Stroke

What is it?

It induces disability of higher order and possible reason for mortality. Detailed reading is available here.  Typically it is either ischemic(loss of supply of blood to brain) or heamorrhagic(rapture of blood vessel or bleeding). Stroke affected person needs immediate attention, the first hour is the most important as recurrent stroke or other problems based on the patient’s other problems could arise.  In US of A  and UK – newer treatment are available (tissue plasminogen activator, or t-PA – not effective for hemmoragic folks, Ancrod - snake venom ) which can be effectively used to prevent damage and recuperate faster. But usually the life of stroke affected person is changed for ever and has slower recovery(TIA – milder form of stroke is usually warning and recovers faster)

Once patient is recovering, prevention of embolism is as important.  Once stroke makes an appearance, near and dear family needs to step and become caregiver to the patient and each other. Acceptance for the patient and self is the most difficult piece, once that is done, rest things fall in place. External/professional caregivers will have limitations and challenges and in general in case of Indian families  - near family needs to right thinking. This could involve adjustments in approach to life and generally everything.

Treatment

Heparin  does is usually the first mode depending on the patient hsitory. Warfarin is used in the earlier stages of treatment and usually stopped, aspirin in other form of Clopidogrel on other hand is continued for anti-platelet action to prevent clotting. But best way to prevent clotting or heamorrhage is physical exercise and general calmness of mind.  Warfarin and aspirin dosage are to be prescribed by an expert  to prevent untoward event.   Vitamin K plays an important role during the treatment. While taking warf one needs constant INR monitoring. For the patients already using stamlo or similar drugs for controlling cardiovascular wellness(blood pressure), expert doctors can prescribe the dosage and timings (which are crucial). In general feet swelling is noticed in immoble folks affected with stroke.  Prevention of infection due to neutropenia  – is important but not controllable per se. So cleanliness, prevention of cold etc is super important while giving care.  Incontinence  can be overcome by use of adult diapers and regular timings and “sensitivity” towards the patient. Speech impairment and apraxia (inability to control the limb movement)/paralysis usually follows. Latter two can be treated with physiotherapy aided by the willingness of the patient to undergo the routine.

UK site has better updated information from time to time. In India btw stroke is 2nd biggest reason for mortality and age related immobility.

Can it be prevented from happening again?

Rehabilitation and family care are the most important factors which promote recovery,  Many medicines prevent recurrence of  stroke, but except aspirin in 1% of the cases, no medicine has been proven to enhance rehabilitation.

Research to follow up on.

Some of the research followed here sounds flimsy(spirituality, healing touch, spousal care taking pattern etc) but has roots in the difficult to handle aspects of the event.

Anticoagulants - have seperate branch of study.

Ahajournal has provided lot of information and tactical stuff but breakthrough is still awaited.

FDA has great site to follow up on medicines/sideeffects.  In developing countries the local agencies are not so transparent or helpful as usual.

Healthnet too has good information.

Stroke Association

How to take care

1) Patience with patient/self.

2) Sense of belonging to patient and self

3) Acceptance

4) Healthier food habits

 Is India better place to take care of patients

Yes from personal experience as the family support system is the most critical piece in the caring of the patient. Most of the drugs (except tPa possibly) are available and treatment known to the doctors.

At home

One of the challenges for meaningful life after stroke comes from the badly designed house/apartments/common spaces, shopping areas etc. Depending on the disability minimum which is required is the need for support(railings), space, access to wheelchair(depends on disability) and stepless design to common areas. I guess here the developed world is far ahead of developing countries. One needs to use common sense at home to drive the comfort of patient.

Guidelines at strokecenter, Center for accessible environments are pretty exhaustive for local places which may need adaptations for local deployment.

Books

Read  

1. Electricity - A short take on research and impact of the electricity over the centuries. This book does not have the farmulaes or any kind of clarification and sometimes gets too lost in radar work for world war 2.  Few good things I take away from book were with regards to Morse(who came out as bad person in my book), Harris( the allied airforce person responsible for deliberate bombing of the Hamburg civilian quarters).  I also liked the statement of faraday – where after seeing the rainbow he realizes something.  We believe in theories of physics based on explanation and few experiments and deny the bigger wonder which exists. 

To read

2. Laurence A. Wolsey, Integer Programming, Wiley 1998, ISBN 0-471-28366-5

Experience of Home loan procedure plus moving into apartment – India (What/How/What not)

As promised I am planning to share the experience of getting the home loan approval and further stuff here.

Let me collect the thoughts and experiences till tommorow and aggregate it and dump it here.

Big thing on the list is clarify.  

Clarification on the emi, emi time, pre-emi ( a fancy term for just charging you interest with no effect on the main amount) , terms of pre-part-payment etc, when is the interest calculated.  This world of credit is what I wanted to stay away from but got caught in it .

Added on 16th July 2007

We moved in. Puja/move was smooth. Registration was smoother becuase we had good broker (Anil/Raghu from Akanksha  group – if any one is interested I can share the email/address/phone).

My procedure involved getting

1. Form16

2. PAN

3. Salary report for 3 months

4. Bank statement – 6 months

5. 2 photos

6. residence proof

Things which are usually not clear

1. Old houses will have Association whose terms and conditions can take you off gaurd. Let me list some

a. Move in charges of 1000 rs

 - is it towards use of elevator/initial setup of house in terms of help provided for 10-12 nails/washing machine/aqua guard etc.

b. Transfer charges to be paid by buyer worth 30000 Rs

- for older associations this is way to build larger base for maintenance in face of rising costs

c. Maintenance charges (1600Rs*3 months)

In my case broker did not have inkling and pushed it on to me and seller to settle it . Since seller also claimed he came to know these things were news to him, I agreed to pay the transfer charges at the last minute. In my case seller has moved to us of a and out of touch with latest developments. So while buying old apartment – just talking to broker and seller will not help and you need to take extra step to meet with the manager/association president to get clarity.

d. pre-emi – This is an instrument of death and usually bad way banks make money for the ready to move in properties. When property is ready to move in and you are ready to pay the emi when required , I do not understand the need for the pre-emi. Here again the broker provided “bank loan expert” could not help much. We ended up paying 20 days of interest for the disbursed amount.

Good parts of the move

1. We got good broker(Anil) and good seller (SB)who were clean and simple. You need to have synergy with these people and mutual trust  needs to develop. SB in particular was ok with out of station cheques and delay in bank process and also wanted clear deal.

2. Good Bank person in form of RR who was clean and straight forward. The other person at main bank (BS) was unfortunately never clear about the help/clarifications or documents.

 3. Cost of the cable etc is lower due to the bulk captive customer availability.

Bad parts of the move/Buying

1. In the day of template and internet – easiest things which banks can do is keep template of the documents to carry and send it on email, showing procedure etc. In our case we kept on requesting what all is needed and this information never came from BS of hdfc bank till the last day.  They did not even consider the request that we will pay the registration etc otherwise outstation cheques take long time to disburse, this resulted in last minute hassle. One needs to carry x post dated cheques(you need to listen to bank folks use the acronyms and as software person you will happy there are still some more to be learnt) and security cheque with actualy sale deed/agreement of sale  form duly signed for preparation of cheque.

2. Disbursal of the loan cheque/dd itself – this is smallest step in the registration office but one where we wasted 3 hrs waiting for the courier gentleman to appear. This guy first demanded money to give the cheque indirectly and then refused to give the copy of the document. Apparently this person belongs to the bank - I need to follow up on the behavior.

3. Problems in the house – we found we ended up putting in another 10k -15k for basic repairs of the light fixtures/water/washing machine connection/cooking gas connection/broken rusted hinges, windows etc. These are the things you can’t really check up while you are visiting the house. We have had major problem with the door where whole door is coming apart. Unlike US of A where you can get professional checkup done at a cost this is more of trust and  in our case SB was trustable and we did not enquire much. Unfortunately the pressure at home did not allow us to do the same but I would recommend anybody else to do thorough professional checkup.

4. Cost of vegetables, milk, condiments , household help is higher in apartments.

5. Maintenance is on higher side for the house

 Few other things

Banks like to pay for registration and keep all orginals of everything including the agreement of sale, property taxes, khata, ec etc as was in our case. 

Move needs to be planned well, rates vary from 3500 to 10k depending on mover, items, bedrooms and kind of packing/moving you want. In our case we packed most of our stuff excluding tv/refrigerator/washing machine/sofa/dining table. We also moved majority of smaller/glass/required for immediate use items ourselves in 2-3 trips.

You may want to move in day time early afternoon to avoid the school children moving about, rush of office goers and wait for  lift(elevator).

Avoid weekends as the rush way too much everywhere. Avoid evenings in places like Bangalore – where it rains.

Once you move in you need to think of

- milk (get the stock till you decide in terms of tetrapacks)

- water (depending on hardness of water – you may want to opt for something else)

- connecting washing machine/water filter/lighting fixtures, setting up bathroom(supplies for bathroom)

- nearby shoping(provision/vegetable), medical stores, furniture, hardware in order of priority.

- connectivity (thanks to cell phone intra city tx are easy), internet/tv may need time depending on the provider as we found out our cable provider came within an hour vs tata indicom guy who never picked up the phone for 2 days.

- Cooking gas  – easy inter city transfer

- Clothes drying (well it is green year – be kind to environment and use simple ropes   )

- Dishwashing (you will need maid help if you tend to keep things for later and they turn out to be costly)

Food roundup

One thing which was lingering long after the travel was the smell and taste of the various food items I had chance to sample this time to Belgaum.

Belgaum to Bangalore – On the way to Belgaum by 4 wheeler, the major pitstops were unfortunately at only Reliance A1 places. Over the last 2 years I have found there are good and bad variations to this chain. One near the Chitradurga is good and provides better menu for both non veg/veg choices.  They can make bhurji, bhajji, puri-bhaji(with what ever choice) , usual indo-chinease affair(best to be avoided) and north indian spread(roti – order the tandooris), tadka daal, korma etc. The one before Hubli is unfortunately way below par even the normal roadside ones. It has awful upma and does not really work the full time, in early morning at 8 am – they just had one dish – upma. 

When you are near Hubli/Dharwad – it is better to take a trip to the city and enjoy better food. Dharwad has amazing pedhas(Mishra), wadai/idli and usual tindi stores(maitri paradise,bombay , brindavana ), if you get chance visit the university and gorge on awesome chilli bhajji in the evening with local chutney and cuppa half-cut tea with friends for company. The view/location/food is good.  Hubli is good for full meal kind of stop.   Chitradurga is blessed with better culinary items but unfortunately you need local home access to taste it. Every other restaurant has become “pan-indianized/secularized” serving everything from other country dishes(read the up north chinease ) to north/south offerings thus diluting the local offerings. Davangere has better name in terms of the food – benne/kali  dosai,  kara-mandakki ,menasinakaayi etc. In Bangalore/Belgaum one even finds shops with the name Davangere benne dosa.  Well sad part was I missed the kamath after Tumkur which has decent tindi items.  

2. Belgaum

Belgaum is blessed with good food joints like new grand, pranam(opposite globe), kamath, “ajanta” , “milan”  .  The food from these udupi restaurants is delighful and varied in offerings. Every place has different idli, vadai, dosai. I have never tasted non-veg in Belgaum so Jyoti(my wife) has exposed us to recently “khyber” food which according to connossieurs of the good nonveg is delightful.  I am not including Tilakwadi etc since I have never had food on other side except the road side stuff.  BTW the cold coffee stall near the GIT college on khanapur road is history replaced with hip liquor and grocery shops .   The toast is peculiar offering of Belgaum where 2 slices of bread are toasted and applied with butter and toasted again.  On top of it a little bit of “chutney podi”  and dash of regular coconut chutney. It is served with surprisingly onion rings(raw), but it tastes heavenly with cup of tea/coffee.  Vada pav of Balu in front of Ramdev is also very famous, with right fried color and ginger based Potato curry and fried green chilli. The pavs being fresh are just gobbled up smoothly. Highway hotel(irani)/Kakati/CBT bus stop(irani) has good tea and lip smacking snacks. The irani tea taste is a secret I have been trying to replicate and understoo one of the process step being – just boiling the conoction over and over again.  The idlis/dosai from Ajanta/New grand are wonderful preparation with just right lingering taste of udad pulse and local groundnut chutney(thicker version compared to watery bangalore version).  Belgaum also has the sweetmeat shops – nagauri etc who provide kunda/kardant(although gokak is famous for it – you get similar stuff in belgaum) etc.   Belgaum also has the freshest of the vegetables of all kind and delight for veggies. The usual fare is jowar roti with brinjal curry and dollop of butter.  The methi/palak/red palak etc too is abundant.  Jyoti was the one who also got the Kaaps ( fried cut veggies) introduced in our household available in some puneri restaurants. I was unaware of the dish till I ate it first time.

New grand is pretty old establishment on the college road with clean/small place for years. The chairs are old style laid with sunmica and pantry covered half with treakwood almirah with glass for sweet storage. It also has efficient cleaning service. Another item which has gained popularity with masses is Puri-bhaji – fluffy light puris with “usal” based bhaji is good tiffin item to splurge on. The taste of bhaji will be tad sweeter than usual ones and stand out because of “usal” base rather than potatoes.

Ajanta was renovated in nineties and converted into cosy place with trolleys for cleaning and nice seating places. It sees massive traffic and serves great dosai, upma. Restaurant has done nice thing – it has kept one big chunk in the front open and empty to allow for light and “take home” folks to sit around. The idlies here are delight simply becuase of the lightness they bring to the senses. Niether chutney nor sambhar overpower the senses so as to kill the taste of idli. Idli retains the original taste down to the last bite.

Pranam opposite the globe has tastiest chakalies(murruku) on the planet. Try the chunkier, lighter version with small hole in the middle. The taste will be amalgamation of ajwain, chana flour. It also has good idli and dosai in early morning. I am not big fan of upma – but Belgaum upma are usually sweeter and have less of peas etc and full of “chana”/”udad” pulse garnished with “sev” and “coconut grating”. It just melts in the first bite and taste stays with you forever.

3. Gadhinglaj

A place where my sister stays has fabulous store – mahalakshmi for bhadang which is served after 5 pm till 7 pm strictly. It has the neatly laid out row of benches with narrow table in between.  Vada pav too has stall owner who likes to serve it hot on the goa road. It has the folks from rajasthan for chaat/paani-puri etc. My sister makes heavenly misal pav which I miss terribly. 

4. Kolhapur is famous for rassa, sugarcane products, milk and misal. I like sugarcane and walking across to “jaggery makers- gurhal”  and having bite into fresh jaggery. The misal-pav is again local “usal” based and description can be had from earlier Gaurav Sabnis’s excellent entry. This misal pav is more closer to Puneri style with bigger portions.  Everything in Kolhapur is more of bigger portion – vehicles/houses/people and their food. The mutton/chicken preparations are beyond me. Good hotels to try out are Hotel Victor Palace, Panchshil(veg), Pearl, Vrushali,Rayson and Yatri Nivas etc. This time though the chances of meateaters did not have chance as we were on piligrimage to jotiba/mahalakshmi.

Special – Somebody has collected local specialities for each station/place.

Tindi – eatables/light snacks

Reviews like these make the mouth ….

Foodies

Vikram Karve’s unofficial food guide to pune/Mumbai.

Sigfood

Pooja with her Goan stuff

Nupur’s Hotstove - awesome content/recipe/photos. (you need to bow down to the creator for this much of perfection)

Somethings do not change –

On recent visit to Belgaum one of the major initiative was to be with mom to witness her trials and tribulations she faces as wife of a bedridden retired soldier. The treatment in the Bank etc for old people is terrible to say the least. The concept of customer at least as in case of old folks standing with pain and tension does not seem to be the main problem for the bank which has monopoly on the distribution of government official pensions.

1. Old folks stand in line for hours to just get a checkbook updated where a person doing the job can ask them to go to another counter arbitarily at any time without giving any reason(possibly valid reason – hungry – i am shutting down).

Resolution – just have automated check updating machines with attenders to help old/people who can not read/write the interface.

2. Old folks stand in the one or 2 lines for the pension for hours again with shoddy service and personal question barrage – why do you need so much money when you are old, why are you withdrawing all the money, where will you spend the money etc. Customers also undergo shouting of various kind completely arbitarirly based on the mood of the teller. The teller folks seem to be doing a favor by giving the pension.

Resolution – why not have special monthly counters for disbursement of the pension by more # of people.  Get the servicing folks a training how not to ask personal questions and treat customers with more respect. (you have to be present physically to see the treatment).

3. Transfer of pension and easier validation of the pensioner – This is another sadly ironic stuff, a pensioner is person who puts in x years of life in the service and deserves the humane touch only when he has become dependent or is keeping unwell and can’t keep pace with the life.  I have to ensure mother has enough heart to go back to bank and get the pension as everytime the bank folks ask uncomfortable questions before disbursing the pension due to my father. Earlier I used to tell mom to just leave the pension and not worry about it, but she considers that as her/father’s right to have and be on her own. I was apalled to see how she and her compatriots of older age have to struggle and literally made to beg the pension due to them, they are made to run from pillar to post to get signatures and approvals and everytime this keeps on changing. I was trying to ask the manager how this can change as father can’t move or talk – one was insensitive to the extent to say – it is not their problem – it stuck me it is true. Least they can do is understand the dependents and make simple arrangement for identification. But I was expecting too much. BTW this manager was “educated” upper crust material with unfortunate lack of understanding of “service” and brimming with arrogance of being SBI person.  Anyway point was earlier on few occassions we met with few folks who could understand the situation and help.  we are keeping the fingers crossed as the transfer of pension to place of location is very cumbersome and totally unclear. Armed forces too do not have good mechanism to address the same or simple information disbursal for the needy.

4. Credit card woes – As mentioned earlier the local credit card companies are fast loosing the trust of the customers by delaying the cheque encashing, “forgetting to encash” , “blaming the courier/system” etc. Technique seems to be similar – delay the cheque encashment. Personally I have been stung by it in HSBC and ABN AMro lately. HSBC card I have cut off. The process was cathartic to say the least – I pre-paid the money, they denied having recieved the cheque, confirmation was done through courier firm(where we found the cheque was carried and deposited into black hole). They did not deposit the cheque for almost 20 days and later on system generated message reaches me threatening with consequences of not paying or paying late complete with  late charges. I question the same and share the cheque information, they deny having it, I share there own pick up(skypack reciept). It goes on till they say they have found the cheque with incomplete details and that is why they did not deposit it. Wow ! – what was incomplete – hmm name was not present. I look at my copy of the cheque – everything seems allright. But what the heck – I ask for latest charges including late and ask to be cancelled. I call up 6 times to cancel the credit card, every time I am promised somebody will call up to get the reason and cancel. It does not happen and in between I again get another letter of not having paid the amount. I call up with new reference, One person says my credit is closed and shows x amount credited extra(i have basically paid extra). another person responds saying they have not recieved anything at all . In the end – I record the call and keep it handy for you never know when they can reopen the account and create another fraud. I wonder what kind of CIO/IT systems these folks run (I was under the impression only government banks can be so bad).

ABN-AMRO is presently contesting they have not recieved the cheque dated 14th June for 9000 Rs and gone ahead and charged me extra amount. I am trying to see how can I survive without the credit card as I did 2 years ago to live a sedate, peaceful life.

Times are changing

Reflecting on changes sweeping through the processes. I found few things refreshing

1. I am sunbscriber of the SBI life insurance (don’t ask me how I got entangled) and needed to pay delayed premium this year June. I got the premium advice of May in June end and was dated February. So I had little expectation about efficiency and was worried more about lethargic “level of service” which will be offered when I call up to get status and how to fix it. To remedy the situation I called up the service center which was closed but it mentioned a web address to go on and find more information. On the web SBI has massive spread of real estate in terms of various websites. Getting access to the right one (intuitiveness is lacking in most of them) and finding out contact mail was not easy but what did surprise me was the detailed email which mentioned the minimum amount, place to deposit and detailed information.  Sweet. If nothing else somebody there is working hard to ensure customer remains with them for longer.

2. Packing & Moving : India is surely changing. In most part of the life I have experienced moving/packing being part of the armed forces family. Cutting off the friends/relations, experiencing the thrilling move in train (mostly) or 3-tonner(local houses move) became more of a norm through the growing years. The intercity move was co-ordinated well with father booking the tickets and mom packing up everything neatly easy to be picked up 2 people anytime. We also learnt not to accumulate (lately lost the art of convincing – how one does not need the stuff).  But moving as civilian once father retired was always a pain and I dreaded the move in the city or out of the city(we did shift 3 times before we settled down at malmaruti extension). I have already done one move from Belgaum to Bangalore and this one should be hopefully last one into “permanent” address. After the ease of moving and packing in US, I was dreading this move but sweetly surprised to find “directory of household movers” , aquapm, goel etc. One could reach them through the sms or otherwise. Only challenge being what kind of people will be brought in to move the stuff. Which for some strange reason is “basis” of unknown fear since normally move is done with friends and family help. I decided to call few of them to get more information and got good rates. Now the experience starts – will post back later the update.