Wednesday, April 25, 2018
From Tampopo to Sideways: Merlot at last.
After this post first came out in 2008 when I started blogging, The Cockroach Catcher has at last had a chance to taste a most amazing Merlot.
It is amazing how easy it is to influence modern day consumers with nothing other than a well made film. As far as wine is concerned the film Sideways has more or less changed the wine landscape of California if not elsewhere. This is because of two simple lines from the film. The wine snob character Miles tells friend Jack before a double-date dinner:
“If anyone orders Merlot, I' m leaving. I am not drinking any……Merlot.”
is 45% Merlot is lost to the vast majority. In fact if Petrus had not refused permission, Miles would have drunk Petrus in the film, and that, one of the most expensive wines in the world, is 95% Merlot. Towards the end of the film, he was being comforted by a bottle of Cheval Blanc, 1961 no less and arguably best of the post war ones.
Ours is more recent, 2000 but what a wine.
Many blogger thought it was a Hollywood goof. To me it is one of the smartest irony: for the Merlot hater to be raving about a Merlot (with Cabernet Franc) is deliberate as it was originally going to be the Petrus. Merlot sale unfortunately suffered, but only the Californian variety.
There is a beautiful wine tasting scene, by a group of hobos following the lead of a professor. The professor realises that life as a hobo is much freer, with no one above him telling him what he should do, no targets to meet, and no paperwork.
The wine tasting is not at a winery or a restaurant. It is in a park by the back door of a restaurant. The wine is that little bit left at the bottom of a bottle. There is not enough to go round; so the hobos allow the professor to do the tasting and are content to just listen to his analysis. (In the Cockroach Catcher, I wrote that a blind case presentation at Queen Square
It is one of the most enjoyable scenes for wine lovers and if you are not a wine lover you will become one.
The wine?
This wine has since become a favourite of the Far East .
Chateau Pichon Lalande is not as expensive as the First Growths but is fast catching up. Fortnum and Mason of London used to have a house Pauillac made by Chateau Pichon Lalande. I was tipped off to get the last few bottles some years ago. Now the supplier of their house Pauillac is Chateau Haut Bages Averous, a vineyard next to the new rising star of Bordeaux : Chateaux Lynch-Bages.
The best year in recent vintages has to be 1989, a great year for most of Bordeaux and rumour has it that it will become drinkable in 2009. Hurrah. The 2000 is superb too but recent vintages have all been great and if you can store them buy them now.
The biggest wine influence worldwide came from a documentary. In 1991, after the airing of 60 Minutes on CBS, wine sales went up 44% in the next four weeks in the U.S. It was about the French Paradox: the incidence of coronary heart disease in France being 40% percent lower than in the U.S.
Health sells.
Once upon a time in Hong Kong, when people made money they drank the most expensive Cognac and Scotch, with Hennesy XO and Dimple being the “Gold Standards”, partly because of their highly recognisable bottles. To have such a bottle on your dining table was a sure sign that you had arrived. Now, the status symbol is the most expensive red wine, and it is often taken with just about any dish that is served.
But then the French perhaps always knew; including its own most famous psychoanalyst Jean Laplanche (born 1924). His book The Language of Psychoanalysis was first published in 1967 and translated into English in 1973. All of us training at the Tavistock had a copy and it is to this day one of the best reference books on the subject. He has co-authored a number of other books in psychoanalysis.
What is not so widely known is that Laplanche was for many years the owner of Chateau de Pommard, a Burgundy vineyard, and actively involved with the wine-making processes. He sold the vineyard in 2003 but continues to live on the estate with his wife and to act in the capacity of a consultant to the new owners on wine making matters.
Wine Posts:
Saturday, April 21, 2018
London Marathon: Hyponatraemia & Rehydration
There is little doubt that overhydration is now the biggest threat to the runners. Most fatality is due to hyponatraemia and as far as my searches go, no one has died from dehydration during the various Marathons.
Despite what you may have read: DEHYDRATION is not the problem. Low SODIUM is!
Elite Marathon runners in the past rarely drank much during races. Mike Gratton, when he won the London Marathon in 1983, apparently drank nothing.
It has been said that even doctors may overlook the role of low sodium in rescues especially as there are sports drinks in abundance.
Marathon runners who drink too much water are at risk of a deadly condition
© 2016Am Ang Zhang
As runners from around the world prepared themselves for the London Marathon. I will publish my take from an earlier post.
It is amazing to hear of advice on drinking plenty of water in any heat wave both here and in the US.
Marathons:
Of 766 runners enrolled, 488 runners (64 percent) provided a usable blood sample at the finish line. Thirteen percent had hyponatremia (a serum sodium concentration of 135 mmol per liter or less); 0.6 percent had critical hyponatremia (120 mmol per liter or less). On univariate analyses,hyponatremia was associated with substantial weight gain, consumption of more than 3 liters of fluids during the race, consumption of fluids every mile, a racing time of >4:00 hours, female sex, and low body-mass index.
Modern marathon advice is to up the intake of salty food in the pre-race preparation. When dehydrated taking salt and water alone will not work: see below.
Watermelon:
When I was growing up in the tropics, one of the fruits we were given after a long walk was watermelon with salt sprinkled on it. This was long before the current understanding of Oral Rehydration. My parents were careful to warn us then that just drinking water is no good. Why? They did not know!
Now I do but watermelon is still my favourite and in the tropics you can buy fresh water melon juice in the summer.
Chinese farm workers:
It has to be said that the diet of many Chinese farm workers was generally higher in sodium, from dried salted fish and vegetables. It is likely that the serum sodium of many such workers would have been at the high end of the normal range. Modern advice on cutting down sodium often does not take account of sweating in hot countries. A friend of mine with hypertension had an epileptic seizure when he went to work in Singapore. Luckily the medical services there were alert to the problem and he survived. He was on a low sodium diet and on diuretics amongst other medications.
Free water:
Thailand:
In Thailand, workers in rice fields, fruit orchards and vegetable patches manage to survive temperatures of over 100°F.
Golf:
When the first public golf course was opened on the beautiful island of Kau Sai Chau in Hong Kong, drinking water was provided along the course. One player drank so much that he nearly died of water intoxication (result of drinking excessive amounts of plain water which causes a low concentration of sodium in the blood leading to amongst other problems: ‘brain’ swelling---cerebral oedema).
Cocktails:
Drowning:
Cholera:
“Ideas without precedent are generally looked upon with disfavor and men are shocked if their conceptions of an orderly world are challenged.”
Bretz, J Harlen 1928.
It is amazing to hear of advice on drinking plenty of water in any heat wave both here and in the US.
Marathons:
Marathons are often sponsored by bottled water companies and their main aim is to let the public get he image of runners with bottles of their water.
Of 766 runners enrolled, 488 runners (64 percent) provided a usable blood sample at the finish line. Thirteen percent had hyponatremia (a serum sodium concentration of 135 mmol per liter or less); 0.6 percent had critical hyponatremia (120 mmol per liter or less). On univariate analyses,hyponatremia was associated with substantial weight gain, consumption of more than 3 liters of fluids during the race, consumption of fluids every mile, a racing time of >4:00 hours, female sex, and low body-mass index.
Modern marathon advice is to up the intake of salty food in the pre-race preparation. When dehydrated taking salt and water alone will not work: see below.
Watermelon:
When I was growing up in the tropics, one of the fruits we were given after a long walk was watermelon with salt sprinkled on it. This was long before the current understanding of Oral Rehydration. My parents were careful to warn us then that just drinking water is no good. Why? They did not know!
Now I do but watermelon is still my favourite and in the tropics you can buy fresh water melon juice in the summer.
Chinese farm workers:
It has to be said that the diet of many Chinese farm workers was generally higher in sodium, from dried salted fish and vegetables. It is likely that the serum sodium of many such workers would have been at the high end of the normal range. Modern advice on cutting down sodium often does not take account of sweating in hot countries. A friend of mine with hypertension had an epileptic seizure when he went to work in Singapore. Luckily the medical services there were alert to the problem and he survived. He was on a low sodium diet and on diuretics amongst other medications.
Free water:
Free water:
I also remember one very hot August day when we hiked down Grand Canyon to Angel Point. There were warnings everywhere of the risks and even fatalities on such walks. The National Park did have clean drinking water taps along the way and one particular girl overdid the drinking. She had a narrow escape, as the Ranger fortunately knew a thing or two about rehydration. He put some salt in a can of Sprite and reverted a potentially serious situation.
Thailand:
Thailand:
The first time we went to Thailand the most amazing dip was simply a bowl of sugar that has been mixed with salt and some chopped chilies for good measure. This dip was used for serving unripe mangoes, papayas, guavas and other local fruits, and gave me a taste sensation that was unforgettable. Same principle as ORT.
In Thailand, workers in rice fields, fruit orchards and vegetable patches manage to survive temperatures of over 100°F.
In Thailand, workers in rice fields, fruit orchards and vegetable patches manage to survive temperatures of over 100°F.
Golf:
The Cockroach Catcher plays golf in his holiday home in the tropics and he uses his own mix of diluted Pomegranate juice and a pinch of salt for Oral rehydration. I would never drink plain water alone. This is one time where a bit of sugar helped the body to absorb salt and fruit juice is higher in potassium.
When the first public golf course was opened on the beautiful island of Kau Sai Chau in Hong Kong, drinking water was provided along the course. One player drank so much that he nearly died of water intoxication (result of drinking excessive amounts of plain water which causes a low concentration of sodium in the blood leading to amongst other problems: ‘brain’ swelling---cerebral oedema).
Cocktails:
It seems wrong to recommend alcohol but has anyone worked out why cocktails from hot countries would be served with the rim of the glass covered in salt!!!
Drowning:
I remember one of my professors telling us: the body survives dehydration much better than drowning. How right he was, as water intoxication is in a sense a kind of drowning.
Cholera:
I well remember
The scientists at Johns Hopkins and Dr Mahalanabis received the Pollin Prize of $100,000 in 2002.
“Ideas without precedent are generally looked upon with disfavor and men are shocked if their conceptions of an orderly world are challenged.”
Bretz, J Harlen 1928.
Thursday, April 19, 2018
Osthmanthus & Guava: An older and more sedate time!
Guava fruit and the beautiful trunk.
Osthmanthus fragrans©Am Ang Zhang 2011
The examinations were finally over and I was back home in the village that I had more or less abandoned for the most of the last five years. I could not remember skies as bright and temperature as high, but it was a nice interlude from the mad preparations and the nerve-wracking examinations.
We had an unusually dry May. The worst of the 1966 rains seemed like a distant memory and the crisp blue skies somehow made the heat tolerable. Even back then we seemed to be complaining of the ever rising temperatures in Hong Kong . The way we had been complaining about the rise every year, the temperature should really have reached 110 or more by now. The air-conditioning of offices, followed by that of private homes, necessarily led to the feeling of higher ambient temperatures in the streets.
The garden was filled with the fragrance of the white tropical jasmines. That fragrance is only second to that of the Osmanthus (Gui Hua)[1], the flowers of which are tiny and appear more towards winter. We used to collect the Osmanthus flowers, dry them and use them to flavour our best teas. Jasmine is more a late spring and summer flower and we had a big bush. By nightfall the cooling hill breeze brought with it occasional whiffs that made you want summer to last forever.
It was a peculiar time for those of us who had lived in or around the university for the past five years. We left home as school children and now we were back, and with any luck the majority of us would in a few weeks become fully fledged doctors ready to apply our skills.
We had changed and the rest of the family probably not as much; and yet it was a time to savour – the last of the old before embarking on the new and brave.
It was good to be reminded of the fine cooking back home, of an older and more sedate time when shopping was done twice a day for fresh ingredients. This practice of course still continues in some parts of the world.
.........The guavas were not quite ready but our own giant papaya tree seemed capable of fruiting through the year. These were yellow fleshed and delicious though without the special fragrance associated with the red variety. Bananas too grew wild and bunches were cut when ready and suspended from a tripod for indoor ripening. It was too risky to let them ripe on the tree as various animals and birds would have had first claim.
[1] Osmanthus (Gui Hua) - Osmanthus fragrans is a flower native to China that is valued for its delicate fruity-floral apricot aroma. It is especially valued as an additive for tea and other beverages in the Far East .
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Tuesday, April 10, 2018
Tioman Island vs The Great Barrier Reef!
The Great Barrier Reef at 18.2871° S is hitting the news with much bleaching.
Tioman Island: 2.8167°N Not Bleached.
Ideas without precedent are generally looked upon with disfavour
and men are shocked if their conceptions of an orderly world are challenged.
Bretz, J Harlen 1928.
and men are shocked if their conceptions of an orderly world are challenged.
Bretz, J Harlen 1928.
We have always been led to believe that bleaching of the world's coral reefs is final proof of global warming. Not quite according to the NOAA:
When corals are stressed by changes in conditions such as temperature, light, or nutrients, they expel the symbiotic algae living in their tissues, causing them to turn completely white.
Warmer water temperatures can result in coral bleaching. When water is too warm, corals will expel the algae (zooxanthellae) living in their tissues causing the coral to turn completely white. This is called coral bleaching. When a coral bleaches, it is not dead. Corals can survive a bleaching event, but they are under more stress and are subject to mortality.
In 2005, the U.S. lost half of its coral reefs in the Caribbean in one year due to a massive bleaching event. The warm waters centered around the northern Antilles near the Virgin Islands and Puerto Rico expanded southward. Comparison of satellite data from the previous 20 years confirmed that thermal stress from the 2005 event was greater than the previous 20 years combined.
Not all bleaching events are due to warm water.
In January 2010, cold water temperatures in the Florida Keys caused a coral bleaching event that resulted in some coral death. Water temperatures dropped 12.06 degrees Fahrenheit lower than the typical temperatures observed at this time of year. Researchers will evaluate if this cold-stress event will make corals more susceptible to disease in the same way that warmer waters impact corals.
The Great Barrier Reef at 18.2871° S is hitting the news with much bleaching.
These are doing fine at Tioman Island, 2.8167°N
All photos©2014 Am Ang Zhang
Medicine and Snorkelling: Think outside the box!
The first modern snorkel was invented by none other than Leonardo da Vinci, apparently at the request of the Venetian senate. It consisted of a hollow breathing tube attached to a diver's helmet of leather.
You may wonder why I wrote about snorkels in my book The Cockroach Catcher. The evolution of the snorkel tube makes me think about progress in medicine.
“... In those days we had snorkels that had a Ping Pong ball at the top end – a sort of umbrella handle at the top with the Ping PongBall inside a little cage so that it floated up to stop water coming in. ….
Imagine the shock when we went to the Great Barrier Reef and were given snorkels that bore no resemblance to the ones I used in my childhood. There was no Ping Pong ball in a cage and there was a drain at the bottom. The top was slightly curved with a clever design so that water from waves could not get in. Any water that managed to get in was drained away at the bottom. I looked at it and smiled. One must always question traditional beliefs. We can be blinded by what looks like a most sensible and reasonable approach – Ping Pong ball in a cage. ...
Medical Schools should remember to teach future doctors that without breaking rules and old dogma, no progress would ever be made in medicine....”
My Point is that doctors sometimes need to “think outside the box”.
Snorkelling is one of my favourite hobbies. I find it so relaxing and therapeutic. Slow breathing, say for 15 minutes a day, is now proven to help reduce blood pressure by a clinically significant amount. What better way to do it than in the sea, surrounded by fish and corals?
NHS & Gawande: Morbidity and Mortality Conference M+M
The GMC warned that the safety of hospital patients is being put at risk because inexperienced young doctors are too often being left in charge of A&E and other units. We need to look at the way medical liability is covered in Hospitals where indeed all juniors must be covered by a consultant in one way or another. The responsibility would indeed be that of the hospital management and not on the poor Junior Doctor. The difficulty is the choice between NO doctor or a less experienced one. Should the patient be told or should the A&E just be closed? Will management do that or just continue to abuse the poor juniors and blame them when things go wrong. No wonder my friends' children prefer to become lawyers.
I read Gawande when I was touring Peggy's Cove and posted about his book Complications! Honestly, I did not know Gawande was giving the Reith Lectures.
Latest Gawande Book:
In one of the most moving passages in the book, Gawande’s father, in hospice, rises from his wheelchair to hear his son lecture at their hometown university. “I was almost overcome just witnessing it,” Gawande writes.
........Gawande offers no manifesto, no checklist, for a better end of life. Rather, he profiles professionals who have challenged the status quo, including Bill Thomas and other geriatricians, palliative-care specialists, and hospice workers. Particularly inspiring are the stories of patients who made hard decisions about balancing their desire to live longer with their desire to live better. These include Gawande’s daughter’s piano teacher, who gave lessons until the last month of her life, and Gawande’s father, also a surgeon, who continued work on a school he founded in India
He’s awed not only by his father’s strength, but by the hospice care that helped the dying man articulate what mattered most to him, and to do it. Gawande thinks, as he watches his proud father climb the bleachers, “Here is what a different kind of care — a different kind of medicine — makes possible.”
What would lawyers say about M + M:
- ‘There is one place, however, where doctors can talk candidly about their mistakes, if not with patients, then at least with one another. It is called the Morbidity and Mortality Conference – or, more simply, M+M – and it takes place, usually once a week, at nearly every academic hospital in the country. This institution survives because laws protecting its proceedings from legal discovery have stayed on the books in most states, despite frequent challenges.’
>>>See also Dr No: We Have No Black Boxes
>>>See also Dr No: We Have No Black Boxes
Abetternhs's Blog What are we afraid of?
August 27 2014:
What a charming place: Peggy's Cove of Halifax.
The Cockroach Catcher was finishing reading the book Complications and such charming old landscape reminds him of the old traditional medical training he received and how some doctors still do. Like the author of this book.
The book reads more like a collection of blog posts and in fact it was. Yet it was real and touching. Sometimes it was brunt and brutal. and after all doctors are as human as anyone. Complications includes those doctors themselves may suffer: mental illness and alcoholism as well as the serious cardiac condition of the author's young son.
We, doctors make mistakes and please we must be allowed to sort them out without affecting career or worst, future medical behaviour.
A great book for doctors in particular and when on holiday in a charming place.
All photos©2014 Am Ang Zhang
(Metropolitan Books, 288 pages, $24), a collection of 14 pieces, some of which were originally published in The New Yorker and Slate magazines, Gawande uses real-life scenarios – a burned-out doctor who refuses to quit; a terminal patient who opts for risky surgery, with fatal results – to explore the larger ethical issues that underlie medicine. He asks: How much input should a patient have? How can young doctors gain hands-on experience without endangering lives? And how responsible are these doctors for their mistakes?
While “Complications” is full of tragic errors and near misses, the book is not intended to be an expose. Rather, Gawande asserts, it is meant to deepen our understanding of the intricacies of medicine. “In most medical writing, the doctor is either a hero or a villain,” he says, with an edge in his voice. “What I am trying to do is push beyond that and show how ordinary doctors are – and at the same time show that what they can do is extraordinary.”
John Freeman, Copyright (c) 2002 The Denver
Quotes
- ‘There have now been many studies of elite performers – international violinists, chess grand masters, professional ice-skaters, mathematicians, and so forth – and the biggest difference… is the cumulative amount of deliberate practice they’ve had.’
- ‘We have long faced a conflict between the imperative to give patients the best possible care and the need to provide novices with experience. Residencies attempt to mitigate potential harm through supervision and graduated responsibility. And there is reason to think patients actually benefit from teaching. Studies generally find teaching hospitals have better outcomes than non-teaching hospitals. Residents may be amateurs, but having them around checking on patients, asking questions, and keeping faculty on their toes seem to help. But there is still getting around those first few unsteady times a young physician tries to put in a central line, remove a breast cancer, or sew together two segments of a colon… the ward services and clinics where residents have the most responsibility are populated by the poor, the uninsured, the drunk, and the demented… By traditional ethics and public insistence (not to mention court rulings), a patient’s right to the best care possible must trump the objective of training novices. We want perfection without practice. Yet everyone is harmed if no one is trained for the future. So learning is hidden behind drapes and anesthesia and the elisions of language.’
- ‘There is one place, however, where doctors can talk candidly about their mistakes, if not with patients, then at least with one another. It is called the Morbidity and Mortality Conference – or, more simply, M+M – and it takes place, usually once a week, at nearly every academic hospital in the country. This institution survives because laws protecting its proceedings from legal discovery have stayed on the books in most states, despite frequent challenges.’
Quotes
- ‘There have now been many studies of elite performers – international violinists, chess grand masters, professional ice-skaters, mathematicians, and so forth – and the biggest difference… is the cumulative amount of deliberate practice they’ve had.’
- ‘We have long faced a conflict between the imperative to give patients the best possible care and the need to provide novices with experience. Residencies attempt to mitigate potential harm through supervision and graduated responsibility. And there is reason to think patients actually benefit from teaching. Studies generally find teaching hospitals have better outcomes than non-teaching hospitals. Residents may be amateurs, but having them around checking on patients, asking questions, and keeping faculty on their toes seem to help. But there is still getting around those first few unsteady times a young physician tries to put in a central line, remove a breast cancer, or sew together two segments of a colon… the ward services and clinics where residents have the most responsibility are populated by the poor, the uninsured, the drunk, and the demented… By traditional ethics and public insistence (not to mention court rulings), a patient’s right to the best care possible must trump the objective of training novices. We want perfection without practice. Yet everyone is harmed if no one is trained for the future. So learning is hidden behind drapes and anesthesia and the elisions of language.’
- ‘There is one place, however, where doctors can talk candidly about their mistakes, if not with patients, then at least with one another. It is called the Morbidity and Mortality Conference – or, more simply, M+M – and it takes place, usually once a week, at nearly every academic hospital in the country. This institution survives because laws protecting its proceedings from legal discovery have stayed on the books in most states, despite frequent challenges.’
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