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Wednesday, 03 August 2011 10:37

A visit to the post office

Written by Kamal Shah
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I got an email from LIC India one day saying that they sent a cheque to me (pertaining to a policy that my parents had taken for me) quite a while back and it had not been encashed. They wanted to check if I received it or not. As it turns out, my address in their records was an old one and that is why I did not get the cheque.

The email asked me to send the new address if it had changed which I promptly did. I got a response confirming receipt of the new address and that I should contact a certain person with such and such telephone number in case I did not receive the cheque after ten days.

After ten days I contacted the person and asked him about the cheque. He said it had been sent by Registered Post and that I should get it in the next 2-3 days. I waited for 5 days. No sign of the cheque. I called the guy again. He was surprised that I had not yet got it. He asked me to call back the next day and he would enquire about it.

The next day when I reached home, my cook told me that the post man had come home with a registered  post cover and refused to give it to her. He insisted that only I collect it. He left a message asking me to come to the post office to collect it. No mention of which post office. No mention of who to meet and when. Just come to the post office and collect it.

I was lost. I had no idea what to do. The cheque amount was non-insignificant. I had to do something.

I mustered all the courage I could and went to the General Post Office at Rashtrapathi Road in Secunderabad. The building looks quite majestic from outside. Only when you go in do you realize that it is a fit case for the saying, "Paina pataram, lona lotaram"!

There is an Enquiry counter inside. I went up to it and asked the person behind the desk where I could pick up registered post? Without as much as a look back, he said "Go inside". Well, wasn't I already? I figured he meant really deep inside the maze that the office was. There some counters with monstrous lines in the front with an almost hidden entrance to the "inside".

I went through. There were dozens of tables with people behind them animatedly scribbling away on papers with dog ears. Not one computer in sight! I had to ask random people on the way where the Registered Post delivery was made. After listening to contradictory responses and going back and forth "inside" and "outside", I finally met one man, deep inside, that asked me, what I thought was the first relevant question in my adventure.

"Which area do you live in?"

"Balamrai", I responded.

"Oh, vaadu elipoindu", the guy responded, adding that the concerned person left at 11 in the morning. That was a first, I thought to myself. I have heard of truant and lazy government servants. This took the cake. I realized later, however, that I had to basically meet the same postman that delivers letters to my house and that he is usually there in the post office from 8 a.m. to 11 a.m. and I had to come at that time the following day if I had any hope of getting my cheque.

Cut to the following day. I confidently walked to the same room and asked a totally random person in there where I could colect Registered Post for Balamrai. "No. 30", he responded. I asked around where No. 30 was and was directed to a post man sitting on a desk that had a small label that said "30" inside a shelf on the desk. So much for "No. 30"!

I asked him about the cover and he promptly pulled it out and made me sign the Receipt paper. To his credit, he did not ask me for a tip. I was totally shocked!

A few questions still remain unanswered in my mind:

1. How did any random person I asked about where I could collect my cover have an answer? How come no one said I don't know?

2. Why can't they have one section for uncollected registered post with a big sign board that says so where anyone can go and collect their post?

3. Why didn't the postman tell my cook that I had to come to the GPO at R.P. Road between 8 a.m. and 11 a.m.?

4. Why does LIC have to send cheques by registered post when almost the whole world uses private courier companies to deliver cheques?

5. In fact, why can't LIC have a direct credit to bank account option?

6. And finally, why, oh why, did my parents take an LIC policy for me?

... http://www.kamaldshah.com/2011/08/visit-to-post-office.html

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Monday, 01 August 2011 04:01

My AJKD article now available as a podcast!

Written by Kamal Shah
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My AJKD article, "Taking the Uncharted Path" is now available as a podcast! You can find the podcast here.


Thanks to Dr. Sidharth Sethi for posting about the podcast on his website and also letting me know about it. I had no clue! By the way, thanks also Dr. Sethi for complimenting my voice. And you haven't even heard me sing! Hahahaha!

... http://www.kamaldshah.com/2011/08/my-ajkd-article-now-available-as.html

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(Sorry about the delay in writing.  I have been working on a post about the appropriate treatment for fistula haemorrhage, signs and symptoms, actions to take, so that people can compare what should be done to what was done.  It is taking longer than expected, but it’s coming soon.)

For a range of reasons, I stopped going to the gym about six months or so ago.  I had aches and pains and a little arthritis, and it seemed to me that the gym wasn’t helping.  Also, my knees became wonky to the point where I couldn’t run for 30 minutes without ending up needing a Zimmer frame for the rest of the day (almost).  I had lost my Moxy – my style, my coolness, my confidence.  So I got the sulks, and decided that would I drop my gym sessions and runs, and replace them with extra walks and more rides on my exercise bike at the BigD.  What difference could it make?

Not my smartest decision.

Of course I didn’t walk much more than before.  And the time I used to take exercising, I either slept away or just worked more.  And while the BigD bike is good, it’s not vigorous enough to replace a three-times a week exercise program.  So I slowly (actually, not so slowly) became less fit, even more creaky, less enthusiastic about life and maybe a little dumber.  So Julie (who could see my new mini-exercise idea was mini-smart) suggested I try Pilates, a much lower impact exercise regimen.

For the last five months I have done Pilates twice a week, once at a studio, once at home.  I found it a little disconcerting at first.  I was the only man, and there was lots of talk about exercising your pelvic floor, a mystery to me until I read the handout: “It is important to grasp the correct feeling when exercising the pelvic floor: for women, squeezing a tampon, for men, lifting the penis.”  Got it.

Pilates is all about flexibility, posture and core strength, and at first it seems a little lightweight.  Nothing too strenuous or painful, just prolonged bends and lifts at funny angles, to exercise a single muscle or group.  But after a while my aches and pains diminished and I felt fitter.  After a few months I was ready to do a more.

Talk about timing.  A new gym has opened up near where I live, offering a pretty good deal to get started (at around the same price as the YMCA gym I used to go to).  So I went along and ended up joining.  I also purchased the most unheard thing I ever heard of, time with a personal trainer.

This turned out to be just what I needed.  I had gone to the same gym for about four years, doing the same exercises throughout.  Now I know that any sensible person will tell you just how dumb that is: for in the gym as in all, variety is the spice of life.

The first thing my trainer said was to keep changing the exercise routine.  If you go three times per week, have at least three different routines, so your body doesn’t get used to the exercise and you don’t get bored.  So far, it’s working a treat.  I am enjoying the exercises.  I actually feel a little stronger (I can lift weights that would not move two weeks ago).  Of course, I’m starting from a very low base, but don’t we all?

I paid the trainer (a surprisingly respectable fee) for the first 10 sessions. I began with twice a week, but quickly dropped to once a week.  During this time I told him what parts of my magnificent body I wanted to develop, and he designed exercises (mostly using machines) to build them.  And I am definitely sore in all the right places.  I have now dropped back to monthly sessions, by which time I may be ready to move to free-standing weights.

I also purchased some new gym clothing.  The stuff I used to wear was pretty tired, and has now been promoted to gardening duty.  I must say I get a psychological lift from the new gym gear, shallow as that sounds.  I have a long-sleeved lightweight top that covers my fistula and makes me look like any other scrawn working on building up.  Real gym shorts, rather than football shorts and even a poncy little gym towel complete the outfit.

I am still a little creaky, but I am starting to stand up straight again, I feel pretty good most of the time, and I have my moxy back!   A giant change from six months ago.

If it works for me, it can work for you (whether or not you are a BigD member).  Pilates is a good start, about an hour per session a couple of times a week, then as your moxy begins its long trip back to centre stage, think about the gym…

... http://bigdandme.wordpress.com/2011/07/31/dialysis-steal-your-moxy-exercise-and-variety-gets-it-back/

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I have been a part of two startups. Effigent and NephroPlus. I have seen both these companies from scratch. There is one thing that I have seen in both. The identity of the company is often shaped by the first few employees in the company.

I find this to be universally true because the management can do only so much in shaping the attitude and behavior of the team. Though the overall guidelines can be given, values and missions stated, unless the first set of hires really believes in them and adopts them genuinely, it is very difficult for the rest of the hires to do so.

That is why the first set of hires is so important!

At Effigent, we were really lucky to get someone called Neelapalla Srinivas as one of the first few employees. He was an amazing guy. Technically solid. Amazing attitude. He would help the juniors come up to speed, spend time with them, coach them. Not only did this help the juniors in grasping programming concepts the right way but it also encouraged them to help others at work. This attitude in everyone was one of the most liked by the Effigent team. The folks that joined later carried on this legacy much after Srinivas left.

At NephroPlus, Sara the nurse that was hired in the early stages set the standards in nursing care at NephroPlus. The NephroPlus standard of care was informally institutionalized by her. She walks out all the patients after dialysis holding their bags and seeing them off. This is one of the many things that patients love at NephroPlus - personalized, homely care. Today, as Sara moves on to bigger challenges, her impact will not be lost. Nurses after her must adhere to the same standards that have been set.

Fortunately the managements of both these companies strongly believed in the values that the first few employees were torch bearers of! And the companies were fortunate enough to get these people to actually help realize their dreams.

... http://www.kamaldshah.com/2011/07/teams-contribution-to-companys-identity.html

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Monday, 25 July 2011 09:09

Zindagi na milegi dobara - must watch

Written by Kamal Shah
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I watched Zindagi na milegi dobara the day after Delhi Belly. What a change! Maybe I liked it so much because I watched it immediately after such a bakwaas movie like Delhi Belly.

I won't go into the story and performances. You can find that anywhere. I will tell you what I liked about the movie.

Basically, there are two messages for me from this movie. One is Hrithik's story. He is fully engrossed in his work. His life is pretty much calls, meetings, customers, money, money and more money. Many of us get into this mode of making work our entire life. We don't realize that work is only a part of life and not life itself. Hrithik's character understands this as the movie progresses and eventually breaks free.

The other part is where the characters face their deepest fears head on. It does seem too simplistic and unrealistic at times. But then this is a movie, not a news show. Let's not forget that. The key is to face our fears. It is easier said than done. But once we do this, it does not seem that difficult at all. This is something worth hanging on to.

The music is really good. The Senorita song is excellent. But then, I did not want to do a review!

If you haven't watched this movie yet, go watch it! You will love it!

... http://www.kamaldshah.com/2011/07/zindagi-na-milegi-dobara-must-watch.html

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Sunday, 24 July 2011 04:07

Started off on Chloroquine

Written by Kamal Shah
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I have been put on Chloroquine to treat my suspected Porphyria Cutanea Tarda.

This is purely an empirical treatment which means treating based on symptoms and not any confirmation of the diagnosis. So, they can confirm the diagnosis using a test of the urine where they test for the presence of Uroporphyrins in the urine but since I am anuric that is ruled out. The blood can be tested for this but no one does it in India apparently.

The other option is a biopsy of the skin where they take a small bit of skin and then analyse it for signs of this disease. However skin biopsies can only be useful if done on a blister that has actually formed and for some reason, my dermatologist says it can be done only on blisters that form on the back of my hand or feet and all the blisters that I get are on the fingers and toes! Also, he says, biopsies are often inconclusive.

Since the symptoms are all in tune with Porphyria Cutanea Tarda, we are going ahead, empirically if you will, and treating it.

Chloroquine, most famously used for treating malaria is supposed to be effective for this disease as well if given over long periods. So, I've been asked to take it for a month and watch out for any rashes or change in vision.

Ha! That's the beauty of medicines these days. They will cure you of one condition but can give you another!

... http://www.kamaldshah.com/2011/07/started-off-on-chloroquine.html

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Saturday, 23 July 2011 12:54

Nx Stage at Home -Progress

Written by Steve Bone
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Had some more problems, this time with the cartridges (the lines and dialyser) where they fail priming at the same stage every time. It happened to four cartridges from the same batch (out of about 27 used so far). However, Kimal are on to this and have sent me some cartridges from a different batch – and so far, so good. My blood results last week very greatly improved, no I am going to see what they are like this week. I’ll be doing my next bloods, probably on Tuesday and I would love to see some consistency. To date the results have been erratic, but like all things, stick with it and allow things to develop. I am using slower pump speeds, and hence longer sessions to ensure I hit the middle molecule(MM)  clearance, e.g. PO4 (phosphate). At the moment I am looking for the balance between phosphate, calcium, and the impact on PTH (parathormone). My PTH has come down, but it still has a way to go.

The suggestion from Kimal is to reduce the Flow Fraction from my set 35, to say 32/33, so to saturate the dialysate more, and by increasing the time dialysed, so improve the MM removal that way.

So, to Flow Fraction. Let me have a go at this.

Flow fraction (FF) defines level of dialysate saturation, a key component of the way the NXStage works, divided by the blood flow rate.

Flow fraction is the ratio of effluent flow divided by blood flow rate. The Effluent is the spent dilaysate plus the UF (ultrafiltration). I am on dialysis at the moment and taking off 2 litres and so this is what is added to the spent dialysate, over a period of 3 hours on today’s session. Once the UF finishes, then the effluent is just composed of spent dialysate, so the Flow Fraction reduces – so it needs to be increased back to the prescription rate, and so shortens the final stage of dialysis. Keeping up?

So, I’ll have a go at expressing that in one line:

FF = (Spent dialysate + UF)/Blood flow rate

There is a fancy formula for working this out a bit more precisely, so if you are interested, let me know.

The longer the dwell time of dialysate in the dialyser, the better the absorption of waste/toxins etc. Better use is made of the dialsyate, and overall the system uses way less water – made this point in an earlier blog post. So for any treatment I am using 30 litres of water, give or take, against in excess of 200+ for a conventional machine. When I last dialysed at home, using a Gambro, my water bills were horrendous, and I was dialysing every other day. Imagine daily! Hmmm, best not!

The key to NxStage is better utilisation of the dialysate, mimicking the way that PD works. It’s, on the face of it, a logical idea, but then armed with hindsight, we can all be scientists! Odd nobody went down this route before. Still, all part of the developing works of dialysis treatment. Long may it continue!

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... http://mydialysis.co.uk/blog/2011/07/23/nx-stage-at-home-progress/

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A nephrologist I hold in really high esteem, Dr. Ashwin K. Aiyangar now has a blog. Its called Kidney Pulse.

From the blog: "This blog is an attempt to try to help those millions who may be patients suffering from the disease, their relatives, friends and well wishers, or just someone who wishes to know about the kidney and wants to contribute .... perhaps aiming to make this so-called dreadful disease not-so-dreadful anymore."

An excellent start I must say!

Welcome Dr. Ashwin!

... http://www.kamaldshah.com/2011/07/dr-ashwin-aiyangar-nephrologist-is-in.html

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Saturday, 16 July 2011 11:57

Yes, crucify me, but I hated Delhi Belly!

Written by Kamal Shah
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First things first. In a twist to a famous quote, "You may not agree with what I say but you must fight for my right to say it!"

So, you may have liked the movie but I didn't. Simple. And I will not deny that I thought the movie was disgusting. However much you thought it was hilarious.

I don't like movies that show dirty, shabby houses, toilets, flushes falling on people and such other gross things.

For most of the movie, one of the main characters is struck by diarrhea. Hasn't he heard of antibiotics and other astringents? Worse, hasn't his doctor? Even if they haven't, why take the camera behind him whenever he has to relieve himself.

The worst part of the movie was a scene where they actually show someone pouring out liquid human poop (purportedly, a sample given for a test to a lab). I almost threw up right there. I closed my eyes after one single frame to prevent this.

This, in the name of entertainment? And you have hordes of people loving the movie!

Well, I don't hold any grudges against those who liked the movie. To each, his own! But I found it horrible. Utterly disgusting. A pathetic attempt at humor.

... http://www.kamaldshah.com/2011/07/yes-crucify-me-but-i-hated-delhi-belly.html

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