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Tuesday, 07 October 2014 22:16

Stopping the 'Brownian motion' in our minds

Written by Kamal Shah
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When I think about what I think, I find that whenever I am doing anything other than work, my mind wanders around like crazy. I am thinking about one thing after another all the time, continuously. For example, when I am swimming, I am thinking about a hundred other things, each for a few seconds. Instead of enjoying the swim, I am ruining it by not focussing on it. When I am driving as well, thoughts flood my mind; when I am drinking tea as well!

When I am feeling a little weak once in a way and am lying down, I reach out for my phone and check arbitrary things, things that are not at all important. I have noise in my brain all the time. Much like Brownian motion!

Many times, I feel I need to control my mind. I need to focus on what I am doing and live and relish every moment of it. I have heard that meditation helps to make the mind more peaceful, to enjoy the moment, so to speak. However, I find it very difficult to meditate even for a minute. The whole concept of sitting and doing nothing else and just emptying my mind and focussing on one thing like breathing for example, seems totally beyond me. I have tried many times.

So, when this article came up in my Pocket recommendations, I read it and found it to have some practical solutions to this problem. It talks about some easy ways to achieve the same results as meditation without the boredom associated with it. The results are similar to those achieved by meditation - at least the ones I am interested in - to reduce the noise in my brain.

I have started practising some of the techniques mentioned there and I think it might be working.

... http://www.kamaldshah.com/2014/10/stopping-brownian-motion-in-our-minds.html


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Friday, 03 October 2014 07:51

Making progress on different aspects of life

Written by Kamal Shah
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Krishna, a very dear friend once told me that he tries to make progress on different fronts of his life regularly. I found that idea to be a very good one. I have been trying to do this of late. I don't remember exactly the specific areas he had talked about but I guess for me the important areas would be - career, finances, spirituality, health and hobbies.

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On the career front, things have been going pretty well. I got started on a very exciting new project for NephroPlus a few months back. This project could really change the way decisions regarding dialysis patients are made in the country. It will not only impact NephroPlus patients but also patients from all over the country whether they are dialysing at NephroPlus or not! Things have become fairly hectic over the past few months with multiple streams of work picking up momentum and a large number of centres being opened this year - we are 30 centre strong now! So, on the work front, things have been pretty good!

On the finances front, things are just about stable. I am able to take care of my dialysis expenses and able to save just enough to buy the latest devices Tim Cook and his team come out with from time to time! However, a few days back, my Bank Relationship Manager visited me. He brought along a colleague who advises on mutual funds and they advised me to invest regularly in some mutual funds. They said I should be investing in a mix of Mid-cap and Balanced funds and keep a small part of my earnings in Fixed Deposits (FD). I hate FDs because the interest rate is so pathetically low that the returns are practically nothing! I have taken their advice and have set up a small portion of my salary into some mutual funds. I guess the Apple Watch might have to wait for some time!

On spirituality, I have taken one big step. I now go every Sunday morning from 9:30 to 11:30 to teach kids about the basic concepts of Jain Dharm. I believe unflinchingly in the basic concepts of Jain Dharm (not the various add-ons that have been introduced over the past many decades!) and I really enjoy teaching these concepts to the young, inquisitive minds (12 years and over), mostly in English. This needs me to read up on the stuff as well, something I have been meaning to do from a long time but haven't!

On the health front, there is one nagging issue - the bone pain in my right upper thigh and the neuropathy/bone pain in my feet. The left foot especially has been bothering me. There is a sharp pain in the upper, middle part and the numbness is crazy. I have no clue what this is and what the heck we can do to fix it! And then of course, there's the dialysis bit which I can't really do too much about. But things are stable here. Swimming is on as well.

I have taken on a new hobby these days. Reading! I am currently reading three books simultaneously! Two of them have been gifted by a dear friend from Bengaluru. The three books are of three disparate genres. One is an English translation of 'Parva' by Bhyrappa which is a de-mythified version of the Mahabharata. It presents the Mahabharata in a completely historical manner where there's no supernatural stuff happening. Very interesting take on the Mahabharata. It gives me a lot of clues into the truth behind the supernatural stuff that has been introduced into my religion as well. I also took to playing the keyboard (musical) after many, many years!

So that's an update on the major fronts in my life!

I really believe that it is very important for each of us to make small advances in each sphere that is important to us. Often, we get so engrossed in our day-to day lives that we ignore everything else. Again, these aspects could be different for every one of us. But it is essential to make a conscious choice of what's important and what is not and then work on each of these. They could change as well from time to time. We must make sure that it is happening consciously and not merely by default.

... http://www.kamaldshah.com/2014/10/making-progress-on-different-aspects-of.html


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Tuesday, 30 September 2014 22:13

Baa retire thaay chhe...

Written by Kamal Shah
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My mother retired yesterday after a 37 year long stint at Andhra Bank. Along with my family, I went for the retirement function. It was really great to hear all the senior management of the bank pay glowing tributes to my mother's commitment, sincerity and capability.

She, by no means, plans to take it easy. She is now looking for opportunities and, if I know her well enough, will not be a stay-at-home person even after retirement. She had me prepare her resume a few weeks back. I have been pushing her to do something less exacting. I would not want her to do nothing for sure but I do not want her to take up a regular job!

Here are some pics from her retirement event at the bank:

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... http://www.kamaldshah.com/2014/10/baa-retire-thaay-chhe.html


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Tuesday, 30 September 2014 22:06

Birthday 2014

Written by Kamal Shah
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Just had a fantastic birthday. The celebrations started from the 27th night itself with a party with my HPS friends (school friends). It was midnight by the time I reached home and found the NephroPlus gang waiting there with cakes! 28th evening I had my team-mates from NephroPlus Hyderabad and close by places come home for a big party. This was great fun as well!

Here are some pictures:

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... http://www.kamaldshah.com/2014/10/birthday-2014.html


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Friday, 26 September 2014 01:27

The Best Dialysis Machine?

Written by Greg Collette
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I had an interesting email from Lawrence recently, about the pros and cons of the various brands of dialysis machine:

Hi Greg

I’ve been dialysing for a year now on Fresenius machines and in the last few months have been doing home hemo on a Fresenius.  I’ve had constant issues with poor arterial pressures and alarms. The techies have been out to try and sort the problems and eventually decided that it must be my line which was the problem.  

This week I am on holiday and have been dialysing on a Braun machine.  What a difference!! I’ve been attaining pump speeds of 350 (I can barely make 300 on the Fresenius) and the arterial and venous pressures are brilliant! My KTV is 1.5.  

I communicated this to my unit who have been stonily silent on the subject.  Has anyone else come across this kind of difference?  I’d be interested to know.  The Braun seems a much superior machine to me, with far more streamlined tubing.  I’ve tried to research on the internet but can’t find any comparative studies on dialysis machines.

Best wishes, Lawrence

Hi Lawrence.  I don’t have a lot to contribute about various machines.  I dialyse on Gambro, which are fine.  I regularly achieve a pump speed of 370 milliLitres per minute (mL/min).  Gambro have the usual alarms and hassles, but do the job well for me.

On holidays I have dialysed on Fresenius, Braun and Nipro.  I have found that I don’t usually achieve more than about 350 on the Fresenius machines I use on holidays (through the nurses usually say that the Fresenius doesn’t need to go as fast to do a better job!).  Just the same, all seem fine to me, though technicians I have spoken to tend to rate Nipro a little behind all the others.

I have heard the NxStage machines tend to under dialyse because of their portable nature and use of limited water supply.

Regards, Greg

I look forward to hearing the thoughts from other BigD-ers!

... https://bigdandme.wordpress.com/2014/09/26/the-best-dialysis-machine/


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Tuesday, 23 September 2014 22:08

Callousness towards the cold chain

Written by Kamal Shah
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I was considering a product for use recently. This was not the traditional Erythropoietin injection for which generally the cold chain is recommended. Cold chain means maintaining the product at a temperature of between 2 to 8 degrees centigrade to ensure that it remains effective when it is used. This is because the product contains certain ingredients that are effective only if maintained at that temperature. The moment you keep them outside the required temperature, the product loses its effectiveness and even after that period, if you bring it back to the temperature, it is no longer effective.

On the product I was reviewing, it was clearly written that it must be maintained between 2 to 8 degrees centigrade. The samples that I had got did not come with an ice pack (which is the most common way to maintain the product at the desired temperature for short periods when they are delivered to the end user). I was surprised. I thought that the person who delivered the product might have messed up.

I irately called up the vendor and told him that the product was delivered to me without an ice pack. I was shocked by his response. He said this product did not require to be maintained at cold temperatures! I told him it clearly stated on the pack. He said that they write that but it really does not require the cold chain.

I gave up.

The horrifying thing about this is that this product is in use at many hospitals from ages. I can almost guarantee that many people are using this without realising that the product is not effective. Many patients have been put at untold danger by using this product. When the vendor himself is so callous about such an important aspect, where does that leave the poor patients?

I remember reading some peer reviewed papers in medical journals that tested this product and found it to be as effective as another product that did not need a cold chain but had certain other disadvantages. Somehow Indian doctors were a little apprehensive about the results. I now know why!

I sometimes feel very helpless. Before any product reaches me, the end user, a patient, how many people does it go through? Even if we assume that the manufacturer did a good job (it is in his interest that the proper conditions are maintained because the effectiveness of his product is extremely important for him), what about the numerous other people who would not be as careful? Even if one person is not careful enough, the product could be rendered ineffective!

With so many challenges faced by us patients, here is yet another.

... http://www.kamaldshah.com/2014/09/callousness-towards-cold-chain.html


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Friday, 19 September 2014 21:57

What is wrong with medical journalism in India?

Written by Kamal Shah
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This morning, in my inbox, I saw an article from the Hindustan Times about a PD solution infecting a set of patients. Investigations revealed that a particular batch of fluid from an unspecified manufacturer contained 'extraneous matter'. The company is supposed to have called the patients who had been delivered the batch and asked them not to use that fluid and said it would be replaced.

No mention of the brand, no mention of the batch numbers, no mention of what the 'extraneous matter' was.

A few months back, in the US, there was a huge hue and cry over Fresenius' dialysis solution and it was all over the press. This is how it should be! Patients need to be told about which company manufactured the fluid. The manufacturer should issue a proper advisory to all its patients with the correct batch and ask them not to use it. What if the patients affected have not received a call? Is someone senior enough doing the calls to make sure no one is left out?

One of the patients affected had to undergo removal of his PD catheter. This, by no means, is a small thing.

Another major error I found in the article is this:

"...needs to undergo three sessions of dialysis a day, owing to her advanced kidney disease."

This line gives the impression that the patient referred to was in a very advanced stage of kidney disease! Anyone undergoing PD would need to undergo three 'exchanges' per day (and not three sessions of dialysis!). There is no connection between the stage of kidney disease and the number of exchanges. Anyone who is put on dialysis has crossed Stage 5 of kidney disease.

Newspaper journalists need to research their articles more carefully. Such statements can create a lot of misinformation among the general public. Without understanding the basics, journalists must not be allowed to cover such topics.

Medical journalists in India must take a leaf out of the newspapers of their counterparts elsewhere!

... http://www.kamaldshah.com/2014/09/what-is-wrong-with-medical-journalism.html


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Wednesday, 10 September 2014 21:25

Advised a major surgery

Written by Kamal Shah
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Yesterday I had written about the diagnosis for my bone pain in the hip area. I went to the orthopaedic doctor and he has given me three options:
  • Grin and bear the pain until I can
  • Undergo a major surgery involving four days of hospitalisation, four weeks of rest and six months for complete recovery
  • 'Try' an injection that may or may not work, has to be injected in the Operation Theatre, and if it works, can give me relief for a couple of years
Nice!

Mysteriously, the pain has reduced almost instantaneously! :-)

On a serious note, I am planning to see my nephrologist this evening to get his thoughts on this. I really don't want to go through a major surgery at this point. For dialysis during the four days of vacation in the hospital, I would need to be taken on a stretcher in an ambulance to a dialysis centre!

My initial thoughts: bear the pain until I have absolutely no other option. Then go for the big surgery so that it is a 100% solution.

I might change my mind of course. After all, I am about as indecisive a Libran as you will ever find.

... http://www.kamaldshah.com/2014/09/advised-major-surgery.html


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It's been a while since i updated the blog but i only try and put really useful information up on the blog so that's my excuse.
The topic of Nocturnal dialysis is floating about now allot so with myself being on Nocturnal dialysis now since early March 2014 and i must say it has really changed my life i decided i better tell you all about it and the experiences.
Ok at the start its a pain, more training in the hospital about 3 days of 8 hours yes that's days not nights i know why would you do training during the day and not night i guess it was for the reason that bloods can be taken and you get the results on the same day etc..
Apart from doing dialysis at night time  your dialysis machine needs to be setup for Nocturnal dialysis Baxter the dialysis company who look after my machine do this on behalf of the hospital.
The blood flow will only run at 200 now so you'll see your pressures allot lower than before
I normally do 8 - 9 hours a night sometime 9.3 hours as that's how long all my stock i use on the machine will last for
The machine is set for a max of 10 hours so that's the maxium time i can do with out doing a clean and setting up again , but why would i do that ;-) 9 hours in one night is nearly twice as much as i was doing before in 2 days.  I now do 4,5 night a week thats 36 or 45 hours a week i was only doing 4 hours 3,4 times a week a max of 16 hours if it was 4 times a week..
I now use heparin and use it for 8.2 hours of the 9 hours there is a heparin stop time of 40 mins before you come off the machine.
My room has now a bed , initially i had the bed in the room before i went on Nocturnal dialysis, my room is not that big so i bought a 3ft, 3" bed and modified it myself to 3ft  ( and no i am not a carpenter but i've a good set of hands on me)  i post a picture soon of the room and bed, it cosy to say the least... 
It took a while to reap the rewards as your whole routine will be very different espically if you work like me.  First you feel allot better and you'll probably need to come off phosphate binders straight away , in fact in some cases you have to add phosphate while your on treatment.. You get to eat all them good foods you had to give up, milk , yogurt etc.. these are to help level out you phosphate as it will drop after 8-9 hours of dialysis. 

With doing 8,9 hours of dialysis each night or every 2nd night like me you'll start to feeling much better you see that you much healthier and you'll have allot more energy as your eating much more normal foods...
I have always had high Blood Pressure and i mean very high since i was very young and was always on BP tablets  but now you'll never believe it but i do not take any BP tablets at all. It took a while for this to happen so don't worry if you don't see the affect straight away. 
The big problem i had was not being scared of the needles falling out as they are in very secure but the noise of the water pump and the machine keeping me awake. It did take me a few sessions to get use to it all along with using ear plugs and turning down the alarms and light on the machine.
Well that's all for now i hope you get a bit of a insight into what its like, If you any questions regarding the of my posting please do drop me a note I'd love to hear from yea...

... http://home-hemodialysis.blogspot.com/2014/07/nocturnal-dialysis-hi-all-its-been.html

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