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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In July, on my trip to the US, I will be getting less than optimal dialysis. Its going to be a three week trip. I will be doing some nocturnal sessions in dialysis centers and some regular four hour sessions. These will also be spaced out with one or two day gaps.

This is the part I hate about holidaying while on dialysis. You need to watch your fluid and diet! I mean you're on a holiday! What fun is a holiday with diet and fluid restrictions?!

But I guess it is better than not holidaying at all!

So, I have two fears mainly - one of course is the fluid. With one and two day gaps, will I be able to restrict my fluid intake? This is not the first time I have had to restrict my fluid after getting on to nocturnal. I've been on trips to Goa and I have got less frequent dialysis there. But the big difference was those were only 4-5 day trips whereas this is a whole three weeks!

Second, the fear that with three weeks of non-frequent dialysis, will my other uremic symptoms like nausea start rearing their head? 

Well, I have scheduled my sessions so that I get nocturnal after a two day break and things like that. But still, I am a little worried. I will be on a holiday that is costing me a bomb. This is most likely going to be my only such trip ever and I want things to go perfectly! Can you blame me??

On the other hand, I will be achieving my two big dreams - one is to go on a cruise and the other is to go to the Niagara Falls from the Canadian side. Ever since I saw the pictures from my parents' trip last year and heard from them about the Niagara Falls, it has been on my list of absolute must-dos. Here is a picture (I have it as my desktop background for ages now!):

image


... http://www.kamaldshah.com/2012/05/will-i-be-able-to-manage-with-less.html

Friday, 04 May 2012 23:08

There's something about grandparents

My grandmother (mother's mother) stays alone in a huge bungalow right next to ours. She has a Tata Sky connection. Left to herself she would have much rather continued her cable connection where the cable operator would come and ask her for the monthly rent and she would hand out the cash. Now, she has to depend on someone to recharge the account and she does not Iike that one bit. Of course, she did not realize this when the connection was set up by Rudy, her grand-son-in-law!

So now she comes home a couple of weeks before the recharge is due with a crisp Rs. 1000 note and asks me to recharge her account. She also brings in her account id just in case I don't have it. I get on to my laptop and log on to the Tata Sky web page and within a couple of minutes I have her account recharged for three months.

She is usually profusely thankful. She compliments me on how fast I did the recharge and how she is out of tune with the times where everything can now be done on a computer!

That however is not the point of this post.

I often feel embarrassed when she thanks me. For something as little as that. I tell her it was nothing. What I leave out is the number of things she and her late husband, my grandfather have done for me.

It was nothing big really. That's the beauty of it all. Nothing big. Just so many small little things that shows the infinite, unconditional and selfless love they had for me that caused them to do these things. As I write this, my eyes turn moist. I miss you Dada!



... http://www.kamaldshah.com/2012/05/there-something-about-grandparents.html

Tuesday, 01 May 2012 21:37

My experiments with bread

Ever since my parents brought home a bread maker from the US last year, I have been experimenting with different types of breads. Bread makers really make your job easy. All you need to do is put the ingredients of the recipe in the right quantity and in the right order into the bread maker and the rest of the job is taken care of for you.

The important thing as the manual keeps stressing again and again is to use exact quantities of the ingredients specified in the recipe and to put them in the right order. To help with the quantities, my parents also brought home a set of measures that helps me measure out exact quantities - 1 and 3/4 cup, 1 and 1/8 cup for example - all such measures can be done exactly!

There is one problem with the bread maker however. There is a small mixer that is to be fixed at the base. This causes an uneven hole to form at the bottom of the bread. I can live with that however. I guess they cannot avoid that!

I have tried different types of bread - regular white, whole wheat, cinnamon and raisin, honey grain, Italian Herb etc.. Most of them turned out very well. The 100% whole wheat was an exception. It wouldn't rise well enough and wouldn't be fluffy. I tried many changes to the recipe. More water, more yeast, a touch of oil. Though most variations were better than the original recipe, none was frankly, good enough. When I look at the whole wheat breads available in the market and take a closer look at the ingredients, I find that most of them are not 100% whole wheat! They all list wheat flour (maida) as one of the ingredients. Now I know why!

Here are some pictures of the bread that I have made:

image

Italian Herb Bread - this one contains Parmesan Cheese, Parsley and Basil. Tastes really good with all those herbs. You get a mix of the flavors from the main ingredients. The bread usually caves in at the top - I have no clue on how to avoid this! No problem in rising however and it is as soft and fluffy as it should be. 

image

Honey Grain Bread - contains a mix of maida, whole wheat flour, oats and honey. I sometimes use this as the base for other recipes. It is healthier than the regular maida bread. I have used it successfully with Italian Herbs as well. The bread itself is neutral to taste. But the addition of whole wheat and oats makes it an excellent alternative to regular bread.

image

Cinnamon and raisin bread - is a complete refined flour bread with a dash of cinnamon powder and black raisins. This one is slightly sweet due to the raisins - not cloying by any means. This one rose so well that it was a treat to look at and eat as well!



... http://www.kamaldshah.com/2012/05/my-experiments-with-bread.html

Monday, 30 April 2012 10:52

A small tweak to my dialysis schedule

I dialyze six nights a week, about seven hours each night. I take Sundays off. 

I swim six days a week in the morning. Wednesdays, the pool is closed for maintenance.

How are these related? Well, I usually don't swim the morning after I don't dialyze. So, until now I wouldn't swim on Mondays because I did not dialyze on Sunday nights. 

Why wouldn't I swim the morning after the night of no dialysis? I feel a little heavy in my chest the day after I don't dialyze. It is probably excess fluid. It could also be that I am so used to being almost close to my dry weight that even a little fluid makes me uncomfortable (which is actually a bad sign because I am going to be dialyzing irregularly during my US trip in July - anyway, we'll deal with that later).

So, I don't swim on Mondays because I don't dialyze on Sundays. And Wednesdays the pool is closed. So, that way I end up missing two days of swimming during the week.

So, what I now do (with the great co-operation of the two techs from NephroPlus - thanks guys!) is to dialyze on Sundays and skip dialysis on Tuesdays. That way I coincide my dialysis weekly off with the pool weekly off! 

This has had another unintended benefit. Sundays being a holiday I am generally not that busy plus I usually do a movie and dinner out with my parents. These are all sure recipes for fluid intake disasters! So, if I dialyze on Sundays, I can be sure that all that extra fluid is removed without any delay.

'A stroke of genius', did I hear you say? Thanks!

... http://www.kamaldshah.com/2012/04/small-tweak-to-my-dialysis-schedule.html

First off, why do we use heparin during dialysis?

During dialysis, as you might be aware, the blood goes out of the body to be filtered through the artificial kidney. Now let us move away from dialysis for a bit and think about what happens to your blood when you get cut and blood oozes out? It clots soon enough, right?

This is an inherent characteristic of blood. It clots when it is out of the body! Another example of the amazing way our body works. The body has figured out a way in which it causes the blood to clot when outside the body but not when it is within!

Coming back to dialysis, when the blood is drawn out of the body, the body does not realize the reason the blood is going out. So, it would tend to begin the clotting mechanism and cause the blood to clot which would be disastrous! So, what we do is to continuously pump a small amount of a substance that prevents this clotting from happening. This class of substances are also called anti-coagulants.

Heparin is one such anti-coagulant.

So, what happens in a dialysis machine is that a small quantity of heparin is taken in a syringe, diluted many times and fixed to a pump that pumps the resultant solution very slowly into the blood that is coming out of the body to prevent this clotting from happening.

Now the quantity of heparin that is used must be the bare minimum that is required to prevent clotting. The reason is that heparin can have some very deleterious consequences. When you use too much heparin, the time taken for the blood to stop oozing from the arterial and venous sites after terminating the dialysis session may be too long. Too much heparin can also lead to a condition called Thrombocytopenia which means a reduction in the amount of platelets in the body. Long term use can lead to thinning of the skin and even osteoporosis.

So, folks like me who intend to live for many more years need to be wary of the long term side-effects of heparin and make sure techs who do not know about the long term effects do not use too much heparin! Chances are, however, that they will not use too much. Heparin is frightfully expensive, you see!

... http://www.kamaldshah.com/2012/04/with-heparin-on-dialysis-you-need-to.html

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