Oops!

I blew it! It was careless of me not to avoid it. I was not thinking of it at all.

Recently, I have come to another hospital every Thursday to learn general internal medicine and emergency medicine. The hospital is far from my residential area. In addition, my jobs start early in the morning ― 6:15 am.

I left my home and arrive there before dawn since it is winter in Japan. My mistake on that day was that I did not turn off the head lights of my car when I got off. As you guess, I found my car lost its electric power when I came back to get something in the car around noon.

All I had to do was call my insurance company. Luckily, it provided everything I was going to need, what's more, for free. I had Ramen noodle while waiting because it would take an hour for the rescue staff to arrive. Soon, my car revived without difficulty. I really appreciated to them.

I got back to my home with caution in order to charge my car's batteries. That is, I DID NOT use air conditioning or audio system. Since then, my car has been doing well, indicating that the batteries are still workable.

This is my second time to have an experience of dead car batteries; it has been more than a decade since my first oops!

Tough but worth watching

Last night, my daughter and I did it. We knew it was quite a tough challenge to achieve but worth giving a try.

It was Kobe Luminarie, a light festival held in Kobe, Hyogo prefecture. To be honest, I have been to the festival. It was about 20 years ago, when I was a resident doctor. I asked my wife on a data; she was a student in music collage at that time. All I can remember is that the festival was incredibly crowded.

Yesterday, my daughter and I spent about 1.5 hours waiting to see the beautiful spectacle in a bad condition. It was freezing cold outdoors. It was not en easy task, as you guess, but we were at lost for words when we managed to reach the light gate of Kobe Luminarie, as shown in the left picture.

It was beyond the description. Awesome and Fantastic! No explanation was needed. We forgot all we had struggled until we arrived here. Simultaneously, the spectacle reminded me of 20 years ago. At that time, my wife and I were extremely impressed by the wonderful illumination. We though as if we were in heaven.

Maybe, 20 years later, I 'd like to visit there again, with my wife and daughter, and possibly my daughter's daughter. It would take me back 20 years ago and 40 years ago.

P.S.
My two sons refused going to see Kobe Luminarie. Instead, they reported that they enjoyed playing a video game, Mario Cart, at home while we were out. Biological differences may exist between boys and girls.

Nose hair to be removed

Today, while I was having my hair cut at a barber near my residential area, I found a new ad under the mirror in front of me, saying "try new service, clean your nose."

I realized that the service is nasal hair removal with special wax. I was really curious about it because not only it is ashamed that nasal hair is showing but I have never had any experience of unhairing. More important, the cost was only $3. How affordable, is it? I decided to give it a try.

First, the staff put some cream around the entrances of my nose holes. Second, he inserted one stick, which was several centimeters in length, into each nose. It was actually smooth and what I expected. However, one minute late, the staff forcefully pulled out the sticks from my nose. It was something that was beyond my thought. I was really astonished, crying out in my mind, "What in the world happened?"

The action was too quick for me to feel any pain. The staff showed me the stick that had been staying in my nose hole for a minute, smiling, "A lot of nose hair, here. Successful!" Then, I was able to figure out what happened with my nose.

After the hair removal, I found myself breathing more smoothly than I was. The problem is that the effect only can last for a month, but it does not matter to me, because I come to the barber every month. Imagination that I would have this thrilling experience every month makes me excited. The stick covered in my short nasal hair does seem really disgusting, though.

Rebellious Period

I found it just before leaving home for work. It was 5:20 AM. It was an unexpected massage to me from my daughter.

The lovely handwriting reminded me of last night's event, when I had gotten upset to my daughter because of her rude behavior to me. She even kicked me in the leg.

I know that she is going through a rebellious period. Now my daughter is 13 years of age, meaning the beginning of so-called teenager. However, I want my daughter to remember that I have been standing with you, and I am 100% sure I will, for ever.

"Dear Aya, you will get married and have teenagers decades later, like my wife and me. You might say it is too far distant to imagine, Dad. I swear, however, time flies and the moment comes to you way much faster than you would think."

I would be happy if I could remember this blog when I see my daughter struggling with her teenagers' kids in the future. It is likely that my future is surely full with something fun. Aging is not bad at all!

My 3rd Book

My third book, entitled "Practical Handbook of Phonocardiography" has been published.

The book has a subtitle, "50 Case Studies with Embedded Audio and Video." What I want to emphasize is the word Embedded. It is true that some medical books have videos, especially in the field of cardiology. This is because seeing is believing, as proven by echocardiographic movies.

I know that books regarding auscultation often include a CD with audio files or a secret number to access Internet contents where you can download audio files.

What makes my book distinct is that both audio tracks and echo videos are embedded. That means you do not have to stop reading the book to listen to audio or to watch echo. How convenient. Don't you agree with me? I created this book since it would be one I've really wanted for years. Nobody dose make it, so I made it by myself.

Whether the book sells like hot cakes does not matter to me because I made this book for education, in order not to make money with royalty. I want medical staff in the world to use this book, so now I am wondering how I can advertise it. Becoming popular by word of mouth would be ideal, although easier said than done. Social media may be available and practical, but I am 100% sure that this blog would not work in this context.

Anyway I am very happy with my product regarding its educational objective as well as its technical achievement.

Orange Picking

The other day, my little son and I went to an orange farm close to my residential area. The fruit park is likely to be kind of a secret place. It has no ad or homepage, but I've known it by word of mouth.

The farm is inconspicuously located in front of a monorail station. The station is not my station but I go through the station twice a day during commute. Recently, I have seen a lot of oranges on trees in the farm.

On the day, when I got up, I decided to go there to hunt oranges with my kid because it was a beautifully sunny day, which is characteristic of Autumn in Japan.

One good thing about the orange park is you can eat as many oranges as you want to eat at a price of $6. What's more, you can take out one kilo of oranges per person, which may be a good souvenir for your family. Don't you think that the price — of course, it includes the entry fee — is really affordable?

My son was excited to pick oranges from trees with scissors. It seems like that he preferred getting oranges to eating them. What was fun for me was to see his excitement with joy.

When it comes to all-you-can-eat, I did not eat so much although I grabbed several oranges. To be honest, I was not hungry at all; I had 3 rice balls before we came to the farm park for no specific reason. I was, however, happy because I spent wonderful hours with my son.

November 11: Pocky's Day

My daughter told me that November 11th  is Pocky's Day.
Have you ever heard of the word Pocky's Day?

I am going to talk about what her classmates including her did on the day, but first, let me explain Pocky because I think that tons of people do not know what Pocky is.

Pocky is a stick-like biscuit with its two-thirds coated with chocolate. No doubt that Pocky is popular among kids in Japan. Grown-ups also like it because it is various regarding the chocolate taste; some have bitter-taste chocolate, which is my thing since it goes well with beer as well as wine.

November 11th is named Pocky's Day because of the similarity of their shapes; 1111 likes like four sticks of Pocky. I do not completely agree with the way to coin, but anyway, the day is likely to be accepted among teenagers.

Aside from the naming, what impressed me is a surprise performance by all peers in the class of her middle school on Pocky's day. It seems like that they stood up suddenly during society class, did a one-minute dance of Pocky (which is also known in Japan), and sit down as if nothing had happened.

I feel sorry for the teacher. If I were in the position, it is hard to say about my response to their unexpected dance. I would freak out because I would think how badly they teased me. Another surprising me is that the teacher showed nothing after the performance and continued the class as usual. On top of that, my daughter said that her classmates did nothing special after that, either.

I am not sure which response is intuitive, e.g., bursting into laughter, just smile, angry, ignorance. Anyway, to me, both look cool on the Pocky's day.

This event will remind me of their surprise performance whenever I eat Pokcy.

I like GIF but dislike GIF

Today's title includes two GIFs.
You know what I am getting at?

The former GIF is a style of imaging, and the latter GIF stands for gastrointestinal fiber, one of medical procedures. The other day, I underwent GIF in my hospital.

I have been asymptomatic about the stomach, but it is a rule for the employees of my hospital to have an annual checkup including GIF once they turn 40 years of age.

Before the GIF, I was given a cold candy, which was kind of a medical drug to make the throat numb enough to swallow the fiber without difficulty. I have to admit that the non-tasty candy worked to some extent, but the procedure was not smooth.

One good thing about the medical device is that it enabled me to see my stomach, as shown in the picture above. The surface of my stomach was almost the same as I would have expected, hoping for good health. I have some knowledge about the stomach since I have seen a lot of my patients receiving GIF in my hospital, although I am not a gastroenterologist (but a cardiologist).

Anyway, I am happy with the GIF because the results were undoubtedly OK. What is more, according to my colleague who performed the GIF, it seems like that I do not need to undergo GIF at least for a few years to come.

Pokemon Go

I was wondering if I had a wonderful time this weekend when I started writing this blog.

What I did this weekend, both on Saturday and Sunday, is that my younger son and I went to a big park called the Expo'70 Commemorative Park and hung around to get Hitokage, Pokemon monster.

According to my little son, 25 Hitokages are required to create Lizadon, which is one of the strongest monsters. In general, it is not easy to capture Hitokage because Hitokage is quite a rare Pokemon. Luckily, the park is likely to the best place to get Hitokage only this weekend.

Yesterday, we got 25 Hitokages and succeeded in having a character called Lizardon. My little son and I were really satisfied with our efforts since the Lizardon actually looked cool. My older son was, however, not happy with the result. He said that we could have gotten a better one. It seems like that the key to get a stronger Lizardon depends on the selection of Hitokage.

Thus, my little son and I went to the park again in order to get additional 25 Hitokages. We finally made it, although it took about 3 hours. A two-day, walking around under the strong sunlight, not typical in Autumn in Japan, made me worn out.

After getting back home, I saw my 2 sons (my big son was studying at home while we were out) talking cheerfully about the new Lizardon, which has a lot of potential to grow more powerful.

Before I finished this blog, it occurred to me that, this weekend, I surely spent a wonderful time with my kids. On top of that, I would say that the tiredness makes it possible for me to have a good sleep tonight.

I blew it

Yesterday in the morning, my wife came to my hospital to undergo a stool test for occult blood. The day before yesterday, she had an annual checkup including blood examinantion, electrocardiography, chest radiography, and examination of female reproductive organs. A stool test was scheduled but not performed because of her constipation. After my wife took a container which included a small amount of her stool to the laboratory room of the hosiptal, she left my hospital and went back home.

One hour later, the result proved to be negative. I breathed a sigh of relief; a positive result of occult blood would indicate the need for stomach camera and colon fiber. Upper endoscopy would be OK, but, from my experience, colon fiber is not something that is acceptable in terms of its preparation and procedure itself.

During my lunch, I was going to send good news, i.e., the negative result of her stool, however I noticed that my cell phone was not on my desk or in my bag. All of a sudden, I remembered that I put my smart phone on the seat of the train, and got off the train without holding it while I commuted to work this morning. Oh my goodness...

I regretted having such a careless behavior but I had been still optimistic because I know that Japan is one of the safest countries and the Japanese generally have good manners. I called lost and found at the station, and found myself being depressed after letting me know that no smart phone had been delivered so far. I called my cell phone several times, without any response; it seemed like that the power stayed off.

Google gave me information about what to do if you lost your smart phone. According to the advise, I call the provider company and asked it to stop the data connection. On top of that, I have altered my password, e.g., Amazon.com, on the Internet to avoid being abused.

Hopelessly, I am waiting for the reunion to my priceless cellphone that is full with lots of photos with my dear family. I am not going to disregard the possibility that the robber would read this blog and return it to me.

Athletic meeting

It was a special day. An athletic meeting was held at my little son's elementary school. On top of that, he was elected as one of the members for a 100-meter relay on behalf of his class. My son is really athletic and very good at any kind of sports, except for swimming.

I was excited, but an emergency call woke me up at 3 am. I went to my hospital to treat my inpatient. It was lucky for me to go back home around 8 in the morning because I thought I was able to attend the sport festival, which was supposed to start at 9 am.

It was 8:30, however, that I had a second emergency call form the hospital. There was no other way but to give up the athletic meet since it takes at least an hour to get to my hospital.

Lucky enough again, I come back home just before noon. I headed to the elementary school, in a hurry, because I knew that my son was about to start the race around noon. No sooner had I arrived there than I saw my son being ready for the race.

The race started several minutes after I got there. His team's first runner was not as fast as others. He got the baton in the last position. My little son ran with his best efforts, as shown the image above. I shouted, "GO FOR IT!" He overtook some rivals and passed the yellow baton to the next runner almost in the top place.

His team finally came to the last or second last but I do not care about it. It is not the result that matters. No doubt, the process is way much more important. I was very proud of my son and his team. Also, I was satisfied with myself not only because I am his father but also because I did not turn my back to my patients.

Anyway, it was a tough day to me and I will never, ever forget the day.

Rainbow park

There is a park called Rainbow park in my residential area. It is not close to my home; it takes several minutes by car. One of the most amazing things that the park includes is two sliders. I think that no explanation is needed to understand the characteristics of the twin sliders. Just taking a look at the right picture is enough. Can't you believe the steep angle, can you?

My guess is that they are the steepest sliders in the world. Of course, I cannot rule out the possibility that there would be steeper slider somewhere. However, even if steeper sliders were available, it would be nothing but a fall. Not a slider for fun, although our sliders seem horrible to some people.

Today, my little son, 9 years old, and I went to the Rainbow park after he had his hair cut. This was our third time to visit the park. Whenever we went there and saw the sliders, we climbed up to the entrance of the slider and gave up sliding because of fear.

Today, however, we were different. I succeeded in sliding the smaller slider, followed by my little kid, as you can see in the right picture. The small kid is my son. We would say that we got brave. In our opinions, the thrill was not so strong as we expected it would be.

Nevertheless, we may be still cowards because we were unable to give a try to the larger slider. We found the fear way much big, as compared with the smaller one, when we were at the entrance point to the big slider. Promising to try the bigger one next time, he and I climbed down with the steps. I an not sure when the next comes to us, though.

A 70-year-old man presented with a 3-hour history of lower abdominal pain

　　　 　　　　　

The objective of this post is to make sure whether the codes that I wrote today work well; the codes were for the sake of controlling video files with a frame by frame movement. It seems like that everything is OK.

Bubble gum

"Dad, look. I made it." My little sun suddenly told me. I took this photo in haste.

On that day, he has been battling with bubble gum. His goal appeared to make a balloon with gum. I explained how to create it but he did not succeed. It took him a few hours, nevertheless he did not give up.

Sorry for the blurred shot, but his success developed all of a sudden and did not last more than a second. Literally within a second, the gum balloon that he was successful in making burst with a popping sound.

I was waiting for his second success, but it never came to him and me. Before long, he stopped challenging, saying "I did it, anyway."

I love his attitude that he never gives up until he achieves a goal that he once decided to reach.

That night, he was scolded by his mother at the dinner because of the leftovers. No doubt, he was not starved at all with tons of sweet gum during the day time.

Blackout

One day, in the evening, my family was in the living room and chatting about something not important, such as dinner or TV programs on that night, when it started to thunder all of a sudden. Before long, we found all of the household appliances stop working.

I have never had blackout for more than a decade, thankfully due to durable infrastructure Japan provides us with. Seeing my kids enjoying the blackout, I thought that everything will be resuming soon, but my expectation did not come true.

After sunset, my residential area was covered with complete darkness.

One hour later, electronic experts came here and climbed a pole close to my house. Although I did not figure out what was being done on the electric pole, it took me by surprise that electrical power came back to our town a few hours after their arrival.

What a relief! It seems like that the recovery was not a blessing for my little kid because he made believe he was exploring a cave in an unmanned island. Maybe, it was the case with me, since the sky during the blackout had the most beautiful stars that I have ever seen.

P.S.
Next day, my wife noticed that the electronic shutter of the garage did not work. I tried to fix it, without success. A mechanic told me that it would cost about $1,000 to have it repair. Oh my goodness. However, he continued, saying that the same trouble developed around here, findings suggestive of the association with the thunder, and the unexpected expenditure would be guaranteed by insurance. The negotiation is still under way, but I am really positive about this accident. We have to be thankful to the electric pole struck by the thunder, instead of us; Nobody was injured and nobody was killed. Money cannot buy anyone of our family.

Elon Musk's first work?

Are you a big fan of computer games?
If so, have you ever heard of a game called Blastar?

I am reading a biography of Elon Musk, a well-known inventor and innovator. According the book that I am really into right now, he got his first computer at the age of 9 years and started learning programming using BASIC ― one of the computer languages to write codes.

BASIC was the easiest language to master at that time, and I also learned it when I was a middle school student. What was wonderful is the age that he studied it ― just 9 years old!

He created a video game, Blastar, as shown in the left panel at the age of 12. It is reported that, when he was asked the game, he said, "a trivial game, but better than Floppy Bird."

Surprisingly, the game Blastar is still available in modern age. If you want to try it, click here. It does not matter which is better, Blastar or Floppy Bird, since the backgrounds are completely different. The former was in 1984 and the latter was around 2014 or 30 years after Musk's first work.

Reportedly, Elon Musk sold the game to a computer magazine for $500 (equivalent to $1,200 nowadays). That means that he has been a good business person since he was very young.

High school baseball

My little son, my wife, and I went to a baseball stadium called Koshien to watch a game of the Japanese high school baseball championship in summer.

It was a fine weather without any cloud in the sky, as you can see (some clouds can be shown though). To be honest, it was too hot to watch a baseball game outdoors. My skin got red and hurt after the game, but I was satisfied because my elder son's high school won the game. The victory, however, did not surprise us because his school is considered one of the teams that would come in first place in the competition.

This is my first visit to the Koshien stadium for the first time in three or four years. I do not think that I am a big fan of high school baseball, which is very popular in Japan and some are crazy about it, like my Dad, but I have plans to get there again in order to root for the team.

Now, the Rio 2016 Summer Olympic games are also going on, and proudly, Japanese athletes have achieved great results including 6 gold medals, 1 silver medal, and 10 bronze medals so far. How fantastic they are. They have been pouring energy into everything and everyplace in Japan.

Not to mention that I have been so excited about sports this summer.

Shimanto River

My family of five had a 3-day trip to Shikoku Island by car. It was a lot of fun.

One thing that interested me was Shimanto river, which is considered one of the purest river in Japan. The river is close to nature, less controlled by humans, and rich in traditional Japanese scenery. I was actually moved by the landscape surrounding Shimanto river.

Over the river, there were some unique bridges that had no side walls on he bridge. No wonder that lack of side walls put passengers and cars crossing the bridge at risk for falling into the water. It seems, however, that the structure is useful for the bridge to protect itself from breaking down when a massive flood occurs.

I have heard that a bridge like that is called "Chinka bashi", meaning "able to get under the water for safety in the situation of increasing in river water." I am not 100% sure if this theory works on practice, but there is no doubt that crossing this bridge by car makes the driver feel uneasy.

Take a look at the left lower panel, where we are going over the bridge with our car. I could see anything but the surface of the river through the side windows of the car, because the bridge had no protect side wall. What was worse was the width of the bridge, which was almost as wide as that of a family car. This can explain the reason why the trial scared me (I am not a coward), although my three kids were excited.

I guess that we should not have crossed the river by car because a car itself would not be suitable to such a beautiful nature.

Money box

My summer vacation this year has just started.

While I was having toast and coffee in the living room, my youngest sun wake up and came to me, saying, "Dad, do me a favor and help me create this." What he showed me was Piggy bank on the book. Strictly speaking, it a coin bank with a miraculous trick.

Take a look at the left picture. This is a saving box that my son and I  made this morning. It was not a tough job and totally took about an hour.

One thing that is really interesting to me is a ball of Pokemon in the white box. It looks like as if the ball is floating in the air, doesn't it?

This trick box is consisted of a hemisphere attached on a mirror and a cardboard cube with a window in the front side. The combination may be simple but the effect is beyond my imagination when the mirror is obliquely placed.

Another thing that surprised me was his ability to create something. Over years, I have helped my son with his craft homework during his summer vacation, however I have never felt his powerfulness regarding doing it yourself than ever before.

No wonder that my little son is evolving. Next year, I might not be needed anymore.

Upload of sound

This blog is hosted by Google. I am actually satisfied with this system because of no ads, no fee, and what's more, its user-friendliness. I have knowledge about how to write codes, but the ability of programming is not required in this system. Everyone is able to make a blog using this content without difficulty.

One disadvantage of this sophisticated system is the absence of a function to upload sound files. You can upload audio contents via YouTube because YouTube handles audio files as a movie, but I do not think that this is a smart solution. Let me inform you, however, that I have succeeded in posting a sound file as it is.

Here is one example of a heart sound, so-called gallop, in a patient with decompensated heart failure.


The way that I used is very simple. All I did was just to write codes, to upload them to another site, and to make a link to it. The program is shown as below.

<script src="https://***/audio.min.js" type="text/javascript"></script>
<link href="https://***/audio.css" media="all" rel="stylesheet" type="text/css"></link>
<script>
   audiojs.events.ready(function() {
      audiojs.createAll();
   });
</script>
<audio id="sampleAudio" src="http://***.mp3"></audio>

I would be happy if this codes were practical and informative.

WiFi router

The other day, my house lost the connection to the Internet. All devices including iPad, tablets, and lap-top computers became something useless because they are unable to connect to the Internet using 3G or 4G. Under these circumstances, only smartphones were available.

The WiFi router in my house was likely to be the cause of the trouble. I have tried changing the WiFi's setting, without success. There was no other way but to replace a new router, and I bought one today (i.e., three days after the accident).

Although some struggles were needed to be overcome, the Internet started working again. What a relief. Needless to say, WiFi has become something of a necessity. My three kids said, "Thanks, Dad!" over and over again because they are really into YouTube.

Between you and me, the new WiFi that I bought today has a unique function which allows me to control time available. For example, with my setting, my younger kid uses iPad only 60 minutes per day. This function may be good to avoid wasting time online because it is way much more important for children to do homework or talk to their parents.

However, I am of two minds whether to use this function. Maybe, I would want my kids to get to learn how to use their time wisely through communications with us, although it would take more time.

One of my best days

I am attending an event like commencement. Every attendee seems to have to make a speech in public. Any topic will do. Most of my friends talk about their ambitions, such as launching a new business or moving abroad to research. It won't be long before my turn, but I have not decided what to say. I am gradually getting nervous because I have nothing that would impress other people.

When I get a microphone to speech, I find the place empty aside from a woman. Everyone vanishes for no reason. She is one that I fell in love at first sight but have never asked her out for fear of being turned down. I feel awkward because she is gazing at me.

I do not think that I am an aggressive man in terms of romance, however, I take a chance and say, "The most fantastic thing in my life is I met you, Shouji. I really appreciate it. We had little chance to talk, though." She smiles at me, replying, "me too."

We hold hands and leave the stage together.
Before long, we find a lot of our friends running after us to celebrate.

...and then, I woke up.

I went downstairs and found my wife, Shouji, sleeping on the sofa in the living room. I lay down beside her and took her hand. It made her wake up. I told her the dream that I've just had. Staring at me, she gave me a warm smile, which was the same as the smile I saw in my dream.

I was extremely busy at work on that day, but my dream kept me feeling happy.

NEJM image conference

Today, while I was learning about general internal medicine at another hospital, I came up with an excellent idea regarding Matsushita ER lunch conference.

Matsushita ER conference is a meeting where residents and experienced doctors discuss real cases who presented to the emergency room of Matsushita Memorial Hospital for various complains, such as fevers, dyspnea, or loss of consciousness.

Last month, I started this conference on Mondays, then not only on Mondays but also on Wednesdays because of a good response to the resident doctors. It seems like the meeting has been more effective to improve medical skills than I thought it would be.

Recently, I have been thinking of having this conference even on Fridays, i.e., three times a week, but my concern was what should be added, the same style or something new.

According to my new idea, I decided to add a brand-new element, in which residents present NEJM images in Japanese. NEJM images are very informative, short case reports with a few images and a 100- to 200-word explanation, attracting tons of worldwide medical experts including me.

I bet it will turn out fine because it is useful for resident doctors to learn English as well as enhance knowledge in clinical practice.

Matsushita ER Lunch Conference

I have started a new conference called Matsushita ER Lunch Conference; ER means the emergency room of hospitals. Also, I have created the website.

The objective of the conference is to learn clinical skills that would help doctors treat patients in the emergency room. The field of medicine requires experiences in order to provide high-quality medical care. Thus, it is intuitive that sharing experiences is a good way to enhance the ability of each practitioner.

One advantage of the Matsushita ER Lunch Conference is to use spare time effectively. We are able to learn while eating lunch. Another point is that we are allowed to post what you have learned to the website. The post will enable you to catch up with the conference that you did not attend for some reason.

Never too late to learn! I am still learning.

SAM

Tell me what SAM is. If you work at a hospital, you may know that SAM stands for a systolic anterior motion of the mitral valve.

It may be difficult even for medical staff, except for cardiologists and sonographers, to actually imagine what SAM is. Anyway, take a look at a finding called SAM in movie because seeing is believing as the proverb goes.

You can see the anterior leaflet of the mitral valve moving toward the base of ventricular septum during mid- to late systole. This is SAM! In my opinion, SAM is shown more impressively in short axis images than in long axis images of echocardiography; hence, I'd prefer the last third of the video.

SAM can be a cause of left ventricular outflow tract obstruction, leading to chest pain, heart failure, and arrhythmias. To reduce outflow obstruction or to improve symptoms and outcomes, treatment with negative inotropic effects, such as beta-blockers, should be considered in patients with SAM.

This phenomenon appers to be often missed because the leaflet is tiny in the heart and the motion never lasts through a cardiac cycle. However, given the impact of SAM on hemodynamics, more attention should be paid to in the detection of SAM, as to vegetations among patients with fevers and heart murmurs to assess the possibility of infective endocarditis.

Remember: a tiny finding can be a giant in the heart.

You lucky duck!

I think that my daughter is given a good luck by her Mom.

Take a look at the right shot. It is a postcard saying that my daughter won a lottery. What she got is not a big amount of money ー ¥1000 or about $9 ー but what is important is not the winning amount but winning a lottery.

I bet that my wife really has a good luck. Actually we were able to get the land we build our house 8 years earlier by her sheer luck. She won the lottery. So far, I have seen my wife and my daughter with a good luck many times. I am happy to be under such situations.

My two sons may think that I am not as lucky as my wife and daughter, but I insist that it is not true. I might as well ask them, "Who is the most lucky member among my family?"

You know what they say, the luckiest guy is a person who are with lucky people. In this context, my sons and I have to tell me, "You lucky duck."

General medicine

Recently, I have started learning about a general medicine at another hospital, as shown in the left photo, where my senior colleague is one of the managers.

The reason why I made up my mind to try the challenge, regardless of the possibility that it would just add to my burdens, is not because there are some complains about the department I belong to. I am a cardiologist and pretty satisfied with my current situation at work as well as at home.

I love trying something new because it would make me more excited, as long as it includes no danger. Do not get me wrong ― I am not a coward. What I am getting at here is that I am not a thrill seeker. I am reluctant to ride a roller coaster or to do a bungee jump even though safety is almost guaranteed.

If the staff that I would try is really worth a try in terms of education for residents, I would make every effort to complete it, since I had been educated by staff doctors in the same way while I was a resident doctor after graduating medical college.

I am looking forward to seeing the future, in which my first step would lead to a blessing for the residents of our hospital as well as the staff including me.

  

Kyoto Heart Echo Square

Today, let me allow to introduce a website call "Kyoto Heart Echo Square". I am one of the managers of this content. You can access here.

This content was launched in June 21th, 2015, for the sake of echocardiographic education. As the proverb goes, one picture is more valuable than 100 words. The same goes with the field of echocardiography; seeing is believing.

Ultrasonographers in high volume centers may experience lots of different kinds of rare heart diseases, but most sonographers are not lucky enough to have such good chances. This is why I was determined to create a website, in which everyone is able to learn echocardiography by sharing videos, wherever you work and whenever you want.

As a result of little request to upload echo movies, I have sent videos on my own with a pace of 1 or 2 posts a month. This slow pace, however, does not seem to make the website attractive. More new echo movies, at least every week, may be required to catch many followers of the content, I guess.

So,  from now on, I am going to upload more frequently. But I still wonder if I could keep on posting videos at a high rate like that, since I know that I get tired easily.

I look forward to reading this blog again months later.

A Fourth heart sound

The heart has a lot of different kinds of sounds. The combination varies, making it more complex to figure our what the heart is implying. The diversity may discourage physicians to learn auscultation. Nowadays, there are few cardiologists who are boating of skills enough to realize the heart sounds.

In my opinion, however, heart sounds are so impressive and still worth learning. In order not to get lost in the deep field of heart sounds, focusing on a specific sound may be a good way for a beginner.

A fourth heart sound, as shown in the left phonocardiogram with apexcardiography, is one of my recommendations among sounds produced by the heart.

The fourth sound is common in hypertrophied ventricles, such as hypertrophic cardiomyopathy and aortic stenosis. It should also be kept in mind that it can be audible in the acute phase of ischemic heart disease.

To my knowledge, there is no definitive evidence to support that the presence of the fourth heart sound is associated with an increased risk of adverse outcomes in patients with hypertrophic cardiomyopathy.

Splatoon

Take a look at the picture and guess what my son is doing.

There are 3 choices.
  A. He is playing a video game alone.
  B. He is playing an online game alone.
  C. He is playing an online game with his friend.

My son is alone in the room and playing an online game, Splatoon, chatting with his friend as a team via the Internet. So, the answer is C.

Let me explain the situation. First, he has an ear-phone in the right ear and a microphone that are connected to his smartphone. Second, his friend is playing the same game at a different place using the same system. Third, making a strategy as a team, they are fighting opponents in the world of Splatoon.

Looking back my childhood, a situation like that was completely beyond our imagination. It did not exist even in sci-fi. What an advanced technology!

My son is one of the Millennials; he was born in 2000. The concept that the Millennial generation is remarkable makes sense to me, because they are digital native. It seems like they have an inborn talent of how to adapt to new technologies without hesitating.

I am really looking forward to seeing what on earth their kids would be like. Is there any room to advance more?

Bird droppings

I am walking on the way to my hospital at 5:20 AM. It is a little bit cool but refreshing as a result of heavy rain before dawn. I love my residential area after rain because of the effect on nature as an energizer.

All of a sudden, I feel something hit my left cheek. I think that it would be a flying insect or bug. However, I notice something soft on my face when I touch the hit-point with my right hand for no specific reason.

It is white, partially green. It takes no time before I am sure that the stuff is kind of bird droppings. Luckily, it has no odor. I wipe it with some tissue paper and, after I arrive at the station, wash myself with soap.

I am shocked with the bad luck, but before long I start to think that good luck is still on my side because the word "dropping" has the same pronunciation as the word "luck" in Japanese. Maybe, it would be a good day for me today.

・・・・・

After work, I told the story to my kids and wife during dinner time, saying "Positive thinking makes you happy." My daughter asked me, "Then, Dad, how was your day, today? Anything good happened?" I answered, "Nothing lucky, but no trouble all day. What a nice day."

She started watching her favorite YouTuber, Kinoshita Yuka or Japanese female big eater, on my iPad with no specific response to my words.

Beetle Larvae

Do you like larvae? Of course not?

Then, how about beetle larvae? YES!

This weekend, my younger son asked me to take him to a place where there are beetle larvae. This is because he has learned about them in school. One of his advantages is that he is curious about everything.

First, we went to a park close to my house, with no success. Next place we headed to was a larger, natural park, which is 15-minute away by car. His big brother and I once caught some beetle larvae in the forest of the park.

It was not easy to find out larvae there ― fighting against tons of mosquitoes! ― but we managed to get several larvae in one hour. He was really excited, so was I.

Later on that day, his cousins visited us. To my surprise, he gave 2 or 3 larvae to them with a big smile. I am proud of his behavior; sharing fun with others is paramount no matter how young you are.

The problem is whether the larvae were male beetles or not remains unclear. I am sure that he hopes a male beetle because of its cool, big horns.

Time will tell, so wait and see, my little boy.

200th Anniversary

The stethoscope was invented by Laennec, a French physicist, 200 years ago.

The name "stethoscope" was derived from the two Greek words, stethos (chest) and skopein (to see).

The concept of the stethoscope came from an incidence with a young woman on September 13th, 1816, when he hesitated to put his ear on her chest and then rolled paper into a kind of cylinder and applied it to the chest and his ear.

Laennec also found the second heart sound for the first time, although this does not seem to be well known.

I am a big fan of the stethoscope because it enables cardiologists to communicate directly with the heart. The heart is so talkative, murmuring a lot in the center of the body.

Nothing gets me excited more than attempting to understand the heart language.

Children's Day

This year, May 5th is a national holiday in Japan. We call it Children's day.

On the children's day, my daughter, my younger son, and I visited my parents who live in another prefecture, roughly 100 km north of my house. Needless to say, I was born and raised there. I have always been cherishing an period of 19 years I spent as a child and adolescence with my parents.

I took my two kids to my elementary school. Actually, this is my first time in almost three decades to visit the school after I left my home town in the late teens. One of things that surprised me is how clearly I can remember what I did at this elementary school.

Let me show one example.

You can see the ground in front of the school building (and my two children) in the photo, where 10-year-old my friends and I found a small whirlwind standing still. I was not brave at that time (maybe not yet now), but something encouraged me to jump into the whirlwind. I was still wondering what on earth the something was.

I felt kind of pains probably because some small stones hit me in the face. However, before long, the whirlwind disappeared spontaneously. Given no other guys attempting to enter the wind, I was proud of my behavior. On top of that, it looked like I attacked the wind with guts and defeated it without a trace.

I did not tell my story to my kids, hoping that, someday in the future, my kids read this blog and remember what they did with me on Children's day, with their future children.

Smoke-like echo

Take a look at this echocardiogram, which was obtained 4 days after the onset of acute anterior myocardial infarction in a middle-aged guy.

It is notable that smoke-like echo or spontaneous echo contrast is seen in the left ventricle, although the patient underwent emergency intervention with stent implantation and his clinical course has been uneventful.

Since this finding is associated with an increased risk of developing thrombus, the administration of anticoagulants should be considered as soon as possible.

Actually, in this patient, an apical thrombus is detected although it might be obscure in this movie. Follow-up echocardiographic examination showed a decrease in size of the thrombus with heparin treatment.

Sprit picture

Take a look at the picture on the left side.

This is a photo that I took on the way to my office early in the morning, around at 6 am, last week. Do not ask me why I did shoot such a weird scene.

I did not notice but my daughter found something creepy, as shown in a black arrow. She said in an eerie way, "There is a girl!" I can assure you that none existed at that time on this point.

That night, I had an emergency call from my hospital. I had to head to the hospital at midnight because a bad event occurred － I cannot write it in details because of concerns about personal information.

On the way home after I finished my work, I asked a taxi driver to take me to the place that I took the above shot. It was dark but clear enough to recognize that "the ghost girl", named by my daughter, was the combination of a yellow flowerpot and a white garbage plastic bag with something inside.

After all, this picture is not a ghost shot but remains weird to me, given the association of the terrible event in my hospital. I would recall the night's event every time I see this photo.

The Wind-up Bird Chronicle

Recently I have been spending hours reading a series of books called "Nejimaki dori chronicle or The Wind-up Bird Chronicle in English."

I do not think that I am a big fan of reading books, especially novels or fiction.  My favorite genre is non-fiction, such as scientific reports about the universe and deep-sea fish. I prefer books with a lot of pictures.

Why I started reading the series was that I heard on Podcast Rebuild, which is one of my favorite podcasts brought by well-experienced software engineers, that this series was the best work by Haruki Murakami, a famous Japanese writer.

The series is composed of 3 books, and I have finished only 1 of the 3. So far, I have found myself pretty fascinated by the plot. However, I have no confidence in keeping on reading and completing the series without difficulty, because I am kind of impatient.

It would be fantastic if I was patient enough to finish the series. It would take away more hours from my tight schedule, though.

ECG Book

Recently, my book has been published. Truth be told, this is my second book but first one in which I am a sole author.

The preface is shown as below.

"Images of majestic outer space are overwhelming. Also breathtaking are pictures of mysterious deep-sea fish. They are so brilliant that no explanation is needed. The same goes with ECG, which shows a miraculous brief moment of the electrical activity of the heart. This book is designed to display the value of ECG; 100 images were selected from tens of thousands of ECGs. It would be appreciated if the concept could be shared. All the data are based on weekly ECG conferences or Matsushita ECG school of Matsushita Memorial Hospital."

I have not received any royalties in order to make the book more affordable. I am really expecting young medical doctors and staff to have it to learn the wonderful world of ECG with a lot of fun.

You can get the book here.

All you can eat buffet

The other day, at my children's request, my family of 5 went to a unique restaurant where you can eat as much as you want to eat at the same price.

The shop serves a variety of foods, including grilled meat, sushi, curry and rice, noodles, desserts, you name it. The entry fee is affordable, 13 dollars per adult and 10 dollars per child for about 100 minutes.

It is common that the quality of food at such restaurants is not as good as those in standard ones, but it is not true with the all-you-can-eat buffet that we had lunch.

We had a fun time there, but the problem is the amount that my family has eaten. Judging based on the plates piling on the table after eating, our portions were way much small than other people. This is because, among 5 members, 4 except for me are really small eaters.

It seems like that our 3 kids like such a fun atmosphere at an all-you-can-eat restaurant, instead of trying to eat economically.

Paradoxic flow

Take a look at an echocardiogram on the left. What is your impression?

This color-M mode image was obtained with a Doppler cursor in the mid-ventricle in a patient with mid-obstructive hypertrophic cardiomyopathy.

As you may know if you are a sonographer, a flow in the left ventricular cavity moves toward the apex during early diastole due to an apical suction.

In this case, however, the opposite phenomenon is shown; note a blue signal (white arrow), which is a blood flow from the apex toward the base of the left ventricle during early diastole or isovolumic relaxation time.

This situation is called diastolic paradoxic jet flow. This unique echocardiographic finding indicates the presence of a high-pressure apical chamber and has been reported to be associated with adverse outcomes.

For more information, you can access here.

On the radio

I made a radio debut with a big success!

I talked about the current understanding of cardiac rehabilitation on a live radio show. The radio broadcast is local, not nationwide, but I am very honored to have such a lucky opportunity.

I get stage fright easily, but I did not become nervous at all although it was my first time that I talked something on the radio or TV. Truth be told, when I received the offer, I thought I would be stressed out on the radio.

My success may be due to a good support with a well-experienced female anchor. No wonder she has fantastic skills with her beautiful voice to make guests feel easy in the studio. I cannot thank her.

On top of that, her multitasking abilities really surprised me. She was actually busy not only helping me but also organizing the time table.

I got a audio file of the 15-minute talks between a pro anchor and an amateur doctor. My family's reaction to the recording was, unexpectedly, not bad. My three children, who are likely to be indifferent to such stuff, kept on listening to the whole file, not complaining but sometimes laughing.

J league

The J. League or Japan Professional Football League has started a new season.

Today, my younger son and I went to a football stadium in my residential area to watch one of the opening games, as shown in the left picture.

This is my first time that I went to the stadium, which was just built a few months ago as a new home ground of Gamga Osaka. I am a fan of the team.

I have found the brand new stadium audience-friendly, as compared with the old one. We could see the players more closely. I could hear as if they breathing roughly next to me.

My son and I really got excited by the match, although our team Gamba Osaka has lost.

Fragmented QRS

Take a look at an ECG on the left and give me your diagnosis.

Note small notches in both lead V1 and lead V2, findings suggestive of tiny myocardial fibrosis in the area reflecting the leads or the anteroseptal wall.

You may make a diagnosis of fragmented QRS, which is defined as 2 or more notches in consecutive leads of the same group (i.e., inferior leads, lateral leads, or leads V1-4). Attention must be paid on ECG with bundle branch blocks, though.

The clinical significance of fragmented QRS remains unestablished but there are some reports to show that fragmented QRS is significantly associated with an increased risk of cardiovascular adverse events in the future.

We did it

As you may know, tons of people were surprised to see news last week, which said "We did it. At last, we've got an evidence of gravitational waves." No wonder, it is an historical moment in the filed of science and I was so happy to be with the moment (I am not a member of the research team, though).

Yesterday, my colleagues and I said at around noon, "We did it. At last we've got an evidence!"

What we succeeded in detecting is a new heart murmur associated with a paradoxical jet flow from the apex to the base of the left ventricular during early diastole. This unique flow was found by my senior colleague about 30 years ago, and has been well known among experienced sonographers all over the world.

To our knowledge, this is a first case in which a diastolic murmur was confirmed in relation to a paradoxical jet flow. We have to write a report regarding this fantastic heart sound as soon as possible.

Entrance examination

Today, my son may be a little bit feeling nervous although he looked like the same, for me, in the morning.

This is my first time that one of my kids has entrance exams. My elder son attends local junior high school now and will start a high school life this spring or April. As you may know, a new school year starts in April in Japan.

I hope that he passes the exams because he deserves it; he has studied pretty hard for more than a year. I was impressed to see that my son did not stop studying even during new years holidays.

All I can do is to encourage and support him, given his superiority to me in terms of school subjects.

I am always keeping my fingers crossed for our children. Good luck on my proud son!

Let's do CPX!

It has been almost a month since I posted my last blog.

So I have to say, "Long time no see. How have you been doing?" Me? I've been doing well. Thanks for asking.

Today, I have good news. The website that I have been spending tons of hours creating has been finally completed, where you can learn about cardiopulmonary exercise testing or CPX for free.

http://phio.panasonic.co.jp/kinen/cpx/index.html

Feel free to contact me if there are any comments or suggestions. The possible problem is that you need knowledge of Japanese language in order to understand the website because the content is written almost only in Japanese. Sorry about that.

Duel masters

Today, my younger son came to me with a blue box made of metal. He looked happy.

He open it and asked me, "Dad, you know it. Tell me how to play." I saw a lot of cards in the box and immediately understand what they were. The many different kinds of cool, paper cards were Duel masters, which had been popular among teenagers a few years ago.

It seems like that he found it in the closet of his older brother's room. The cards remained me of our old days, when my older son and I played them every day.

I have almost forgot the rule of Duel masters, so had to watch YouTube to remember it. What surprised me is that my younger son also watched the YouTube next to me, and understood the rule of Duel masters as good as what I understood.

Thereafter, as you guess, we spent hours playing the cards.

Happy new year

As usual, I woke up before 5 am, got on a train, and arrived at my hospital.

Today, I was a duty doctor and spent more than 8 hours in the hospital. You may think I was not happy, but I have to insist that it is not true.

Actually, I did not have Osechi, which we Japanese usually eat with their family in the morning on new year's day, but I enjoyed it with my family members for dinner.

The Osechi that my wife cooked for us was so delicious. I have always admired her because she is a really good cook, wife, as well as mother. On top of that, she never complains no matter how busy she is.