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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Saturday, 16 April 2011 11:59

Home alone

My parents have gone on a month and a half long trip to the US. My brother Karan is graduating around now and they have gone for that followed by holidays at a few cities in the US and Canada.

So, that leaves me at home, alone. Well, at 25, you might ask, what's the big deal? Well, nothing much, I say. Just that this is the longest I will be staying alone at home. My parents have gone for short 2-3 day trips and recently a week long trip to Dubai. Never this long. So, its just that I am not used to it, that's all.

For instance, I am at home and some bill arrives in the post. For an instant I think my dad will take care of it. Only, I have to take care of it.

When you're home alone, there are some very unexpected things you need to take care of. For instance, yesterday, two servants in my house fought which ended in one of them 'firing' the other. Who was she, I wondered to 'fire' the other. In such matters, logic finds no place. Stranger things have happened!

Staying alone has its share of advantages too. You are generally the king of the castle. You do as you wish. You eat what you want. You come when you wish and you go when you like. Nobody asks you a question. You have no care in the world!

I do wonder though how long this will last? One week? Two? More? I doubt it. Very soon, I am fairly certain, I will miss being in the company of my parents. I will miss things simply getting 'done'. I will miss seeing only the show on the stage without knowing what's happening backstage! I will have to pretty much manage the backstage!

... http://www.kamaldshah.com/2011/04/home-alone.html

Friday, 08 April 2011 20:30

'Email is not working'

My mother has an ICICI Bank credit card. She was asked by the customer care to send them an email and action, they said, would be taken in 24 hours. So, my mother wanted to send an email. She's had a Rediffmail account for some time now which she uses sporadically. If you send her an email, you need to call her and tell her to check her email.

So, she asked me what the email address for ICICI Bank's customer care was. A google search threw up the answer and I told her. A little while back she came back and said it was asking her to check the address she was using. I re-checked the email address she was using. It seemed to be correct. I asked her whether she had logged into her Rediffmail account. She asked why she needed to do that? I was a little horrified.

I asked her where she was typing the email address I gave her? She said in the line where she types addresses. I quickly figured out that she was typing the email address in the browser URL field!

I then explained to her that she needed to log in to her Rediffmail account to send email!

... http://www.kamaldshah.com/2011/04/email-is-not-working.html

Tuesday, 05 April 2011 23:03

Morning lark or night owl?

Do you like to wake early in the morning or stay up late at night when it comes to study or work?

I used to debate which is better for me right from school days when an exam was coming up. I used to mostly stay up late rather than wake early (unless I had to do both!). The main reason for this was staying up at night was a safer option. Let's say you had some stuff to complete. You estimated it would take two hours to complete. So, you decided to do it in the morning and woke at 5 a.m. because you had to start getting ready at 7 a.m. Now if it got extended for whatever reason, panic would set in and possibly you may not finish what you set out to do at all! On the other hand, if you stayed up late, you had the entire night ahead even if things took longer than you thought they would.

The morning larks however would argue that you would generally finish whatever would otherwise take 2 hours, in an hour. Simply because your mind is totally fresh, completely rested and very efficient. This argument has merits. I have switched to a consultant model with the software company I worked with. So, I work from home, work according to my convenience and bill for the hours put in and the work done. I find that I am at my best in the morning. I am usually done with my dialysis around 5 a.m. and then have about an hour to two hours to finish off some work (unless I feel like and am able to go back to sleep). I am able to complete really complicated stuff very quickly.

The Hindu scriptures extol the virtues of the morning too. Most scholars arise early in the morning and practice their shlokas at that time. I guess, for work that involves the mind, no time is as good as the morning. Especially when there is no deadline involved.

... http://www.kamaldshah.com/2011/04/morning-lark-or-night-owl.html

Friday, 01 April 2011 20:14

Ultrasound scans for people on dialysis

I was in the East Marredpally unit of NephroPlus a couple of days back. A patient's son wanted to speak to me. He said his father was advised to undergo a KUB Ultrasound Scan and they went to Apollo Hospital in Secunderabad. There, the assisting nurse asked his father, the patient, to drink a lot of water and make sure his bladder was full. Only then could they do the scan.

The family was in a dilemma. They had, all along, been advised to restrict his fluids to a liter per day. Now, here was a nurse asking him to drink a lot more. They explained this to the nurse. The nurse wouldn't listen. She insisted that the scan couldn't be done without a full bladder. The family relented. The patient was made to drink about three liters of water in a span of about an hour. The scan was done.

By next morning, the patient was overloaded with fluid. His feet were swollen and he could barely walk.

This is so outrageous!

First, the bladder wouldn't have been full even if the patient would have had 100 liters of water. Simply because his kidneys weren't functioning. Second, in all patients with kidney failure ultrasound scans are routinely done with empty bladders. There is simply no choice. This shows the complete ignorance and apathy of the staff at the hospital. Again, it is not only this hospital. I have myself been asked several times to drink a lot of water when I went in for an ultrasound scan. I simply tell them my bladder is already full. The radiologist usually understands. It is the staff outside that does not.

This is a very basic facet of kidney disease that should be taught to anyone who is likely to deal with these kinds of cases. Ultrasound scanning staff to start with. Nephrologists of each hospital should probably take the lead on this and instruct the departments to make this a part of the rules/handbook/training or whatever such mechanism might be available.

If the patient is on dialysis, there is NO NEED FOR A FULL BLADDER. DO NOT DRINK ANY WATER AT ALL. If the team there insists, refuse to do the scan and ask them to speak to the nephrologist.

... http://www.kamaldshah.com/2011/04/ultrasound-scans-for-people-on-dialysis.html

I have seen pretty much all modalities of renal replacement in my almost 14 years of experience with kidney disease. Here is the list of modalities in order of my preference:

1. Kidney Transplant: Top there is the indisputable king, a renal transplant. Despite all the risks, the costs, the possible complications, a kidney transplant continues to offer the best outcomes. For me, the most important benefits of a transplant are the freedom from dialysis and the freedom from fluid restrictions. Despite all what people say about daily nocturnal offering outcomes equivalent to cadaveric transplants, I still find dialysis and its attendant problems, both physical and mental, too overwhelming. I would take a transplant any day.

I would go so far to say that once you are diagnosed with kidney failure and are going to need some form of replacement 'soon', do all you can to get a transplant without having to get on to dialysis at all. Try not to know fluid restrictions at all. This is possible and is happening quite often these days. All it needs is swift, prompt, proactive action.

2. CCPD:Second would be Peritoneal Dialysis connected to a cycler at night. This would free up your days and give you the benefits of minimal fluid and diet restrictions. With portable cyclers already available, travel would also not be an issue.

3. CAPD:Third would be manual Peritoneal Dialysis. Three to four exchanges every day. This offers the advantages of minimal diet and fluid restrictions. The only hassle being the 30-35 minutes three to four times a day that you need to spend on the exchanges. Travel is also possible because most providers nowadays have the facility of supplying bags wherever you go. Ideally the patient should self-administer the exchanges to realize the true flexibility and independence of PD.

4. Daily nocturnal home hemodialysis: The best hemodialysis modality. 7 to 8 hours, 6 to 7 nights a week. The problem is you still need to suffer the needles. There is also a certain element of risk. Blood leaks can happen. Hypotension and cramps can happen. Despite all this, the benefits far outweigh the risks. The full advantage of the modality can be realized only if you self-dialyze. It is difficult but can be achieved with proper training available in some countries (not in mine).

5. Short daily home hemodialysis: Two to three hours everyday at home. The problem with this is the fluid removal rates can still be high. Fluid restrictions will still apply. Risks are reduced because you are most likely awake.

6. In center nocturnal hemodialysis:4 to 6 times a week, 7 to 8 hours in center. Offers the benefits of longer duration dialysis but you need to go in-center. Cross infections, inflexibilities.

7. Twice/Thrice a week home hemodialysis: Regular hemodialysis except that its at home. The problems of the modality remain. However at least you are saved from the danger of cross infections with viruses such as Hepatitis B, C and HIV.

8. Regular, in-center hemodialysis: Regular hemodialysis in a center. My least favored option. The default for most people. The only option most people are told about.

... http://www.kamaldshah.com/2011/03/my-list-of-preferences-for-renal.html

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