Monday, February 26, 2018

"Bring in the past only if you are going to build from it." - Domenico Estrada

I will do a fast forward on the happenings from 10th July to 21st November 1986, the day of my surgery/transplant. 

Straight onto the surgery room , and Dr. H . Manchanda begins the procedure of inserting a Dialysis line, under local anaesthesia. I still remember feeling uneasy ,  while the catheter is inserted & my chanting the most tuneless Hanuman chalisa, to ward off the pain & discomfort.  That experience still traumatises me , apart from few other's in the following months! 

The procedures in the ICU ,for removal of excess body fluids & waste ( toxins ) from the blood,  continues for around 36 hours.  The medications have made me woozy. Strange as it may sound, on the occasions that I do surface , I get a feeling of being in a science fiction movie, what with all those wires, tubes, machines , hooked up to me, being enhanced with the effects of the lights, nurse's in white as floating apparition. Being the sci fi buff, I feel pleasantly at home. My first proper vision once my head is mostly cleared  , is that of Dr. Nitu Manke ( Cardialogist), watching me intensely , through the glass partition, twirling his huge moustache, wondering if my heart would survive this ordeal - that's a memory etched!

While a drama of making sure I make it, inspite of my extreme serious condition, was unfolding inside the ICU , there was another happening outside. My parents are being updated with my medical condition. Water in Lungs, swollen Heart ,  Liver & a complete Renal failure. The kidney size is like a child's, very small. Has the kidney stopped working due to shrinking caused by  some trauma/ infection or did it stop growing after a few years, is anyone's guess. Shape of the kidney & the clear surface, did have a story to tell. Cause would have been known, had a biopsy been performed. 

There is complete disbelief & confusion outside the ICU , but inside, I am blissfully unaware. My treatment is taken care of,  by the best , in each department. Dr B Gandhi , takes over as the nephrologist. State of emergency amongst the immediate family & friends. The medical professionals within this circle, gauge the situation. Major discussions follow, with Dr B Gandhi at the helm, on line of treatment. Basic protocol is to be followed, Fistula, Dialysis, Transplant

Fistula is done once I am out of the ICU & I go for my first Heamo Dialysis. That & all others to follow are nightmares. I am constantly throwing up , uneasy & in pain. An experience which I would like to forget ! Due to this, the decision for transplant at the earliest is decided. The scrutiny for a donor has begun. 

Once I am discharged from the hospital, the dietary restrictions come into the foray.

Faith is a very strong tool. God, Blessings, Prayers are integral to our family. Blessed in abundance by spiritual Guru's who have been a part of our growing up years, with my Nana , a Goddess Kali devotee, we do have a very strong armour of protection. While the spiritual & religious practice of fasting, visiting temples, churches, temples, lighting an Akhand Diya at the Choudwar temple, reciting of the Hanuman chalisa & much more has begun , not only by my parents, but many a family & friends. Many an oath taken for my recovery. Miracle is simply the amalgamation of positive energy.  I am that Miracle, who survived every medical emergency that came my way. They don't call me cat without a reason, I continue to enjoy the few remaining of my 9 cat lives! 

Much against my wishes & discomfort , I begin Urine therapy ( Morarjee Desai, being the man behind the concept then ). What all a man does … hope against hope , that the kidney shall revive without any surgery!!! "Hope is being able to see that there is light despite the darkness." - Desmond Tutu 

On the other hand, discussions on my transplant, on the donor, the hospital , has all begun in earnest. From consulting Nephrologist in the US to London, to my personal visit at the Apollo hospital , Madras & meeting Dr.M K Mani, the census between the doctors & family has been reached. I am young, need my people around me, need to be in my comfort zone & so, the surgery shall be done at Breach Candy hospital , with Dr. Gandhi continuing to be my nephrologist. 

Focus shifts to the donor. As explained to us, same blood type & immediate family are first choice, with multiple tests to match the kidney. And so, in generalisation , it is, 100% match is of twins, then siblings with 75%, parents with 50% , anyone else, would be from 25-50%. Parents are the immediate choice. First choice is my Dad, same blood group, however , he has diabetes. Mom being a universal donor , with O+ blood group , is then the one. 

However, it's best if donor is same blood group & feelers are sent across the board. None come forward, for obvious reasons - the lack of knowledge , the fear of loosing an organ, lack of support from immediate relations. The one's who come forward , are kids from my extended family, who will go any lengths for me. All of 15-18 years - ready to donate their kidney! In a way it is a circus with everyone giving their own suggestion, however , this entire dialogue comes to an end , when my Nana says, it shall be my Nani ( same blood group), who shall be the donor. Tests done & She is the perfect match , in every respect.  They have the healthiest lifestyle. My Nana takes my Nani to Chinmaya mission, Powai. They stay there for a week before the surgery , building mental strength & spiritual energy, a well as a cleansing process for the body & mind, making sure the kidney is not just a match , but a twin to mine.

Date for the surgery is set for 21st Nov. As we begin to count the days, 2 medical emergencies rock our boat. 
Its my 17th Dialysis & I collapse on reaching my room. Rush to BCH, immediate tests & a case of acute pancreatitis is diagnosed by Dr. Karlo. With the symptoms clashing closely with my reaction to dialysis, no one suspected an inflamed pancreas. With treatments quite the opposite , difficult task for the doctors to maintain a medical balance between the two organs, Private day & night nurse are appointed, to keep a constant watch for any emergency & they go home with me. Sis Tampal, the day nurse, stayed with me , for a little less that a year. She was a tough one, when it came to my well being & would take on anyone, if she thought there was any room for error on my daily routine. My melodrama went to deaf ears, with her - an absolute sweetheart! 

I was back in hospital , with the next emergency. Blood in stool , which just wouldn't stop. A round of tests & the diagnosis by Dr Desai & Dr Agarwal is, Hemorrhage, the blood is not clotting. No medication works. However , there is an injection , which if injected immediately, will help clot the blood immediately. A miracle drug of sorts. To get this drug , which is rarely required , is next to impossible to get & even if one does manage , it will be too late. Just when all hope is lost, a ray of light. A patient who had asked for the same injection does not need it anymore. My time on this Earth is not done, as yet! 

Amongst all this , there is also the time at the hospital, when all veins collapsed, impossible to put in the intravenous injection , the nurses have tried every to find a good vein on my hand & leg. Resident doctors try, nothing. With drips at a standstill , situation is critical. I have lost all sensation after all the umpreenth puntures , And my father looses it. He throws everyone out of the room. No one shall touch my daughter, no more pain for her. Let her die. And then , Dr Mangal Jain comes , a young resident  , who requests my Dad for one last chance. One last attempt , Dr Jain manages the Neck IV, something no one else had attempted due to its varied complications. The drip starts. Life falls back to normal! Dr Jain is God sent! Dr Mangal Jain ( Consultant Intensivist & Physician ) , continues to be my physician & the one who constantly guides/backs me in case of any emergency.

Dialysis continues , every alternate days , and date for transplant set for 6th Nov, has to  be postpond to 21st Nov,since report are not 100% perfect for surgery.

18th Nov, Nani & I are admitted to BCH for surgery on 21st Nov. Dr Dastur & Dr Sonawala, are the surgeons. Surgery goes off withou a hitch. While Nani goes home after 3 days , I get home after 3 weeks at hospital under strict supervision & complete seclusion, for fear of infection , no visitors allowed in my room, we can watch each other & through the glass door ( nurse & doctors wore a mask when the came to see me, or I wore one) , strict diet, innumerable medications. 

Within a week I am back in hospital. Case of  loose motions & vomiting. It's  Gastroenteritis , Although serious, all comes under control. The reason for the same is a mystery. My family refuses to take me home. They want me to spend the last few days of 1986 at hospital & begin the new year on a happy, healthy note. And so, 1st Jan87, discharged from hospital. A full year of saga has come to an end . It time to go home. 

Miracle !

Every small gesture of care, love, blessings, support in many a surprising myriad ways & much much more , from family , friends , total Strangers - are all Miracles . Faith , that every so often takes a beating , is restored when we recognise these simple Blessings. It can never be forced on anyone. Its Elusive & still the most accessible. It finds its own way towards you. Like i say always , " The one up there is always with me. The Grace & Protectiion of my 3 Men ( Hanuman, Ganapati & Shiva ) & Devi , without whom nothing ticks , made me this Tough Intimidating Individual ! 

Really?????!!!!

Inconcievable levels of BUN @ approx 40 & Creatinine @ approx 400 , that my case was a disaster waiting to happen , would not be off the mark. 

Interesting fact that we got to know later.  Sis. Tampal had been warned by other nurse's to stay away from me , since I was a complete gonner , no chance of survival, there was no point taking on a patient who was going to die any day& wouldn't be good on her Resume !!! However, Sis Tampal believed not only in herself,  but also on the power of God. And she knew I would survive. Not only did she join, but convinced the night nurse to come on board. 

The patient who did not need the Hemorrhage injection, was Smita Patil, the actress , who died that day , leaving the medication for me !

There was a time when I was kind of comatose . 3 days of my life which I was here in body only ! Quite a stir I created then! 

After the surgery, I had to be kept in a room near the ICU, for 24 hours, since my heart had decided to slow down! 

From the day I was diagnosed till the day I eventually went home after surgery , Blood Transfusion was needed every so often. There was a long list of B+ blood group , ready to donate blood at a minute's notice. The number of Units of Blood , from individuals belonging to different religion, faith , gender, age group, culture. social strata - make me the Perfect example for National Integration!

Today , there are stages of CKD , and with awareness on the rise , many know. However , we had no idea ( maybe then , this categorisation had not been done ) , and Mine was the last stage any ways! BUN - 

I had none of the classical symptoms that relate to Kidney failure

Diet is all about Balancing a healthy lifestyle. Eat everything.  In moderation. Hygiene being an important aspect. Your blood report are a good indicator on the suitability of  your diet/ food habits. In due course , you also begin to understand the demands of your body.What we were not  made aware of & has come about with the passage of time, trial & errors - that one needs to Exercise , lift weights , balance protein intake , which is a major requirement , making sure that loss of body muscle is minimum & your bone density in within range , that one is doing all they can to keep building it. Medications, deplete your muscle - wish I knew about it , some of my diet would have been around that & I would have begun exercise & weights after about 6 months to year , after transplant ( a fracture & constant spraining of my ankle , is what got  the issue of Bone Density to out notice) . Muscle helps protects the joints & bone, against all this. 

People tend to misuse the independence given to them. We need to be Responsible . Eat right. Always take precautions , a few restrictions should become a part of your every day activity. Calculated risks are allowed , even so , always be watchful! 

Much of this , I have already mentioned on my earlier page on Diet & Excercis.

Urine Therapy & all such ( naturopathy , etc ) , is fine initially , take a chance with alternates. However, once you get to the final stage , don't take any chance , stick to Allopathy, with alternate treatments as a support! 

*Acknowledgement* 

It was all on the complete belief & convincing on the part my Uncle ( Dr Satya S Das , Microbiologist ) in London , who insisted on the family & friend's support at India , that my surgery happened at Bombay.  

Information 

Donor Compatibility:

Pancreatitis:

Hemohrrage: 


Fistula: A fistula, an access made by joining an artery and vein in your arm.

Dialysis :
Dialysis line -

Haemodialysis 

Peritoneal 

Gastroenteritis

Neck IV: An intravenous central line is a kind of intravenous (IV) line used to give medicines and fluids. It is a thin, soft, plastic tube called a catheter that is inserted through the skin and into a vein. It is usually put in the neck or chest just below the collarbone. 
Injecting in the neck has been related to adverse health conditions such as deep neck infections that may develop abscesses and related complications such as haematomas, airway obstruction, vocal cord paralysis, wound botulism, extension of infection to other structures, pneumothorax, mycotic subclavian carotid artery.


Akhanda Diya/Jyoti: A wicker lit in a Diya filled with Ghee ,should not be extinguished by itself or by someone, which means it should be lit through out the prayer period which may be more than 24 hours. Japa/Chanting, done in front of a akhand jyoti is 1000 times more effective. Akhand Diya, represents your unshakable and unflickering faith towards your deity. 
Hanuman Chalisa : A significant holy Hymn, https://en.wikipedia.org/wiki/Hanuman_Chalisa
Nana: Mother's father
Choudwar : a small town near Cuttack, Orissa

Dr M K Mani : https://en.m.wikipedia.org/wiki/Muthu_Krishna_Mani

Saturday, December 23, 2017

“Life is what happens to you while you're busy making other plans" - John Lennon

As a child with a mind of my own, self confident, never one to give in to peer pressure. My sister & I, had the Liberty to be who we were , under strict & disciplned supervision at all times , by my Mom & being indulged by my Dad! My sister, 4 years younger, was someone I let bully me,for a few years, till I went the other way of finding the most innovative ways to irritate her & put fear of anything in her childish mind. The power that an elder sister can have over her younger sibling is quite a high! Even today, an argument is totally normal, without it- life would be boring !

My growing up years were spend with boys which made me, brashfully boyish, flying kite, playing marbles, seven stones, gilli danda ( a game which is believed to be the origin of Cricket, baseball & softball!)  & name you what not … so , no lady like quality!!! All this and more helped me be this individual, who has learnt to fight any odds & rise like the Phoenix!!!

Endurance comes from an inner strength. Like it is said, the answers are all there, it is the right question that needs to be asked. Similarly it is said, the Strong are hit by a difficult situation & its their endurance that stands firm, through any trial & tribulation.

Flashback 1986, to the time when our (my family, friends & mine) highly pragmatic era began, which had all the ingredients of a Bollywood Blockbuster!!

Feb - July 1986

I am different.An appealing bohemian  20 year old, fairly intelligent (have not lost a single year inspite of having changed 8 school's) , in my final year of graduation at Sydenham College, Bombay. The world is at my feet. The secret admire's, the umpteen Red Rose's on Rose day, exceptional myriad friends , bunking class, being a part of different societies, boisterous , absurdity & foolery being a daily agenda - the perfect college life.

Life has been channelised according to my vision (& my parents) and a thirst of an adventurous future. The plan is simple, graduation exam in March, go for a holiday, wait for the results (have the inherent confidence that I shall do well!) & take off to the US for my MBA. Since my results in Gmat & Toefl, has been pretty good, I am sure of getting into the university of my choice. Since I am not planning on going to Harvard or Yale, Stanford being my only choice, I am on the perfect track for now.

February, Education bekon . An entire year of not having seen the book once, It is time to give my hundred percent to the books. Not one to panic, it's surprising that this time, the stress has affected my sleep. Which in turn has affected my eyesight, the words are blurring & am also having trouble breathing, while sleeping. Have to be in an elevated position to breathe easier. Heavens, why did I leave studying to the last minute!!! Exams are fast approaching, my breathlessness comes and goes, but reading and grasping every subject is getting more and more difficult for me. Not being able to read, have got Mom to read every subject, while I just focus on listening & assimilating.

And that is how I give my final graduation exams in March, amidst the furor of all my nervous symptoms.

Exams are over & the crazy symptoms disappear & I am ready to go on my vacation.

But parent being parents, they still insist on doing a medical check up before we leave for the holidays. A general check up is done at Jaslok Hospital, but we are so caught up in the holiday mood that we completely forget to collect the report. & it will only be after a couple of months that we will realize the heavy price we paid for ignoring to do so.

Come April & it's a relaxed paced holiday with family & friends at Orissa. From there it is to Shimla & then to Delhi. The one major event that happens during this time, is the extraction of my wisdom tooth , which had been giving me trouble since a while, with infection setting in. While most of the holiday goes without any issue , the last leg at Delhi was quite difficult. I start to get the same symptoms of breathlessness, which I had got during the exams. But this time it is also followed by a gurgling kind of cough. Fluffing of extra pillows is not helping & am sitting upright on the bed every night, trying to catch a few winks. We think, this might be repeat infection from the tooth extraction & take medication, hoping all will be fine.

22nd Jun

We leave for Bombay & things don't seem to be improving, Infact, I don't even feel like eating, complete loss of appetite, nausea & vomiting. And I am starting to feel tired all the time & blame it the on hectic fun filled holiday.

Start to take homeopathy medicine, feel good for a couple of days & then back to square one with all the symptoms coming back. Sleeping curled up in my bed has become a thing of the past. What in the heavens name is happening to me??? Wish I could understand, it was a complete mystery for all at home.

28th Jun

Time for the GP to be called, he looks at me and says it is a case of Jaundice, all symptoms say so & starts me off on medication for the same. Asks, for a blood report to be done, the one very sensible move. However, he either hasn't seen the report properly or hasn't understood it. He wants that I keep drinking water, to flush out the virus ! Drinking so much water was making me extremely uncomfortable, I wanted to throw up & no one  realized , all the water that I was drinking was making things go from bad to worse , every second!

One week & there seems to be no improvement, I am feeling awful. The GP tells Dad that he needs to consult Dr.Sanghvi, the cardiologist, for a second opinion, since he cannot understand why the breathlessness is getting worse. It is also during this week that we remember of the check up at Jaslok & call for the reports.

07th July:

Dr. Snehal Sanghavi comes to visit me in the morning, see's the 2 reports, asks for another blood report, calls dad in the evening after seeing the reports & tells him to take me to the hospital right away, do not waste a single minute, its do or die!!!

I remember the sudden change in attitude, the urgency , and me being lifted out of the bed like a small baby ( by then from a 48kg girl , I have reduced to 40 kg), by Datta to the car & taken straight to Breach Candy Hospital .

Here on begins the saga of my stint with hospital, doctors, medication, hope, prayers, fun and fight for survival!!

Details:
The dates & few details are from my father's diary which he penned from the day Trouble began all the way through till about a year after the surgery ! And reconfirmations to those & other events, details , which i am tad confused about, are from my Mother's elephant memory !

Retrospect:
To blame the GP would be easy. To blame our ignorance & negligence would also surface. And then again , one looks at the brighter side , to what the GP did do - to call Dr. Sanghavi & for my parents to remember about the Jaslok reports, at the right time.   

Latest:
According to a report by the NU Hospital, Bangalore - the classic symptoms of Chronic Kidney Disease are : Chest pain, Shortness of breath, Fatigue & weakness, Vomiting, Loss of appetite  - all signs that I had shown ! 





Thursday, November 9, 2017

Swelling & Blood Pressure !

Most will wonder , on the reason for this combination, it's on default that I figured this connect. 

Rewind :

Post surgery , Cyclosporine ,was one of the immunosuppressant drugs, which I was prescribed , including Prednisolone & Azathioprine. The dosage was extremely high. While I had Cyclosporine mixed in warm milk , the rest of the tablets ( including Vitamin tabs)  felt like eating a fistful of after meal mouth freshners :)). I was also given a minimum dosage of BP medication. This continued for a while & over a period of time, Cyclosporine was stopped. Other two medications were reduced & will continue life long !

With Every information being a Google away , I found my answer , as to why , I was being given, BP tabs. According to the information & now what I have also learnt, introduction of Cyclosporine, lead to nominal systemic Hypertension amongst 70-90 % recipients ( one of the many side effects ). This was the reason for the BP medication. 

https://www.ncbi.nlm.nih.gov/m/pubmed/19367007/  ( Combination of Cyclosporine, Azathioprine & Prednisolone as form of treatment).

The Present :

Like I have mentioned earlier , I am on a life long, minimum dose of Prednisolone & Imran, Vitamin's (calcium tabs an important feature ) & BP tabs. Although the dosage for BP tabs hasn't changed , the brand has changed twice ( I am presuming it has to do with the composition & making sure that the body does not get use to it & stop working). Blood reports done once every year, making sure all the levels were very near perfect! 

All was good. It was just recently, that I realised , I had not done my blood test for around 4 years & decided to get one done, been a while after all ! Reports all good. As expected , D3 & B 12 low, my GP wasn't worried , medications would take care of it. Then a general BP check , readings were extremely High. Considering I felt no discomfort , no signals by the body of any kind, left my Doc , completely flummoxed ! 

A change was eminent, medication were revamped, dosage changed. The two main reasons for this, somewhere along the line, the intensity of BP tabs had been reduced & once you near 45-50 years, Hypertension is a symptom during this period of Menopause.

Now comes the link between Hypertension & Swelling. 

It's been around 3-4 years, that I noticed , I was getting swelling on my feet, every so often & stayed for a few days at end. Since my Mom has had this for a while now, happens mostly when she is on her feet too much, lack of rest- I presumed , this was it. However, rest, putting feet on an elevated level, didn't do much. 
Next was, maybe , it was water retention , so - low salt, drink plenty of water & swelling persisted. I did notice, that there was swelling when I ate Rice for a few consecutive meals.  That was put aside, for a few weeks , seemed like it was working , swelling had reduced & then, the erratic behaviour of swelling continued!
What next,  was the call- and I was told to go on a gluten free diet. So, gluten free it was. Off Rice, wheat, white flour (maida), couscous , the works, anything that might have gluten. For a while It worked. At least that's what I thought, but No- Swelling was as whimsical as ever! 
I was getting quite clueless on what was happening. Just decided to ignore it & that's that.

And then, the BP issue happens, medication changes & voila -  swelling has now settled. The BP reading, although slightly on the higher side  ( will take some time to get to normal, considering , I have no idea when the BP had started its upward descend ) , the medication has stabilized the fluctuations, which in turn settled the swelling. 

Since the discussion is on BP also , the following link has the information we all need to know about BP reading , 
http://www.heart.org/idc/groups/heart-public/@wcm/@gsa/documents/downloadable/ucm_484095.pdf
Another link which was interesting was, 
http://www.bloodpressureuk.org/BloodPressureandyou/Thebasics/Whatisnormal

A few ways to keep BP reading in check , from my experience & some which I have read up online & tried which have worked -
Walk Walk Walk, that like the best ! Keep an ideal weight , not more not less!
Cucumber & Pomegranate help. 
You love chocolate, occasional bites of Dark chocolate also benefit!
Avoid excessive Carbohydrates, Alcohol, Tea , Coffee.
Balance your Potassium levels by controlled eating of, a banana in the morning daily, sweet potato, tomato ( always eat after removing the seed) ,dry fruits, prunes, raisins, musk lemon - to name a few.
Balance your Potassium levels by disciplined eating of , fish, tofu, milk , leafy vegetables - a few I know off.
Eating raw Garlic helps.
Try new things , see if it works for you. if it does , great- if not , avoid.

Tried and Tested : 

* Whenever my BP has risen, I have normally taken a spoonful of honey ( at times 2) , which has helped bring the reading down. 
* When BP hits a low, a well beaten coffee / cappuccino ( or expresso) , raise the levels.
* Drink minimum 3 ltr of water in during the day , with atleast , 2-3 glass in the morning on an empty stomach. This helps keep the Swelling in check.

Lessons Learnt : 

* With passage of time, Do not take it easy , where blood reports are concerned. It should be done, atleast once , if not twice in a year, to monitor all readings.
* Every so often , do a 3 time reading of your BP for 3-4 days. That will be an indicator on any abnormalities. High or Low BP reading , can lead to many Disorder's.
* It is essential that you have a very good General Practitioner , who is well versed on an overall medical knowledge & experience. GP shall pick up minute aberration's (which might be missed by a specialized physician) , from the reports & guide you accordingly. 
* Women must monitor their BP after 45 year. The body transition (Menopause) needs to be monitored. ( This is a must for every woman. That they are on Dialysis or post transplant, have to be more vigilant).
* Maintain your body weight. This can also lead to swelling. It has taken me some time to figure out my ideal weight. One or Two kg less, is not problem. However , one kg more than this weight & i get swelling. This is another discovery, I have made, with the numerous permutation and combination, to understand the reason for my swelling.

Either one , or, a combination of BP, Dehydration (lack of Water ), excess salt, Body Weight & stress on the feet leads to swelling on my feet.What i have penned, is my experience. Cause & symptom for every individual,of the most minor deviant , physically or blood report ,can be the most unassuming. Be watchful & be attentive towards your body! 

Friday, November 3, 2017

Information - Renal failure, Diet, Exercise.

30 years of oblivion. A life of Discipline & Restrictions ( some that come with the territory after a transplant & mostly self imposed). Both being the perfect balance to living life to the fullest. It's essential to share now, the reason I stepped back & disappeared into a cocoon, where I cut myself away from the world of Kidney, unless it was to do with my reports, my checkups.

Flashback: 
At the time I was diagnosed with renal failure, July 1986, there was a dearth of awareness & knowledge about kidney failure/ transplant. Our one touch information friend, Google wasn't born then ) . Many didn't even know( including us ) , there was something called a renal failure & even if there was, it definitely did not happen to us or someone we know - which,  lead to many a myths regarding the reason I had fallen ill , why specifically a renal failure , leading to a transplant. This , combined with how people's attitude towards you changed, pulled me back. It's was either a look of pity, a look of - serves her right( she must have done something wrong),  to asking my parents questions which at most times didn't even relate to my illness ( border lined on pure gossip & smirks ) & such , pushed me to a space where I went about the most normal life without discussing or taking about my illness. Even as I pen this, many do not have any idea about my transplant. The few who were a part of my upheaval of 1986, know & a few, got to know, due to special circumstances/ situations or on default. The only times when I have spoken openly about my transplant, discussed the journey , has been when I have been asked to speak to patients or their families, undergoing through the same trauma ( mainly when asked by Dr, B.V.Gandhi, nursing staff of BCH or the few friends, who know about my transplant.

Abeyance, therefore, to the many developments in the field of CKD, kidney failure , kidney transplant, will now seem rational.

The Present:
Hit the landmark of 50 years & I wanted to do something relating to transplant, not sure on the progress , with no information at all, just the want of being able to support this field in some way, I went to the most logical person for a tete a tete. Dr. B.V.Gandhi , my nephrologist , who connected me to Vasundhara. She added me to her Facebook page, The Kidney Warriors & reading all the posts, the information available,questions asked,  the awareness of patients & their families, put me under a shock - The world in this field had moved so much & so fast, it completely blew me away to speechlessness ( a characteristic which is completely contrary to me). I was overwhelmed. 

Assimilating a few questions & posts, i realised , if the vast world of knowledge had put out some confusion in simple situations, a counter to when I was diagnosed, had its own perks with its limited knowledge , where you learnt to listen to your body, learnt from experience, became stronger & very aware. To say, Ignorance is Bliss, will be undermining the progress, the vast guidance it provides. However, Simple basic guide lines , has it's own virtue, it dispels Fear, allows you to Be, to Experiment ( with caution, of course) !

Diet & Exercise , has been a key topic of the KW page. Let me share my experience, on how we managed then ( my Mom & I ) & my routine today. 

Pre - Transplant

Diet & Exercise

With the failure of the kidneys to do the task it was meant to do, aka , not filtering the toxins/waste from the blood & sending it to the bladder, throwing these toxins out of the body during urination - the only solution to filtering the kidneys manually, was Dialysis

With Dialysis twice a week, came the 4 specific diktat ( with no explanation of the Why , except for salt & its leading to water retention ! )  - go low on protein (pulses ) , NO Red Meat, Low on Fat in any form , Salt - just 2 grams in the day ! Phewwww , that was a tall order for a young girl who loved good food & couldn't do without Ghee, Butter & Cheese! To top this was , the liquid intake restraint ( not sure how many ml ), if I felt thirsty, or throat went dry , i was told to take a small piece of ice & rub my lips or suck on it for some succor. quite often, I would go through an entire day, just a sucking on a few pieces of ice cubes. Interesting challenges that I have had to face & overcome. 

Mother dear had a lot on her plate. Eating meals was a chore , getting use to food which was out of my comfort zone, was difficult.To maintain a healthy balance with the prohibitions imposed & to be in sync with the blood reports, she became innovative & creative with her recipe's. With the exception of Red meat & dividing the 2 gm salt in the 3 meals , she made sure I ate everything in moderation. This satiated my cravings enough, not to feel, I had been denied any of my favourite fare ! 

My diet incorporated, white meat ( fish & chicken), all vegetables, an occasional bowl of pulses or boiled egg twice in a week max. Mostly microwave cooked , grilled Or steamed - brushed or with teaspoon of any fat that would enhance the main ingredient , spiced well with lemon juice , pepper & salt, only if I really needed to ! Every preparation was mostly in a semi- dry form ( liquid intake minimum ) ! If a dish felt very dry, then maybe a few spoons of Yogurt.Don't remember eating fruits during these few months of dialysis. Also, carbohydrates ( bread, roti, rice ) were at the barest minimum.Eating only Mom's home cooked meals , she became the Michelin 3 star chef ! 

Dialysis for me was a nightmare. Nausea & vomiting while hooked to the machine. Took me a day to recuperate & another, to gear up for the next session. ( Which is why , Transplant at the earliest was the call - done in Nov 1986).At this point, all I did was read, listen to music, sleep - Exercise in any form, did not feature during these months! What else is expected of someone who, at that time, weighed just about 35 kg !
Today, most patients on Dialysis are aware on the importance of a good routine, working their way into strengthening their body & building their emotional quotient.

It was eons later that I understood the restrictions imposed:
Potassium and Sodium ( salt) , though chemically similar, their effect in the body have different purpose. A balance of both is needed for the BP level to be maintained & to maintain body fluids,  proper muscle contraction , nerve impulse conduction, organs functioning & some. Also excess salt, builds body fluids, builds thirst - a total No No for renal failure! 
Protein In the right quantity , helps builds muscles, tissues - which do get depleted during dialysis! 
Red meat , has very high protein, which can affect the kidney adversely.

Post Surgery

Diet

Extremely heavy dosage of immunosuppressant drugs , had various side effects. Ravenous appetite being one of them. I ate enough for an army, at least , that's what it feels like in retrospect! Except for the low salt which continues , I ate everything. 
A practically salt free diet during dialysis,has made my palate very sensitive to the taste of salt. Even today, my salt intake is low - I have no problem with salt free food, but , do have an issue if salt is high. 

Not much I could do about my weight gain ( another side effect of the drugs) ,not having a sweet tooth became a blessing in disguise . I didn't crave sweets, did help tad.
Since my hemoglobin count was low, liver extract, twice a week & eating beetroot , every other day helped.

With the passage of time, the medications have been reduced to the bare minimum (life long), have lost all the weight gained due to the drugs with the help of controlled, disciplined diet & exercise. Even so, the imbalanced distribution of fat in the body can be extremely annoying. And , you learn to live with some of these quirks in your body ! 

My meal portions are normal now, thank God! I continue to monitor the  sodium, potassium & protein intake. The major change, I am revelling on, the every bite of cheese & ghee ! Also , being able to drink water like a fish! 
Today, there is nothing that I do not eat ( except for beef ,ofcourse). However, all in moderation, keeping in mind basic dietary constraints , with breaks , no over indulgence, no Bingeing ! Have to make sure I do not strain the kidney nor any other organ, due to my food intake ! 
The very heavy meals have been taken over by  - Fruits every morning, specially, papaya & banana . Fruits of the season, always! A bowl of dry fruits, consisting of 5 Almonds, 2 full Walnuts, 2 Date's. Two light meals & dinner by 7.30 pm. Since I am not much of a non vegetarian, vegetable of every variety & salads are a major part of my meals. The cuisine changes with every meal & every day. Same kind of food on a daily basis is extremely boring ! There are times though, when I feel like eating something sweet or I need to add salt to my food. I always heed to the demands of my body.Listen to your body !  This is the body telling you that a certain components is low or high. 

Some might say, what about the sweet content in beetroot or other vegetables/ fruits, then do remember , I mentioned earlier, I stay away from sweets. Do indulge at times on an occasional bite of any Indian sweet, chocolate or desserts. ( ( every individual needs to plan their meals/ diet, according to their situations,schedule & their food habits - modified around their religious beliefs ).

As a rule, stay away from artificial Health food or Diet programme. If you are going to a Nutritionist , make sure you are given a very balanced food , which includes variety & natural foods. Eat Natural food as far as possible. Avoid fizzy drinks, artificial juices, packed snack foods ( tinned foods & processed, high in salt, calorie) & , street food ( paani puri & such). Say No to salads & raw vegetables of any form , unless you are sure on the Hygiene of the place( raw onions , avoid at all cost , these are infections waiting to happen). Stick to cooked steaming hot food, as far as possible. Anything Raw, like fruits, salad leaves, tomato, cucumber, etc - always wash well & last rinse with filter water ( I still do this! ), Be sure of the water you drink outside. Sprouts should be a part of your Diet.

Eating out even today , I am cautious on. At times , its a Dhabba that I am happy eating at than a Restaurant , since i can see the kitchen , watch the food being cooked in front of me , is fresh , is Hot ! Home food , Rocks ! To follow a certain Discipline is important, a few Calculated risks allowed , once you have mastered the art of never abusing your body ! 

Exercise 

From the minute I was transferred to my room from the ICU, I was made to walk minimum half hour in the morning & evening. Today , walking for an hour has become a daily routine. Over a period of time, I have incorporated Yoga & gentle workouts to my daily schedule, never over stepping the line or pushing my body beyond capacity. Always ensured that the frontal area which housed my Nani's kidney, never underwent any physical shock or trauma. 

It's been around 4 years since I have started workouts with a personal trainer. It's only after meeting her , that I realised how badly my muscles mass & bone density, had depleted. All this, due to the side effects of recuperative medicines & inspite of my diet, It's she who explained how the combination of workouts (strength training) & Yoga , would help in , increasing muscle mass & bone density, maintaining healthy metabolism & strengthen all joints.Her routine with me changes every 2 months after necessary evaluation, which explores how much my body is ready to except a new & a more intense exercise/ challenge. Regular breaks, with sips of Water, during the routine , helps maintain my BP, my heart rate & keeps me Hydrated .Our goal is to meet all 5 parameters of fitness- endurance, strength, cardio capacity, BMI & flexibility. Till date, we have successfully tried different types of exercise routines like functional training, yoga & low intensity bootcamp.

Apart from walking , mild exercise & yoga - it is best to work with a trainer who has some knowledge on your medical background. If not - the workouts might backfire. Be gentle & increase intensity of workouts & yoga asana's , in slow pace, keeping in mind,  individual health parameters - age , vital statistics, etc.Give body enough time to recuperate & adjust before increasing intensity. Best to be safe than sorry. Enjoy a good balanced healthy life instead of proving a point. 

Remember a simple basic - your Diet, Exercise & Hydration , go hand in hand. Co-ordination & conformation between the two is a key. 

Memory !

I was young, and quite spoiled by the staff at BCH , including Dr Gandhi. When I created a major uproar on the hospital food & demanded , I get home food post transplant, something had to be done. So, Dr Gandhi came home & was so impressed with the hygiene of our home, specially the kitchen & bathroom ( both area's , which can give you the maximum infection) , that post operation stay at home,wasn't even questioned & home cooked food for me, at the hospital, was approved! 

Post surgery, all my cutlery, dinnerware was kept separate. Before I was served , they were rinsed once more, with hot water. Keeping any form of Infection at bay, was extremely crucial, and every precaution for the same was taken! 

Can't finish this topic without mentioning , Sis Tampal, my day time nurse, from BCH, who stayed with me for more than 6 months, post surgery. Not only did she monitor my vitals, she made the most amazing recipes, falling within the restrictions. Also, between her, Mom & their grandmother's remedies, everyday ailments did not need any medications! 

Lessons Learnt :

*Sprout's have many benefits, however , should not be taken in excess. A point which was made by Dr Ruchi Puri , Sprouts contain harmful Bacteria , which can cause indigestion & bloating. The best way to avoid this , is to never eat Sprout's Raw, but , to steam it well or boil it for a minute
An interesting article on the Benefits & potential Risk of Sprouts :
https://www.healthline.com/nutrition/raw-sprouts#section6

*I was 20 years too late by the time I began Function & Strength training in earnest with a Trainer. Had I began the same , slowly & steadily , after 1-2 years after surgery ( with the Doctor consultaion , overall physical condition & reports ), my physical condition would have been way better than it is today ! 

*Walk, some form of exercise & yoga ( in consultation with the doctor & other paramater's) , during Dialysis , is also very important. Builds your physical strength to cope with Dialysis !

A very simple note on Nutrition /Diet - 
http://www.med.umich.edu/pdf/kidney-transplant/Nutrition.pdf

Nani : Mother's Mother !
BCH : Breach Candy Hospital
CKD: Chronic kidney disease 
KW : Kidney Warriors
BMI: Body Mass Index
Functional training involves: Weight bearing activities which target core muscles of abdomen & lower back.
Strength Training Exercise : helps in overall health & well being - builds & strengthens muscles, improves bone density , metabolism , cardiac function.