“Rasam idlis: My all time favorite dish”

Ever since I struck with this Kidney disease, Idlies became my first preference of outside food, because I feel they are served fresh and hot at every place so there would be no possibility of bad effects like stomach upsets food poisoning etc. The other reason for choosing Idlies is, oil is not used in its preparation.

I think it is about 2 years back or so, I happened to stop at Hotel Swathi (Coffee shop) near Paradise fly over while coming back from Dialysis. I was feeling slightly giddy and weekish that day. As I saw this Snack center, I decided to stop and have something to eat and then once I feel better I would resume going home.

I rushed in to the hotel and just by referring to the menu card, eventually I took a token for Rasam Idly, as every time I have been trying to go for a different combination with Idlies. Here in Hyderabad we get different combinations for Idlies than just the Idlies itself. Like Plain Idly, Sambar Idly, Rasam Idly, Button Idly, Rava Idly, Ghee Idly, Guntoor Idly and so on and I may have to see the menu card for the full list of variants.

As I placed the token at the serving counter, the Rasam Idly quickly made ready by the time I came back from the hand-wash. And as this is a self-service place, myself picked the dish and took it to the table. The hot idlis were put in a bowl. Poured rasam on top and then added some kara - bhoondi over it as you can see all this in the below picture. Almost the idlies are dipped in rasam and making them to soak fully.

Idlies served hot at Swati Coffee shop

The best part of this dish, what I liked the most, is the rasam they served. They might be adding little pepper powder to the Rasam while preparation.  It gives me a great feeling to my throat while eating. Since then I have been stopping at this place for these rasam idlies every time, while I am on the way back to home from dialysis.

Believe me, I stopped referring the menu card for other stuff and I really enjoy the rasam idlies here and it becomes my all time favorite dish.

దీపావళి శుభాకాంక్షలు!

చిన్ననాటి జ్ఞాపకాలు!

మేము చిన్నప్పుడు దీపావళిని ఎంతో సరాదాగా జరుపుకొనేవాలం. దీపావళి కి వారం ముందుగానే ఆ సందడి మొదలయ్యేది. మా ఊరి దుఖనాలలో ముందుగానే దీపావళికి సంభందించిన పిల్లలు ఆడుకునే సామగ్రి విక్రయించేవారు. Kids gun, రీల్ లాంటి వాటిని ముందుగానే కొనుక్కొని వాటితో చాల సరదాగా ఆడుకొనే వాళ్ళం. ఆ జ్ఞాపకాలు చాల మధురమినవి.

ఊ రిలో ప్రతివొక్కరు వారి వారి ఇళ్ళను రెండు మూడు రోజులు ముందుగానే క్లీన్ చేసుకోనేవారు. పిండి వంటలు, sweets తయారుచేసే పనిలో ఆడవారు చాల బిజీ గా వుండేవాళ్ళు. సుమారు 20 years ముందు ఈ mixie గ్రైండర్ లు లేవు కనుక దంచడం, రుబ్బడం వంటి  ఏంతో కస్టపడి రకరకాల తినుబండారాలు అరిసెలు, తుల్లట్లు, జంతికలు, గులాబులు లాంటి చాలారకాల నిలువ ఉండే వాటిని తాయారు చేసేవారు.

ఇక దీపావళి నాడు ఉదయాన్నే తలకు స్నానం చేసి కొత్తబట్టలు వేసుకొని వీధులలో స్నేహితులతో కలిసి తిరుగుతూ చాల సరదాగా గడిపేవాళ్ళం. ఇంట్లో ఇచ్చిన డబ్బులు తో మిఠాయి లు కొనుక్కొని తింటూ స్నేహితులతో పంచుకోనేవాళ్ళం.

టపాసులు

సాయంత్రం అవ్వగానే గోగు పుల్లల కోసం ఊరి చుట్టూ తిరిగి ఏదోలా సంపాదించాలి. ఇంటి ముందర 5 చిన్న గోతులు తీసి వాటిలో ఈ గోగు పుల్లలు పాతి  పెట్టి వాటికి పలుచని బట్ట చుట్టి ఆయిల్  పోసి పెట్టాలి. రాత్రి ముందుగా ఇంట్లో పూజ జరిపి ఇంట్లో ఒక చిన్న టపాసు కాల్చి ఆతరువాత  ఇంటి చుటూ  పెట్టిన ప్రమిదలు వెలిగించి లక్ష్మేదెవి ని ఆహ్వానిస్తూ దీపాలంకరణ జరుగుతుంది. ఆ తరువాత అసలు పర్వం తాపసులు తో మొదలై మోత మోగేది.

గత 5 years నుండి నేను మా ఊరికి Dialysis కారణంగా వెళ్ళలేక పోతున్నాను. 

I wish a very happy Deepavali to all my villagers, and a big thank you to all those who genuinely remember me and ask about me when my parents reach my village occassionally. I am also very grateful to all my childhood friends and families who helped me and my family during our tough times.

Here is a list of my childhood friends I can remember from my school days and I specially wish them and their families a very very happy and safe deepavali.

1. Dakkata. Tarakeswara reddy & his Family (Now working for Jagjeet industries, Hyderabad)
2. Mangi.Bheemasankar & his Family (now working in Saudi Arebia)
3. Neelapu. Narasimhulu & his Family  (Working for NTPC, Talcheru, orissa)
4. Jogala. Viswanadham (my cousin, Farming in my village)
5. Gedela. Jagan kumar (a private job in Dubai)
6. Gedela. Jejerao (a private job in UAE)
7. Mangi. Padmanabham (CRPF, A cetral security service)
8. Ladi. DharmaRaju (Indian Army)
9. Mangi. DilliRao (a small contractor in Gurgaon)
10. Mangi. Jagan mohan reddy (L&T, Gurgaon)
11. Savarasi Mohan Rao (a private job as welder Qatar)
12. Dakkata. Nookaraju (Farming in my village)
13. Jogala. Nookarau (Farming in my village)
14. Mangi. Shivakumar (Bhima's brother)
15. Mangi. Shiva (Indian Navy)
16. Mangi. Balaraju (Working for a software Company in PUNE)
17. Mangi. Kumar (Now working for Nucon industries, Hyderabad)
18. Jogala. Bhairagi (MCA Completed)
19. Jogala. Tumbayya (Indian Army)
20. Jogala. Sesha rao
21. Jogala. Venkatesh (Persuing Diploma Mechanical) 
22. Dakkata.Tirupathi (Site Incharge, for a private company)
23. Dakkata. Sanjeev
24. Dakkata. Dora
25. Durgasi. Chandrayya
26. Palepu. Tonkarao
27. Gedela. Sekhar
28. Gedela. Umamaheswar
29. Pandi. Vaasu
30. Pandi. Prakash

I hope had listed out all the friends here. Please forgive me by any chance if had i forget anyone. But guys believe me it would not be an exaggeration to say that to day I have been able to live inspite of such a chronic ailment is only because of all your blessings and well wishes. Once again wish you all a very happy Deepavali.

                                                                                         ---- Your's Loving friend, Murali.

My Calcium and iPTH both are low. Why?

(Is my PTH is not responding or is it got suppressed by the use of Calcitriol?)

  

Recently when I got my blood tests done, the calcium and PTH (Parathytoid hormone) levels of my blood observed little lower than the normal range. PTH is inversely proportional to Calcium. So when calcium falls then PTH should increase. Whereas, both PTH & Ca found to be low in my case. Why?

Blood tests Dtd.10/10/2012

My Calcium:   8 mg/dl (Target Calcium - 8.5 to 10.5 mg/dl.)

My PTH:         71 pg/ml (Target PTH in Stage-5, CKD: 150-300 pg/mL)

Something important to know in general for all:

Calcium: is the most plentiful mineral in the body that is essential for building new bone cells and keeping existing bones strong and also to keep the nerves function properly. If calcium levels in the blood become too low, the parathyroid glands (four small glands at neck) release a hormone called parathyroid hormone (PTH). This hormone regulates calcium levels in the blood.

Vitamin D: Healthy kidneys activate vitamin D. The activated form of vitamin D is called calcitriol. Calcitriol helps the body absorb calcium. Working together, calcitriol helps maintain normal parathyroid hormone (PTH) levels, and they carefully balance calcium in our system (Body).

If blood calcium levels are too low (either it may be due to vitamin D deficiency or low calcium intake with food or for any other reasons like kidney failure) the PTH hormone will begin removing calcium from the bones to get calcium blood levels back to normal. Over months and years to this effect, as calcium is stripped from the bones, this can make the bones weak, so their texture becomes more like a piece of chalk than of a sturdy bone.

So to understand in a simpler way, the body needs Vitamin D, Healthy Kidneys and active PTH gland to maintain normal levels of calcium in the blood.

For the people on Dialysis:

When kidneys fail, they stop converting inactive vitamin D to calcitriol. The result is your body is unable to absorb calcium from food, so it “borrows” the calcium it needs from the greatest calcium storage depot — the bones as described in the previous paragraph.

Doctors prescribe Kidney disease patients (whose kidneys aren’t making enough calcitriol) a special “active vitamin D” supplement, and may also prescribe a calcium supplement if needed. On the other hand, once the calcium level is high, your doctor may withhold vitamin D therapy until calcium levels are back to normal. Because with too much Calcium in the blood, the Calcium starts getting deposited on the walls of your veins and arteries leading to vascular calcification which can be fatal if not corrected in time.

Now coming to my case:

Few months back during my routine consultation with nephrologist, I was complaining about body and muscular pains. My calcium was normal but nearer to the lower side of the range and PTH was not tested then. My doctor prescribed calcitriol (active vitamin D” supplement) also suggested me to come with PTH report in the next month’s visit. This may be attributing to secondary hyperparathyroidism ‘low calcium and high PTH’, which is a long term side effect of kidney disease. The idea might be, “Calcitriol increases Calcium absorption and also decreases PTH”.

But recently when I did my blood tests, the reports come out with both calcium and PTH low. And subsequently when I consulted the doctor, he stopped me to continue Calcitriol and asked me to start another supplement that is Calciriol granules (which is basically Inactive Vitamin D3 – Cholecalciferol ). Hopefully this should help my calcium to increase and PTH to settle at a normal value that assigned to ESRD folks.

Why my PTH fall to a low value when the Calcium is Low? And where the mistake took place?

I think by taking the Calcitriol(Vitamin D3) my PTH gland got suppressed its ability to regulate calcium levels in the blood as Calcitriol decreases PTH. If had I got tested my PTH at the first instant and as it would come normal, my doctor should not have prescribed Calcitriol at all and instead he should have prescribed some calcium supplements to increase my calcium levels in the blood. Since I have stopped the Calcitriol now, hopefully my PTH will raise its head and work normally to regulate blood calcium value to the required level.

But still I did not understand one thing is that if I stop calcitriol while living with failed Kidneys, how vitamin D will activate and help my body to absorb enough calcium? Because only Healthy kidneys can activate vitamin D that we get either from food or sunlight further enabling body to absorb calcium.

Ahhh! for me It’s been quite tiring to keep thinking about all this for some time. Now I decided not to worry too much and just leave it to my nephrologist during my next visit.

Nurses may not be angles, but they are the next best!

Nurses are indeed the backbone of the medical field. This is very much true in dialysis centers too. They’re on the front line to deal with patient’s issues every day, while also ensuring that they feel comfortable and secure every step of the way.

Anu, Divya & Soumya were working as nurses in the center where I am getting dialysis. Recently Divya & Soumya had resigned on their personal reasons and left a month back. Now I learnt that Anu is also resigned and in notice period of 1 month. She said 3rd Sept 2012 will be her last working day at our center. These nurses are very friendly and very much cordial with all the patients during the dialysis sessions. Almost for 1 year I have been associated with this center so with them also. Such a nice gentle ladies they are and the whole magnitude of their association as quite gratifying.



Divya, Chari Brother(Sr.Technician), Soumya and Anu.( From Left to Right)

 This time I felt a bit miserable while saying good bye to them. Some where in-depth of my mind I feel like why can't we get all the people together in the world that we really like and then just stay together? I guess that wouldn't work. Someone would leave. Someone always leaves. Then we would have to say good-bye. Honestly, I am not a kind of person to say good-bye with that ease when I knew that I will never be able to see them again. I hate good-byes. But this is all about life. A journey that, we all have to reach our destinations and different destinations. I guess we need to accept that life is all about change.

Here I wish them a great success in all their future endeavors with full of happiness throughout their lives. Though missing a lot, wish you all the best ladies! Thank you very much for the service provided to me during the period of my dialysis and everything you have contributed to the center!

Shall I use the High flux dialyzers or go with the standard F6 Dialyzers? I am a bit confused…

In India most of the dialysis centers use low flux dialyzers for the Dialysis process as a standard practice irrespective of the patient weight and for the no. of years he/ she is being on dialysis. Particularly in our country in most of the dialysis centers the role of nephrologist is just and only limited to verification of blood reports and accordingly prescribing the medication. Their role in dialysis unit is very less except only advising the patient if he needs the dialysis of 3 times or 2 times in a weak and about the need of EPO and Iron injections. As a standard practice many centers use Fresenius (F-6) Low-Flux dialyzers for either Bi-weekly or tri-weekly dialysis process. The entire dialysis process is simply left to the technicians who themselves don’t have much theoretical knowledge, so without doing much for customizing on patient requirements they simply set the machines at standard parameters and operate.

But in many developed countries, now high-flux hemodialysis is the most common mode of dialysis therapy. Its steadily increasing use is largely based on the desire to reduce the excessively high morbidity and mortality of end-stage renal disease patients comparing with the patients maintained on conventional dialysis (i.e. Low flux dialysis). Studies of medical research says for selected subgroups of high-flux dialysis patients by the use of High Flux dialyzers, the clearance of B2-microglobulin molecules, phosphorous, homocysteine is far high and this will protect the patient from the comorbidity conditions of primary decease like amyloidosis and Cardio vascular decease etc. So it may be concluded like the mortality of the patient is much better with the use of High flux dialyzers as compared to the use of standard low flux dialyzers of F-6 Class.

The major disadvantage of high-flux hemodialysis relates to the use of dialysis fluid, which is commonly not pure and may endanger patients treated with high-flux hemodialysis. Endotoxin fragments and other bacterial substances derived from bacteriologically contaminated dialysis fluid may (even at bacterial counts or endotoxin concentrations within the limits of accepted standards of dialysis fluid purity) enter from the dialysate into the patient's blood either by convective transfer (backfiltration) or by movement down the concentration gradient (backdiffusion). And this may cause severe infections.

After reading so much on internet about these articles, from some time I had been seriously thinking about switch over to use of high flux dialyzers. Recently I came to know that a great friend of me (who himself on dialysis) being started the use of high flux dialyzers. This I knew while I was reading his blog. Immediately I spoke to him and requested him if he can get one or two H.F.Dialysers for me. After convincing him, to switch over to this mode of dialysis, initially I got 2 numbers of “HF80S” Dialyzers from him. I need 12 to 13 Dialysis per month, so I decided to re-use this HF80S for six times and the remaining 6/7 with the regular F-6 Class low flux dialyzers. Till this everything was fine.

I have started using HF80S from 18/08/2012. Now all of sudden I have developed Cold, Cough and a very light fever with a bit of chills and this is all only after started using high flux dialyzer. Though I don’t have any solid evidence about the reason for this infection, still I am a bit worried if it might be due to the use of H.F.D. The reason for this is as I mentioned in the previous paragraph, when I use H.F.D., the quality of the water used for dialysis process shall be of ultra-pure quality. I have no guarantee for the quality of water that is being used in my Dialysis center. I strongly feel there is no control on it and hardly have they ever done the periodical testing to check the quality of the water.

For the last one year I have not been to any infections like this. Though I have been consulting my nephrologist time to time but that is only to show my blood reports and to get his advises on medication if any change that may be proposed by him. Otherwise I was normal. But as I got this viral infection now and again that is only after the use of H.F.D., I am a bit confused if to continue this mode of therapy or stop for some time?

Please advice....! Kamal, are you listening?

Kamal Shah!

(Dear Friends! please read this and must watch the article published in HINDU daily)

Kamal Shah, Co-founder and Director, Patient services of Nephroplus, kidney care clinics.

Kamal is an Indan-Idol for kidney patients. He, himself being a dialysis patient, the will power what he has is enormous. No words are sufficient to appreciate his good work done in Kidney patient services and the work done in educating the kidney patients.

To my surprise, Kamal invited me and Ayodhya ram to a movie and last Sunday we had been to Eega at Prasads Imax. Honestly speaking, for that evening I was watching movie with kamal was like a dream. I still can’t believe that it happened. Thank you kamal!

An article about him is featured in the largest circulated daily news paper ‘THE HINDU’!

(Proud of you Kamal! Keep it up.)

Here is a link to the article:

http://www.thehindu.com/life-and-style/society/article3763299.ece

(Here is a short message how I met him and made myself positive about the life with dialysis)

I had seen him first time in the month of Jan’ 2010 at Jain trust while Dialysis coupons distribution activity. Those were the days; I had completely lost hope in my life as my transplanted kidney also failed by then and my doctor advised me to start and be on regular dialysis. That meant I had to reach dialysis center every other day almost. The hell…

But there I saw this miracle man!

Till then I had no clue at all that such a wonderful, down-to- earth personality living in this part of world. I saw him there at Jain Trust, having a bunch of pamphlets in one hand and holding the mike in other, announcing about the invitation for all the patients to attend one full day fun program being organized at Hotel Fortune select Mahohar. That was on 6th Feb 2011. The event called 'Aashayein - Let's celebrate life' (The one day exclusive free event for dialysis patients). There I had carefully observed the patient educational talks by nephrologists, urologists, dietitians and also few patients. I had never thought for such an event that would be made for all the patients. I learnt so much there about the importance of blood tests, diet, medication, dialysis and how to get the adequacy in dialysis and also how to protect the AV Fistula which is life line for the dialysis patient. There was also being a whole lot of fun and games like antakshari etc. exclusively for dialysis patients. And an elaborate lunch served as per the dialysis patient diet.

The event Aashayen-2011 was a hit. The way Kamal organized the event was really great. For anyone it is very difficult to imagine the hard work and tremendous negotiations he might had with nephrologists, urologists, dieticians in inviting them to attend the program for making it success. Who cares for the patient events? Again it is difficult to imagine his initiatives! and assume how nicely he would have convinced so many intellectuals and event sponsors to make his wonderful thought a reality.

He also maintaining a web site naming “Hyderabad Kidney foundation” in which he launches a newsletter regularly providing information  exclusively for patients of kidney disease, whether on hemodialysis, peritoneal dialysis, transplant recipients or any other kidney disease.

Again this year in 19^th February 2012, he extraordinarily organized the annual event Aashayen-2012. This time it created a sensation and a huge hit by participation of more number of patients. He also initiated with a new event called “Patient support group talks” inviting all the kidney patients to get together and discuss their problems and involving medical professionals for advising them.

Is it not something that he is doing more that expecting? Thank you once again Kamal! I am very grateful to you always.

Nature continuously expresses itself with unconditional love, light, sound and color!

(if you do not have enough time to read the below lines…it’s OK. But don’t miss to follow the link to watch the mind blowing panaromic view of Tajmahal...!!! enjoyyy...)

http://www.airpano.ru/files/Taj-Mahal-India/2-3

Taj Mahal was built by Shah Jahan, the famous mughal king for his favourite wife Mumtaz as her final resting place. His love for his wife was deeply rooted in this awesome monument. It is indeed fascinating.

Built of marble with 4 perfect symmetrical minarets leaning slightly away from the main monument for factor of quake, it took 22 years (1630-1652) of hard labour. Story had it that Shah Jahah ordered that coins be thrown around the site to lure thousands of workers to work on this piece of life art. Interior walls have inlay of semi-precious stones of ruby, sapphire, pearls, just to name a few.

The facade of the arch facing the monument are verses of the Holy Koran inscribed on it, magnificient enough that all the wordings are sized the same, from any directions. At the top of the arch are 22 small domes, signifying the number of years the monument took to build.

Surrounding the main monument are beautiful parks with water. A masterpiece of symmetry, as if floating in the air when view from a distance.

Built by the Persian architect, Ustad Isa, the Taj Mahal is on the bank of the Yamuna River. It can be seen like a mirage from the Agra Fort where Shah Jahan was imprisoned here by his very own son, Aurangzeb. Shah Jahan spent the last eight years of his life at the Fort staring at his beautiful beloved, Taj Mahal. History had it that the tomb of Mumtaz Mahal is under the monument. Subsequently his son also erected Shah Jahan's tomb next to his wife.

Taj Mahal built on a marble platform stands above a sandstone and the dome has a diameter of 60 feet and height of 80 feet.

Taj Mahal is indeed a living art of a husband’ s love for his wife and provides such a flavor one cannot find elsewhere. It makes one want to come back for more; sunrise and sunset at the Taj throws a different spectrum!

Importance of drinking water

Importance of drinking water at the correct time maximizes its effectiveness on the Human body :

1.) 2 glasses of water after waking up helps activate internal organs.

2.) 1 glass of water 30 minutes before a meal helps digestion.

3.) 1 glass of water before taking a bath helps lower blood pressure.

4.) 1 glass of water before going to bed avoids stroke or heart attack

Recover your credibility

Friends,

At many instances, most of us make a commitment to others that to those they may be within our family or friends or even the fellow colleagues at our work place. And then we take light or don’t really bother for that and finally fail to honor the commitment. These things may even like inability to quickly return their phone calls, to be on time to meet with them, or to get ready on time when we are going for family outings are a few of the circumstances where we failed to keep our word. This will definitely cause some disappointment to the person other side that we have committed but couldn’t honor.

Sometimes this happens to us also. This is what Credibility gap.

Prasad Kaipa is a senior fellow in center for leadership, innovation and change at the Indian School of Business, Hyderabad.

Below here is the link in which you can read more about the views of Prasad Kaipa about Credibility gap and how to “recover your credibility”.

And just understand how are you minding your credibility gap? What is working and what is missing?

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Not long ago, I called a friend of mine who had promised to help me with a project. He was... Read more

Dr. A.P.J.Abdul Kalam

Om Namo Venkatesaya...

Om Namo Venkatesaya...