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In a brilliant blog post on Home Dialysis Central, Dori Schatell of the Medical Education Institute says:

"At the NKF Spring Clinicals meeting in March, a comment I was told that someone made at the microphone during a session still bothers me months later. The gist of it was: “Why does all of the responsibility for improving outcomes fall on clinicians—where is the patient in all of this?” [Good point, but it goes on…] “I lose money if my patients don’t reach the quality targets. Why can’t we fine the patients if they don’t do their part?—and audience members applauded!"

This attitude among some nephrologists (not all are like this, of course) is extremely bothersome. No one chooses to be on dialysis. It is something thrust upon them. How can anyone have such a callous attitude towards them? 

The entire healthcare system has failed us dialysis patients. Look at the amount of innovation that has happened in cardiology and compare that with the innovation that has happened in dialysis. Only one word can describe this: pathetic.

The situation in India in terms of problems that patients have is far worse. Add all the problems that patients in developed countries have and add the fact that you need to pay out-of-pocket for everything and the cocktail becomes that much more heady. When there are better options available in the world today, we are still expected to make do with something that is hardly optimal.

And yet, we are called non-compliant!

I am not finding fault with nephrologists. The problem is the system. Healthcare in India is a different beast. The humungous population, the lack of resources, non-protocolised delivery and the very low patient to nephrologist ratio all contribute in some measure to the problem.

All I am saying is that healthcare providers need to be a little more sympathetic to these problems. Treat us with a little more dignity, a little more compassion. That should be doable, right?

... http://www.kamaldshah.com/2015/08/dont-blame-us-for-being-non-compliant.html


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Sunday, 16 August 2015 21:11

A possible solution to end Parliament disruptions

Written by Kamal Shah
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The recent Parliament session was a complete wash-out. Disruptions by the opposition, led by the Congress prevented important bills from being passed. Apart from the huge loss of money incurred by running the houses of Parliament without any business being transacted, there has been an incalculable loss in terms of opportunity by not passing important bills.

Who is really to blame?

The supporters of the BJP lay the blame squarely on the shoulders of the Gandhis who have such a pathological hate for Prime Minister Narendra Modi that they are loath to see him become successful in anything. The Congress, on the other hand says that they are not doing anything the BJP did not do when it was in the opposition. This is not entirely devoid of truth. Yes, of course, if they did something wrong, it does not mean you do it as well!

This cycle of disrupting Parliament needs a permanent solution.

Consider what Parliamentarians earn. Apart from a monthly salary and allowances of Rs. 1.3 lakh per month, they get a daily allowance of Rs. 2,000 to attend Parliament. All this is tax-free. Apart from this, "MPs can travel anywhere in the country by rail, first class, and get 34 free air tickets for themselves or a companion a year. Spouses of MPs can  travel free by air from their residence to New Delhi eight times a year when Parliament  is in session and unlimited number of times by rail."

What needs to be implemented strictly is a pro-rata system. Pay only for the work done. For example, if the official number of hours Parliament was supposed to function was x, of which due to various disruptions, it worked only for y, pay only y/x of all the above mentioned amounts. The important thing is that all the allowances, air tickets, household expenses etc. should all be paid pro-rata. Just doing this for the salary would hardly achieve anything.

As it is, most MPs are wealthy enough for this to make much of a difference. So, we need to be very stringent about these conditions.

There has been some talk about such a proposal, to which there already has been some opposition.

We need to implement this quickly. The country has already lost a lot of money due to our inconsiderate and egoistic leaders.

... http://www.kamaldshah.com/2015/08/a-possible-solution-to-end-parliament.html


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Tuesday, 11 August 2015 21:26

MSCs help us Reject Rejection

Written by Greg Collette
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The light of rejection-free, healthy kidney transplants has entered the tunnel, and should arrive at our end in just three to five years.

Last month a senior researcher from the Cell and Tissue Therapies WA at the Royal Perth Hospital (CTTWA) presented a paper to the Renal Society of Australia‘s annual conference that has profound implications for us BigDers.  It detailed their early clinical trial successes in using Mesenchymal Stem Cells (MSCs) to stop kidney transplant rejection and to repair acute kidney injury (among many other medical wonders).

Quick MSC primer:

Stem cells in our bodies have the amazing ability to self-renew (make exact copies of themselves) as well transform, or differentiate, into other cell types with specialized functions, such as blood cells, muscle cells, and so on.  They become the various cells throughout our bodies during early development, and help maintain and repair certain tissues during growth and adulthood.

MSC Manufacture

MSC Manufacture

Mesenchymal (“Mezen-kye mel”) Stem Cells are adult stem cells that can give rise to many types of tissue, such as bone, cartilage and fat.  MSCs were originally discovered in bone marrow, but they also exist in other body tissues, including skin, fat, placenta and umbilical cord blood.

In the mid-2000s, early clinical trials found MSCs could suppress inflammation and repair damaged tissue, and might potentially be used to treat diseases like myocardial infarction, liver cirrhosis, Crohn’s disease and amyotrophic lateral sclerosis (ALS).

Then in 2006, researchers found that they could also help repair damaged tissue, suppress immune reactions and even prevent rejection.  Not just for matched donor-recipients, but for universal use: they induce no immune response of their own so they can be manufactured, frozen and provided at call, off the shelf.

Successes with transplants

CTTWA at Royal Perth Hospital, like many others around the world, began working with MSCs around 2005.  Initially, they developed processes and techniques to manufacture them (they are now a licenced MSC manufacturer and provide frozen MSCs for clinical trials evaluation to hospitals around Australia).

Then, following the finding of MSCs capacity to suppress the immune system, they also began clinical studies to evaluate their safety and effectiveness for treating transplant rejection.  Their first trial, in 2007, was as the last resort for a young bone marrow transplant patient who was suffering the final (and usually fatal) stage of Graft vs Host Disease (GVHD).  This may happen after a bone marrow transplant where the donor’s bone marrow attacks the patient’s organs and tissues, in serious cases with horrendous consequences.

Soon after infusion, the MSC’s calmed the immune reaction, reduced the symptoms and began repairing tissue.  Subsequent treatments over the following weeks saw almost complete remission.  Months later, the GVHD returned, but faded again with further MSC treatment.  This cycle of remission and relapse continued for the next few years.  Now in 2015, the patient has been free of GVHD for over three years.

Protocols for treating patients continue to be developed.  For example, there is now a clinical trial with MSCs being administered as soon as the GVHD is detected, rather than waiting until the disease becomes life threatening.  Subsequent GVHD trial patient recovery numbers show that MSCs can significantly reduce and even eliminate rejection (52% recovery vs 10-15% recovery rate before MSCs).

Two years ago the Centre began clinical trials on lung and kidney transplant rejection, and on repairing donor kidneys that have been damaged during removal, between transplants, or when blood supply returns to the kidney when first transplanted.

MSCs stop rejectionA typical kidney transplant rejection treatment protocol consists of a series of small infusions (about 40mls) of MSCs into a vein, typically over a 4 week period: the rejection fades away.

While as yet incomplete, all of these trials have provided clear evidence of the effectiveness of MSCs in suppressing rejection and repairing damaged organs.

So what are we waiting for?

The paperwork.  Every new drug treatment needs detailed written clinical trial evidence of safety and efficacy.  In the right format, over an extended period, in triplicate.

Formal clinical trials are longwinded, meticulous beasts (as they should be, we don’t want the cure to be worse than the disease).  They usually go through three phases before release:

  • Phase I clinical trials test a small group of people (e.g. 20-80) to evaluate safety (e.g. to determine a safe dosage range and identify side effects). These are cheap to run and are often run in-house
  • Phase II clinical trials may test from twenty to several hundred to check that it works as intended and to further evaluate its safety (the number depends on how effective the therapy is: these Phase II studies only need 20-66 patients)
  • Phase III studies may test several hundred to several thousand by comparing the therapy to other therapies, monitoring for adverse effects, determining dosing schedules etc, depending on the design of the trial and expected response.

There is also a fourth Phase IV done after the treatment has been released for use.  Where clinicians monitor the effectiveness on the general population and check for adverse effects of widespread use over longer periods of time, etc.

The current MSC kidney transplant rejection trials are in Phase 1.  Phases II and III get progressively more expensive (we are talking several to many $millions) and time-consuming (3-5 years depending on the recruitment numbers).  However, if the early Phase clinical trial outcomes demonstrate high clinical efficacy then it may be possible to fast track release (making it even less than 3 years).

So for those who want to be involved right now, it’s not easy.  Patients may be recruited to a trial if they fit the profile and eligibility criteria (people who are actively rejecting a transplanted kidney and being located in the right city are two big ones) and are prepared to accept the risks.  Some patients may be granted special/compassionate access to a trial, for example if the treatment is their last resort, having exhausted all other avenues.

So, in summary, MSCs look like they can be used to stop rejection in its tracks, but we need to wait for the clinical trial outcomes.  While frustrating, this is a lot better than where we were a few years or two ago, when things looked positive, but unproven.

The light in the tunnel is getting brighter, but there are still a few stops before it arrives.  For a working transplant, I can wait, and maybe even put off any transplant until it does.

... https://bigdandme.wordpress.com/2015/08/12/mscs-help-us-reject-rejection/


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Tuesday, 04 August 2015 21:08

Announcing India's first Atypical HUS Registry!

Written by Kamal Shah
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Atypical Hemolytic Uremic Syndrome is an ultra-rare disease affecting a small number of patients world-wide. This devastating disease affects children and adults and without proper management and treatment by experts can lead to kidney failure and in some cases, even death.

Very little data exists about this disease in India. No published data about the incidence and prevalence of this disease is available. It is very important for some database to be available because without this, it is difficult to make a case for pharmaceutical companies, healthcare providers and importantly, the government to take any decisions regarding this disease.

This is my primary disease, the disease that caused my kidneys to fail. I founded The Atypical HUS India Foundation a few months back which is now a registered Trust. Through this foundation, I have started a registry for Atypical HUS Indian patients.

I am requesting patients and family members to please spare a few minutes and fill out the registry form so that we can make a small beginning in collecting some data about this disease in India.

The link to the registry form is here.

Please share this with anyone you know who is afflicted with this disease or has a family member or friend who has this disease and request them to fill out the form. No personal data would be shared with anyone. The data will only be used for analysis. Thanks!

... http://www.kamaldshah.com/2015/08/announcing-indias-first-atypical-hus.html


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I was at one our dialysis centres this Saturday afternoon. This centre is inside a hospital. I did my usual round of the centre, talking to a few guests, inspecting the facility and then settled down at the Duty Doctor's desk. A few minutes later, a patient was wheeled into the unit on a stretcher. There was commotion all around. The patient was critical and needed to be put on a ventilator and dialysed. The patient was shifted onto the bed and a ventilator was brought in. A doctor in blue scrubs followed. Over the next half an hour or so, the patient was put on the ventilator by the doctor, presumably an anesthetist.

For the first time, I had seen someone being put on a ventilator. The way the anesthetist went about the whole process really blew me away. He remained calm and composed throughout the process. At times, there was panic among the other staff from the ICU who had accompanied him. But he remained at ease, skillfully going about his job. He realised that a mistake could cause the life he was literally holding in his hands to slip away.

A few minutes later, dialysis was begun.

When I was nearing completion of my 10th, I was very clear in my head. I wanted to take up engineering. It was primarily driven by my hate for biology. I would do anything to not study biology any further. Looking back, I feel that not enough counselling is available in India to help you decide. Also, at that age, I am not really sure how many people are mature enough to make up their minds on such an important aspect.

However, it was not until a few years after I was diagnosed with kidney disease myself in 1997 did it dawn on me that I would have really loved being a doctor. Maybe, if I was not diagnosed with kidney disease, I might not have felt that way!

When you are on dialysis, you see a variety of doctors. Your life practically revolves around doctors. I genuinely believe there is no feeling greater in this world than that felt by a doctor when a patient thanks you profusely for relieving him of a major problem. It is not the financial reward, it is not ego, it is not power. It is a simple connect between two human beings. This connect is impossible in high paying software jobs, in closing huge business deals, in financial services and - you're not going to believe I said this - in making great food!

Some people argue that by being in a healthcare company, the impact that can be made is much greater since you are bringing quality healthcare to a lot more people than that possible by being a doctor. I beg to differ. For me, it is all about the personal connect. That 30 seconds of the warm, fuzzy feeling in your heart when you look into your patient's eye and see the genuine gratitude. No other job in the world can rival that.

... http://www.kamaldshah.com/2015/07/i-will-always-regret-not-taking-up.html


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I attended the aHUS UK patient meeting and the aHUS Alliance meeting in London during the last week of June. I learnt a lot of new things about aHUS. I am going to summarise the learnings here.

The biggest takeaway for me was that there are four new drugs in the pipeline to treat Atypical HUS. Dr. Wynne Weston-Davies of Volution Immuno Pharmaceuticals presented this information:

- ALN-CC5 from Alnylam
- Compstatin from Apellis
- OMS721 from Omeros
- Coversin from Volution

This should ideally result in a reduction of the price of Soliris from Alexion which would mean a better chance of access to it as well. Competition is always a good thing!

For more details on this, please click here

Each of these drugs acts in different ways but the end result would be similar - treatment of aHUS, at initial occurrence, subsequent occurrences, for kidney transplants etc. Another advantage of some of these drugs is that they could be administered by sub-cutaneous injection or even orally rather than the IV infusions that Soliris needs. There was also some talk about Alexion working on a sub-cutaneous version of Soliris.

All these drugs are still in early stages of development and clinical trials and may be years before they will be usable by patients in India. However, at least something is happening!

I also learnt of a new mutation that is implicated in aHUS - DGKE. This mutation unfortunately is not treatable by Soliris since it is not associated with complement activity.

Another important discussion that was had was the availability of complement inhibitors (currently only Soliris) in different countries. Here is a summary of the information:

Ideally, any patient should have access to a complement inhibitor (currently only Soliris)  without having to pay out of pocket:

- At initial diagnosis
- Subsequent episodes
- During a Transplant and after to maintain the transplanted kidney

The following table summarises the situation in different countries with respect to this:
Country Status
France Full access
Italy Full access
UK Full access
Germany Full access
USA Full access
Russia Full access
Belgium Available for those with current aHUS activity, not available for transplants
Spain Available with some restrictions
Canada Available in some provinces and to others on a case by case basis
Netherlands Full access, future uncertain
Australia Available only for flairs and for a maximum of 12 months
India No access
*Full Access means access for all the above three situations

We had a good discussion on how to improve situations in countries where access is not complete.

Another discussion was had on the possibility of withdrawing Soliris and monitoring closely. This would reduce the cost per patient enabling more patients to get access to the drug. Patients were wary of this due to the risks involved.

Prof. Tim Goodship presented the history of aHUS treatment in the UK and said that currently a National Service has been created temporarily being managed by his team at Newcastle upon Tyne. The National Service is responsible to decide which patients should be given Soliris.

Overall, it was a great opportunity to meet so many others from different countries, each fighting the same battle. Here's a picture of the entire team:

image

... http://www.kamaldshah.com/2015/07/updates-from-ahus-uk-and-ahus-alliance.html


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Tuesday, 14 July 2015 18:55

Fistulas and fatal haemorrhages: what to do

Written by Greg Collette
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In February 2010, I wrote Dialysis: death via a damaged fistula, which was about Maya’s father, who died when his sore and swollen fistula burst in bed and he bled to death.  At the time I asked some of the experts I knew about this and all said it happens, but was very rare.

However, over the following 18 months I had a steady flow of posts about other people who had died or came close to death from a leaking or haemorrhaging fistula, and it started to look a lot less rare.

In August 2011, I wrote: Dialysis, fistulas and fatal haemorrhages setting out some expert opinion on how to spot the danger signs and action to take to prevent a rupture.

Several people wrote back, saying how they had taken action and prevented their loved one’s fistula from rupturing.  But still, the horror stories keep coming, with more than 30 deaths and near misses posted over the last four years.

Most people posting were still unaware that ruptures could happen and had zero training on what to do if a rupture occurred.

This seems like pretty important information, which should be posted in every dialysis unit and office, everywhere.  So in an effort to get the word out, I have done more research on three areas:

  • Just how common are fatal haemorrhages?
  • The best way to avoid a rupture and
  • What to do if one happens.

Until 2013, apart from the odd passing reference, not much had been written about fatal fistula ruptures.  Presumably most people assumed they were a rarity and not worth the effort.  Then Lynda K. Ball, MSN, RN, CNN, the Vascular Access Specialist for Fresenius Medical Care in Washington State published the excellent Fatal Vascular Access Hemorrhage: Reducing the Odds, in the Nephrology Nursing Journal, of the American Nephrology Nurses’ Association.

Though written for nurses rather than for the proud owners of fistulas, it is right on the money: “..how to recognise accesses (fistulas and grafts) at-risk for Fatal Vascular Access Hemorrhage (FVAH) and implement strategies to decrease FVAHs” (you know the problem has gone mainstream when it gets its own acronym).  For good measure, she also throws in the best technique for stopping the bleeding if the worst happens.  It’s a good read (though the pictures are a bit gruesome).

Here are some highlights.

Firstly, two FVAH factors listed in the paper jumped out from the page:

  1. Fistula/access-related complications had occurred within six months prior to bleeding deaths.
  2. In some states, up to 80 per cent of rupture deaths occurred at home.

We’ll come back to these factors shortly.

How common are fatal haemorrhages?

It seems that no one actually knows for sure, but they are more common than most people imagine.

In the US, End Stage Renal Disease Notification of Death CMS-2746 forms indicated that between the years 2000 and 2006 (the most recent national data available), there were 1654 fatal vascular access hemorrhages.  This represented about 0.4% of deaths of patients on hemodialysis.  However, these are only reported deaths and are considered an underestimate.

It could certainly be double that figure, say 0.8 per cent.  That seems a small number until you realise that there with about 500,000 people on dialysis in the US, 0.8% is 4,000 people.

FVAH deaths don’t seem to be tracked separately in most other countries.  This blog finds out about between five and ten a year from shocked relatives looking for answers, but it is by no means a definitive list.  Posts come from as far apart as the US, Estonia, New Zealand, India and 170-odd other countries around the world.

There does not seem to be a trend by country, rather it is much more local: it seems to depend on the quality of the unit.  In a well-run unit, fistula/graft haemorrhages really are rare.

Which brings us back to the two factors mentioned earlier.

The best way to avoid a rupture

Be fistula fussy

  1. Fistula/access-related complications had occurred within six months prior to bleeding deaths.

Fistulas don’t weaken to a point where they haemorrhage overnight.  The fistula slowly becomes weak, fragile and weepy due to infection, stenosis (reducing blood flow and building pressure) or an aneurysm (the fistula wall balloons and becomes thin).  In other words, red and sore fistulas that are infected, blocked or have weak spots that fail to re-seal after needling are warning signs of impending rupture for both dialysis staff and us.

From the stories posted on this blog, in well-run units, fistula/graft haemorrhages are rare.  Staff check everyone’s fistula regularly and if they see a problem, they act: either with antibiotics and treatment, or a referral to a hospital or vascular surgeon, to examine and rebuild the fistula.

That doesn’t make it any less traumatic for the families when it happens, but mostly, unless you have some specific problems with your graft or fistula, it is not something to lose sleep over.  Most fistulas and grafts are solid and robust.  Fistulas grow slowly and are usually quite firm and elastic.

Be fistula fussy: if your fistula has any of these warning signs tell the unit staff and ask for medical attention.  Don’t take no for an answer.  If they are slow to act, tell them that you consider the problem life threatening.  Make sure they do something.  Tell your carers and get them to tell the staff.  Tell your doctor.  Make a fuss, but get it fixed.

What to do if a rupture happens

Finger press; arm lift

  1. Approximately three-quarters of the deaths occurred at home, in assisted living, or nursing homes.

You cannot assume that medical care will always be at hand for emergencies.  If your fistula starts to bleed you need to know how to deal with it, even if just for a few minutes.

The easiest and safest way to control the bleeding is to:

  • Immediately apply direct pressure over the site of bleeding with a single finger (or more if the rupture is bigger) and
  • Raise the ruptured area of the bleeding above the level of your heart, to make it more difficult for the blood flow to reach the ruptured area due to gravity. (To see how effective this is, raise your fistula arm up above your head now – the blood will quickly drain away from your fistula.)

Do not take time to look for gauze or a tourniquet – these can hide the bleeding area and you may press on the wrong spot – put your fingers directly over the ruptured area and apply pressure immediately, then lift your arm.  Hold the pressure on the site for at least 10 minutes without peeking.

Once things are stabilised, call for medical help.

If someone is with you, they can call while you press on the site (or vice-versa).

 

Pass on this information: print out this or Lynda’s paper and put it on your unit’s noticeboard.  These strategies will help avoid fistula ruptures and save lives – yours and mine.

... https://bigdandme.wordpress.com/2015/07/15/fistulas-and-fatal-haemorrhages-what-to-do/


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I recently finished reading this book. I had read Atul Gawande's earlier two books - Better and The Checklist Manifesto and had been impressed by both. This book also has the familiar Gawande style - incidents from his practice interspersed with various insights into the issue.

Many years back, when I had healthy kidneys, I had briefly studied a Jain text called 'Vairagya Shatak'. I vividly remember a line from that text - '.... tinni jana anulagga, rogo-a, jara-a, macchu-a' which roughly translated to '(Once an individual is born), three people run after him - disease, aging and death'. During those days, I was too young to understand the importance of that line. I was invincible. None of these could catch up with me! Or so, I thought.

Gawande's book talks about people in their last few years and the challenges healthcare faces today in looking after them. He emphasises that what is a priority for medicine may not necessarily be the priority of the people being treated.

He highlights the need to give people a purpose in life. He narrates the happenings at Chase Memorial Nursing Home where eighty severely disabled people were being nursed. The nursing home was a depressing place to be, with strict routines, fixed times for everything from waking up to eating to sleeping. Until Dr. Bill Thomas entered the scene. Dr. Thomas tried an experiment. He enlivened the place by putting in green plants in every room, creating a vegetable and flower garden and bringing in animals. The authorities and the staff balked at first but decided to give it a shot. The results were amazing. Outcomes improved dramatically. The number of anti-depressants people were taking reduced.

The above experiment is a lesson to a lot of healthcare experts. Even on dialysis, I strongly believe, people should work. A purpose in life is often what differentiates people who do well from those who don't.

Another important thing that Gawande explains in his book is independence. Even the elderly like to be independent. He explains how people preferred to stay in centres where they had individual apartments with a door that closed to common living areas where people did not have any privacy. Even though, at first thought, it might seem that having such apartments might be risky for the elderly (should there be a fall or something), the amount of control that is lost by not doing so can play a huge part in keeping the person depressed.

Healthcare professionals have been conditioned to save lives. They are not, however, taught about the importance of the quality of life after it is saved. What purpose is saving a life if it is sustained by means of a feeding tube or on the ventilator? He advocates that people who are particularly vulnerable be asked, well in advance, what is important to them? "...what trade-offs he was willing to make and not willing to make to try to stop what was happening to him?"

For some people, complete physical paralysis, for example, may just not be acceptable. For some, just being around to see their grandchildren play, even if from a wheel chair might be good enough. The important thing is each of us is different. This is what medical professionals must realise.

This applies to anyone with a chronic condition as well. It is important for us to think through what we would be willing to compromise on should things come to that. And then give an advanced directive to our kin. The directive could be simple answers to the following questions: (from Gawande's book)


1. Do you want to be resuscitated if your heart stops? 
2. Do you want aggressive treatments such as intubation and mechanical ventilation? 
3. Do you want antibiotics?
4. Do you want tube or intravenous feeding if you can’t eat on your own?

You could also have answers like - try this for x days only.

If we don't do such a thing, these decisions are left to people who would not know the answer and we would be putting them in a very difficult situation.

I would recommend this book to every person in healthcare even if he or she is not caring for the elderly. 

... http://www.kamaldshah.com/2015/07/being-mortal-medicine-and-what-matters.html


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Friday, 10 July 2015 22:02

Appreciate the value of good health

Written by Kamal Shah
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I had just got back from London a few days back. I suddenly developed some breathlessness. My fluid weight gain was under control. Everything else seemed normal. I visited the nephrologist who referred me to a cardiologist. We did some tests. They mostly came out ok. Nothing serious. I was put on some medication which should settle the issue.

Around the same time however, I had to change my buttonhole sites and was using sharp needles instead of the usual blunt ones. Due to this, I had some sleepless nights. The sharp needles hurt.

Again, at the same time, I had changed one particular medication which was supposed to reduce the itching I was experiencing. The itching did not reduce. Instead I began having symptoms of restless legs.

Dealing with all these things at the same time became quite onerous. I became frustrated and depressed. I usually am fairly good at dealing with issues. But when they come all at once, I find it difficult to handle.

Kidney disease is something that takes over your body completely. Not one part of it is spared. Even a transplant is not a 100% solution. There are issues from time to time. There is always the stress of your creatinine value going slightly up and worrying about losing the transplant.

I met a friend with CKD a few weeks back. We were chatting about our lives in general. We were at a restaurant and were looking around us. My friend remarked, "Look at all these people. They are all laughing and joking. They are probably talking about what they're going to be doing this weekend. And look at us. We are talking about how many more years we might be able to live!"

It was so true. People with and without a chronic condition have such different perspectives about life. The things that are important to each group are so very different!

One sad part however is that healthy people never realize the importance of good health. They live in a world where they think that nothing would happen to them. Many people continuously abuse their bodies. They take good health for granted.

This is really sad. I feel like pleading with them not to do this. I want to tell them that they have no idea what it is like to have a chronic disease. I want to tell them that they are not as safe as they think they are. All it takes is one moment in time when things could completely change. The've changed for me. The've changed for many others.

Please don't take your body for granted. Be grateful for good health. Preserve it with all your might.

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... http://www.kamaldshah.com/2015/07/appreciate-value-of-good-health.html

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