Travelling with Discipline , Eating with Caution - a Key to good Health.

To travel or not to travel or how to travel , that is the question !

"Work, Travel, Save, Repeat"

This should be the Mantra for all of us. However, today we focus on Travel. Being someone with CKD , travel can be quite daunting with the various restrictions that are imposed on us. There was no travel in the few months while I was on dialysis except to Madras , which was an overnight medical related , to meet Dr. M.K. Mani at Apollo Hospital . Post transplant, travel began , a year later ,  at a slow measured pace within India. Two years later ,  we were courageous on venturing Abroad , as was Dr.Gandhi, with my progress. He was very clear though  , since he was confident about the hygiene & quality of food , in Europe , I could go there. Since then, travel has picked up momentum with every journey.

Life - It will never be perfect , make it work ! And that's what one learns with every expedition. Its easy to say, Throw caution to the wind, but the question to ask yourself is - is it worth it ? Over the years , my experience has taught me to be Responsible. " Calculated risks " , that's the call ! Every trip has taught me something , which is why , travel today is a piece of cake . No trip is intimidating , it's always an adventure , a memory to be captured in my camera. Following is an amalgamation of a check list that I have formulated, helps me travel unafraid.

Packing , travel begins the minute you begin packing your bags! Always make sure the following are organised before you leave for any trip.

Handbag ( with you in person at all times)
*Medicine : one full strip of every life saving medication, that you take on a daily basis ( Steroids, BP, Diabetes , etc)
*Sanitizer & a small bar of soap / soap strip
*Snacks :A small bottle of Water , Biscuit  packet/ snack bar , small pouch of dry fruits ( to munch on, in case hunger pangs hit )

*HankyTissue packs

*Prescription of your Doctor , incase of medical emergency while travelling 

Suitcase
*Medicine : The quantity of tablets/ medication ,depends on the number of days that you are travelling for , then , add an extra weeks supply . A packet of some Basic meds : fever, cold, sprain, body ache, headache, allergy, electoral powder ( in case of dehydration ) , loose motion, vomiting, motion sickness . 

Once you have hit the roads, be it a holiday or for work - one needs to be attentive to these main elements -

*Eating : No salads , Only hot food, No fresh juice ( unless absolutely sure about hygiene), Fruits wash with filter water , Wipe plates & all cutlery well before using. Incase , worried about the next meal , best to carry packed meal, either from home or hotel. ( Paratha's, Thepla, sandwitch & such ) 
*Water : Filter & boiled if possible or a good reliable company mineral water. Buy these , as far as possible from a Chemist  
* Toilet/Washrooms : ~Make sure its clean , indian style toilets are more hygienic. At times its easier to relieve yourself in the wild , than a filthy washroom.~ Sanitize the toilet seat before you sit ( wipe it clean ).~Wash your hands properly once done , hygiene , remember is , Priority !  

*Alarm for Medicine: We all carry a smart phone. Depending on when you take your medication , always set an alarm for each day . Put it on snooze & stop the alarm ,only after you have taken your meds. 

*Electric Water Kettle : Request the hotel to place a water kettle in your room , if they haven't . Most convenient to boil water. Also , if you are staying with family , Boil the filter water.

*Chef: Either restaurants or hotels, always speak with the Chef & specify your diet essentials. More often than not , they will always heed your request. 

Incidents/Situations, which are valuable lessons -

*We were flying to Nairobi. The KQ flight had a technical snag & we were moved to a hotel for the night. Next late night, we flew to Nairobi. On arrival, my bags were missing. I got my bag the next day. The reason , I mention this episode - had I not kept the strip of medicines in my handbag , there could have been a medical crisis for not taking my medications on time.

*Juice : Sugar cane juice be one of my favourite. And have had it a few times by making sure I cleaned the machine with filter water , before allowing them to remove the juice & only if I did not see any flies around!

The first few years while travelling , I always carried a portable water filter from Zero B. It was the size of a cup , compact & perfect for travel. It no longer in production, which they hadn't stopped! 

Travelling overseas 

Travel Insurance : A must when travelling outside the country. 
International Time Zone & Medication: Setting an Alarm helps one not miss a dose & adjusting the Time Zone to few hours difference. When 24 hours Time Zone , then best to have an extra dose to adjust to the current time zone. 

Vaccinations & other such medical requirements, in accordance to the visa required need to be complied to. 

At all times, counter check with your Doctor in regards to medications ( eg Diamox, recommended for acclimatization to high altitude conditions , like in Leh )/ Vaccination ( eg Yellow fever for African countries ) &  keep your doctor updated on your travel plan for any medical issue , if travelling to a destination you are unsure about.


Trains (Play safe with fast trains aka Express trains-Rajdhani, Duronto, etc , High speed trains-Shatabdi , etc)
Travel by train has been on rare occasions & short distances, for eg Delhi Amritsar, Bhubaneswar Calcutta - the Shatabdi category. A few trips have been over nighter's , like the Rajdhani, to Delhi, Indore. Precautions that I have taken , while on train-
*Washroom: Have requested the TT to get someone to clean the washroom, if so required & they always help.*Always rinse your mouth with Filter / mineral water. *Carry meals from home - the meals provided in the trains, might not be the best. *Drink hot tea or coffee , if u feel the need. At times , eating freshly made snacks at stations , are safe.

My Travels have included , water sports , hiking , cruises, driving holiday & much more.

"Do not let the Wanderlust be intimidated by the doubts of restriction , let the adventure begin with the strength of discipline & caution !"

Triple Whammy - Dehydration uncover's Malaria Stain & Hepatitis C !

"Life is a balance of building up & letting go ! " - Rumi

Kenya, August 2010, our first trip during the Migration season. Many a wild beasts to be seen & weather, just right for the visit, cold ,yet , the sun bright,spreading just enough warmth. 

The trip begins with an amalgamation of every aspect of a good trip. Being pampered by my cousin & his wife, cafe's , restaurants & exploring Kenya, as one would with a local.

It's difficult to pinpoint when Trouble began. A slow but steady decline in my health began primarily with my aversion to food. Anything that I ate , tried to eat , either tasted funny or the aroma , completely put me off almost all types of cuisines. For someone who is a complete foodie , this was heart wrenching to neither be able to eat nor be around the most aromatic dishes! Therefore , I survived mainly on curd rice. I felt like a ballon almost always & Coke with lemon juice & sprinkle of black salt became my favourite drink ! The pleasure of a Burp was soul satisfying ! 

This did not deter me from the week long trip that was lined up. Physically incapable of taking the 5-7 hours road trip to Masai Mara , I fly both ways, while the family takes on the road journey. Inspite of my condition taking a constant plunge , I manage to survive trips to Lake Nakuru , Sweetwaters, Serena Mountain lodge. Other complications are cropping - swelling on my feet , low Fever, Cold inspite of the weather being quite moderate, every morsel I eat , I want to throw up. An occasional Foot Massage at the Spa was a temporary relief.  

Extremely weak, is how I head back to Nairobi. Medications are not helping. We speak with my cousins friend , Dr Mohapatra, who is a physician,  suspects Malaria ( since we have taken Yellow fever vaccine & both are spread by an infected mosquito ) when the symptoms are mentioned & wants to do a blood test . He sends a technician home ,who cannot draw out any blood. Next day , I wake up with stomach cramps & am taken to Dr Mohapatra's clinic. His assistant tries to draw , it's multiple punctures again , which , Dr Mahapatra suspects , might be due to an extreme case of Dehydration. After much difficulty , blood is drawn out & sent for testing. In the mean while , he gives me some medication & asks me to drink plenty of liquids to hydrate myself. He sends me home , suggesting  , I am taken to the hospital to administer Saline drip ( a counter for Dehydration) , in case there is no improvement. 

However, by evening,  things go from bad to worse, the cramps are killing me. I am carried to the Agha Khan University Hospital , an immediate admission, blood test carried out, Saline Drip is initiated. The haemoglobin has reached a high of a little more than 20 gms. It's a classic case of extreme Dehydration & due to that, Creatinine, Urea & all other parameters have gone erratic. Being a kidney transplant patient , consulting nephrologist, Dr Twahir Ahmed is briefed, who ensures the transplanted kidney is not affected , Saline drips is on for 3 days, untill all parameter's get to normal & any calamity due to dehydration is averted. 

This would have been a simple end to a critical issue. However, Dr Mohapatra , does an additional manual testing , since Malaria is not detected in the reports ( clinic & hospital ) & wants to take no chances.Reports of this test puts him on an alert. He discovers Malaria stain( which according to him is an old one & not one acquired on this trip) , which wasn't as grave, as uncovering, that I had the HepC virus !  Dr Mohapatra apprise's Dr Twahir on these development , both surprised that we are completely clueless about this virus & HepC test has never been a part of any blood test. The closest association of any form of Hepatitis for us was Jaundice.There is a possibility of some symptoms like vomitting ,etc, were due to the HepC Virus. Not wanting to alarm us, we are given the fundamental facts & treatment. Since Dr Twahir is acquainted with  Dr Gandhi, he writes a personal note , regarding the Malaria stain & HepC , with his recommendation.Three days later , I am discharged & soon after ,we return to Bombay, with Dr Mohapatra's clear advice,  on a thorough check up & treatment for both. My first trip to Kenya has become an iconic one! 

It's not even a day , since my return to Bombay & I am hit by the chills , fever. Since Malaria test is done when the patient has fever, I am taken to the hospital & as a safety measure admitted. The Malaria virus has resurfaced & I am put on medications. Dr Gandhi is informed & he is given the letter written by Dr Twahir. Simply put, all hell breaks loose. I am referred to, Dr Samir Shah , the consulting Hepatologist &  I am subject to every conceivable & available test pertaining to HepC, before & after discharge at BCH ( Breach Candy Hospital) & Jaslok Hospital. After a detailed study of reports , Prognosis of the virus being inactive ( was it some medication that had been given to me at Agha Khan hospital, Nairobi or was it the body managing on its own , we still do not know) , puts everyone at ease to some extent & major , when my Mama , Dr Atul K Mohanty ( Mom's brother , who himself is a Pathologist  ) , gives this simple explanation - " There is an uninvited guest in the body , living there , not interfering in anyways - leave the guest , don't remind the guest of its presence which might create upheaval ! ". And we did just that. The virus is very much a part of Me, a Dormant Guest who hasn't made its presence felt in so many years & I trust , it will Never ! 

Retrospect

Trouble began, a week after our arrival. My cousin from London was to arrive. With time in hand before heading for the airport , we spent the day , driving around & visiting a few places , which included a few Cafe stopovers for some locally brewed coffee. The weather being very pleasant , cool breeze - I wasn't thirsty & the day went past with me drinking only Coffee & just a few sips of Water. Water is the Nectar & I should have had enough Water through the day , irrespective that I wasn't thirsty & the fact that , I was drinking excessive coffee! This, in most probability, was the beginning of Dehydration. 

Preposterous

It's a family trip to China the following year of July 2011. Two weeks of total family & visits to the main cities & attractions, is marred withing a few days , by fever & chills. Initially I tell no one about it , just have Crocin ( paracetamol ) & enjoy the elements. However, it's becoming difficult to keep it hidden, I am also starting to feel Tired more easily & my Enthusiasm levels are fluctuating  . Fearful that I might not be Hydrating enough since it is cold , I make sure there is enough liquid intake. Some ups & downs , however , it's been a wonderful 2 weeks. Back to Bombay , fever still persists & once again , admitted to BCH. Blood tests & once again Malaria is detected. With all attention moving to HepC in 2010, although I was discharged once the fever was under control, the Malaria stain/ virus , had not been tackled. This time around , the treatment eradicated every stain of the virus. Since then , Grace working double time, Malaria has not shown up & I do take precautions to ward of mosquitoes - no surprises wanted ! 

Lesson learnt

~No matter, the weather is cool , chilly & one is not thirsty - you are on a Holiday or at Home - you still need to HYDRATE , drink enough liquid .  

~Liquids means primarily Water . Coffee , Aerated drinks , Tea , Alcohol , do not come under the category of Liquid & just in case you indulge once in a while in these , compensate by a double intake of water! 

~Insufficient liquids intake is as concerning as is Excessive liquid intake. Be Aware - a Delicate balance needs to be maintained. 

~If you have been hit by the Malaria virus , make sure every stain is removed , with the right treatment. 

~ Precaution , since I know I have dormant HepC virus , which can surface anytime,physical fitness is a must & diet is not only about Kidney but Liver as well , basically be disciplned enough with eating & drinking to protect both ! 

The Doctors 

Dr Mahapatra : https://medihealgroup.com/nairobiupperhill/mahapatra.htmlo

His knowledge on Medicine is extensive - which helped him diagnose my issues ! 

Dr Ahmed Twahir:  https://kenyarenal.org/the-team/

Dr Samir Shah: https://www.gleneaglesglobalhospitals.com/hepatology-doctors-mumbai-parel/dr-samir-shah

Information:

* Most questions regarding HepC answered  in this link -

https://www.cdc.gov/hepatitis/hcv/cfaq.htm

* Mandatory screening of donated blood for Hepatitis C virus was introduced as late as 2002 under the National Blood Policy. Blood banks now screen for Hepatitis C along with Hepatitis B, HIV, Syphillis and Malaria. But many had already been infected before the policy came into being, main culprit being , Blood transfusion ( just like me ). Most patients who have had a blood transfusion before 2002, are likely to have a Dormant HepC virus. It's common , remains undetected & causes absolutely No Harm. However, there is a chance that the virus will affect the liver & one might end up with a liver transplant. 

* It's a challenge for the doctors to maintain a transplanted kidney & at the same time to treat a Liver ailment, the treatments being quite contrasted. An active HepC virus, is a grievious complication for any CKD patient. However , with medical science progressive extensively , medications ,treatments & liver transplant , HepC is being tackled.

* The normal range for hemoglobin is: For men, 13.5 to 17.5 grams per deciliter. For women, 12.0 to 15.5 grams per deciliter.

* Yellow fever virus is spread by the bite of an infected female mousquito. And a vaccine is mandatory for some countries - Kenya being one of them. 

https://en.m.wikipedia.org/wiki/Yellow_fever

Pillars at Kenya

* Pannaga ( Cousin)  & his wife , Rinnie - strength of family at Kenya - the backbones.

* Sabrina ( Cousin) , in her A levels, has decided to pursue Medicine since she was a kid, got her first experience on what it's like to be faced with & handle medical emergencies.

* Vicky & his wife, Dipti -  friend of Pannaga , his unconditional support can never be measured. 

"Faith does not mean trusting God to stop the Storm. it means , trusting him to strengthen us, as we walk through the Storm! "

~ Prayers are an integral part  , as are some Humour , Laughter & Smile , through the crisis. 

~ an Abhishek at a temple in Hyderabad , by Dad & Shubhada Amma

~ Mom manages for 3 days in the hospital under most uncomfortable & difficult situation.