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Tuesday, 15 March 2011 09:11

Rest in peace, Narsimhan uncle

Written by Kamal Shah
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Mr. P. L. Narsimhan, celebrating his last birthday at NephroPlus, with wife Lakshmi. He passed away yesterday morning. He was on dialysis from the last few years. He was also the father of Ashwin and Anand, my childhood friends. Rest in peace, uncle.

... http://www.kamaldshah.com/2011/03/rest-in-peace-narsimhan-uncle.html

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Saturday, 12 March 2011 18:22

NephroPlus turns one!

Written by Kamal Shah
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NephroPlus turns one tomorrow! What a year it has been! We started with one center with four beds and one patient. Today we have two centers with 14 beds and about forty patients. The numbers don't tell the whole story.

When we started, there were two things that were paramount. Prevention of cross-infections and making the whole dialysis experience more pleasant. In my mind, these were the two biggest problem areas in dialysis.

When a person is suffering from kidney failure and needs to undergo dialysis week after week with no respite, no breaks, isn't it criminal to give him or her another life-threatening disease involving another critical organ of the body? Vikram, Sandeep and I realized the gravity of this problem. Vikram and Sandeep brought in their out-of-the-box thinking and expertise in processes and have, touch wood, solved the problem. By institutionalizing novel methods and unique systems, they helped remove the scourge of cross-infections from NephroPlus. I pitched in a little myself by dissecting the guidelines published by the Center for Disease Control in the USA and provided inputs. Prevention of cross infection remains NephroPlus' number one priority.

The second thing we were keen on doing was to improve the dialysis experience for patients, whom we call guests today. Having experienced dialysis sessions at many hospitals in India, I explained to Vikram and Sandeep the thorough boredom I felt during a dialysis session. I also explained the drained feeling I usually felt at the end of a session. Both of them understood entirely and they decided to put an individual television set for each dialysis station and provide free Wi-Fi access. This facility is there in very few dialysis centers in India today.


With Vikram and Sandeep at the launch a year back

Apart from all this, when I interact with guests at NephroPlus, there is one thing most of them say - the center feels like home. The technicians and nurses treat them with so much love and care that the whole experience becomes that much less painful. 

We have set very high standards in the first year of operations. It is going to be very difficult to live up to them. But I am sure we will. The main reason being we all love what we are doing. That makes the task much easier. Going every morning to the center is not a chore. We all look forward to it.

Here's wishing ourselves many more years of success!

... http://www.kamaldshah.com/2011/03/nephroplus-turns-one.html

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No matter whose side you are on in the Telangana issue, there's one thing you can't deny - there is a definite groundswell of support for a separate state. A large majority of people in the area do want a separate state. There has been a massive agitation going on for the past many months and this has effected normal life in the state especially the capital Hyderabad.

Despite this, I find, rather surprisingly, that the national media chooses to ignore the entire agitation.

Take 10th March for example. Hyderabad was almost shut down. Many statues were vandalized on Tank Bund. Despite all this, the matter was barely covered in the national media. Channels like NDTV have a penchant to cover news that barely effects us. The amount of time they spent in covering Aarushi Talwar murder case and now the Radhika murder case is frankly, quite ridiculous. These were ghastly murders, no doubt. However, how important are they to the nation? How many people do they effect?

Compare this to the question of Telangana. An entire population might be divided (not that it is wrong or right, but it will definitely effect all of them). Depending on which side of the divide you are, you either get what is rightfully yours or your basic identity is going to be broken. Isn't this more important than one single family?

For weeks, the government was paralyzed. Many important decisions were withheld. The conduct of examinations and careers of thousands of students were in jeopardy. In spite of this, channels do not find this important. The union government is of course doing nothing. Instead of deciding on the issue one way or the other, it is in a state of limbo. That again is a topic for another post. But the press, truly needs to get its priorities right.

... http://www.kamaldshah.com/2011/03/why-does-national-media-ignore.html

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Thursday, 10 March 2011 19:14

Who is ultimately responsible for your health?

Written by Kamal Shah
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You. Of course.

Especially when you have a chronic condition like kidney disease. I have found that you absolutely need to know it all. If you don't, find out. There is so much happening in the world of medicine every single day. Yes, doctors are there. But they are very busy. More so in a country like India where the ratio of nephrologists to patients is horribly low.

Nephrologists, in spite of their best intentions have very little time for individual patients. So, though they will be able to advise you on general things, there will be many things specific to your condition that they will not have the time to read up on. It is really up to you to figure out. Yes, discuss your findings with him or her. Hope that your nephrologist is open to such discussions (mine is).

Even on general things, it is important for you to be aware of the different options. You know your body best. You know your mind best.

Another thing that I have learned over the years is that the advice you are given is not necessarily in your best interest. In this industry there are a lot of factors at play. A lot of non-medical factors. This is sad but true. As patients we must be aware of this reality. Read up as much as possible. Talk to as many people as possible. Only then take a decision.

... http://www.kamaldshah.com/2011/03/who-is-ultimately-responsible-for-your.html

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Wednesday, 09 March 2011 19:11

Protect your kidneys, Save your heart

Written by Kamal Shah
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Today is World Kidney Day. This year's theme is "Protect your kidneys, Save your heart", which is very true. Most people who have kidney disease do not die of kidney disease, they die of other conditions caused by failed kidneys, most likely related to the heart.

So, it is important that if you do not have kidney disease, you should take steps to make sure that you don't ever get it. The best part is - it is in your control! The only thing you need to do is to recognize that fact and do something about it.

Here are five things you can do to reduce your risk of getting kidney disease (mostly taken from the official World Kidney Day website):

  • Reduce your salt intake
  • Drink at least 8 glasses of water every day
  • Exercise at least 30 minutes every day
  • Eat natural, healthy food
  • Avoid antibiotics and pain killers unless prescribed by your doctor

A quick glance at the list and you might be saying, "What's new?" Exactly! That's what it is. The same old stuff. But take one more look at the list and see how many you are doing? It is very simple. You don't need anything complicated to prevent kidney disease. It is all straight forward. Its just about being disciplined and consciously making an effort.

Most of us get caught up in our daily lives without realizing that there could be a time bomb ticking inside us. We realize this only when it blows up. And by then it is too late. We all think that we are immune to these kinds of chronic conditions. "We will never get them". Honestly, I never, ever, even remotely considered the possibility of being diagnosed with a life threatening, life-long condition such as this. When it happened, it happened. I could do nothing.

You are probably in a stage where you can do something. The list above, when you think about it, is very general. It will help prevent a lot of chronic conditions. It is not at all specific to the kidneys! So, make a pledge. Use whatever tricks that work for you to follow these. You will not regret it.

... http://www.kamaldshah.com/2011/03/protect-your-kidneys-save-your-heart.html

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I have been keenly following the Aruna Shanbaug case in which the Supreme Court gave its verdict yesterday. You can read the details of the case and the verdict here. The court turned down the plea of Pinky Virani who was fighting for allowing Aruna Shanbaug to die rather than keeping her alive when she could not lead a life of dignity.

This is a very tricky case. On the one hand you have a woman who has been confined to a bed for the last three decades in a semi-vegitative state. On the other hand, she has not expressed any desire to die and she is not totally in a coma as she consumes food put in her mouth and expresses emotions too.

I think the Supreme Court's judgement is right.

The desire to live is a very basic, primordial thing. Every living cell wants to live. So, when there is no means to determine that a person wants to die, there is no option but to assume that he or she wants to live, in whatever form.

I have often wondered if ever, I were in a similar situation, what would I want? I really have no answer. It is impossible to say without being in that situation. At that point, would my suffering be so much that I would want it ended? Or would my desire to live supersede that desire?

I really hope I never have to be in that situation!

... http://www.kamaldshah.com/2011/03/aruna-shanbaug-case-sc-does-not-allow.html

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Friday, 04 March 2011 00:19

Stopping Dialysis: how long before The End?

Written by Greg Collette
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Getting bogged on a muddy road is not normally a life-threatening situation.  Unless you are driving 475km (300 miles) for dialysis on a muddy dirt road after floods.  A guy in the Queensland outback was doing exactly that three days ago, travelling from Mt Isa to Doomadgee Hospital, a nine-hour trip.  He and three companions, including his son, were travelling along the muddy Thorntonia Rd, a 56km (35 mile) stretch about half way there, when they were hopelessly bogged.

They spent the night in the car waiting for someone else to come along, but nobody did.  They began to worry about the man missing dialysis, now one day late, so early morning two of his friends, a 33-year-old man and a woman (age unknown) decided to walk to the Gregory Downs Hotel 40km (25 miles) further along the road to Doomadgee for help.  They walked all day along the muddy road in persistent rain until they arrived after nightfall.

The hotel staff called the North Queensland Rescue Helicopter, which the following morning picked up the man and his son and took them to Century Mine, 25km away.  From there, the man, now two days late for dialysis, was taken by Royal Flying Doctor Service to about 1000km east to Townsville Hospital, where he at last received his BigD treatment.

A great story eh?  His friends must have been really worried.  Should they have been?

Absolutely yes.  Another day or two and he would almost certainly have died.

I have often wondered how long I would have if I stopped dialysing, so I asked our Unit Manager, who has known several people who have decided to stop.  Her answer was immediate: three to five days for most people.

The length of time depends on a few things: whether you have any residual kidney function (I do not), how well you tolerate too much potassium, which causes increasingly severe arrhythmia (irregular heartbeat) and how well you can tolerate the fluid build up (which makes it hard to breath and places great strain on the heart).

The high level of toxins are an unpleasant extra that tends to slow down your thinking and make you feel generally unwell.

Eventually, death is usually caused by heart failure.

Most people on the BigD have had some or all of these symptoms, so they are not all that hard to imagine (I have some pretty ugly photos of me to prove it).  But luckily we have had dialysis available to get us back to some semblance of good health.

To me, this Queensland story is a useful reminder to make doubly sure of my dialysis treatment plans when I go on holiday, or if I travel far from my unit.  It’s the kind of frustrating situation I sometimes dream about, where no matter how hard you try, you can’t seem to get where you want to go (I must remember to dream up a helicopter or the RFDS next time!).

It is also a nice reminder of just how great it is to have good friends.  Yet another reason to hang on to life with both hands.

... http://bigdandme.wordpress.com/2011/03/04/stopping-dialysis-how-long-before-the-end/

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Thursday, 03 March 2011 08:25

My iPhone 4 is now in Mumbai

Written by Kamal Shah
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I have been yearning to get an iPhone 4 from the time it has been announced. I couldn't get it from the US too. The main problem was Apple did not sell the phone without an AT & T contract. So, there was no way you could get a phone even if you could unlock it here.

Then, I somehow got to know that factory-unlocked iPhone 4s were being sold by Apple in some countries like Hong Kong. My cousin Nisha was travelling to Hong Kong in November and I asked her to buy one for me from there. She went to the Apple store in Hong Kong when she was there. There was a waiting period of 4 to 6 weeks! They asked her to leave her credit card details and her phone number and they would call her when the phone arrived. My cousin did that despite having to leave Hong Kong in a few days. The plan was to get a friend to pick it up and send it to India whenever it arrived.

Four to six weeks became two months. But finally the phone arrived at the Hong Kong store. My cousin got a call and she requested a friend to pick it up. Now the next step was to bring it to India! We waited and waited for someone to make plans to come to India from Hong Kong. My cousin, by now, was as anxious as I was to get the phone. Shipping it wasn't an option. Who wants to risk shipping an iPhone and have it come through Indian customs?!

A few misses (people coming but we not knowing) later, finally the lady who picked up the phone herself arrived at Mumbai a couple of days back. Nisha has yet to lay her hands on the phone but confirmed reports say the phone has indeed arrived.

I am off to Mumbai this Saturday to pick it up.

... http://www.kamaldshah.com/2011/03/my-iphone-4-is-now-in-mumbai.html

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I have seen such conflicting opinions about the blood tests people on dialysis need to do regularly - monthly, quarterly and so on. Every doctor, every hospital and every dialysis technician has his or her own opinion. Yes, every individual has a specific requirement and the list of tests will vary depending on his or her condition. But there surely must be a common bare minimum that every dialyzor must get done, right?

Hemoglobin is probably the only test that everyone concurs. Most people get this done every month at least. A good hemoglobin is essential for general well-being. It also dictates the amount of Erythropoietin you need to take.

On the rest of the tests, pretty much everyone has their own opinion.

Some people get the Creatinine and Urea done every month. I totally understand getting these done for people in the early stages of CKD. What purpose does the Creatinine serve, however, once someone is on regular Maintenance Hemodialysis? The kidneys have pretty much shut shop, never to open again. What is the point in doing the Creatinine? A test should be done if, based on the result, some action can be taken. If someone's Creatinine goes up by 2 points, is the frequency of dialysis going to be increased? If the Creatinine has gone down by 2 points, are you going to reduce his frequency of dialysis?

Coming to Urea, if you are going to do the pre-HD and post-HD urea and use it to estimate the Kt/V, a measure of adequacy of dialysis, fine. Doing only the pre-HD urea serves no purpose, in my humble, non-medical, only-based-on-common-sense opinion.

Clinics that are concerned about HCV cross-infection often insist on a SGPT, a liver function indicator, every month. That is fine and should be encouraged with the rampant cross-infection with this virus (at least in India) these days.

Calcium and Phosphorus are tested with varying frequency. With the amount of trouble I had with both of these, I would really suggest keeping a tab on these. At least quarterly, if not monthly?

The biggest problem with dialysis in India, as I keep repeating ad nauseam, is that patients have to pay out of pocket for their medical expenses. When that happens, automatically, non-medical factors come into play while deciding the frequency and type of blood tests. At NephroPlus, we are constantly battling this problem. Patients often suspect our intentions when we recommend blood tests for them. I can totally understand and relate to their thinking. So, it is important for patients to be educated and aware enough of their medical condition to be able to take such decisions in their best interests, balancing their financial concerns with their medical ones.

... http://www.kamaldshah.com/2011/03/which-blood-tests-do-people-on-dialysis.html

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