Kidney Centres in Seattle.

Bill’s most significant contribution to dialysis patients world over was due chiefly to what he called his ‘wanderlust comorbidity’! He loved to travel. Even after getting on dialysis, he traveled. As he wrote in his blog, he got dialysis in 32 countries in five continents of the world. In what was probably his most famous trip, he got dialysis on a rafting trip down the River Rogue in the Grand Canyon. He has also done boat trips, cruises and many other regular trips round the world. Click on this link for a bunch of posts from his blog on traveling on dialysis.

Bill getting dialysis on the raft in the River Rogue

Bill Peckham was my hero on dialysis. He continued to guide me through various ups and downs I faced on HHD. Whenever I had any issue which I was unable to get my head around, I would reach out to him. He always had some useful answers. He was my inspiration to travel despite being on dialysis. I myself got dialysis in a few countries and went on a dialysis cruise thanks to his continuous encouragement. Even as recently as a few months back, he pushed me to get a physiotherapist to help with my strength training. The ‘old friend’ I talk about in this post is Bill.

I had the privilege of meeting Bill during my trip to the US in 2012. I saw his HHD setup and spent a happy hour with him chatting about life on HHD.


With Bill at his home in Seattle

Bill is now gone. But he continues to live on in our hearts, our hearts filled with gratitude with all that he’s done for us. We will miss you Bill Peckham.

Monday, January 14, 2019

Your Dialysis Access: Your Lifeline

A Dialysis Access is the means by which an external system to cleanse the blood gets access to the blood. Since the native kidneys are not functioning, we need to rely on an external mechanism to perform the primary function of the kidney - purification of the blood to remove the excess solutes and water. The other functions of the kidney like regulating the production of Red Blood Corpuscles and regulating absorption of Calcium from the gut are not replaced by dialysis.

For Peritoneal Dialysis (PD), the access is the Catheter that goes into the abdomen into the peritoneal cavity. One end of the catheter is in the cavity while the other end is outside. This enables the PD fluid to be infused into the Peritoneal Cavity. Here, through the peritoneum (which is a semi-permeable membrane), the solutes and excess water diffuse into the PD fluid. After a few hours, the saturated fluid is drained through the same catheter. 

It is obviously very important that those on PD take utmost care of the PD catheter. Daily Exit Site dressing is mandatory. Watch for signs of infection on the exit site (the point where the catheter comes out of the abdomen) which could include redness, itching, tenderness, presence of puss etc. A fever could also be a symptom of an infection. Immediately alert your doctor if you suspect an infection. Early intervention can save your catheter.

For Hemodialysis (HD), the access could be a temporary access like a jugular or femoral catheter or a more permanent access like an Arteriovenous Fistula (AVF), an Arteriovenous Graft (AVG) or a Permanent Catheter (Perm Cath). All these types of accesses perform the same function - provide access to a vein to draw the blood and return it after purification in the artificial kidney (the dialyser). 

In a temporary access, a double-lumen catheter is inserted into a vein in the body allowing the blood to be drawn through one lumen and returned through the other lumen. In an AVF, a surgery is performed to join an artery and a vein. This causes blood to flow at a higher pressure through the vein and allow better cleaning during dialysis. In an AVG, the vein and artery are joined by an artificial tube. 

Temporary accesses are used when dialysis needs to be done immediately. AVFs and AVGs need a few weeks for them to become suitable to use for dialysis.

AVFs are the gold standard for accesses in HD followed by AVGs followed by Perm Caths.

For temporary or permanent catheters, it is important to not allow the site of insertion of the catheter to get wet. Proper dressing after cleaning the site during dialysis is important. Again, watch for the signs of infection mentioned earlier for a PD catheter.

For accesses like an AVF or an AVG, it is important to exercise the arm in which the surgery was done until it matures. Typically a squeeze ball is given and this exercise must be done several times a day to encourage the veins to become big enough for effective dialysis.

Once it is formed, care must be taken to keep the access healthy and efficient. The area must be cleaned thoroughly before cannulation. Care must be take to avoid cross-punctures during cannulation. This is done by levelling off (going in horizontally rather than at an angle) once the needle enters the vein. Cannulation of both needles should ideally be done such that the needle is in the direction of blood flow (away from the hand). This reduces the chance of aneurysms. Avoid carrying heavy objects with the access hand. Try not to hang purses or bags on the access sites.

Remember, there are limitations of the number of sites you can get an access. So, to be assured of a long, trouble-free life with your access, take every precaution possible to keep it healthy and efficient.

Friday, January 11, 2019

Harvard, hard work or something else?

We had our 25-year reunion at school last month. Meeting friends after so long was quite refreshing. We could drop the masks donned for our professional lives and experience the child within even if only for a few days. The Hyderabad Public School (HPS) has quite a reputation. From leaders of the world’s top IT companies to politicians to sportsmen, HPS has produced the most distinguished alumni among schools in India.

As I mingled with my classmates from decades ago, one thing struck me. There was absolutely no correlation between how we did in school, whether in academics, sports or other extra-curricular activities and how we did in life - neither a positive nor a negative correlation. It seemed completely random. 

This begs the question: is all the pressure that parents put on their kids these days to do well in school worth it? Several kids kill themselves because of this. I wish parents would realise the futility of getting good grades, admission into great schools and colleges and being a part of the rat-race.

What is it then that can ensure success in life? It is impossible to put this down to one or two things. There are several factors. Hard work, social skills, communication, shrewdness of the mind, being street-smart are just some of them. A lot of it is also being in the right place at the right time. Some people call this luck.

While we’re at it, what exactly is success, really? Is it money? Is it fame? Power? For each of us, success means different things. For an individual, the meaning of success changes with age as well.

Personally, I have come to realise that success is much more than money, fame or power. It is difficult to describe what success is. Vaguely, I think it is something to do with happiness. If you are in a state of contentment, have days filled with joy, irrespective of how much money you have, how famous and powerful you are, you can consider yourself successful. Again, there is no inverse correlation either. It does not mean that wealthy, famous and powerful people are not happy or successful. Just that like your school report card, these are not the only measures of success.

This reunion had a simple message for me: a gold medal in school does not guarantee a gold medal in the race of life.