Monday, May 1, 2023

The Barrel Bistro

また割り込み記事ですが、サンマテオのカジュアルな Fine Dining をご紹介します。

開店以来数年間、今までず~~~っと食べた事がなかった、Bストリートのビストロです。
我が家から徒歩3分なのも原因かもしれませんが、いつか試さなきゃ… のまんま、先送りになっていました。

結論から申し上げれば… また一軒、良い店を発掘できました。
店内はこんな感じ。今はいい季節なのでみんなテラスシーティングしますけど…。

入って右側の壁は「ワインの壁」です。
ものごっつい種類のワインが飾られていますが… ここに飾ってあるのは飲まないと思う。

その反対側は、バーです。ちゃんとしたハードリカー・バーです。
カリフォルニア州は酒類販売のライセンスがとても厳格で、アルコールが 25%以上のお酒「ハードリカー」を売るときには、専用のライセンスが必要です。パンデミック前はサンマテオ市内ではハードリカーライセンスは15万ドルくらいで売買されていたと聞いていました。そのくらいライセンスの取得が大変です。なので、このバーは立派。

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で、この店の2軒隣が家人の親友・ビクターさんのやっている靴の修理屋さんで、儂が毎日のように通りかかると、この店のオーナーのアポさんとビクターさんがテラスシートで話し込んでいます。その前を通る度に声を掛けられ、いつの間にかアポさんとも仲良しになったので、これはぜひ試してみなくちゃ、となりました。

そこで、以前 Campbell(F) さんの、クロネコに壊された超高級なカバンをビクターさんが無料であっという間に修理してくれた… という経緯もあって、その御礼にビクターさんも誘って3名でランチをいただいてまいりました。
道端ダイニング。
サンマテオ市は B Street の数ブロックを塞いで、テラスシーティングさせてくれています。

ぢつわ…最初は儂がビクターさんをランチに誘ったんですが、乗ってきません…。
そこで「あの高級バッグを修理した彼女も呼ぶから」の一声で、乗ってきました。
女性が来ると判った時点で、オーナーのアポさんも主菜が届くまで同席してるし。
ごっつい見かけの男って、なんでこんなに女好きかな?ってのが率直な感想。(笑)

さて、まず3名でシェアしたのが、このお店の前菜盛り合わせ。
THE BARREL SAMPLE PLATE (FOR 2)
Dungeness crab cakes, prosciutto, provolone, calamari, spring roll, bruschetta and mixed olives.

出てきて「これで2人前かい!?」って3人で叫んだ。それ聞いたオーナーさんはとても自慢げ。(笑)

この盛り合わせに限らず、ここんちはサービングサイズがボリューミーです。いろいろ試そうと思って注文しすぎると、以後2日くらいはお持ち帰りした食べ残しで過ごす日々になること、請け合います。

下画面・中央あたりにある「半切りのコロッケ」みたいなのが、クラブケーキです。
アポさんが「シーズン中は冷凍ものじゃないカニを使ってる」って自慢するだけありました。ダンジネス・クラブ独特な蟹肉の食感がハッキリ判る、気合いの入った逸品です。添付のアイオリソースも嬉しい♪

カラマリフライも、ハムもチーズも美味しい。オリーブも上質。

「食材はケチらずに選んでる」と、自信たっぷりのアポさんの前で食べているから、なおのこと美味しい。

ただひとつ、普通だったのは… 春巻。
儂らがアジア人なので評価が厳しいのかもしれませんが、春巻は無くてもいいかも。
ブルスケッタもサクサクのベースにみずみずしいトマトや、甘酸っぱい「煮切りバルサミコ」がかかって最高♪

そして Campbell(F) さんが「これ… 体に悪いのは判ってるけど」と言いつつ、逃れられなかった魅惑の前菜。
ROASTED BONE MARROW
Spicy breadcrumb toasted French baguette and paprika garlic olive oil.

ローストした骨髄です。美味しいに決まってるけど、糖尿持ちにはヤバすぎます。

オーナーさんはパン粉を振るのが好きくないみたいですが、儂らは大歓迎。
大腿骨みたいな太い骨の中心部をスプーンですくって、トーストされたバゲットに載せていただきます。

予想通りに、とてもヤバい前菜でした。この皿に限っては量が少なめなのが幸いしました。儂的にはパン粉が無かったら味付けがキツすぎると思うけど、バゲットに載せる前提の味付けなので、これで正解なんでしょう。

もう、これら前菜2品を退治している時点で…
「ここ、いけてるからまた来よう! いつにする?」
「あたし金曜日(3日後)にサンマテオへ来る!」
「じゃあ次回は金曜日で!!」
…と、とんとん拍子で再訪することを決めちゃいました。(笑)

さて… 各自の主菜はこんなでした。こちら、ビクターさんが召し上がった豪華なリゾット。
LOBSTER RISOTTO
Served with skewered salmon, prawns, jumbo scallops with arugula, basil pesto, cherry tomato, yellow corn.

これ、嫉妬しそうにメッチャ美味しそうです。一口いただきましたが… オレンジ色のリゾットの内部には、ロブスターの肉がゴロゴロに入ってるし、串刺し2本には大きな海老、ホタテ、サーモンが。さらに味変が楽しめるように、あちこちにペストソースがかかっていたり、ルッコラとコーンのサラダも添えられています。分量も凄いです。

正直言って、髭面で男臭いけど若干華奢なビクターさんが、これをかなり食べきったのには驚きました。
でも翌日、靴修理のお店の前で会ったら「少し残した… ごめん。悔しい」って。(爆)

さてこちらは、Campbell(F) さんが試した、自家製パスタです。
SEAFOOD LINGUINE
Pasta tossed with prawns, salmon, clams, mussels, calamari, diced tomato, basil and spicy marinara.

プレゼンテーションのためもあるんでしょうが… もの凄い量のムール貝。スイスの先生がいたら狂喜乱舞は確実。さらに大きな海老やアサリがたんまり入っていて、儂と Campbell(F) さんは互いのパスタでどっちにするか競り合っただけのことはある一品でした。ひとくち貰ったけど、自家製パスタもトマトソースも上出来です。

儂も同じく、自家製パスタに惹かれました。儂のはもうちっと太い方で、にくにくしい一品♪
TAGLIATELLE WITH BRAISED SHORT RIBS
Homemade pasta tossed with short ribs, mixed mushrooms, green peas and feta cheese.

タリアテッレも自家製で、生パスタらしいコシとモチモチな仕上がりです。
ショートリブを使った肉系のパスタですが… 煮込んだショートリブの部分は上等なオソブッコみたいに美味。でも分量がもの凄くて、3分の1くらいは持ち帰りました。

そして… 前菜と主菜のオーダーをかける時に、オーナーのアポさんが…
「デザートは店のおごりだから」
…と、注文を取ってくれているウエイターさんに伝えました。

余談ですが… ここんちのサービスパーソンは、ほぼ男性。見るからにごっつい見かけのオーナー、みんながアポさんの手下っぽくて「山賊の一味が経営しているレストラン」と言われても信じてしまいそう。(ホントにそうだったり (笑))

お店のおごりとか、そういう話になったらチェックが厳しい Campbell(F)さん(笑)。お会計時にホントにデザートが全くチャージされていないのをしっかり確認して、とても喜んでいました。

いくら顔見知りだとは言え、初めて来訪した客にこのサービスは嬉しい限りです。

で… Campbell(F) さんの選んだデザートは、こちら。
STICKY TOFFEE PUDDING
Served with Vanilla bean gelato

これ… ひとくちもらったけど『ベタベタのトフィー』の御題どおりに、ネッチョネチョなカラメルトフィーがからみつきます。プディングの中心までシロップが染み込んでいて、ものすごいリッチなお味。そこに冷たいバニラアイスが添えてあって、温度差を愉しみながら食べ進めるデザートです。

儂は…意地悪かもしれんが、初めての店なので味の比較ができる皿にしました。
TIRAMISU
Served with chocolate sauce

普通のアメリカ式にレディフィンガーを使ってあるけど、そう感じさせないほどの完成度。
なにしろマスカルポーネが新鮮でコクも舌触りもしっかりしていて、素直に感心しました。

ここんちは『カリフォルニア風のイタめし』といえば一言で言い表せるかと思いますが、魅力的な品がいろいろあってヤバすぎます。この記事の続きは、金曜日に2回目を体験してからまとめあげますね。

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そして金曜日に、お約束どおりに2回目のトライ。

正午ごろにやってきました。他にはもう一組がパラソルの下でお食事中なだけで、混んでくる直前に到着。
ディナータイムになったら上写真のあたりで、生のギター弾きが演奏していました。
買い物に行く時でもタピ茶一杯買いに行く時でも、ほぼこの店の前を通るから知ってる。

お店に着いたら、オーナーのアポさんが折良く店の前で電話中。
軽く会釈したら、オーナーが直々に注文取りに来てくれました
多分 Campbell(F) さんが一緒だから。女性がいるとこうも違う。(笑)

で、今回儂はハンバーガーを試すつもりだったので、ダイエットコークで。Campbell(F) さんも同じ物で。
他には炭酸水を。ここんちのは炭酸がキツめで、氷無しだとなかなか厳しく美味しい。

前菜は省略するつもりでしたが、これだけは試してみたかった、デンデン虫。

アポさんに「どうせ6つくらいでしょ?」って聞いたら…
「そんな事ない。もっと沢山入ってる!って言われました。

出てきて驚いた、何この盛り付け? 殻入りエスカルゴ6個用の容器に、数えたら18個入っていました。
OVEN ESCARGOTS À LA BOURGUIGNONNE
Served with parsley garlic butter sauce and toasted French baguette

儂に下世話な事を聞かれて大盛りにした可能性が大。他の客の写真だとこの半分くらい

でもエスカルゴは身が欲しいわけではなく、出汁とパセリ風味のガーリックバターをパンに浸して食べたい。

「前菜一品で分け合う」って伝えたら、アポさんが「じゃあ、ブラータをおごる♪って…
BAKED BURRATA
Oven baked and served with green peas, green onions, toasted French baguette and truffle oil.

焼いたブラータチーズ。パッと見たら刻んだ青葱だけみたいですが、グリーンピースがいっぱい乗っています。

これはアポさんが自慢げだっただけあって、美味しくて Campbell(F) さんと感動しました。
女好きの店主のレストランへは女性と行けばサービスが過激だと、よ~く判る事例でした。

ちなみに、儂はブッファーラとブラータって同じチーズが違う呼び名になっていると思ってたんですが… ブラータは牛乳で、ブッファーラは水牛の乳で造られたモッツァレラ系チーズでした。

主菜は… Campbell(F) さんが熟考して選んだのは、ステーキサラダの美味しそうな皿。
GRILLED RIBEYE SALAD
Avocado, quinoa, cherry tomatoes, cucumber, baby kale, Brussel sprouts, raspberry dressing.

リブアイステーキが載ったグリーンサラダです。量も、もの凄いたっぷり。
儂的には芽キャベツが苦手だけど、アボカドもたっぷりだし、美味しそうなサラダです。

Google Maps に挙がっていた写真に嫉妬して、是非試したくなったハンバーガーが、こちら。
THE BARREL BURGER
Grilled Kobe beef served with pickles, lettuce, onion, tomatoes and our chef's choice of special sauce

なにせオーナーが注文取りしてくれていますから、詳細なカスタマイズが可能。
日系神戸牛(笑)の挽肉はミディアムレアで、チーズはプロボロン、ベーコン追加で。

サイドにはガーリック&トリュフ風味のフレンチフライを添えてもらいました。

ヤバすぎるほど美味しい。お店で座ってハンバーガーを食べるなら、今度からここんちです。
ちょっとカットした状態の図。

ビーフはいい火加減で、とてもジューシー。プロボロンが上質だし、ベーコンはカリカリ。
シェフの特製ソースというのは、アイオリソースの事でしたが、このバーガーにピッタリ。
それに、バンズがブリオーシュ生地です。どこにも手抜きが無い、上等なハンバーガー♪

そしてフレンチフライは、ガーリック白トリュフ風味
SIDES  GARLIC TRUFFLE FRIES
見ただけで降参。食べきれないのは最初から判っていて、注文かけています。
持ち帰らせていただき、エアフライヤーで温め直せば美味しさが蘇りました。

見るからに美味しそうなので、お向かいの Campbell(F) さんの手がヒョイヒョイ伸びてきました。(爆)

アポさんに良くしていただけるので、最低でも隔週1回くらいは通いたい店になりました。
・・・でも女性抜きで行くと冷遇されそう。(笑)

The Barrel Bistro and Wine Bar
246 S B St, San Mateo, CA 94401
+1 (650) 445-7250

30 comments:

  1. You may be modestly referring to us readers as an "interrupting article," but compared to ones such as "The Lemon-colored BMW" and the "Suspicious US-made Cup Noodle," this one is truly remarkable. It's only natural since casual dining in your hometown is Fine Dining in other town.

    Huh? You've never eaten there even though it's only a 3-minute walk from your house and it's been open for years? That's unusual for someone like you who has a good sense of gourmet food. Well, I guess San Mateo has a lot of Fine Dining restaurants.

    The "Wine Wall" may seem a bit contrived (I've seen it in Azabu, where we'll go together next time, but I've never really observed it in detail), but it still catches our eyes.

    Huh? You say that liquor sales licenses are very strict in California, but a hard liquor license costs $150,000!? Converted to the current dollar-yen exchange rate, it's about 37.47 years of Centurion annual membership fees in Japan (I tend to think of everything in terms of AmEx conversions…lol). You can't run a bar in California without a prospect of making that money back. I'm starting to look like "the bar owner in California must be rich."

    ReplyDelete
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    1. Yamada Denki sensei,

      This articles is my stereotypical dining report, and I wanted to share this information early because the same pictures are on Google, Yelp! And TripAdvisor.

      Unfortunately I kept skipping this bistrot… I can’t find a reason why but some of the surrounding restaurants are not my favor, so I also skipped this one. However, I met the owner, and he is very confident for the dishes he serves, so I made a try. My friend Victor also strongly recommended.

      Hard liquor license in California is limited and restricted. More than half of restaurants don’t have license so they can only offer beers, wines or so. Once the restaurant received a hard liquor license, they can serve variety of cocktails, aperitif and digestif. In other words, the rank or status of the restaurant goes up by liquor license.
      Therefore, if the restaurant owner wishes the real success of his/her business, they borrow money and try purchasing the liquor license. Therefore they are not really rich but under a big deficit at the start of new restaurants, usually.
      I wrote this somewhere but again, 95% of food business in San Mateo fails within one year. If it survives over 5 years, that business is somewhat stable. But this theory has been completely reset by pandemic, so I don’t know the current situations really.

      Delete
  2. I might be accused of being a " whack-a-mole" again, but this time I want to respond to your comment from another article in this post because I want other readers to know about your good deeds.

    I'm not sure why you had previously exchanged greetings with that homeless person on the street, but he was squatting on the concrete floor in the parking lot and had a high fever, so you took him to your home, warmed his body with hot water and protein drinks, and cured him by giving him Nyquil (which seems a cold medicine effective for coughing, sneezing, stuffy nose, minor aches and pains, although it is not used in Japan) and doxycycline. This may have been the best treatment, not just in hindsight.

    First of all, Nyquil not only has anti-inflammatory effects but also has a preventive effect on allergic reactions to doxycycline administered later. And doxycycline is a tetracycline antibiotic that is effective against Mycoplasma, Chlamydia, Rickettsia, which are not susceptible to penicillin or cephalosporin antibiotics, so it was probably suitable for his symptoms.

    You should have become an internist after all. You would have become a much better doctor than me, at least.

    ReplyDelete
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    1. Yamada Denki sensei,

      I didn’t know the reason why I started say hi to that homeless person. But actually when I started exchanging the greetings, he wasn’t a homeless yet, he was sharing a room with other Latino guys. However, if I correctly understood what he explained in Spanish, they lost the eligibility at that room, cruel landlord kicked them out.
      Then… by those 2-3 days of keeping eyes on him, I found he has some similarities to the one of my college colleagues during I was attending T-gakuen. Because we are both department of agriculture, he looked a typical down-to-earth farmer. And Mr. homeless looked the same.
      In regards to the treatments I gave, because he refused any pain pills, Nyquil is the only choice for giving him relatively safe pain relief. I also detected the signs of infections by staphylococcus or some sort, which is yellowish cloudy sleepy-bugs or yellow-green buggers. I used Google translator to explain why I insist giving him doxycycline, and finally he agreed, took it twice, then all the symptoms are gone. I was simply lucky or I might kill him… I also have New Quinolone (ciprofloxacin) or modern Penicillin (amoxicillin) but doxycycline is the safest within my stoks, I thought.

      Oh! doxycycline is against to Chlamydia?? So I cannot take it before endoscopy, right? (lol)

      Now I understand how healthcare workers are severely working for someone’s lives. I cannot be responsible if I take care of someone seriously. On this particular case, I kept telling me I am always ready and no hesitance to call 911.

      Delete
  3. I see, so the pictures of the food at this bistro are also on Google, Yelp!, and TripAdvisor. However, I'm convinced that the pictures you took are much more beautiful and appealing to readers than the ones on other sites, and that's why you wanted to post this article early.
    But it seems that you had been skipping this bistro for a long time. If you had posted this article earlier, this bistro might have been even more prosperous.

    It was surprising to hear that in California, more than half of the restaurants do not have a license to serve hard liquor and can only offer beer and wine. Conversely, Japan may be too lenient in terms of obtaining licenses.

    In my previous comment, I wrote casually that "the bar owner in California must be rich," but it seems that the reality is much tougher. Restaurant owners are not only required to prepare land, buildings, and talented employees, but also to make a significant investment in obtaining a license for serving hard liquor. So, they are forced to make huge investments when starting a new restaurant, if they want to make it to a hi-end one.

    This may be similar to new doctors starting their own clinics in Japan. Although it's not as harsh as the situation in San Mateo’s restaurants, currently in Japan, the prognosis for newly opened medical clinics is that the top 40% make a profit, the middle 50% break even, and the bottom 10% are eliminated.
    It has been over 27 years since I succeeded my father's clinic. If this had happened today... I might have been eliminated and gone back to being a salaried physician.

    ReplyDelete
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    1. Yamada Denki sensei,

      Thank you for the kind words. Actually, I primarily uploaded these pictures to Google then mentioned owner about it. He checked my photo, then replied me "Yelp!?? TripAdvisor??” (lol) When I posted the images to Yelp!, the owner immediately sent me “Nice!” and “Thank you from the business” signs. I think I definitely developed one more favorite restaurant in walking distance.

      This bistrot themselves is popular already. Google Maps keeps sending me my pictures are catching viewers’ eyes, already hit several thousands of “viewed” on each image. Goodle is the strongest tool for sure. In comparison, TripAdvisor is slower but it’s my favorite. When I posted images, no one did it for The Barrel so my images are the first ones, TripAdvisor used my images as representing this restaurant which is honorable for me.

      California has stricter alcohol licenses because there are so many people under dependency, damaging our society. It might be milder than narcotic junkies but form my point of view, no big difference. So many DUI (Driving Under the Influence) cases on the court of law and I have to serve as a juror… gimme a break!

      For the food business, liquor license or décor of the restaurant are initial cost which we can expect or control the cost. However, the most expensive and the difficult part must be – expenses for the labor. Employing someone is not just for payments but supports flinge benefits as well as their family, so if you have to fire someone, you will be responsible his/her children or parents. That’s a tough job. And thts is a reason why we hire シルバー人材 so that we don’t have to worry about their insurances or pensions. Aren’t we clever?

      So… even for medical clinics, being a business owner is a tough job too. I can’t imagine you have to be responsible for your business in black side, and simultaneously keep most of clients up and running, at least not crossing the River of Sanzu. (not funny in this case…)

      Delete
  4. Yes, I saw that you uploaded these pictures to Google, and I confirmed at least four images of The Barrel Bistro and Wine Bar. Your photos are clearly more professional-looking than those taken by other people, and since we have become accustomed to your detailed still images on this blog, I can sort of recognize when a photo was taken by you. This should have been an invaluable PR effect for the owner of this bistro. In any case, I think you've developed a favorite restaurant within walking distance from your home, which I envy.

    Wow, so Google Maps shows "viewed" by several thousands of people on each of your pictures. Now, I'm also one of those viewers. And it seems that your photos are also being used as representative images of this bistro on TripAdvisor, not just on Google. This is certainly an honor for you and for us readers.

    I learned that obtaining a hard liquor license has become more difficult in the United States due to the fact that alcohol dependency has become a big problem, just like drug addiction. Fortunately, Japanese people have a relatively low tolerance for alcohol compared to Americans, and there are relatively few alcohol-dependent people in Japan. However, I still encounter such patients to some extent in my daily practice.

    Especially young patients with esophageal cancer are typical examples.
    As you know, the activity of enzymes involved in the breakdown of acetaldehyde, which is produced in the body by drinking alcohol, is naturally weak in some people. It has been reported that such people with a predisposition to esophageal cancer are at an increased risk of developing the disease if they start drinking and smoking while they are underage and continue to do so excessively. Eventually, they develop difficulty in swallowing and come knocking on the door of our clinic.

    ReplyDelete
    Replies
    1. Yamada Denki sensei,

      As a graduate of Photographic institute and received ‘summa cum laude’ there, I am still confident for my picture taking as well as retouching. But I almost lost that know-how by digital imaging… Some still work, fortunately and I am delighted if someone feels “Nice!” on it..

      Google Maps is a very strong tool here in SF Bay Area because the company itself has a local presence and the vast majority of users are pretty much cooperative. If I introduced one shop or restaurant, I keep receiving the updates or sometimes questions for a week or two. It’s a great communication tool for me since I don’t do any SNS basically.

      Japan has better situation for the alcohol dependencies… US is severely damaged but not too bad as Russians yet. The key must be the supports from common people with appropriate knowledge but the real world is much more complicated… it’s strongly related to healthcare services so I am so sorry for your responsibilities as well, sensei.

      I do know more than third of Japanese doesn’t have enough Acetaldehyde Dehydrogenase in them, and I am one of them. Therefore I can’t drink much, when I had some my face immediately goes red as “Oriental Flash.” I really envy like you enjoying strong splits… but on the other side, I have less chance of receiving dependency of alcohol because I can’t enjoy it.

      Esophageal cancer is the one Mr. Okawa got and left… I think Japanese people have higher chances of cancers on alimentary canal if I compare to Americans or Europeans. Lung cancers are very common here in the States as well as in Europe, I think. But I spent almost 40 years in Japan so I am more worried about Japanese-centric cancers and diseases, that’s why I visit your clinic…

      Delete
  5. I can understand well that labor costs are the most expensive and difficult part of the business. In our clinic, we provide health insurance and welfare pension to all staff members, rather than national health insurance. As you know, if we choose national health insurance, the burden on the employer is less. However, with health insurance and welfare pension, the employer is forced to bear the same or higher burden as the employee. Although we accept this as a welfare benefit for our staff, the more staff we have, the more pressure it puts on the management of the clinic. In fact, many other clinics are turning a blind eye and using national health insurance.

    It seems that the local industry around the clinic also employs silver talent, but they rely more on foreign workers. Recently, it is particularly noticeable that migrant workers from Vietnam and Brazil are working in this area. For some reason, such workers come to our clinic and try to undergo endoscopic examinations, so we are considering seriously studying Vietnamese and Portuguese.

    Especially, the infection rate of H. pylori in Vietnamese people is high, and even if they answer the questionnaire that they received eradication treatment before coming to Japan, when we ask them for the details, they were given suspicious drugs. In all cases, so far, it was revealed that the results of that eradication treatment had failed when they actually underwent endoscopic examination. If we perform eradication treatment recognized by Japanese insurance treatment, we can eradicate H. pylori with high probability, and many Vietnamese patients' stomach-related symptoms disappear.

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    1. Yamada Denki sensei,

      You are offering very good fringe benefits to your employees, I am amazed. We only pay money and the else are up to them. We have a young lady working for us, but she had her strong opinion and decisions so we don’t have to offer insurances. Other old boys are already pretty much covered with Medicare, and I’m joining it. (lol)

      I didn’t know there are certain presences of Vietnamese and Brazilians in your area… language barriers are very tough thing, I actually learned about it a week ago with Mr. homeless. I had iPad/iPhone with online translator but the difficulties are not there – he doesn’t have enough knowledge of medical and pharmaceutical issues, so I had a hard time explaining why I wanted him to take acetaminophen, antihistamine and tetracycline.
      Also, I didn’t know there are higher chances of infections of Helicopters on Vietnamese people. The doctors in our area should have that information – maybe they do already, because the population of Vietnamese immigrants is higher than Japanese.
      But for me, it is simply interesting rice eaters are the people who infected with Helicopter.
      Anyway, you guys have good medicines like claris and amoxicillin with PPI. Oh, I had those too. (lol)

      Delete
  6. By the way, let's return to the homeless person. I'm not sure why that Latino man ended up in San Mateo. Did he go there to work as a migrant worker, as I mentioned in my previous comment? In any case, his situation is difficult. Especially when he gets sick and can't go to a medical facility, it becomes a very difficult situation. And if he can't speak English, and he has no money, it becomes even worse. In the situation where he was forced out by a heartless landlord, seeing a philanthropist like you is quite fortunate for him.

    I don't know why he refused the pain reliever you tried to give him. I understand why you chose Nyquil, which seemed almost safe for pain relief (even from the spelling of the drug name, it reminds me of "tranquil" and seems safe...).

    If I were in your position, I might have chosen ciprofloxacin over doxycycline, considering the broad spectrum of antibacterial activity. And since his rapid recovery was required, I might have considered using both drugs together for a short period. However, this is just an opinion from an internist who has not seen actual patients, and in a clinical setting, I think there is a high possibility that I would have adopted the same approach as you.

    You modestly say, "I cannot be responsible if I take care of someone seriously. I cannot be responsible for someone's life." I strongly felt this way when I became a doctor. But in any profession, it's important to learn through experience.
    I remind myself of my initial enthusiasm as a doctor every day, but it's impossible to perfectly manage every medical action I take, and some compromise is necessary. In other words, everyday clinical practice may be like walking a tightrope, but please leave the comprehensive management to us when you come to our clinic. We’ll do our best for you, I promise!

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    1. Yamada Denki sensei,

      As long as I know now is; Mr. homeless changed his territories – he is now around Mission in San Francisco where lots of miserable people are lounging… hope he recovers completely.
      Unless otherwise he stays in the county of San Francisco or San Mateo, where we call “Sanctuary Cities” for undocumented immigrants, he is secured and can receive minimum healthcare services by government. That is the only hope but if he comes back to San Mateo, I will donate a blankets or a sleeping bag. I offer3ed him to sleep in our studio from sunset to sunrise which won’t affect our businesses, but he refused staying with us… he chose the freedom, not strong company with me.

      I chose doxycycline because Tetracycline and Chloramphenicol are the long time of my friends fighting for tonsillitis. (lol) Cipro is my primary choice during my travel but that medication didn’t come to my mind when I started taking care of him. I was a little bit in a panic mode, I think… even I knew him for years, he was still a stranger and inviting him when I am staying home alone… I was worried about some risks.

      But he recovered and left San Mateo. I can’t push anything further unless otherwise he comes back our town and showing up in front of me.

      With you, sensei, I am totally being rest assured and no worries – basically. My only concern is the control of glucose. Since I started injecting Lantus Solostar, 60 units/day but actually 72 units/day because I manage the ‘expected loss’ nicely, I frequently go low blood sugar situation when I am starved… it’s scary for me.
      So… in the morning of endoscopies, I am just considering how I can keep my glucose level properly before attending the clinic. Once I arrived at your clinic you can do whatever you like – just i.v. is the easiest way, for example. But can I take sugar (I’ll only have sucrose) or Pocali Sweat with Maguro-call? (both taste the same though (lol)) The healthcare in California doesn’t give me ‘glucose tablet’ or anything… so I’m just wondering. Please instruct me when I arrived at Crowne Plaza.

      Delete
  7. As for me, the oden I usually see is mostly transparent and doesn't look very brown. However, recently there have been some oden ingredients that are quite brown, perhaps due to the threat from the Eastern Japan (lol), and they have a soy sauce-like color. I'm worried that this might destroy the good food culture of Western Japan (lol). But when you started living in Tokyo, you felt that the oden lacked soy sauce. Hearing that, it seems that Chiba is so addicted to soy sauce that it can be considered exceptional even in the Kanto region.

    After spending six heavenly days in Barcelona, you will take ANA7 to NRT (which is still heaven as you’re in first class), and then you will come to Okayama by Shinkansen after only one night's rest. This Shinkansen ride is the beginning of hell. You must not touch any delicious station bento (ice cream is okay, though). As you said, the real suffering starts the day before, and it continues until the endoscopy is over the next day. Maybe to you, Dr. Doi and I may look like demons, devils, or vampires. But in Azabu afterward, maybe we will look like angels, light, and beauty to you?

    I'm sorry we can't all get together at Wellington's on June 1st. But please don't worry about the 3rd. I understand that everyone has his/her tight schedule.

    What? Meet you at Crowne Plaza Okayama on May 25th, go to a restaurant, I eat, and you just watch? That's a little unsettling, so let's just have coffee at a café. Soft drinks won't affect the next day's examination.

    Even though you're a seasoned traveler, and even if that long-distance travel is in first class, you will still be affected by jet lag. Although a slight feeling of hunger may not be a problem for a healthy person, it's a concern for you as a diabetic patient injecting insulin.

    You're injecting 72 units/day of Lantus Solostar, and frequently experiencing hypoglycemic situations when you're hungry. It's scary not only for you but also for us who have to monitor your general condition including your diabetes.

    On the morning of the endoscopy, you need to think about how to properly maintain your blood glucose levels before coming to our clinic. Basically, we instruct you to inject half of the insulin dose you normally inject before breakfast, even if you consume fewer calories. However, this is a case-by-case basis, and if your recent HbA1c level is well controlled below 7.5, you may not need to inject insulin in the morning of the day. Once you arrive at our clinic, we will handle blood glucose measurements at any time, so leave it to us.

    In some cases, one option is to attach FreeStyle Libre to your arm from the previous day. It allows you to measure glucose levels anytime, anywhere, even on top of your clothes without daily finger piercing. The sensor is disposable and does not require cleaning or disinfection, and can provide glucose data for up to 14 days. The sensor's memory lasts for 8 hours and saves glucose values every 15 minutes. The measurement information is displayed in easy-to-understand graphs on the Reader, among other advantages.
    https://www.myfreestyle.jp/patient/
    Please let us know your preferences.

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    1. Yamada Denki sensei,

      When convenience stores started selling odens in front of the casher, I was so terrified by those “never seen in my life” ingredients like gyu-suji, winner sausage (lol), or chikuwa-bu. Gyu-suji is the worst thing… it makes entire oden pot or entire convenience store smells like dog house without cleaning for years. On the other hand, I loved hampen or eggs abandoned in the broth for more than half day and got severely brown. The casher person warned me “This hampen is too brown… may I replace to a new one, sir?” then my clear answer is “No, I take it as-is!” (lol) When I was in Tokyo I heard from Western friends that they call oden as Kanto-daki which is a different cooking for them… no wonder it’s too brown!!

      So… I can’t buy Chicken Bento at Shinkansen home? Actually chicken bento is by JR East (originally Nihon Shokudo) therefore it’s not being sold within Central/West JR territory, so I have to find it before approaching the Tokaido platform. …I can’t buy it anyway. (sob)
      Instead, I will keep buying solid hard ice cream in Shinkansen even they only have Matcha or Orange flavored… those were the availabilities last time from Okayama to Tokyo. Disappointed. (But I could buy vanilla flavored one around Himeji – Shin Kobe)

      I prepared my glucose test kit in my bag to Okayama. I stopped carrying it since I can control my blood sugar high enough but not too high. My scariest situation is the glucose level went under 65. I start shaking my fingers if it went lower than 80 so I can detect by myself, so I can save myself for sure – even I breach the orders not having anything.
      Just FYI, my most recent A1c was 8.5. I have logs of blood exams since 2011 so I can show you if you wish.

      I totally understand once I arrived at your clinic I will be under i.v. so you can drain whatever you want, right? (lol)

      And in regards to Freestyle Libre by Abott, I have one information. I don’t have any allergy to medicines but I have sensitive skin. If I put ‘regular’ band-aid for over 3 days, the bandage peels my cortex together… I still have those scars everywhere on my arms and legs. So the short answer is, no thank you for those sticky sensors. Sorry! Instead I am happy to poke my fingers everyday every night.

      Delete
  8. I realized what you said is true – a long time ago, convenience stores didn't sell oden in front of the cash register. But now it's being sold all over the country, and for a considerable length of time each year. There must be a lot of demand for it, but I have had some concerns about it since it was introduced to be sold.
    First, I wonder about the hygiene management, and second, even when the clerk is not at the cash register, the oden is left open for anyone to touch, and if any suspicious poison or other substance were mixed in, no one would notice.
    Because of these two points, I have never bought oden at a convenience store. Even if I want oden, I will buy the packaged oden that can be heated in a microwave at home, which is sold in the same convenience store, and can be eaten immediately without having to buy premade oden.

    At home, we like to eat oden with ingredients like beef tendon and winner sausage. I personally prefer the classic boiled egg, konjac, and potato.
    Yes, I also call oden with very dark ingredients "Kanto-daki." It's not a completely different dish to me, but I do want to distinguish it from the Kansai-style oden, which is not as dark.

    Of course, on May 27th (Sat), on your return trip on the Shinkansen from Okayama, you can buy as many chicken bento boxes as you like. Until you leave Okayama, you will be under our strict control, but once you leave Okayama, you are free to do anything (lol).
    However, if Dr. Doi finds a relatively large polyp during the endoscopic examination the day before and performs an endoscopic resection on the spot, it will be an exception. In this case, you will need to follow Dr. Doi's instructions, who is the therapist, and if any complications occur… Of course, even in such a situation, it is our duty as doctors to provide you with the best possible treatment.

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    1. Yamada Denki sensei,

      I read Japanese economy news and it said convenience stores are discontinuing oden pots because of the maintenance of hygiene as well as the extra burden for the clerk, as you pointed out. And I totally understand that decisions because of the zoo-like smell in winter… yet, I miss my hampen and kinchaku-mochi by 7-Eleven, if those became brown enough. (lol)
      Ah… I still have one serving of frozen oden-kit by Kibun. I have to though it soon. But wait… I have to boil eggs first!
      It’s just like “Ah… I want to have okonomi-yaki” then it starts from Tempura for the first night’s dinner, then followed by okonomi-yaki with yesterday’s ten-kasu. This unbelievable behavior was explained by a college colleague from the West.
      I personally felt he should go Konan or somewhere in Kansai because of his strong Western dependency and disliking Tokyo/Kanto. But we gave him initiation practices for eating natto (hold him and drain well-whipped natto in his mouse and put duct tape on his mouse – you may call it ‘torture’), he overcame this and natto became his favorite food! However, he notified us he can’t find fresh natto in his hometown during his summer holidays…(lol)

      Wait… a potato? A potato in oden??

      Yes indeed, boiled eggs and kon’nyaku are classic. But POTATOES in oden??
      Another evidence here…Western Japanese are the different tribe. Fortunately not far enough as Koreans though.

      So, make everything clear – Knasai style oden is relatively clear broth/soup, adding gyu-suji and potatoes are typical. I understand it’s far from Kanto-saki certainly. But somehow, can you feel some similarity to Nikujaga because of the flabors and ingredients?
      I made Nikujaga for my better-half-san with quick cooking – use frozen gyudon base by Yoshinoya, adding potatoes and extra onions. Voila! here’s western style nikujaga!!
      When my mother was staying here, I cooked this quick Nikujaga. She was totally disappointed and insisted me to cook real ObaKoba homemade Nikujaga – Pork, Carrots, Onions and quite an amount of soy sauce with mirin and sugar. (lol) My better-half-san surprised and enjoyed the real Nikujaga, and told me he will only accept homemade style from now on… I lost my innovative cooking. (sob)

      Sensei… I can’t buy Chicken Bento from Okayama! It’s sold by JR East!! But instead, I will have Omusubi Kororing or some sort. It’s fun choosing bento boxes at Okayama Station.

      If any polyps Doi-sensei found, please just chop-chop and I will have super spicy Indian curry to disinfect and kill the suspicious cells around! …I don’t want to receive chemo or gamma knife. (SOB)

      Delete
  9. Yamada Denki sensei,

    The ice creams in Shinkansen are very famous about its hardness. Some people say it’s second hardest from diamond which is as hard as sapphire crystal. (lol)
    And yes, I only experienced Tokaido Sanyo Shinkansen except one time ride of Tokyo ⇄ Nasu Shiobara by Kodama-like ones. And I only go Okayama except I stayed at Westin Osaka and Kobe Bay Sheraton. Even those stays, my primary destination is a clinic in Okayama.
    So, when I take Shinkansen from Tokyo, I arrive Tokyo station about one hour prior to departure of my Nozomi – I am very confortable this situation by air travels. Then, what I do is browsing and shoipping around Eki-naka, including bento shops by JE East and JR Central. Interestingly, the variety of bento boxes and beverages between these two are different. The Chicken Bento is my primary choice, then I usually buy one or two more because I expect three hours of durations.
    But… NO BENTO this time?? Okay, I will keep having ice creams, including crystal-hard ice creams by Sujata, or hot and fresh coffee with ‘Fresh’ by Sujata.

    And… antithrombotic?? For myself?? “No.” is the right answer, I believe.

    I only take LDA, 81mg of acetylsalicylic acid every morning. My better-half-san takes 5mg of rivaroxaban (Xarelto by Jansen), factor Xa inhibitor, but no such strong and nasty meds for me. Actually I asked my primary doctor about apixaban for the prevention of DVT/PE during my long-haul airplane rides, but his answer was clearly NO. (sob) I thought Jansen is my friend… I take InvocaMet (Canagliflozin 50mg+ Metformin 500mg) from Jansen, twice a day, and it’s free!

    Now I almost disclose my meds hereby…
    InvocaMet – twice/day
    Atorvastatin 20mg – once in Evening
    LDA – once a day
    These are the thru-mouth ‘meds’ I take everyday besides the injections, I also take multivitamins and 50mg of zinc, probiotics (50 billion, 31 strains!) .
    So… I will refrain from taking these meds 24hours prior to the endoscopies, right?.

    For the glucose managements, I’ll refrain from injecting insulin from the evening in Okayama, so I will skip two shots and attending your clinic. My highest is usally around 250-300 so it’s lower than 350, high sugar won’t harm me immediately like one day. I sometimes forget injections… but these days, I use Health App in my iPhone so my cellphone warns if I forgot the injection in a right time manner.

    …the words you wrote “secure your blood vessels” reminds me the hell in the ER of Saiseikai Hospital. I got a fever and my parents didn’t hesitate calling 119, I was sent to that ER and the first thing resident doctor did was… securing my blood vessel with catheter. I was surprised that thick needle and asked “why you use gage #20 or so?” then the young doctor surprised and asked me back “Are you in the healthcare services?” of course my answer was “No, but it’s easy to identify the gage! And my schoolmates are medical doctors graduated Chiba!” Finally, the resident dude explained installing catheter is the standard procedure for the patients like me… but it’s so uninformative, isn’t it??

    However, at your clinic, I won’t argue even if you guys try installing catheters or anything. I will bear whatever you do. Fingers crossed.

    For the upper endoscopy, I prefer thru left nostril but I do remember – last time you got upset because I swallowed my saliva… so it’s up to Doi-sensei. Though I am quite good for deep throat, I’m not as good as suppressing the vomiting reflex.

    Ando for lower endoscopy, due to my understandings, you will apply Propofol or something similar during the ‘foregoing’ period, and then I will be back to conscious, Doi-sensei starts go ‘backwards’ and see the monitor together… if the procedures are not changed significantly from the last time.
    I was so touched and impressed your wife-san holding my hand during my unconsciousness, but now I learned she was checking whether I am breathing or not, considering of the side-effect by Propofol… which we lost Michel the King of Pops. (he’s our age, btw)

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  10. I have never actually eaten ice cream while riding on the shinkansen, but I prefer it to be slightly melted rather than completely hard, so I think I would deliberately delay starting to eat it.

    I have ridden a whole section on the Tokaido/Sanyo Shinkansen between Tokyo and Hakata, and the Hokuriku Shinkansen between Kanazawa and Tokyo, however a partial section on the Tohoku Shinkansen between Sendai and Tokyo, thus I have not ridden on it north of Sendai. If I were to go further north, I would probably use a plane.

    I see, so if you are taking the shinkansen from Tokyo, you arrive at Tokyo Station about an hour before your scheduled departure time to look for bento boxes (←why? plural!). By the way, I know about JR East, but JR Central? Is it JR Tokai? Just like Tokyo Station, Shin-Osaka station is a junction that is served by two railway companies (JR Tokai and JR West), so there are "Midori no Madoguchi" ticket offices affiliated with each company, as well as bento shops. I also occasionally buy food before riding, but most of it is sandwiches, and I rarely buy bento boxes. That's because, in my case, when I see a bento box in front of me, I inevitably want alcohol. If I can drink alcohol, then a bento box is fine, but if not, I exercise self-restraint.


    You usually buy one or two bento boxes, but unfortunately, this time there are no bento boxes, or if you accidentally (lol) bought one, please throw away half of it. But it's okay, feel free to have as much ice cream as you want, which is as hard as diamonds, and coffee, to your hearts’ content.

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    1. Yamada Denki sensei,

      Have you never had The Shinkansen Ice Cream powered by Sujata!? …you are something.
      For me, Shinkansen is powered by Sujata ice cream and nothing beyond. (lol)

      It doesn’t matter the Shinkansen-like products by JR East. For me, Shinkansen runs from Tokyo to Shin-Osaka. Beyond that, I can arbitrate any opposite opinions if the varieties are Nozomi, Hikari and Kodama. Otherwise, the burret trains in Japan are Shinkansen inspired trains. I don’t accept rather than Nozomi or Kodama. (I don’t think I take Hikari…) On the other hand, I do accept 5000 series of silver-pencil Shinkansen. They are super cute.

      Oh… I didn’t realize bento box are plural. Like sheep or salmon, if there are too many, it’s uncountable hence it’s not plural, I thought. (lol) But no bento next time anyway. (sob)

      > You usually buy one or two bento boxes
      …actually, about ten years ago from Okayama, I bought Omusubi Kororing, 豚トコTON and とりどり鶏 with Coffee by West Japan Railway Food Service Company, then vanilla ace cream by Sujata. I love foods by JR West – if its’ not strongly involved with soy sauce.
      In two weeks, I will repeat the behaviors for sure except I change trains at Shinagawa.

      Does it call JR Tokai?? Due to the Google and the URL, it reads Central Japan Railway Company… I don’t pay much attention anyway as long as Nozomi runs on time.
      Yes, my largest problem is the separation of 日本國有鐵道. Although they are separated in several companies, the Midori-no-Madoguchi remains the same. However, if I buy Shinkansen ticket online thru Eki-Net powered by JR East, I cannot receive the tangible tickets except JR East…And if I buy Shinkansen ticket thru JR Central, I have to buy joshaken separately thru JR East or JR West. Furthermore, The express ticket online service by JR Central like EX is somewhat complicated for me. This is utterly definitely disgustingly idiotically inconvenient. JR companies don’t stand for the customers at all, especially for foreigners.
      Therefore, I stopped using online service by JR’s and decided to go Midori in Narita airport T1. It’s operated by JR East but I’m quite sure they can sell joshaken between Tsudanuma and Okayama with Nozomi tickets for the next day service. If I failed, I’ll let you know I won’t make Okayama trip, so please keep your fingers crossed.

      And the following time, I want to take maglev to Okayama… if I’m still alive.
      It’s really depends on the people in Shizuoka – I found they are really pissed off no maglev stops within Shizuoka, so they interfere digging the tunnels. Japanese government must take that territory from Shizuoka and give it to Yamanashi. If anyone against to the order, they must be got penalty of death by hanging. This is the democracy. wwwwwwwwww

      Delete
  11. Oops, I forgot to mention something in my previous email. Of course, I have also ridden a whole section on the Joetsu Shinkansen between Niigata and Tokyo. Together with our mutual friend O, we took the overnight express train "Tsurugi" from Osaka to Niigata and suffered a big loss at the Niigata Horse Racecourse, but instead of learning our lesson, we then took the Joetsu and Tokaido Shinkansen to Kyoto on the following day, where we lost even more money at the Kyoto Horse Racecourse. We were incorrigible (lots of masochistically laugh).

    By the way, I understand that you take LDA for thrombosis prevention. Please be aware that for the sake of reducing the risk of bleeding after colon polyp removal surgery, you should stop taking LDA on the day of your endoscopic examination, just to be safe. If no hemorrhagic treatment is performed, you can resume taking LDA after the endoscopic examination.

    It seems that you have asked your doctor about taking apixaban to prevent DVT/PE during long flights. If you need it, please let me know and I will prescribe it for you.

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    1. Yamada Denki sensei,

      Sensei… this is not an email but comment section on my blog, so no privacies are secured.
      All privacies are not really secured by Google, but this place is one of the worst, you should remember. (LOL)

      Oh I forgot it too. I also took Shinkansen like train between Ueno and Niigata. It was 200 series which looks like Shinkansen but the blue painted belt turns into green… the JR East color. I wasn’t impressed but it was a fun ride because I was with my friends of T, attending a bridal.
      In terms of the local express by JR-Whatever, I don’t remember where but… I saw two express trains named Thunderbird and Raicho almost next to each other. I was simply curious how JR can explain the difference in English.

      Thank you for the suggestions of suspending LDA. If I remember correctly, my platelets will be back to normal in 72 hours so I will suspend LDA 3 days prior to the endoscopy so that my blood helps me if Doi-sensei stuck the camera into my colon.

      And thank you for offering apixaban… I can always steal rivaroxaban from my better-half-san so it’s not needed. I saw my better-half-san was in the pool of blood when he cut the forehead, so I don’t want to experience such nasty situation… but instead, please prescribe me sodium loxoprofen. It’s not available in California so I have to stick with 220mg of naproxen as a primary NSAID but it doesn’t work well compared to 60mg of Loxonin. Sorry for the detailed request… I have too many friends under pharmaceutical industry as you know.

      Delete
  12. Oh, I see that combination drugs containing SGLT2 inhibitors and metformin are used in the United States. As far as I know, such combination drugs have not yet been used in Japan. Combination drugs are beneficial for patients in terms of improving medication compliance, but as prescribing doctors, it can be difficult to adjust the dosage, which is a double-edged sword.

    Furthermore, you are taking atorvastatin 20mg once a day (after dinner), which is twice the usual dose in Japan (This is America!?). If you are refraining from insulin injections from the evening before your endoscopic examination, I believe that you can take your oral medication except for LDA. How does that sound?

    As you think, a temporary increase in your blood sugar level to around 250-300 should not cause any particular problems. If it goes over 350, we will consider insulin injections (this is more likely to happen in Azabu than during your stay at our clinic...hahaha).

    By the way, the indwelling needle we use to secure patients’ blood vessels in our clinic is 24 gauge. It seems that Narashino Saiseikai Hospital's ER used a 20 gauge needle, but in ERs where a wide variety of drugs are often used in a short period of time, it is safer to use slightly thicker indwelling needles, and I understand the intention behind it. Also, even if you were to ask the young doctor who first took charge of you why they were using that thickness of catheter to secure your blood vessels, it is understandable that they were at a loss for an answer, since that hospital's protocol may be considered the global standard for that young doctor (of course, it is always better to answer the patient's psychological anxiety as much as possible).

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    1. Yamada Denki sensei,

      I totally understand the pros and cons of combo drugs, but I prefer InvocaMet rather than Invocana which is 50mg of canagliflozin only.
      I take metformin because Dr. Chris M. introduced this.

      “The beneficial effects of metformin on cancer prevention and therapy”
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6497052/

      So… metformin prevents proliferation, so I can be rest assured some risks of “Meta-Meta.”

      Due to the amount of atorvastatin, 20mg is tiny. My better-half-san takes 80mg of it.There might be 10mg tablets, but we Americans are BIG and LARGE, so 20mg is lower than average… 40mg is the medium amount, I guess.
      I am totally okay to skip all of through the mouth medicines in prior to the endoscopy. Forgetting one dose happens often, so there won’t be no scare, no big difference for sure.

      So before going to the steakhouse, I will apply the injection. I usually injecting insulin at 7 am then 7 pm but if I have a dinner reservation or a party, I take injection early. As you know better than me, Lantus Solostar by Sanofi Pasteur works 24hrs, so I originally got prescribed 60 units per day. Then, I asked my primary doctor if I can do it twice a day, 30 units each so that the remaining amount in my body would be more flattered. Doctor agreed with my proposal then I started injecting 30 and 30 everyday, every night… then, replacing the needle is somehow bothersome. Next time I saw my doctor, can I use the same needle for several shots and he told me it’ll be okay, but unofficial. After all, I don’t change needles until I complete 3mg of whole amount. Then, I found pretty much excess amounts of insulin left in the syringe, because never loss of needle replacements. I tried to increase some amounts… so far, I can shot 36-38 units each time and complete the entire pen in four days. This is very easy to calculate how many pens I should bring with me for every trip. Because I can’t do the math well, as you know, I bring the necessary amount of pens + one usually.

      At the ER in Saiseikai Hospital, that gauge #20 (btw. In the US, it’s always odd number. my insulin injection is #31) was a bit sensational for me… I felt some pains on my vein so I notified to the nurse that I am feeling 血管痛. Then… again… they really doubted whether I am not in the healthcare services. That behavior is seriously 上から目線 for their patients and I was so uncomfortable about it. The patients are not such idiots! …sometimes. (lol)

      Delete
  13. 明日からはイスタンブール旅行記が始まるお

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    1. 岡山へ行ってる時におしまいだお

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    2. もう自動公開にセットしたお。だからバルセロナでくたばっても見れるお

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  14. I see that you prefer to be inserted the endoscope through the left nostril. Last time, you were swallowing saliva during the examination, but that is not something that would make the performing doctor angry; it is because swallowing saliva can make it easier to trigger the gag reflex. Nasal endoscopy is relatively easier to suppress the gag reflex compared to oral endoscopy, but even sensitive patients may experience some reflex, and that is within our expectations as endoscopists.

    As you understand, we use propofol for endoscopic examinations. This is not intended to make a patient lose consciousness but rather to make an examination as comfortable as possible (within safe limits, of course). Additionally, Dr. Doi has qualifications as an anesthesiologist and will monitor your vital signs while proceeding with the examination accurately.

    As for whether my wife will hold your hand this time, I cannot predict that. She may not hold your hand, but she will at least check whether you are breathing properly.
    MJ was the star of our generation (however, it seems that he lived a life completely opposite to ours and lived in a world, Neverland, that we have never been allowed to get in), and propofol was given a bad reputation as a drug that caused the King of Pop's death. However, there is no doubt that it is a relatively safe sedative that is easy to use for us gastroenterologists.

    Personally, when I underwent right inguinal hernia surgery at F Hospital in March two years ago, it was a lumbar spinal anesthesia, but since I had known I would remain conscious during operation, I asked Dr. W, who was in charge, to use propofol as well in advance. The lumbar puncture at the start of anesthesia is a bit painful, but I was able to complete the surgery comfortably afterward. Apparently, propofol not only has a sedative effect but also brings about a manic state for me, and during the surgery, I skipped through a flower field the entire time and talked about that scene to the surgeons, causing some trouble (hahaha).

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    1. Yamada Denki sensei,

      That nostril endoscopy you did for me was the most ‘comfortable’ 胃カメラ I never had. The oral one which your wife-san gave me ice cubed ‘num shot’ like preparation was amazing but thru the nose is the easiest for me. If Doi-sensei does the same, let me try draining all of my saliva in front of your wife-san which is quite being ashamed but let me try thinking it’s a part of torture – such as… showing my very personal thing to the public. (lol)

      I don’t blame on propofol at all. I just remembered that was used for Mr. Jackson and some Korean celebrities these days. And thank you for reminding me that Dr. Doi use to be the pro of giving anesthesia. I anyway don’t worry about those things, but simply curious how consciousness goes away and coming back artificially. I just took s-zopiclone a minute ago and this is also involving with my consciousness, much mildly though. There are so many wonders on human science!! (being impressed like an elementally school kid with almost Medicare joining old and filthy body)

      Yes, I confess I am looking forward to hold your wife-sans hand during my unconsciousness and I will be in a happy dream – hopping around the Turkish bath and hugging, cuddling with old mustached daddies. Mmm… I actually do this every other month. I’m already halfway in heaven.

      So, sensei had a hard time in Dr. F’s general hospital. That’s the largest one around your area, right? so you could see the best surgeon in town. …I personally see Dr. F. If it happens, I only demand his hug. Nothing further unless otherwise he wishes the beyond. Dr. F is my eye candy in Saidaiji…
      Anyway, I am glad you recovered well and nothing remains except abnormal nightmares.

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  15. By the way, was the nasal endoscopy that was performed on you in our clinic comfortable? For oral endoscopy, we still use the "frozen lump of local anesthetic mixed into zero-calorie cider" as a throat anesthetic, which you experienced before. People's preferences vary, some find the nasal endoscopy the most comfortable like you, while others prefer oral with the use of propofol. In our clinic, we basically try to cater to the patient's preferences. Doi-sensei, more than me, finely caters to the patient's preferences, which always amazes me.

    During the examination, it's beneficial for both the patient and the examiner if all saliva can be spit out, not only because it suppresses the gag reflex but also because it makes observation of the esophagus much easier.

    The indications for propofol are:

    (1) Introduction and maintenance of general anesthesia
    (2) Sedation during examination
    (3) Sedation in intensive care

    However, (2) is currently off-label in our country. Of course, it is used for a lot of cases for the purpose of (2), but since the manufacturer does not apply for expansion of indications, we are forced to use it in a narrow status as "off-label use" for 28 years since it was released in our country.
    In 2009, it was one of the drugs that led to the death of Michael Jackson, and in Japan, in the 2014 Tokyo Women's Medical University incident, it was the cause of death of a child, and each time it became a topic of discussion.
    Still, its effect appears rapidly after the start of administration, and the patient loses consciousness within a few seconds. But, if administration is stopped, although it depends on the administration speed and time, usually the patient regains consciousness within about 10 minutes and opens their eyes in response to stimuli. This can be said to be a safe sedative, easy to use even for medical institutions like ours that do not have a vast recovery space, as long as the usage method is not mistaken.

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