I was chatting with two patients at NephroPlus. Both of them were around my age, relatively recently diagnosed, on dialysis for a few months, still coming to terms with this dirty disease.

One of them remarked, "I often think - I never touched alcohol, never smoked, never had any bad habits. Despite this how did I end up with this problem? I had many friends who had every bad habit conceivable. They are all perfectly healthy." The other laughed and said, "Those people will never have any health problems! It is only fools like us who lead good lives that end up with this!" I totally agreed.

I have also experienced this. I was the 'good' guy in my family and at school. I was very well-behaved, conscientious, studious. I was also very religious. My grandmother once famously remarked that I was the 'essence of correctness', a phrase that has come back to haunt me from time to time.

Yet I was the guy who got diagnosed with this life-changing illness.

Even among people on dialysis, I get the best possible dialysis. Very few people get the amount of dialysis I do. I am also very proactive about my health. I research about my condition, try to read up about my condition and participate in the forums on the internet. In spite of all this, I have all the co-morbidities of long term kidney disease. I am now battling a skin condition.

On the other hand, I know of people who get dialysed barely twice a week, do not control their diet, don't even visit their doctor regularly, are least bothered about their condition and the new research that is coming out. Yet, they are totally normal apart from the dialysis bit.

All three of us agreed that we shouldn't have been so good and should have 'enjoyed life' so to speak. Its too late now though and our medical conditions forbid us from doing anything even remotely intemperate. Well, there we go again!

I have been using Google + for just a couple of days. I really like it. Thanks Jayadeep Reddy Thum for the invite! It has what I love about Facebook. It does not have what I hate about Facebook. So, there!

One problem I have had a lot with Facebook is my home page would be flooded with useless updates - updates I have no interest in. This guy became friends with seven other people or this girl was tagged in that guy's picture. This dude and four others changed their profile picture. Who cares? And don't even get me started on yes, you guessed it - Farmville and the gazillion other nonsensical games that people play on Facebook.

At any given time, about 75% of my home page on Facebook is absolute junk. There probably might even be a way to turn off all that junk on my feed. But who has the will to find out? That should be the default.

So far, Google + has managed to keep out the junk. But I must wait and watch for a few days before I decide that it truly is well done.

Another problem I have with Facebook is that often I would like to post something only to a selected group of my friends. No way you can do that. So, my posts actually add junk to other people's home pages! Google + has solved that beautifully with Circles. So, now I can create multiple circles of my friends and post stuff only to selected circles! Brilliant!

The Hangout feature where you can video conference with multiple people at once also has been talked about a lot and many people have loved it. I haven't yet got a chance to use that but it sounds exciting.

So far, the ride with Google + has been excellent. If this continues, I am going to bid adieu to Facebook very soon. I am hoping all my friends on Facebook also move to Google +. The only catch - you still need invitations to be able to sign up!

I used to hate bhindi (ladies finger, okra). When I was a kid, I used to absolutely detest meals at home that included bhindi. The thickness of the outer part with all those gross seeds inside never appealed to my imagination.

I found many people like me. However, there were also some people who would swear by the bhindi. My dad's elder brother, for example, loved it and in an amazing manifestation of the genetic theory, his son did too. I never understood that part of them though.

As I realized over the years, there were no fence sitters when it came to the bhindi. You either loved the vegetable or you hated it.

In Effigent, we had a lot of young developers who were of, as they call it, 'marriageable age'! In their mid-twenties. As it happened, one by one, they would get married. A lot of them were Telugus. So, we would go for their weddings and receptions. Madhavi was one of the earlier ones among this lot.

Now, you might be wondering what Madhavi's wedding has to do with the bhindi? Bear with me for a bit, dear reader!

So, at Madhavi's wedding there was quite a huge spread. There were hot dosas being made at one side. There was the Dahi Wada, the regular puri, some nice sweets and - you guessed it - the bhindi. At first, instinctively, I passed. When my colleagues and I gathered in one area of the dining hall, plates in hand, making our way through the food, one of them remarked how great the bhindi fry was.

"Yeah, right!" I remarked. How can anything remotely got to do with the bhindi be great? He said I should try it. At first I was very hesitant. All the years of hating the vegetable made it difficult to give in. At this point another colleague joined in. "Even I hate bhindi but the bhindi fry is something else!"

That was it. I had to try it. So I went over to the buffet table and took some rice, some sambar and a little bhindi fry. The vegetable had been cut to small circular bits and deep fried and then some masalas added. They were garnished with curry leaves, fried cashews and peanuts.

I put a little vegetable with rice in my mouth. It was really excellent! It was almost as if the entire evil inside the bhindi was exorcised by deep frying it! I went back for more.

Ever since, I have been an ardent bhindi fry fan. I still haven't made my peace with the plain vegetable. The bhindi fry, however, is 'something else'!

In the context of dialysis and clearance of toxins, molecules such as Creatinine, Urea and Potassium are easy to clear because they are fairly small and pass easily through the membrane of the dialyzer or the artificial kidney. However, there are some bigger molecules such as Beta 2 Microglobulin. These molecules are very difficult to remove since they do not pass through the dialyzer membrane. It is important that these molecules be removed since they are also, after all, toxins and are harmful for the body.

There has been some discussion about how longer duration, more frequent dialysis removes the middle molecules more efficiently than the conventional modalities. I fail to understand how though.

Let's say you drill a hole in a wall about the size of a marble. Now, take a football and hit it against the hole. Will it go through? Obviously not! Now try again and again for a few hours. Will it make any difference? Obviously not!

This is very similar to the middle molecule scenario. The middle molecules simply cannot pass through the membranes of the regular dialyzers because the pore size is not big enough. The duration of dialysis cannot influence the result. Neither can the frequency. So, for a change, you have longer, more frequent dialysis as ineffective at achieving clearance of middle molecules as conventional dialysis.

How can we then clear middle molecules effectively?

High flux dialyzers. These dialyzers have bigger pore sizes and are the only way middle molecules can be cleared. Again, you will need more frequent, longer duration dialysis to be able to do this effectively. But high flux dialyzers really are the key.

This was also demonstrated in a study conducted in Australia outlined in this paper.

Huh?

Well, that's what they suspect my recent skin condition to be!

My skin has become increasingly brittle. It cuts very easily. Barely do I scrape against a wall and my skin gets cut. I also get small blisters on my hands and feet from time to time. Yuck!

So, I showed them to my nephrologist and he asked me to see a dermatologist. The dermatologist carefully examined my hands and suspected that this could be Porphyria Cutanae Tarda, a condition commonly found among people with long term kidney disease.

I have been asked to get tested for the presence of Uroporphyrins which will confirm this diagnosis. The problem is this test is done in very few places in India. I am trying to see if I can get it done at AIIMS, New Delhi.

If the diagnosis is confirmed, then I might be put on Chloroquin, the drug used in Malaria. Wikipedia says with Chloroquin the condition usually settles in 6-12 months.

Well, whatever it is, at least I have a condition that has a fancy sounding name! Kinda cool, you know - Porphyria Cutanae Tarda! Heck, there is even a song by that name - see the second song in this album!