Takarazuka Grand Theater

My wife and I finally had the chance to visit the Takarazuka Grand Theater for the first time. The most difficult part of making this happen was, without question, getting tickets to such an extraordinary and popular performance.

The show was amazing—far beyond anything I had imagined. I had expected a refined blend of music and dance, but what we experienced was much more like entertainment in the style of 吉本新喜劇, in the best possible way. The audience burst into laughter again and again, something I never anticipated until we saw the performance firsthand. I would say the Takarazuka Grand Theater delivers a glamorous, powerful version of 吉本新喜劇.

I was also impressed by how affordable the snacks, meals, and beverages were—almost the same prices you’d find at convenience stores. The hospitality and friendliness were exceptional as well. From my point of view, the concept of the Takarazuka Grand Theater is not so much art as it is entertainment—and that is exactly what makes it so appealing.

I truly hope we can visit again, even though getting tickets is no easy task.

Fulfilling Every Day

I experienced many events in September 2025, although one of them was an unhappy goodbye. It is hard to decide which was the most impressive, so I will list the major events as follows:

• September 10: An image case I wrote was accepted by the New England Journal of Medicine. This is my fourth achievement with the journal.
• September 11: Aya and I visited Nikko Toshogu and Kegon Falls, traveling there by 弾丸ツアー.
• September 13: My wife, Junko, and I celebrated her 52nd birthday at an exclusive restaurant.
• September 14–15: Junko enjoyed watching the World Athletics Competition, held in Tokyo.
• September 19: My close friend and colleague, Takeshi Ishikawa, passed away after a six-year battle with pancreatic cancer. Rest in peace.
• September 19–20: I attended the 73rd Annual Meeting of the Japanese College of Cardiology in Kochi, where I learned the latest updates in cardiology and enjoyed tasting many kinds of bonito, the local specialty.
• September 22: I completed the manuscript of my new book, 心音の世界, which now exceeds 100 pages.

September was a month of accomplishments, celebrations, and farewells — a reminder of both the richness and fragility of life.

A honor

It is undeniably true that my interest in physical examination began when I decided to pursue a career in cardiology at the end of my residency training.

I recall attending the Second Meeting on Cardiac Physical Examination, held at the Kobe Expo Hotel by Professor Yoshikawa in 2004. Unfortunately, the two-day event felt somewhat beyond my level of knowledge at the time. The most memorable moment was a case involving a cardiac symptom, in which Dr. Fukuda—I believe—diagnosed the patient with constrictive pericarditis solely on the basis of physical examination.

While I am now capable of diagnosing constrictive pericarditis based solely on physical findings, at the time I was overwhelmed—and even intimidated—by the idea. As a result, I distanced myself from the scientific community that focused on physical examination and did not attend any further lectures on the subject for many years—until I was invited to give a lecture at a meeting in 2021.

I am deeply honored to have been appointed as an executive member of this distinguished group, composed of leading experts in cardiac physical examination, as you can see in the picture.

I will devote myself to contributing to the education of physicians and medical staff, so that patients with heart disease may benefit from the old but still useful clinical expertise even in an era increasingly dominated by advanced imaging technologies.

EXPO 2025 in Osaka

I’ve visited Expo 2025 in Osaka twice so far.

My first visit was with my daughter, as regular visitors, shown in the top two rows of the pictures. After having an early dinner around 3 p.m. in Umeda, we headed to the Expo. The train and entrance gate weren’t crowded at all—everything went much more smoothly than I had expected. I’m not sure if the three pavilions we visited, all from the Middle East, were particularly impressive, but just being at the Expo was exciting. The most remarkable feature was the massive wooden ring structure. Aya and I walked the entire loop, which was about 2 kilometers.

My second visit was in a professional capacity, working as a doctor at a temporary emergency medical center, shown in the bottom row of the pictures. My shift started at 9 a.m. and ended at 5 p.m. The clinic had three rooms and more than ten beds. We had three experienced nurses who worked efficiently—probably because they were already familiar with treating common conditions like heatstroke and minor injuries. During the eight hours I spent at the facility, I examined four patients with relatively complex conditions. However, compared to those transferred to the emergency department at my hospital, these cases were much easier to manage. To my surprise, all the medical treatment provided was free, although the available supplies were somewhat limited.

Speaking of Expos, this is the third one I’ve attended: Expo 1970 in Osaka, Expo 2005 in Aichi, and now Expo 2025. I’m already looking forward to the next one held in Japan.

Three decades

I went to see a ballet performed by K Ballet Company with my wife. This was my second time enjoying a ballet performance. Both times were at the Festival Hall and with her.

The first time was about 30 years ago, when I was a junior resident. It was an incredibly busy period, but I somehow managed to juggle my duties at the university hospital and make it to the Festival Hall. After the performance, I headed straight back to Kyoto in a hurry, saying goodbye to her or my girlfriend. I think it was winter.

This time, I left the hospital in the afternoon, took a leisurely stroll around Nakanoshima or exclusive areas, and then met up with my wife. We had a light meal at a bar before the performance. After enjoying the ballet by K Ballet Company, we took the subway home together.

Although the experiences were completely different, both were wonderful in their own way. I truly hope we’ll have the chance to go again—maybe even 30 years later.

Wouldn't Believe It

The method of jugular venous assessment that we developed at Matsushita Memorial Hospital has been included in the JCS/JHFS 2025 Guidelines on the Diagnosis and Treatment of Heart Failure, which were thoroughly revised seven years after the previous version was released. To promote this simple technique for use in patients with heart failure, I created a free educational app titled Simple JVP©. The app features 10 representative cases, presented through a five-step method, and may serve as a helpful resource.

The app is bilingual, available in both Japanese and English. My next goal was to raise awareness of this free app outside of Japan. To that end, I submitted a letter to one of the most prominent American medical journals in this field, the Journal of Cardiac Failure. Unfortunately, the response was disappointing.

Next, I submitted it—almost by chance—to ESC Heart Failure, one of the most prestigious European journals in cardiology. I received a reply just three days after submission. I assumed it would be a rejection, as quick responses often are in the case of article submissions.

To my surprise, the email said the following:

Ref.:  Ms. No. ESCHF-25-00635

Simple jugular venous assessment: a new approach to heart failure ESC Heart Failure

Dear Dr Kawasaki,

I am writing to say that your manuscript, Simple jugular venous assessment: a new approach to heart failure, has now been accepted for publication in the ESC Heart Failure. It will appear in the next available issue. 

Please note that your manuscript will undergo an integrity check, that includes the images. Publication will only proceed on the condition that all final files comply with the journal integrity checks. In the event that any file does not comply with our integrity checks, the journal reserves the right to rescind this decision, or, alternatively, you may be contacted to resolve any concerns raised by these checks. 

Thank you for submitting your excellent article to ESC Heart Failure.

Yours sincerely,

Jan Biegus, MD PhD

Deputy Editor-in-Chief

ESC Heart Failure

The letter was published just seven days after the reply—only ten days after my initial submission. I still can’t believe that the app was accepted by such a prestigious medical journal. To my knowledge, it is extremely rare for academic societies to accept and feature an app developed privately.

I am 100% confident that this app will help countless doctors and medical staff in the treatment of patients with heart failure. I’m looking forward to seeing the access report before and after the publication of my free educational app.

I never stop pushing forward, embracing my unique combination of roles: cardiologist, programmer, and passionate educator.

Every day is like a climax

The title of this song by Creepy Nuts really captures how my days have been lately!

• After years of advocating for it, our method of assessing jugular venous response to stress was finally included in the revised heart failure guidelines—seven years in the making—alongside our published paper.
• I bought a box of Hassaku oranges for my father, who loves them, and brought them to him every day.
• I created a little grass garden on my balcony for my dog, Shushu.
• My daughter, Aya, got a new job at Sanno Hospital in Tokyo for next year.
• My homepage hit two major milestones at nearly the same time: 2 million total views and 200,000 monthly views!.

I've truly been enjoying these remarkable days.

The 3rd visit to Hong Kong

I thoroughly enjoyed my trip to Hong Kong with my daughter, Aya. This was my third visit to the city, so I was familiar with much of it, yet there was still an air of excitement as we headed to Macau—my first time there (featured in the right half of the photos).

On our way from the airport to the heart of Hong Kong, we happened upon a station called Kowloon and decided to disembark. I learned that it’s located on the site of the former Kowloon Airport (formerly Kai Tak Airport). My first visit to Hong Kong was when I was 20 years old. The airport, right in the heart of the city, and the once-infamous Kowloon Walled City left a lasting impression on me. Today, the area has transformed into a park and home to the National Palace Museum. While it’s impeccably maintained, a part of me misses the old, unique atmosphere that once defined it.

The bus ride from Hong Kong to Macau took 2.5 hours. We passed through immigration twice, showing our passports, but this minor inconvenience didn’t dampen our spirits. Macau exceeded all my expectations. Its immense scale could easily rival Las Vegas, but it was the attitude of some of the more aggressive Chinese people in the city that felt unsettling.

I’m not sure if a fourth trip to Hong Kong will be in my future, but one thing is certain—the city remains as vibrant and bustling as it was 25 years ago and this time.

My Boom

Recently, I enjoyed meeting up with my daughter, Aya, for a Friday night date. In the upper photos, we had Thai food at Hanshin Bar in Umeda. In the lower photos, we met at the Expo and watched a movie.

The movie was Under Ninja, starring Kent Yamazaki and Minami Hamabe. The content was silly, but extremely enjoyable due to Yamazaki's coolness, Hamabe's cuteness, and the fantastic music, doppelgänger, by Creepy Nuts.

Since then, I have been watching videos related to Under Ninjya on the Internet. Click here to view the movie trailer. And no wonder you will easily understand me. 

A debut as a novelist

One of my dreams is to become a novelist. I had planned to write one when I retired as a doctor, but a strange turn of events brought me to that point much earlier.

At the end of the year, I wrote two short stories based on my daily life as a cardiologist. I tried to submit them to a novel website, but there were many advertisements and some other problems. So I decided to create my own website.

I spent my New Year's break on it. I had a hard time with the layout because I was particular about vertical writing, but in the end I succeeded ー Mokane Hospital.

I dare to close the comments section because there are readers who find even the best novels boring (and my novels are not considered excellent in themselves).

Regardless of the result, let me give it a try anyway. I have tons of experience as a doctor, so I think I can write medical novels.