Monday, November 24, 2014

Colonscopy for Fun and Profit
    — or —
A Show Of Intestinal Fortitude
    — or —
Put it Where the Sun Don't Shine


Colonoscopy. A scary word for some, and embarrassing for most of us. "Yep, I'm going to go have a stranger poke me in the butt. Young women will stand around and watch. And I'll pay for the experience." doesn't quite evoke an image of wholesome family activity. It's not part of polite conversation. Not something to bring up over dinner.

I had mine at Sugiyasu Clinic in Amagasaki. They do colonoscopies and gastroscopies - and only colonoscopies and gastroscopies. That means the clinic owner and his staff is very, very experienced. They've seen it all and they're really good at what they do.

* * *

I'm 45 now, and it's time to worry about serious diseases. As someone once said: "Most of us live through our first fifty years. Very few live through our second fifty." The past ten years we've had several scares and a few losses among friends and family from heart disease, cancers, and infections so I don't take this lightly.

Here's a quick graph of mortality by age group for Japan and Sweden (courtesy of the Ministry of Health, Labour and Welfare, and Statistics Sweden):


Mortality rate in Japan (blue) and Sweden (orange). it tells you the average risk to die during the year for any year of age. The increase is exponential, which means the risk increases by a constant proportion each year. Note that since definitions and methods may differ between the countries the numbers themselves might not be directly comparable. The trend is the same, though.

Notice what happens around age 45-50 or so? Mortality is exponential (think compound interest for disease risk) and really starts to take off in middle age. When you reach the 40's you need to start taking care of yourself in a way you never realized when you were younger.

Here's the same data on a logarithmic scale:


The same data as above, but on a logarithmic scale. The increase is pretty steady, except for people between 15 and 30. Had I plotted the data for 90-95 and 100+ years old as well you would have seen an extra increase there too. 
Overall, the rate of increase is mostly constant through much of our lives. But look at what happens between ages 15-30, for both Japan and Sweden? It's like a hump of recklessness, when we're old enough to strike out into the world on our own, but still not responsible and experienced enough to avoid some very big mistakes.

* * *

A colonoscopy is really very simple. You poke a flexible tube with a fiber-optic camera into the large intestine and look for signs of trouble. If you need to, you can stick in tools through the tube to remove polyps or take samples. A gastroscopy (which I've also had) where you look into the stomach, is much the same but through a different opening as it were.

The problem is that your intestines aren't empty. To actually see anything you need to empty out the bowels, and there's really no comfortable — no delicate — way to do that. That means laxatives and some quality one-on-one time with a toilet.

The preferred way to prepare is apparently different in western countries such as Sweden and the US on one hand, and in Japan on the other. In the west you apparently avoid seeds, tomatoes, fruits, berries and other foods that are colourful or hard to digest for up to a week beforehand. You fast and drink laxatives the entire day before. When you come to the clinic you're already empty (and probably quite hungry) and can go directly on to the examination.

Here in Japan you eat and drink normally until the day before, when you have to avoid fruit, vegetables, milk products or anything with red or purple colouring. I had toast with ham and coffee for breakfast; instant ramen with an egg for lunch; and rice with a fresh egg ("卵かけご飯") for dinner. A chaser of laxative sent me to the bathroom once around bedtime and again the next morning.

When you get to the clinic you sit in a waiting room with half a dozen other patients and drink a bottle-full of laxative over the course of an hour, until the only thing coming through you is water. You dress in a hospital gown, get an enema for that extra-fresh squeaky-clean feeling and are led into the examination room. You're finally ready for your closeup.

* * *

Screening groups of people without symptoms for diseases often only make sense if you're in a high risk group, only once tyou reach a certain age, or (as for prostate cancer) sometimes not at all. Overall, we are probably erring on the side of too much testing, not too little. It's a big issue, and needs a post of its own.

Screening for colorectal cancer starts to make sense once you reach 45-50 years or so. This is one of our most common cancers, and also one of the most treatable. If you find it early the cure rate is nearly 100%. But if you find it late it can often be lethal. And as it often gives you no early symptoms, it's a common cause of death for people in middle age.

The cancer usually appears on polyps that sometimes form in the large intestine. Polyps are quite common, and some people are more likely to get them than others. The best way to prevent cancer is to find and remove the polyps before they cause any trouble. And if one is already turning cancerous you want to find out early, before it spreads outside the polyp itself. In such cases simply removing the polyp during the exam is often all you need; no drugs or hospitalization is necessary.

The easiest test is a stool sample that looks for small traces of blood. You poke a sampling stick into your poo right at home, bring it to the clinic and get the results in a few days. It's not hugely accurate but it's quick, cheap and easy so you can repeat it every year. I've done that for a few years already.

A colonoscopy is much more accurate and will find other things as well, not just polyps, but it's also a lot more invasive. People that tend to get polyps may do it every year, while the stool sample test is sufficient for most other people.

* * *

The examination room is dominated by a steel-frame bed surrounded by piles of hospitalish devices; things with LCD monitors and tubes, things that go beep, that sort of stuff. A couple of nurses in protective garb guide me to the bed where I lie down on my left side, bum conveniently hanging free at the long edge of the bed. I get a saline drip (we've lost a fair amount of liquid with the laxatives after all) and a mild sedative.

The doctor is affable and friendly. I can see the monitor and the sedative has only made me relaxed, not sleepy, so I ask a tentative question about what I see on the screen. Turns out he is just as talkative as I am, and only too happy discussing a job that he clearly loves.

He runs the endoscope through my large intestine up to the ileum, where the appendix and the small intestine starts, then back again, explaining all along. At one point during the return we get into a digression about the appendix, so he runs the endoscope all the way in again to show me. The whole thing was way more informative and much more entertaining than I imagined.


Part of my upper (transverse) colon, I think. Not the most exciting part of this anatomy perhaps, but I really appreciate the composition of triangular forms in this frame.
By the end the tranquilizers were really kicking in (perhaps the nurses were adding more to make us stop talking already) and I was getting quite dizzy. A nurse led me to a reclining chair in the recovery room where I collapsed and promptly fell asleep for half an hour.

Once I woke up I got dressed again, then met the doctor in his office for the results. As I already knew there was not a hint of polyps or of any other problems. My colon is apparently in rude health.

As I had no problems, my plan is to do a stool sample test every year as usual, and redo the endoscopy in five years time. That should be a good balance for me between the risk of missing something bad on one hand, and the risks (it's not completely risk free) and inconveniences of the colonoscopy on the other.

If you are approaching my age or older, and if you don't test yourself for polyps already, then this is a very good time to start. The test can save your life of course, but also be the difference between a quick ten-minute procedure or major surgery and months and years of brutal anti-cancer treatment. The stool sample test is silly easy, and there's really no excuse not to do it.

Tuesday, November 4, 2014

More on Vim Splits


I wrote a post recently on how you can resize split Vim windows automatically as you move between them. I've been playing around with it for a while and have found a better solution.

The small script I presented in that post works OK. But when you have more then 4-5 windows, you'll notice that the non-focused windows get resized very unevenly. Some will hardly change, others might shrink to a single horizontal or vertical line.

Vim already has a function that can almost do what we want: ctrl-w = makes all windows equal size. But, if you read the manual(1) you'll find that it will also try to make the size of the current window to winheight and winwidth if you set those variables. it will still try to set the other windows to be about equal size.

That means that instead of resizing our window explicitly, like the old script did, we can simply set winheight and winwidth to the size we want, call ctrl-w = and we're done.

One more tweak: With large screens and the old script, the vertical resize would sometimes actually resize the command line as well. A bit annoying. I've removed the maximum vertical size restriction below.

" Resize the current split to at least (90,25) but no more than 140
" characters wide, or 2/3 of the available space otherwise.

function Splitresize()
    let &winwidth = min([max([float2nr(&columns*0.66), 90]), 140])
    let &winheight = max([float2nr(&lines*0.66), 25])
    exe "normal! \<C-w>="
endfunction

As in the previous post, you can remap ctrl-h, ctrl-j, ctrl-k, ctrl-l to quickly move between splits and trigger the resize each time:

" move between splits using ctrl-h, j, k and l

nnoremap <silent><C-J> <C-W><C-J>:call Splitresize()<CR>
nnoremap <silent><C-K> <C-W><C-K>:call Splitresize()<CR>
nnoremap <silent><C-L> <C-W><C-L>:call Splitresize()<CR>
nnoremap <silent><C-H> <C-W><C-H>:call Splitresize()<CR>

Try this, and let me know what you think.

#1 Yes, I know. I don't read manuals either. Nobody reads manuals. And yet, we spend huge amounts each year on books that describe exactly the same thing as the manuals we never read.

Wednesday, October 29, 2014

Summer Festival


Summer is winding down here in Osaka. The morning air is crisp and cool, and some trees are already turning yellow and red. A good time to recall the summer. That, and I'm way behind on posting pictures. ^_^

Every summer Kouzu Jinja, "our" neighbourhood shrine, holds a festival. It's fun, so we try to go when we can. I've been there five or six times now, and Ritsuko has of course come here since she was a child. You can go there during the day, but the place really gets going after dark, when people join the festival after work together with their families.

Purification

When you enter the shrine area you're supposed to purify yourself by washing your hands in a fount outside. Frankly, most people don't bother during the festival. This boy seemed to find it endlessly amusing, though.



Yukata

Many young girls dress in summer yukata during festival, which adds to the festival atmosphere. Some men dress in yukata or samue, although it's much less common. I wore a samue this year, and it's really perfect in this climate. The loose, rough-woven cloth is cool and airy in the summer heat. More people should try it.


Mingle

Summer festivals are for the children as much as for the adults. Kids run around in the shrine area, and the street outside is lined with carnival games, candy, drinks and snack food.


Crushed Ice

A summer festival is not complete without food and drink. Shaved ice with syrup is a favourite.


Candied Strawberries

Candied fruit is another great reason to come. Crunchy on the outside, sweet and juicy inside. Just be careful; the hard, sticky candy can easily ruin your teeth.


Lanterns

Festivals are usually sponsored by local companies. And those that become sponsors get a lantern with their name on it hanging along the walkways and stairs. Advertise in style.


Saturday, October 25, 2014

Homemade Olives

Did you know there's olive groves in Osaka? Neither did I. A few weeks ago, Ritsuko found fresh olives at a local farmers market and bought a small bag on a whim.

Olives are pretty much inedible when fresh, so you have to pickle them in brine. There's lots of recipes on the net, and they all vary quite a lot. That's a good thing; it usually means that the details don't really matter too much.

Fresh olives are very bitter, so first you need to soak them to remove that flavour. We cut the olives in top and bottom and put them in a jar. We poured a brine of 1 part salt to 8 parts water (by weight) in the jar, then used a small glass lid as a weight to  keep the olives below the surface.


Our olives just after the second pickling.

It's been two weeks now, and the olives have turned a muted olive green and the brine has turned brown. We strained the olives and washed them in fresh water. The bitterness is gone and there's a faint but definite olive flavour. But they're still kind of raw and crunchy, so we put them back in a clean jar, mixed another batch of brine and added two halved cloves of garlic and one sliced dried chili. Top up with olive oil as a "lid" to avoid contact with air, then put the jar back in the closet again.

The major worry is that they will spoil. If they don't, they should be edible in about two months or so, just in time for the year-end holidays. I'm looking forward to trying them.


Friday, October 10, 2014

Okinawa II


I've finished the film pictures we took in Okinawa earlier this year. The black and white pictures are from my Fuji GF670, a fully modern medium-format rangefinder camera.

The Storm
A storm is approaching. Tancha, Okinawa.


The colour shots are with Ritsuko's Canon Demi. It's a half-frame 35mm camera — it takes two vertical pictures in the space of one horizontal 35mm shot — from the late 1960's. Yes, it's older than me, and I'm not exactly fresh out of the box any more. The half-frame format was popular when colour film was new and still very expensive, as you can get 72 pictures on a single roll.

The Demi has a light meter but no range finder. You simply dial in the lens to the distance you want, guided by small symbols ranging from a head (for close-ups), to a person, to a group of people, to a mountain. It's not very exact, but more than good enough for a semi-wide lens like this one. The high-end Rollei 35S works the same and manages to take excellent pictures. The Demi lens has plenty of distortion and is prone to glare, and the small-size images lack fine detail, but all that just adds to the retro appeal of the finished images. And with 72 shots to a roll you can shoot on a whim and not worry about wasting film.

There's two quirks to be aware of with this camera: First, the camera shoots in portrait orientation, so you'll end up holding the camera vertically a lot. Also, the light meter cells degrade over time. You really need some sort of cover or lid for the meter around the lens when you're not using it. There is no manual mode at all; if the meter stops working, then so does the camera.


As I wrote in an earlier post, we spent a couple of days at Rizzan, a nearby family resort hotel. We felt very touristy and relaxed, exactly what I needed after an intensive month of work.

Poolside
Poolside at the Rizzan hotel. It's all very family-friendly, and that makes for a lively atmosphere without party crowds. As you can see if you check the larger size, there isn't all that much detail in this picture. But it's plenty enough for a blog post like this, and it looks really good in a small-sized print.

Beach Life
Beach Life. This is what happens if you set the wrong film speed and have to correct the image afterwards. I deliberately left the frame edges; it adds to the old-timey feel, I think.


We spent our last day in Naha. Our flight home did not leave until evening, so we deliberately left in early morning in order to get a full day walking around town. Naha is a pleasant, somewhat sleepy town with more than a little south-Asian vibe to it.

Back streets
A lot of Naha is like this, with quiet streets bathed in sunlight. It's probably a pretty good place to live in many ways. I wouldn't mind trying it for a few years.


Kokusai street is a popular area for sightseers, but it's honestly a pure tourist trap now; rows of near-identical souvenir shops and little else. Stay away from that street and try the side streets, the market or other nearby areas instead. It's much more fun.

Jamming
Some people hang out in the shade of a local park just off the end of Kokusai street. It seems pleasant enough, although I'm happy I'm old enough not to have to do this any longer.

Wall Art
Many buildings are brightly painted or decorated. It fits the warm, sunny climate, and adds to the distinct Asian atmosphere.

Makishi market is right next to Kokusai street, an area of small covered alleyways centered around a fish market. Again, the atmosphere feels southeast Asian as much as Japanese. The rear side is not very crowded; it's a pleasant place to walk around in especially around midday when the heat and the sun is strongest.

Makishi Market
A fruit stall at Makishi market.

Umbrellas
Umbrellas are used for protection against the sun as much as rain. Makishi market.

Coffee Break
We're having a coffee at "The Coffee Stand", a tiny, tiny coffee place at the rear of the market. This has to be the best coffee place I've found in Okinawa so far. The owner is a true enthusiast - you can select from any number of single-source beans from around the world, then pick the way you want it made, including drip, french press, aeropress and espresso. The magazine rack is full of coffee speciality magazines. It's a great place to enjoy a seriously good cup of coffee.

Todays Catch
Fish at the market. Tropical seas may not always give you the best-tasting seafood, but it does give you the most colourful.

Mysterious
Mysterious structure behind a school in Naha. A little Hayao Miyazaki-like. Or perhaps it's just the angle.

Up, up into the light
Balconies. Naha, Okinawa.

Wednesday, October 8, 2014

Lunar Eclipse

Lunar eclipse in Japan tonight. As I walked home along Nagahori street in the cool autumn air, people were standing around, talking, and taking pictures. Some office workers sat on a railing outside Yamaya, our local liquor shop, drinking a beer and watching the eclipse.



Tuesday, October 7, 2014

Automatically Resize Vim Splits


If you think "Vim splits" may have something to do with a cleaning product then this post might not be for you. Geekery ahead.

I am a long-time user of the Vim text editor. It's made for use from the keyboard (though you can use a mouse if you want), and works great running on a remote computer. When I program I often use split windows, where I have multiple files open and visible at the same time in different window panes:


A Vim editor with three splits, each editing a different file.

Split windows are very useful. But when you have many splits or when you're on a small laptop screen, each split becomes too small to edit things properly. You can of course resize them in various ways: ctrl-w _ and ctrl-w | will maximize vertically and horizontally; ctrl-w + and -, and < and > will increase and decrease the split size; and ctrl-w = will equalize them all. But that's a hassle; also, when you maximize a split you no longer see the contents of the other ones. Ideally you'd increase the size just enough to edit properly, and do it automatically.

So I have a small function written in Vimscript that I stick in my vimrc file:

" Resize the current split to at least (90,25) but no more than (140,60)
" or 2/3 of the available space otherwise.

function Splitresize()
    let hmax = max([winwidth(0), float2nr(&columns*0.66), 90])
    let vmax = max([winheight(0), float2nr(&lines*0.66), 25])
    exe "vertical resize" . (min([hmax, 140]))
    exe "resize" . (min([vmax, 60]))
endfunction

When you call this (on the command line as :call Splitresize()), it will resize the current split to 2/3 of the entire editor width and height; but always at least 90 columns by 25 rows, and no more than 140 colmuns by 60 rows. That guarantees that the split is always large enough even on small screens, and never becomes ridiculously huge on large screens.


I moved from split 2 on the left to split 3 on the lower
right, and it has resized itself to a comfortable size.

My preferred way to make this automatic is to add these mappings:

" move between splits without the ctrl-w prefix

nnoremap <silent><C-J> <C-W><C-J>:call Splitresize()<CR>
nnoremap <silent><C-K> <C-W><C-K>:call Splitresize()<CR>
nnoremap <silent><C-L> <C-W><C-L>:call Splitresize()<CR>
nnoremap <silent><C-H> <C-W><C-H>:call Splitresize()<CR>

You can move between splits with ctrl-w h, j, k and l. It's a bother to press ctrl-w all the time, though, so many people add mappings so ctrl-h, j, k and l move between splits directly. These mappings add :call Splitresize() to the end, so your splits will resize automatically when you move to them. And you can still use the ctrl-w hjkl mappings or select a split with the mouse when you don't want the split to resize.

If you use Vim then give this a try. And if you have any feedback or ideas to improve this then please get in touch.