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Wednesday, 30 November 2011 09:18

Overheard at the dialysis unit

Written by Kamal Shah
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I was sitting inside the dialysis unit at NephroPlus doing my work at the nursing station desk when the nephrologist from UK I have been talking to came on her daily rounds. She was reviewing all the patients one by one and she came to a young 28 year old guy who has been with us for the past half year or so.

After some discussion, I heard the guy ask, "Can I have one liter of water right now? They can pull it off during dialysis, right?"

All of us including the nephrologist, the other patients on dialysis and I burst out laughing!

In the same breath, he said, "Doctor, I feel like having six liters of water every day!"

No one except a dialysis patient can understand these emotions.

... http://www.kamaldshah.com/2011/11/overheard-at-dialysis-unit.html


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Saturday, 26 November 2011 19:32

Pulling off more than I can handle

Written by Kamal Shah
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Most people on dialysis have this irresistible urge to pull off more fluid during a dialysis session than is actually required. The reason is very simple. We have to restrict our fluid intake. Most of us are allowed no more than a liter of fluids in 24 hours. And this includes anything that is fluid at room temperature. Curd, ice-cream, tea and of course water among other things all put together should not cross more than a liter.

So, when we get off dialysis, the meter starts ticking and every sip of water we take counts towards the fluid weight gain between two dialysis sessions. All the fluid that is present in our body above the 'dry weight' (weight of the body minus any extra fluid that would have been removed if the kidneys were working) is usually targeted for removal during a session.

If too little is removed, you need to watch your fluid intake very carefully until your next session - when you can pull off the extra fluid. Removing too much can cause your Blood Pressure to fall or can cause muscle cramps. Most people on dialysis prefer the latter! Because we hate, simply hate restricting our fluids! The basic restriction is bad enough. Further restricting because you did not remove enough is simply not acceptable.

This is what happened to me recently. I tried removing too much fluid and this caused the low BP.

Most family members of people on dialysis just cannot understand why we do this. Technicians and nurses rarely even make the effort. They treat it like another problem to deal with during dialysis sessions - one that increases their work.

This can be understood only by someone who goes through this. Someone on dialysis.

... http://www.kamaldshah.com/2011/11/pulling-off-more-than-i-can-handle.html


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Friday, 25 November 2011 19:32

The human body's alerting mechanism

Written by Kamal Shah
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Last night I found myself up around 3:30. I was slightly sweaty and felt weird. I tried hard to go back to sleep but couldn't. I waited for a while thinking that I would fall back asleep. No luck. I was feeling strange. I figured that my Blood Pressure (BP) was a little low. My body felt weak and drained.

I then woke up Jairam, the tech who comes to help with my dialysis. It was quite an effort. I told him to check my Blood Pressure and infuse some saline. I also asked him to turn the ultrafiltration (UF - removal of water from the body - an important function of dialysis) down. He did all this. He then checked my BP. The higher one was 60! Which was terribly low. Probably the lowest I have ever had! He infused some more saline. My BP was now 80. I could go back to sleep in a few minutes.

I had had a heavy dinner last night. I had skipped dialysis the previous night. When I checked my weight it was 4 kgs above my dry weight. So, I set the UF target to 4 liters. What I overlooked was that I had just had a heavy meal and 4 kgs was probably only 3 kgs of fluid weight. But I had skipped dialysis the previous night and thought I could not put on anything less than 4 kgs!

The important thing I want to highlight is how my body woke up when the BP went low and I couldn't sleep back. If I would not have woken up, the result could have been disastrous. But despite being very tired, I woke and couldn't sleep back. It was almost like my body realized that something was wrong and something needed to be done.

Isn't this simply amazing? I had written about the human genome and the sheer beauty of it all and this is another example of how fascinating the human body is. It has its own little mechanisms of working. It has its own little sub-systems that are so strikingly complex and yet so strikingly wonderful.

... http://www.kamaldshah.com/2011/11/human-bodys-alerting-mechanism.html


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Thursday, 24 November 2011 23:04

Dialysis Downtime up in the “air”

Written by Greg Collette
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Life away from the BigD machine can be pretty good sometimes.  Julie gave me a birthday present in August which was booked out three months ahead – a Boeing 737 Airliner flight simulator.  My trip was for an hour, flying into and from our local airports and then into and from an airport of my choice.

I have flown plane (non-simulated) before.  I learned to fly a Cessna 150 in Albury, about 35 short years ago.  (It is only since I reached my 50s that I have been able to say 30 years of this, 35 years of that.  It gives me a funny (not Ha Ha) feeling, because I always thought that people who said that kind of thing were old.  I don’t feel old; in my head I feel around 25, but with some occasionally useful, occasionally embarrassing experiences.)

Still, I digress.  I learned to fly when I worked for a small defence electronics company in Albury.  It was a private company, owned and run by the founder, Lindsay Knight.  His products were smart target systems for anything that went bang, from pistols and rifles to vehicle mounted guns and tanks.  He had offices in London and South Carolina and travelled everywhere selling.  He had his own plane, a Beechcraft Baron and which he and his pilot flew around the country.  I was writing his technical manuals and I became friendly with Warren, his pilot.  Warren had invented a nifty little device for helping people land small planes safely and he wanted to patent it.  So I helped him write the patent for flying lessons.  The device was a clever design and worked really well, but like many smart inventions, it didn’t get the exposure it needed.

I well remember my first solo flight.  I met Warren at 0630 on a cool autumn morning for my usual half hour lesson.  We did some touch and go circuits and unexpectedly, Warren said: “You’re ready, do a solo circuit.” He jumped out, and deliberately without thinking, I pushed in the throttle lever and took off.  It was surreal, flying in cool, still crystal clear air all alone, the only one responsible for my safe landing.  It was a perfect circuit and a perfect landing.  And I was still on a high when I went home from work that afternoon.

A little after that we had out third child and Julie suggested that no matter how safe it was, I would be more likely to be there for the kids if I stayed on the ground.  And mostly I have done so, apart from a few lessons in an ultralight (something like a lawn mower attached to a sail) a couple of years ago, and a joy flight in a Tiger Moth last year.

Still, I’m very glad I learned to fly when I did.  I can’t fly now, because after the last transplant I lost much of the sight in one eye, and you need two working eyes to be a pilot.

However, I wanted each of our kids to understand the thrill of flying a small plane, so on their 17th birthdays I took each of them to a local flying school and arranged a half-hour flight, where the instructor gave them an introductory lesson.  None of them have taken up flying – yet – but they have at least had a go.

So last Sunday I climbed into the 737 simulator cockpit (with, for the first time, Julie and my daughter Kathy as passengers in the seats behind me).  I had a briefing from the instructor and when I looked up, we were sitting on the tarmac at Melbourne Tullamarine.

On the runway at Tullamarine

I pulled back the throttle, gently touched the rudder pedals and within a minute, we were airborne.  It only took a moment to believe that we were flying, and as we turned for Avalon airport, much of the feel and responses I haven’t felt for so many years came back to me.  It is so much like the real thing my heart was racing and I was sweating to get aligned for the landing.  The first half hour, touching and going at Avalon, Moorabbin and Essendon airports and landing aback a Tullamarine was a great way to get back into groove.

Innsbruck airport between the mountains

For the last half hour, I chose Innsbruck airport in Austria.  It is a difficult airport, located in a river valley with very high snow-capped mountains all on both sides.  Take off involves getting high very quickly while flying left in a gentle arc that follows the valley.

Getting above the snow line

Mountains get very close.  But the 737 is very powerful and the plane lifts easily over the peaks.  Landing is similarly cramped and the runway is short.  But again, the plane design, air brakes, landing gear and flaps make it relatively smooth.  Luckily there was no wind shear or turbulence.   However we did simulate losing one engine.  That was fun.

In fact the whole thing was a real buzz.  It’s over week now since the flight and I am still enjoying it.  Hopefully I can afford a longer flight next year!  Alternatively, I wonder if they can set up a BigD machine in the co-pilot’s chair, so I can benefit on two fronts?

The one hour flight cost A$275.  The simulator is part of the Flight Experience group. www.flightexperience.com, with simulators in Australia in Melbourne, Sydney, Brisbane, Adelaide and Perth, and in Hong Kong, Bangkok, Singapore, Kuwait and Europe.

... http://bigdandme.wordpress.com/2011/11/25/dialysis-downtime-up-in-the-air/


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Sunday, 20 November 2011 09:56

In search of the perfect Sitafal ice cream

Written by Kamal Shah
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My memories of Sitafal ice cream go back to my childhood when my grandfather (mom's dad) would make it and call my brother Prasan, my cousin Nisha and me to his house to have it (we were his only grandchildren at that time). We absolutely enjoyed this and several other treats he prepared and spoilt us completely with! 'Ferndale' boasted of a garden like few others in the city and he grew amazing sitafal, tamarind, guava and mangoes along with things like curry leaves, limes and badams.

Making sitafal ice cream is definitely not for the lazy. This fruit is, by itself, difficult to eat. Every bit of pulp has a big seed inside and you need to use your teeth dexterously to remove the pulp and throw the seed away. These days, a lot of chemicals are also sprayed on the fruit presumably to prevent pest attacks. This makes it necessary to be careful while eating the fruit so that none of the pesticide gets into your mouth. It can lead to a bad cough. The sitafal itself is often wrongly accused of causing the cough but in reality, I think it has more to do with the pesticide that gets into your mouth in small quantities.

image


Making sitafal ice cream is an infinitely more arduous endeavor. You don't have the luxury of using your teeth to de-seed the pulp. You have to do it with your bare hands if you're doing it at home. Once you have the pulp, you can use it for ice cream or basundi or whatever other concoction you can come up with. Almost anything with sitafal should taste good!

Mumbaikars were treated to sitafal ice cream at the popular Apsara parlour. Then came Naturals. Naturals came to Hyderabad a year or so back and they already have a few outlets in the city. The sitafal ice cream, like many of the other fruit based ice creams is available only during the sitafal season. The sitafal ice cream from Naturals is truly a boon to mankind! It is so good.

image

The sitafal bits which are in abundance in the ice cream really enhance the flavor. It is nice and creamy, has the right degree of sweetness and the texture is just right. This is one of the ice creams you want to relish every little bit of. A little creamy flavor here. A little bit of sitafal pulp there. Every spoonful is a delight in itself. You just don't want the bowl to finish. And when it finally does, you are so disappointed and craving for more, it is difficult to resist the temptation of ordering another.

... http://www.kamaldshah.com/2011/11/in-search-of-perfect-sitafal-ice-cream.html


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Saturday, 19 November 2011 19:32

Dialyzing our elderly

Written by Kamal Shah
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One of our older patients at NephroPlus passed away last night. He would come in twice a week. His son mostly accompanied him. I have rarely seen a son so dutiful and loving. He would bring in his laptop and work from the couch we provide next to the dialysis bed. The patient was getting tired of the disease. A couple of weeks back he had stopped coming. I talked to this son and wife a couple of days back. They said he was not willing to come for dialysis. They were trying hard to convince him but he just wouldn't listen. I talked to them yesterday morning and was planning to go over to their house this morning to try and convince him to come for dialysis. Suddenly last evening he became unconscious and was rushed to a hospital. But I guess it was probably all over.

Dialysis can be mentally draining. Week after week, without any relief, without any end to the suffering in sight, you go on and on. There is no light at the end of the tunnel for many. The lucky few who get a transplant get some respite at the end of it all but for the vast majority, this is a permanent thing, something they have to endure for life.

This has led many to question the necessity of dialyzing people who have 'lived their life'. Dialysis is not going to cure anything. Neither is it going to make their lives more pleasant. Dietary and fluid restrictions can be torturous. But this leads us to the question, "What if you don't intervene? What if you don't dialyze them?"

Dr. John Agar, an Australian nephrologist of international repute, in an answer to a question on a forum, says, "Conservative (non-interventional) care is a real and often advisable course. By intervention here, I mean machine and equipment intervention. Good studies - really sensibly and well done - have come from the UK and elsewhere, showing that CKD patients >80 years of age with more than one comorbidity ... do as well - or better - and certainly maintain an better quality of life if treated conservatively without dialysis. Their survival is a little less than 3 months shorter (on the average) than matched patients who chose dialysis ... but their quality of life, their hospitalisation rates, their last remaining time, is better."

He goes on to add, "The dialysis only adds to the misery, rather then relieving it."

The key here is whether to start dialysis or not? Once you start it is very difficult to withdraw. So, relatives of patients above eighty years of age must weigh the pros and cons carefully before deciding to start dialysis. More importantly, doctors must think hard about the benefits and the difficulties and then together with the family make this decision. I am not, for a moment, suggesting that we should not dialyze anyone over 80. All I am saying is it is not the same as dialyzing someone who is much younger. I am saying weigh the pros and the cons, arrive at a decision after a logical consideration of the facts and if the decision is that the patient is going to benefit with dialysis, then go for it.

Don't do it just because you have to do it.

... http://www.kamaldshah.com/2011/11/dialyzing-our-old.html


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Tuesday, 15 November 2011 08:13

Have Anna Hazare and friends lost their way?

Written by Kamal Shah
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I think so. Ever since Anna Hazare ended his fast at Ram Lila Maidan, the group has been plagued with one problem after another.

It all started with the Hisar by-poll. I agree with the Congress' contention that the entire anti-Congress campaign was unnecessary. What had changed since the fast was called off? Did anyone say the Lok Pal bill would not be passed in the winter session of Parliament? If they had doubts about the Congress' intentions, then the fast itself should not have been called off!

Then the allegations against Kiran Bedi. She billed her hosts for executive class whereas she flew economy. The excess money, she says, went to the NGO and not to her. You cannot call this corruption, for sure. But dishonest, definitely yes! A group of people fighting against corruption at this level and claiming the support of the masses must be totally above board. They must have impeccable credentials and no one should be able to point a finger at them. Sadly, Kiran Bedi has not lived up to this ideal.

Which brings me to the referendum they claim to have held in which an astonishing 99% of the respondents said they would not elect Sonia Gandhi if the Lok Pal bill is not passed. Just what were they thinking? This last act was extremely immature. Dorab Sopariwala, on a news channel said that when pollsters come up with anything more than a 60% majority, they start getting nervous. And here was a 99% result. Obviously, the question was 'leading'. "If your MP does not support the Lok Pal bill in parliament then will you vote for him/her?" Who would answer that with a 'no'?

I am fully in support for a strong Lok Pal bill and have written in support of it here and here. But after the fast, I think the group has failed to act in a mature and reasonable manner. And if the group doesn't correct this, this could cost us the bill. Anna Hazare must be strong and take bold steps and be more in control of what is said and done in his name.

For the sake of this country!

... http://www.kamaldshah.com/2011/11/have-anna-hazare-and-friends-lost-their.html


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Saturday, 12 November 2011 08:26

Tinzaparin Shortage

Written by Steve Bone
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There is a shortage of Tinzaparin, potentially for the next 3 months so make sure you have enough stock to last you. I suspect if the units run out they can revert to pump heparin – not an option with NxStage. Check with your renal pharmacy on supplies for you.

Tags:

... http://mydialysis.co.uk/blog/2011/11/12/tinzaparin-shortage/


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Saturday, 12 November 2011 08:25

300 Series PAK

Written by Steve Bone
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I have started to use the 301 PAKs. Seem to be of a better construction and lines are slightly different and more flexible. Set up on the PureFlow to accept the new PAK type was easy enough – although why it has to be changed I don’t quite understand, as the fluid/concentrate is the same composition.

All working ok.

Tags:

... http://mydialysis.co.uk/blog/2011/11/12/300-series-pak/

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