Sunday, June 30, 2013

Pizza Project

I wrote a few days back about my Margherita cravings. I had decided at that time that I had to make this pizza from scratch - dough, sauce and all. So, last night, I set about doing just that.

First off, I had to make the dough. I had made regular loaves of bread in my bread maker. Though there were recipes for pizza dough and other doughs you used to make buns, croissants and the like, I had never got around to actually trying them. All I made was regular sized and shaped loaves of different flavors. So, yesterday, I religiously followed the recipe for pizza dough that came with the bread maker. It was a simple recipe - flour, water, vegetable oil, salt and yeast. The preparation time for the dough was an hour and a half.

In the meantime, I started working on the sauce. I looked up some recipes for the sauce on the internet and found different versions that contained different ingredients! I decided to experiment here. My cook had prepared a tomato puree and I added some olive oil, some grated parmesan cheese, small quantities of basil and oregano, two teaspoons of honey and salt and let the mixture boil for a while.

When the dough was ready, with my mom's help - I have not kneaded too much dough in my life, you know - took out the dough from the bread maker and then moved it to the pan that would go into the oven - a lowly electric oven, nothing close to a Forno Bravo :-(

My mom spread the dough on the pan and then put a little olive oil on it making sure it was spread evenly. I then poured some of the pizza sauce and generously topped it with mozzarella cheese and some basil. The pizza at least looked promising!

I baked it for 25 minutes at 200 degrees Centigrade. My grandmom (who stays next door) heard I was making pizza from scratch and she promptly stopped by to sample a slice! We all waited anxiously.

At the end of the 25 minutes, we removed the pizza and my mom cut it into slices and served each of us. I was a little nervous. I took a bite. It was delicious! The dough was very well done - nice and crisp, the sauce was really good and the mozzarella cheese with the basil added to the taste.

My grandmom and mom praising it as well. They seemed to absolutely love it. My dad loved it as well. My mom was so excited that she called my brother, Prasan and his son, Naman who were on their way to an ice-cream store to stop by and try it.

I am so glad it turned out well. There are a few ideas I have to try the next time. I leave you with a pic of a slice from my plate!

Wednesday, June 26, 2013

Ban microphones in temples

This Sunday, I went with my extended family (about 20 folks other than me, a wide range of ages) to a temple about 80 kilometers from home. The temple is many, many years old and is one of the most famous Jain temples in South India. We reached in a little under two hours. There were lots of people there. When we got there we realized that the day happened to be a full moon and lot of people believe that a full moon is very auspicious and to top it all it was a Sunday, so convenience got added to the mix! The result - hundreds of people thronged the temple.

With a lot of begging and pleading we got allotted two rooms to bathe and change. Before you can do the pooja, you are supposed to bathe and change into clean clothes. I decided to skip the pooja because the crowd in the temple was huge. For me, temples don't work when they are crowded. They work best when I am all alone. So, I picked a corner and just sat there while my family all joined the crowd and completed the pooja. There was a long queue at the garba-griha. All this took about three hours. As we were leaving, I noticed that the crowd was thinning. I thought - how about coming back after lunch? It would be much more peaceful then.

We all made our way to the lunch hall and ate. After this I hurried back to our room, washed up and wore the pooja clothes and went to the temple. To my delight, there were hardly 8-10 people in the entire temple and not a single person in the garba-griha! I went in and did the pooja in complete peace and then got out into the rang-mandap, sat right in front of the centuries-old idol of Lord Mahavir to do the chaityavandan - a small ritual.

As I started, however, to my utter horror, I heard a lady start screeching on the microphone. She started chanting the verses of the snatra pooja. I was devastated. What could have been a few minutes of complete peace spent in single-minded devotion were now thoroughly compromised! I really wanted to go to her and say, "There are hardly half a dozen people in the entire temple. Why, in the name of God, would you want to use a microphone?!" I refrained.

I tried to focus. My ears seemed to be more powerful than my mind. With every succeeding line the lady got louder and shriller. She probably thought she was sounding pleasant. She probably also forgot that when you use a microphone, you don't need to to scream. The device amplifies your voice. That is the bloody purpose of the microphone, isn't it?

For a minute, in between, she stopped for a part of the ritual. The silence was heavenly. I got in a few lines of my favorite stavan. It was not long before she began again, shattering the calm with her merciless screeching.

Why have microphones in temples? Temples, for me, are a place where you spend some moments of solitude, in quiet introspection and devotion. Microphones serve no purpose but to impose your devotion on others including those who have no interest in it whatsoever. To be honest, they only serve to irritate others who would definitely criticize you and your religion for disturbing their peace at weird hours of the day and night.

To me, microphones in places of worship do more harm than good! Modernization is fine. But thoughtless modernization which ruin the basic concepts of the religion and also add inconvenience to others including more importantly, people who have nothing to do with the religion cannot be justified in the name of religion. Can someone, please ban microphones in places of worship???

Monday, June 24, 2013

Margherita craving

I have this thing about reading some nicely written stuff about some food or drink and then suddenly start craving it like crazy. A few years back I read Mark Tully's article in the newspaper one morning about Darjeeling in which he talked eloquently about Darjeeling tea. I got hooked to this fine tea and to this day relish two and half large cups over my entire day!

A few days back, I stumbled upon this interview with Jimmy Coponi, a pizza obsessive on Flipboard. Jimmy is a seventeen year old whose life revolves around pizza! He goes all out to make great pizza including getting the perfect oven - a Forno Bravo and even - hold your breath - selecting the right kind of wood - white birch! I love such people!

I read and re-read the interview with the tantalizing pictures they had of pizza. Jimmy talks about how he judges a pizzeria by trying the Margherita. I suddenly had my 'craving attack'. I started craving margherita like crazy. Whenever I had some spare time I would look up the internet and read Margherita recipes! I started thinking I should make the pizza at home. But I had no Forno Bravo. Neither did I know where to get White Birch.

This Saturday, I had taken packed lunch from home to work. But I could hold on no longer. I handed over my lunch to one of my colleagues at work (to prevent the scolding I would get on taking back a full lunch box back home in the evening!), called up Foody's and ordered a Margherita Pizza from Via Milano.

The weather was perfect. There was a slight drizzle. The pizza finally arrived. I paid off the bill and took the box to my table. I opened the box and took in the delectable aroma. I picked a slice and took a bite. It was nothing short of a gastronomic orgasm!

A friend was lunching with me. I asked him, albeit reluctantly, to take a slice. He didn't seem too impressed. He was wondering what the fuss was. As I lovingly relished every bite I took, he struggled to finish even one slice. He reached out for the chili flakes and oregano that came with the pizza to make it more palatable. I needed no such frills. The pure margherita was enough for me.

Many people around me (and even me, honestly, until I chanced upon the Jimmy Coponi interview) think a Margherita Pizza is like, too plain. What's a pizza without toppings? The key, I guess, is to have a Margherita that is made well.

My next project is to make this at home - right from scratch. Well, I will have to make do with an electric oven but it can't be that bad!

Monday, June 17, 2013

So, what's the truth about ghee?

I go to this place called Poorna Tiffins every Sunday morning to have Idlis. The idlis here are very soft, light and tasty. The trouble is they pour a lot of ghee on the idlis. This definitely adds to the taste. I am a little worried these days about all that ghee I'm having. I keep reading a lot about how saturated fats are bad for us. They are supposed to cause cholesterol problems and more.

On the other hand is the line of thinking of our family elders. My grandmother always extolled the virtues of ghee and said that it is actually very good for health! I also knew another person who supposedly drank a cup of ghee, plain - everyday! Ghee made from cow's milk is supposed to be used in many ayurvedic medicines.

Proponents of ghee say, "All the cheese you have on your pizzas and pastas isn't doing your cholesterol any good!" Good point!

But that doesn't necessarily prove that ghee is good, does it? At the most, it proves that both cheese and ghee are equally bad - or good!

The trouble with all our ancient knowledge that has been coming down from our ancestors is that there are no studies to prove or disprove the theories. I sometimes wonder how they knew so much. Is there an element of the supernatural?

So, what then is the truth about ghee? Is it good, or is it bad?

It is an important question for me. Here's why: I have been assuming it is bad and yesterday, when I went to Poorna Tiffins, I had my idlis without ghee. I did not enjoy them half as much as I usually do. So, if I go to Poorna Tiffins I will have to do the idlis with ghee. There is a healthier alternative. There is another place that gives great idlis. It is opposite Pragati College near King Koti. They do not serve the idlis with ghee - there is no ghee option at all - and I find those idlis really good as well. Poorna idlis with ghee beats those idlis hands down. But minus the ghee, they could give the Poorna idlis a run for their money!

So, if I am convinced ghee is bad (at least the quantity I polish off with my idlis every Sunday), then I will make the switch to Pragati. If I convinced that the ghee I am having every Sunday is actually good or at the very least, not bad, then I will continue my Sunday pilgrimage to Poorna Tiffins.

Wednesday, June 12, 2013

Treats during dialysis

(Please do not try what is mentioned below without checking with your nephrologist first!) 

Most of us on dialysis have some fairly stringent diet and fluid restrictions imposed on us. When I was put on dialysis in July 1997, I was told by my nephrologist that I could indulge, just a little bit, during the first half an hour of dialysis. For example, he allowed me to drink 100 ml of my favorite drink during that first half an hour.

I was at Medwin Hospital at that time. I would have 100 ml of Fanta sometimes, 100 ml of mixed fruit juice sometimes. It was a great treat. I would take in sip by sip swish in my mouth for a few seconds and then take it in. The logic was that since I was on dialysis, the excess fluid and whatever toxins I was ingesting would be cleaned up by the machine. This is applicable of course, only if you are on thrice weekly, four hours each time dialysis and are strictly following your diet and fluid restrictions. If you come in with a 5 kg fluid weight gain, then, obviously you cannot drink some more fluid during dialysis since 5 kg itself is too much fluid to remove in 4 hours!

But, let us say, if you are a compliant patient and come in with weight gains of 1 kg or 2 kg, then you can afford to add another 100 ml of fluid and it can easily be pulled off. The nurse or technician starting your treatment must be told about this so that the 100 ml can be added to the Ultrafiltration goal.

When I was in Kamineni Hospital, I would have a plate of Idli with coconut chutney as well! Coconut is high in Potassium so it is generally forbidden for those on dialysis. Since I was compliant most of the time, I could afford to indulge in Idli with a little coconut chutney during the first half an hour of dialysis! I also would have a small bowl of watermelon.

My watermelon bowl became so famous that on one occasion, when Dr. J. C. M. Shastry, the Chief Nephrologist there saw the bowl of watermelon in the hand of a relative of mine while bringing it in, he exclaimed, "Oh! Kamal came today for dialysis?!"

For us on dialysis, the diet and fluid restrictions sometimes become a mental obsession. We start craving for things we are not allowed to have. I find that totally cutting off anything would make things even worse. We might even become depressed thinking about those things. If we are allowed to have even a small quantity of these things during the first half an hour of dialysis, our craving is satiated and the entire mental factor is neutralized.

Nephrologists and dietitians must realize that patients are only human after all. Yes, you may think we are super-humans dealing with such a horrible disease! But don't over-estimate our will power. :-) Allow us such liberties. These are not going to harm us. These will help us by reducing our desperate cravings and make us more cheerful and that can't be bad!

Monday, June 10, 2013

Air in the needles

Day before yesterday I had just finished cannulating myself and was ready for the tech, Guruvulu, to connect the lines and start dialysis. I noticed that there were a few air bubbles at the beginning of my venous needle. I asked Guru to use a syringe and remove the air before connecting the line.

When he did that, he got frothy blood out! We were both surprised!

He discarded the frothy blood and tried again. Same thing. All he was getting was a mix of air and blood - in fact, more air than blood. This, when the needle was already inside the vein. He then tried the arterial needle. Surprisingly, he got a little air there as well. The second time he tried the arterial however, he got blood.

We wondered what the problem might be? Air could not come out from the needle because it was definitely in the vein. I use buttonhole needles and there is no way the needle could be in a wrong place because there is no sharp end to create a fresh path. Buttonhole needles have blunt ends and they are meant to slide through an established tract to go into the vein.

Where then could air be coming from? For a minute, I considered the possibility of air coming from within me. No, that was impossible! Even though some people might consider me a gasbag, this was taking things too far.

Guru and I concluded that the needle was defective. There was probably some crack somewhere which was causing air to enter it when we used a syringe to suck.

We decided to pull out both needles and not take any chances. So, we did that and waited for a while for the bleeding to stop. I then re-cannulated myself using the second pair of buttonhole sites (I alternate between two sites) and after a delay of about an hour, we got started on dialysis.

The next day, I discussed this with the other tech, Naidu (I have two techs alternating as well). He argued that if there was indeed a crack in the needle, blood would have come out from the crack once the needle went into the vein. That made sense. He suggested that the needle must have a clot somewhere and air was entering it through the 'eye'.

I am not really sure what caused the air to enter it. There is no explanation that seems perfectly logical. One thing I realized from this incident though is that it is important to push saline into both the needles before cannulation. This makes it easier to detect any problems in the needles before hand. Many people don't do this and lose out on an opportunity to detect such problems.

Whenever any such incident happens, for a moment, I think - is dialyzing at home worth the risks? What if the bubbles went undetected? Since this was the venous line, it could have proved fatal. Any air in the system can be detected only if it is caught before the Air Bubble Detector. After that there is no protective mechanism. I quickly dismiss the thought because I realize that if it were not for daily nocturnal home hemodialysis, I would have given up on life a long time ago. The freedom this modality gives me in terms of the ability to work full time, to be able to swim everyday and have practically no diet and fluid restrictions cannot be imagined on conventional dialysis, at least for me.

Wednesday, June 5, 2013

Is 'Rich Dad, Poor Dad' relevant in the Indian context?

I recently read the book 'Rich Dad, Poor Dad' by Robert Kiyosaki. Sandeep was reading it in the cab when both of us were on our way to Agra from Delhi. He recommended the book very strongly. Now, I don't read a whole lot of books. But he told me a few things he read in the book and I found it interesting. So, when I got home, I bought the e-book on my iPad and read it.

Its a good book overall. However I am not sure how much of it is relevant in the Indian context. It is written keeping a lot of things, which are very US-specific, in mind

For example, the book talks about how someone bought an apartment with a loan taken from the bank and how the rent the apartment fetched was used to repay the EMI the bank charged and after that still left some money on a monthly basis. This would rarely happen in India where the interest rates are about double those in the US.

Many of the concepts presented in the book are interesting. The book suggests that we should never use our earnings directly to meet our expenses. The money must be invested in something that earns money which should then be used for our monthly expenses. That way the primary money always remains with us. Makes a lot of sense. Now, the tough part. How do you find an investment that could fund our monthly expenses on a regular basis? Let me know if you find an answer!

The interest rate difference in different countries changes things quite dramatically. What is true in the US just isn't true in India. If I invested some money in the US in the equivalent of an Indian Fixed Deposit, the returns just wouldn't make as much sense as they do in India. I am not saying FD returns in India are fantastic. Its just that in the US, they are much worse.

Another idea the book gives is to start a company to do all your investments because in a company all your expenses are deducted before you calculate and pay your tax whereas for an individual, whatever money you spend cannot be deducted from your income before you compute your tax. I am not sure it is that simple. But this is definitely worth trying.

The book is definitely an interesting read but would require caution before you start following everything that it recommends. I tend to get swayed by these kinds of books initially but after reading some criticism, I usually think in a more level-headed manner. What seemed like the miracle-cure for all my financial problems suddenly didn't seem very practical!

Sunday, June 2, 2013

Give us the choice!

There are many options for someone who has been diagnosed with chronic kidney disease and needs some form of renal replacement therapy. You could get a transplant, you could do Peritoneal Dialysis, you could do hemodialysis at home or you could do hemodialysis in a dialysis center or a hospital. There is no one-size-fits-all.

Unfortunately, however, most patients are never told about all the options. No proper counseling is given about the pros and cons of each option. The doctor puts the patient on whatever form he thinks is the best. And worse, some doctors puts the patient on whatever form would get him the most money. I would like to think that the latter type are very rare.

For whatever reason, I find it totally unacceptable that patients are not a part of the decision at all. Every individual is different. Why should doctors assume that every patient would want to go onto hemodialysis in the hospital?

It is possible to get a pre-emptive transplant. That way, the patient does not have to undergo dialysis at all! Why are so few such transplants done? Is it solely due to late diagnosis? I don't think so. Very few doctors even consider this a possibility.

About Peritoneal Dialysis, I have written so much already that I can just point you to this post that I wrote for Dr. Kenar Jhaveri's widely read blog Nephron Power. It is very unfortunate that this excellent modality is still treated like an unwanted child by many nephrologists. Yes, some people are not medically suited to PD. Yes, some people are not comfortable with PD. Granted. But why take away the right of the patient to decide? It is after all, his or her life!

This brings me to home hemodialysis. In India, there are hardly any patients who undergo home hemodialysis. It is not the cost that is the primary roadblock. It is the perception of cost. I spend about the same on my dialysis as does a patient who dialyzes at a reasonably priced hospital in India today. And I get about four times the number of hours of dialysis as do people on regular thrice weekly dialysis, four hours each time! Where is the cost? Yes, you have to buy the machine and the RO plant. But there are ways you can get around this as well. I would say anyone who is generally active, mobile and stable can do daily nocturnal home hemodialysis! The best part is with this, he can be even more active, mobile and stable. He can go back to working full time as well which will put him in a better position financially as well.

The trouble is we don't even get to decide. Our decisions are taken for us. Why? Do you know that a study was undertaken in the US where nephrologists were asked which dialysis modality would they opt for if they were diagnosed with ESRD. Guess what? An overwhelming majority of them picked daily nocturnal home hemodialysis! But when it comes to patients, most of them still pick in-center hemodialysis.

Kidney disease is not really that bad. Today, the perception among most people is that ESRD is a death sentence. It is a matter of months before - as they say in Hyderabad - 'Khel khatam, dukaan bandh'! Nothing can be farther from the truth! It is important that doctors take up this responsibility of educating patients about the options and counseling them that life can continue as before, albeit with a few changes. Nobody else can.

Saturday, June 1, 2013

Don't let emails dictate your priorities for the day

I rarely visit my Linkedin profile. The only time I do this is when I receive a request to be added as a contact. I go and check if I know him/her or know someone really close that does and then add him or her or ignore the invitation. That's it. I haven't updated my profile in ages.

I get a weekly email from Linkedin that has some articles (which it figures based on my industry and interests, I assume). Most of the time I delete the emails. Who wants gyaan? Once in a way, however, I quickly scan through the email to see if any of the article titles look interesting. If I find something, I will click on the link and read the article. This happens rarely though.

A few days back, I got a link to this article in the email. Sounded interesting. I went through it. Somewhere in the article it said something about not starting your day by checking your email. The author advised not to let others dictate your priorities for the day. Though the article was referring to how you should start your day, a little reflection made me realize that I let emails not only dictate my morning but also my entire day. Often all I do for an entire morning is to respond to emails sent by others! I was shocked to realize what I was doing.

The things that I considered important, the things that I really need to do related to my work were all getting relegated to the background. All of these were lying untouched in my To-do list. I was happily responding to emails helping others get their work done while my work was all piling up!

So, I thought to myself, why not try a little experiment? One problem with me is I cannot bear 'unread'. If I get email, I HAVE TO READ IT! I cannot bear that red tag on the Mail icon on my dock. It has to be clean! So, the only way I was going to get away from answering email was to quit the Mail app. I did that. To my sheer amazement, the entire morning was so unbelievably productive! I got a lot of my pending stuff done, I worked on some important things that I had been procrastinating on. Just before lunch, I felt so good. I had a great sense of satisfaction.

I then opened my email and saw that the world had not ended just because I did not check email for a few hours. I took care of the emails, had lunch and then repeated the same exercise.

I am going to do this regularly now. I must realize that email is not my work. Email should at best, enable me to communicate. Nothing more than that. If anyone needs me to respond urgently, they can call!