Kamal Shah

Kamal Shah

Hello, I'm Kamal from Hyderabad, India. I have been on dialysis for the last 13 years, six of them on PD, the rest on hemo. I have been on daily nocturnal home hemodialysis for the last four and half years. I can do pretty much everything myself. I love to travel and do short weekend trips or longer trips to places which have dialysis centers. Goa in India is a personal favorite. It is a great holiday destination and has two very good dialysis centers.

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Recently someone on dialysis who had a low hemoglobin was advised by his doctor to take a blood transfusion. Innocently he asked me if he could get a donor and we could take the blood from the donor and transfuse it immediately to him?

The scene from the Bollywood classic Amar Akbar Anthony came instantly to my mind where Amitabh Bachchan, Vinod Khanna and Rishi Kapoor, lying on three beds are donating blood. Blood from the three cannulas is flowing into one bottle and from that bottle, the blood flows through a line to Nirupa Roy's veins - all inline!

Makes for some excellent cinema. Unfortunately, blood transfusions are not so simple and straightforward in real life!

In real life, blood is never directly transferred directly from donor to recipient. It is first collected from the donor, then screened for viruses such as HIV, Hepatitis B and Hepatitis C and then a cross matching sample is taken from the recipient and another test is performed to certify that the donor's blood is suitable for the recipient.

Also, often, the recipient is advised some subset of the whole blood that is drawn. It could be packed cells, platelets etc. Sometimes, whole blood is also infused.

Also, blood transfusions are not a very healthy thing to do too often. There is always a risk of catching viral infections that have not been detected due to the virus being in the incubation period. Even inherently, blood transfusions are unhealthy because they prevent the body from producing antibodies.

This means that we should be constantly monitoring our hemoglobin levels and take the dose of erythropoietin necessary to avoid blood transfusions. The guidelines for the dosage of erythropoietin varies from country to country but the guideline that I have been recommended is to make sure the hemoglobin is between 10.5 and 11.5. Anything less than that and you don't feel as well and is risky in other ways. Anything more than that and you could risk clotting your fistula. Again, you should check with your nephrologist about what hemoglobin range you should target.

... http://www.kamaldshah.com/2011/11/blood-transfusions-very-different-from.html

Wednesday, 26 October 2011 20:40

Update

I have not posted for really long now. I have been down with a bad bout of cough, cold and fever. I was given some very strong anti-biotics which had their own side-effects. Looks like things are turning around now. I should be back pretty soon. I hope you had a great Diwali!

... http://www.kamaldshah.com/2011/10/update.html


Many drugs that are prescribed for people with healthy kidneys have dosing adjustments for those with impaired renal function. This is mainly because the kidneys that usually clear these out from the body are not effective and giving the normal dose can cause unsafe levels of the drug to build up within the body.

So, for example, though the recommended dosage of the drug Levofloxacin, a potent antibiotic for people with normal renal function with certain kinds of bacterial infection is 500 mg every day, those on maintenance dialysis are advised to take only 250 mg every other day after the initial dose of 500 mg. This is simply to prevent the drug from accumulating in the body because the kidneys are not causing the drug to be excreted out of the body.

Dialysis does remove some drugs but only to a certain extent given the short nature of the treatments and the relatively infrequent sessions.

With me? Great! All good so far.

Now, what about people on nocturnal dialysis - those that are getting much longer, better and frequent treatments? One would expect that the dosage for them (rather, us) would be close to those with healthy kidneys.

Not so simple!

There are a lot of factors that come into play here. The molecular weight of the drug is one of them. The ease with which substances are dialyzed out during dialysis is inversely proportional to their size or molecular weight. The protein binding of a drug is also important. The greater the protein binding of a drug, the lesser the tendency for it to dialyze out during a dialysis session.

It is therefore very difficult to come to any conclusion about the dose in those on nocturnal dialysis simply because there just haven't been enough studies on this subject. Well, you would expect that, wouldn't you? There are such small numbers of people doing this therapy that researchers probably feel that it is not worth the effort!

This whole question came up when I was advised by my family doctor to take the regular dose of Levofloxacin along with a cough syrup to battle my horrible cough. As is my habit, I looked it up on the internet and sure enough found that there was an altered dosage recommended for those on dialysis.

I posted this question to the good Dr. John Agar of Australia on the Home Dialysis Central forums. He said the same thing. We don't know for sure but he would recommend going with the hemodialysis dosage.

But in a theoretical sense, it is still an open question!

There is a great article for the medically inclined available here on the subject.

... http://www.kamaldshah.com/2011/10/adjusted-dosage-of-drugs-for-those-on_19.html

I have been down with a bad throat infection and congested nose along with fever for the last few days. As usual, I tried some home remedies but did not get better. I then started an antibiotic and a cough syrup. Two more days. No luck.

One evening, my temperature touched 102 degrees Fahrenheit. I then decided it was time to see a doctor. I went over to Sunshine Hospital to meet our family physician, Dr. Kirit Parekh. Dr. Parekh was the one who diagnosed my kidney disease in 1997 and I have been a huge fan since.

Dr. Parekh examined my throat and lungs and asked me to cough. One sound of the cough and he said, "Azethromycin is not going to work for this!" He then went on to prescribe another more potent antibiotic. He also prescribed a cough syrup. Once I was done with the doctor, I rested on a chair in the waiting lounge and asked my mother to pick up the medicines from the pharmacy. She did. I opened the packet just to see what she bought. I realized that the cough syrup that the pharmacist gave was not right.

There are two types of cough syrups. Cough suppressants and expectorants. Suppressants are used in dry coughs and they suppress the urge to cough. Expectorants, on the other hand are used in coughs where you bring out phlegm and they attempt to loosen up the respiratory tract to make it easy for you to bring out all the phlegm.

What I was prescribed was an expectorant. What I was given was a suppressant. Under normal circumstances, I would not have checked. I would have taken the syrup and my cough would have actually got worse because the phlegm would be suppressed inside. Of course, this would be discounting the action of the more important drug under the circumstances - the antibiotic. But you get the drift right?

When I returned the syrup to the pharmacy, the lady at the counter said that there was no expectorant available under that name. I asked for another expectorant that I had used in the past and she gave me that and I started using it.

This is why it is so important for all of us to be proactive when it comes to our health. These days you can never be sure. I believe a degree in pharmacy is required to run a pharmacy. But who cares about what is required? Whenever you buy some medicines, make sure that the name is exactly what is there in the prescription. There are tons of medicines with similar names with an extra suffix. For example you have Norflox and Norflox - TZ. Both are antibiotics but can have different actions. You have Becosules and Becosules - Z. You have many medicines that have a "plus" added. It is easy for the pharmacist to pass off one for the other because he does not want to lose the sale just because he does not have the correct drug. It is entirely up to you to make sure you have been given what you have been prescribed.

... http://www.kamaldshah.com/2011/10/there-are-cough-syrups-and-there-are.html

Monday, 17 October 2011 09:29

Yours truly on Nephron Power!

Nephron Power is a popular nephrology blog authored by Dr. Kenar Jhaveri, nephrologist from New York. It is an academic blog for nephrologists.

I wrote an article, "Give us the choice" on Dr. Jhaveri's invitation and I am so happy to report, it has been published today on the blog. You can find the post here.

At the end of the post, Dr. Jhaveri comments:

"What Kamal is saying is not only true likely in India but in USA as well. This is an ongoing problem as more and more Younger Nephrologists don't feel well trained or comfortable in taking care of PD.  Meanwhile countries like Japan, have majority of their dialysis patients getting PD.  Economics or patient preferences - both might be playing a role in this sad state of affairs."

Thanks Dr. Jhaveri for keeping the patient's perspective in mind and for giving me a chance to write for your blog!

... http://www.kamaldshah.com/2011/10/yours-truly-on-nephron-power.html

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