Saturday, December 26, 2020

In search of the perfect Adadiya

Hyderabad hardly has a winter these days. We just got done with our grand one week of this season recently. When the temperature goes below fifteen degrees Celsius, you will find Hyderabadis have taken out their woollens and have lit bonfires at night. At those temperatures, folks in Delhi would flaunt their shorts and sleeveless tees.

For whatever little cold weather we get, we try to enjoy things you associate with winter. One such favourite of HBCGs (Hyderabad Born Confused Gujjus) is the Adadiya Pak or Adadiya in short. A sweet made out of ground Urad Dal (Skinned Split Black Lentils flour) roasted in ghee and mixed with sugar and spices, the Adadiya is a dish that possibly originated in the district of Kutch.

Parts of Gujarat can have punishing winters (going strictly by Hyderabad standards) and the people there probably invented dishes like the Adadiya and Lapas, another famous winter sweet to give warmth to the body. The spices in these dishes generate heat and helped cope with the falling temperatures.

How much these spices actually helped in warming the body, I do not know. However, the taste got people hooked for life.

My earliest memories of this wondrous sweet are from childhood when a grand-aunt who stayed in Chennai used to send us plastic boxes filled with Adadiyas packed neatly in rows of three garnished with crushed almonds and pistachios. Hansa Mami, my grandmother's cousin brother's wife, was a legendary cook. Her kitchen was busy throughout the year. Come summer, and she and her dutiful daughters-in-law would get busy preparing pickles of myriad kinds. Winter was when things like Adadiya would keep them busy.

Hansa Mami's Adadiyas, though, were truly her best production. A tad spicier than what others made, you could feel the spices tickle your tongue as you took a bite. Some people make the Adadiyas cloyingly sweet. What, pray, is the difference between your regular sweet and the Adadiya, I ask?

Hansa Mami's stocks run out soon, unfortunately. Then it is up to you to figure out other sources. This is not a sweet you get at your traditional halwai. You need to scour the streets of your city to look for shops whose owners are familiar with Kutchi fare. 

In Hyderabad, there is a famous Sri Gujarati Ram Bharose Sweet Mart in the Koti area. This shop had Adadiya one winter. Not half as good as Hansa Mami's, though. One Good Samaritan recently told us that there was one more shop that sold Kutchi stuff, called Paras Agro and Food. My parents went to this shop and found that they stocked Adadiya as well. They also stocked other Kutchi delicacies like the Pakwan (also known as the "Cardiologist's least favourite food" given that they make it using refined flour and deep fry it in ghee). They had good Adadiyas. Well, still not as flavourful as good old Hansa Mami's but then, at least you could get however many you wanted.

My brother, Prasan, doesn't share the passion I have for traditional Indian sweets, least of all Adadiya. He wonders what all the fuss is about? The length of the Hyderabadi winter, also, doesn't logically justify the hunger for Adadiyas. But what the hell. Who says you needed to do whatever is logical?

Thursday, December 17, 2020

Those on Peritoneal Dialysis, beware of laxity due to fatigue

Peritoneal Dialysis is a wonderful therapy. Who would have thought that the body has a membrane within that is suitable for dialysis? It's as if Mother Nature by itself wanted to take care of the scenario where kidneys stopped working. I have always been fascinated by how dialysis can be done by no external machine and simply two litres of sugar water.

Those on Peritoneal Dialysis should consider themselves lucky that they have access to this therapy where there are no needles, fewer diet and fluid restrictions, no regular visits to the hospital, no intra-dialytic complications like cramps, hypotension and so on, no dependence on others for your dialysis. What's not to like?

Well, there are people who hate this modality. Their experience has not been good. They are happy with Hemodialysis. I fully understand.

However, for those on PD, I have a word of caution. Beware the laxity that sets in due to fatigue.

First, I will recount a personal experience. 

I started PD in 1999, a few months after my failed kidney transplant. Nobody told me about this therapy. I learnt about it on the internet. This always bothers me. Why aren't patients who are diagnosed with kidney failure even told about this modality? Why is the default always hemodialysis? Why not let the patient decide? 

I got to know about PD on the internet and asked my nephrologist if I could do PD instead of hemodialysis after my kidney transplant failed. He said Yes. 

I settled into a very comfortable life on PD. My life became completely normal. I started working full time. I was traveling. I was playing Table Tennis.

A few years down the line, I was introduced to Harish Natarajan who was at that time heading Baxter's Renal Division in India. I was using Baxter's PD Fluid. Harish and I stayed in touch over email and phone calls. Baxter organised a PD conference in Hyderabad and Harish invited me to attend. While waiting for one of the sessions to start, I was chatting with Harish and his colleagues from Baxter when Harish told me that I needed to then be very careful about my hand hygiene and basic sterile precautions as this was typically when fatigue set in and people tended to take chances and not adhere to the protocols completely. This could result in infections which were typically very difficult to treat.

I made a mental note. But maybe did not do too much about it.

About a year later, the Tsunami happened and a few months after that I got my first exit site infection and a series of infections followed. The Pseudomonas Aeruginosa bacteria (see picture above) was my nemesis during the next year or so where we tried to save my PD catheter and my Peritoneal Cavity function. We did not succeed and I had to give up PD.

While there are doubts about why the infection happened - whether it was due to the Tsunami water or the carelessness that set in due to the fatigue - it is true that the infections made me lose my access to PD forever. This was a devastating blow for me as I loved the therapy and the freedom it gave me.

So, I would like to say to all those on PD. Never ever take chances with hand hygiene. Do the hand wash - all the six steps - very diligently. Never take short cuts. Make sure you are cleaning your exit site as per the protocol prescribed to you. Do not miss even a single thing advised by the doctor or your PD Clinical Coordinator. 

Remember, even a single mistake can cause you to lose access to the entire therapy for life. Even a single instance is enough for a bacterium to make its home in your body. And this is one unwelcome guest that rarely leaves your home.