P is for Polanco

Since the announcement of the $35 million 5-year contract in April, Gregory Polanco has been emerging as a shining star.  Last night he drove in 5, including a 3-run homer, in the 12 to 1 crush to Arizona Diamondbacks.  It was an outstanding performance, but not an exception.  Pirates got a bargain out of this “young boy” (24-year-old) from Dominica.

“P” is for Pirates! “P” is for Polanco!

The bitter “bitter melon garden”: A time to plant in Ecclesiastes 3

Katy moved and transplanted many bitter melons and a few Taiwanese pumpkins and tomatoes out to the garden last Sunday (May 8), citing several well-founded reasons: (1) all our garden friends have so done, (2) the weather forecasts all said the lowest temperature would be 42 degrees F to the end of May, (3) the bitter melons have borne fruit (see photo right).

I had my reservation.  I am of the opinion of respecting the mother nature and the conventional wisdom that the last frost of the spring is usually in mid or even late May in western Pennsylvania.  In fact, the last frost fell on Memorial Day weekend a few years ago. 

If one pays attention to the weather forecast, one will see the temperature has been revised practically daily.  Since the planting, the lowest temperature has been revised to 39, then 35, then 32 and now 29 degrees is predicted for tonight and frost for tonight and tomorrow night.  This is the peril of  迫不及待的 (cannot wait) gardeners.

The protective fabric covers (for plants) were sold out at WalMart today; we got the last one. Katy has since dug out the moved most of the bitter melons indoors; it was indeed a bitter “bitter melon garden”.  The tentative moving out for the second time will be Monday (May 16).   They no longer look vigorous or vibrant; their health has been compromised.

Ecclesiastes 3 tells us there is “a time to plant”; the time is around or after Memorial Day weekend in western Pennsylvania.

Ecclesiastes 3: A Time for Everything

There is a time for everything,

    and a season for every activity under the heavens:

a time to be born and a time to die,

a time to plant and a time to uproot,
. . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . .

The beauty of science makes one weepy

I saw this photo (Milky Way over the Wood Island cottage) in the website of our friend, Steve.  It comes with the following comment.

“Sometimes the beauty and scale of the Cosmos just makes me choke up and get weepy ... (this feeling is accentuated by an appreciation of the physics behind it all ... which is a different kind of beauty)”

This reminds me of an article (The making of a scientist) by Richard Feynman, collected in the book of Classic Feynman.  The following three italic paragraphs are the excerpts.

I have a friend who’s an artist, and he sometimes takes a view which I don’t agree with.  He’ll hold up a flower and say, “look how beautiful it is,” and I’ll agree.  But then he’ll say, “I, as an artist, can see how beautiful a flower is.  But you, as a scientist, take it all apart and it becomes dull.”  I think he’s kind of nutty.

First of all, the beauty that he sees is available to other people—and to me, too, I believe.  Although I might not be quite as refined aesthetically as he is, I can appreciate the beauty of a flower.  But at the same time, I see much more in the flower than he sees.  I can imagine the cells inside, which also have a beauty.  There’s beauty not just at the dimension of one centimeter; there’s also beauty at a smaller dimension.

There are the complicated actions of the cells, and other processes.  The fact that the colors in the flower have evolved in order to attract insects to pollinate it is interesting; that means insects can see the colors.  That adds a question: does the aesthetic sense we have also exist in lower forms of life? There are all kinds of interesting questions that come from a knowledge of science, which only adds to the excitement and mystery and awe of a flower.  It only adds.  I don’t understand how it subtracts.

And Feynman did even touch the issue of fragrance, which, I am sure, also evolves over the age.  There is an article (Why do flowers have scent?) on the 4/18/2005 issue of Scientific American.  Like colors of flowers, the distinct scent of certain flowers attracts their pollinators and the nectar and/or pollen is their rewards.

Steve had a good fortune to be able to sit in Feynman’s classroom when he was giving that famous “Feynman’s Lectures on Physics” in early 1960s.  Like teacher; like student!

The art of bargaining (by Lin Yutang)

Lin Yutang

Moment in Peking was written in English targeting the Americans and English-reading readers.  No one can do a better job than Lin Yutang in telling the story of Chinese living in a turbulent period between 1900 and 1938, literally telling the story of His Country and His People.  I’ll write a series of posts with a category of “Moment in Peking” in this blog, let them serve as my “book report”.

His My Country and My People, The Importance of Living and The Importance of Understanding are the best books to introduce Chinese culture to the western world.  I never read his novel until recently when I picked up Moment in Peking.  Pearl Buck repeatedly nominated Lin for Nobel Literature prize; I always thought he was never so honored because he was not a good novelist; how wrong I was!

The following excerpt from Moment in Peking is the best writing of the art of bargaining by Chinese.  Only Lin Yutang can do it.  Western writers would have no such insight whereas Chinese writers couldn’t write such an exquisite English that rivals that of the best American/British writers.

The art of bargaining

He [Mr. Feng, brother of Mrs. Tseng, who is the manager of Mr. Tseng’s shops] had the merchant’s typical manner of talking, which was interspersed with many silent “hah’s” and “haw’s” and ran the gamut from silent whispers to vociferous shouting as circumstances required.  He had acquired all the nuances of raising his voice in an emphatic tone of determination and repudiation when bargaining for a purchase, and softening it to a heartfelt cordiality when closing the bargain, knowing how to appear to stand his ground when he was prepared to yield, and yielding abruptly with a gesture of friendship at the last moment as if he was conferring a favor.  He knew how to condemn or deprecate what he desired to buy and to extol to perfection what he wanted to sell.  All these hot arguments, those red-faced loud-voiced repetitions did not mean anything except he didn’t like the price you quoted, and a stepping down on his part was always conveyed by a whisper in your ear, as if it was the greatest diplomatic secret and you were his most intimate confidant.

When the novelists wrote about medicine: Moment in Peking and Middlemarch

I still have nearly 300 pages to go for the 813-page Moment in Peking.  I would have finished had the garden work not been going on in earnest.  I don’t know exactly how many hours I worked this past Sunday; it was double digits for sure.  I have read many of Lin Yutang’s books and I regret that I haven’t read Moment in Peking sooner.

This is why I am somewhat hesitated to write this post pointing out an error when Lin Yutang talked about medicine (or more precisely insulin)

The following is the excerpt from Chapter 31:

Sutang, who had come to visit them occasionally, had sometime ago convinced him that he [Mr. Tseng] had suffered from the "sugar-urine disease" and that there was a sure scientific cure for it in the Western medicine called insulin. . . .

For three months he observed strict mourning [of his mother's passing], and in the first weeks he even refused to take medicine. Lying there, broken in spirit and body, Mr. Tseng at last yielded enough to try insulin regularly. 

He [Mr. Tseng] was anxious to leave the capital anyway, because Yuan Shihkai's monarchist plans had become public and rebellion had begun.  General Tsai Ao secretly slipped away from Peking, escaping Yuan's vigilance by pretending to debauch himself in sing-song houses, and declared the rebellion on Christmas Day, 1915, in southwest Yunnan. . . .

he [Mr. Tseng] was so grateful for his recovery from near death, he said to Sutung one day, with his usual mandarin dignity: "I will make you my son-in-law.  You have saved my life.  I will give you my daughter."  He did not even mention which daughter, and Sutaung did not dare ask. . . . Sutung took it for granted that it was Ailien that her father meant, . . . He [Mr. Tseng] decided that the wedding was to take place as soon as she [Ailien] was graduated from school, in the summer of 1917.

It clearly said that Sutung [a Western medicine trained doctor] gave Mr. Tseng insulin before “Christmas Day 1915”.  Frederick Banting and Charles Best isolated insulin in 1921.  Insulin was first given to human, a 14-year-old boy, in Toronto in January 1922 and Banting was awarded Nobel Prize in Medicine in 1923.

Thus there is no way that Mr. Tseng could have received insulin back in 1915.  Lin Yutang left New York for Paris in 1938 and spent one year to write Moment in Peking.  Lin must have heard about the wonder of insulin then [Lin wrote “for sure a scientific cure] and didn’t double check the dates of insulin discovery and clinical use.

In preparation of writing Middlemarch George Eliot read medicine and observed how doctors practiced medicine in her time because Dr. Lydgate is a main character. She once visited Oxford University and had a professor of medicine demonstrated the neuro-anatomy for her.

The followings are excerpts from Middlemarch, showing George Eliot’s observation of the medical professionals in her days is still true in our modern time.

In short, Dr. Spragg had weights, and might be expected to grapple with a disease and throw it; while Dr. Minchin might be better able to detect it lurking and to circumvent it.  They enjoyed about equally the mysterious privilege of medical reputation, and concealed with much etiquette their contempt for each other's skill.

The following is what Eliot wrote when Dr. Lydgate read medicine far into the smallest hour.  What a keen insight into a young doctor’s mind.

Lydgate felt a triumphant delight in his studies, and something like pity for those less lucky men who were not of his profession. . . I should never have been happy in any profession that did not call forth the highest intellectual strain, and yet keep me in good warm contact with my neighbors.  There is nothing like the medical profession for that: one can have the exclusive scientific life that touches the distance and befriend the old fogies in the parish too.

 No wonder Virginia Woolf described Middlemarch as ”one of the few English novels written for grown-up people.”

Gardening is a way of showing you believe in tomorrow: A patient gardener grows hollyhock

I previously wrote a post of “holy hollyhock” as it is heavenly; its beauty is soft, exquisite and out of this world.  I might as well call it holy-hock!

The variety we planted in 2014 (see photo right) was “Peach ‘n Dreams”; somewhat similar to peony.There are two ways to plant hollyhocks; both ways we tried:  We planted some bare root hollyhocks a few days ago.  Katy brought some hollyhock seeds from London a few years ago; here they grew; hopefully they will survive and thrive to move out to the garden.

Perennial though they may be, they are short lived, lasting for 2 or 3 years only.  Most are biennial; they grow foliage the first year and bloom only the second year.  We gardeners believe in tomorrow, even if tomorrow only comes next year.

Our friend, Charles said many of his gardener friends are serious (嚴肅, 認真), some are passionate (熱愛) to the level of being obsessive (酷愛), or even addictive (上癮).  A gardener also has to be patient, as “gardening is a way of showing you believe in tomorrow”.

growing hollyhocks from seeds

hollyhock bare root

hollyhock growing from seeds

growing hollyhocks from bare roots

Kale: Dr. Liang was ahead of time

A few years go Dr. Liang first introduced kale to us, extoling its nutrition values: low-calorie, rich in antioxidants, vitamin A and C.  Kale leads the list of healthy leafy greens; it contains more iron than beef; it is also a rich source of omega-3 fatty acids.

Like Thomas Jefferson, Dr. Liang is a kale enthusiast, exhorting every gardener to plant kales. 

We’re still on the experimental stage; trying to figure out which variety is tastier (we have Curly kale and Lucinato kale indoor so far); when it is the best time to harvest and how to prepare for the dinner table.

While Katy was visiting Taiwan, I visited Panera Bread and ordered “Roast turkey Caramelized kale panini”; it is caramelized kale blend and fresh mozzarella on black pepper focaccia—an Italian bread that complements kale well (see photo right and below)

kale panini at Panera

Kale and Taiwanese pumpkin: prepared by Janice & Joy

Janice and Joy are skilled cooking kales; the caramelized kale panini rivals that of Janice and Joy made nearly three years ago.

McDonald has been testing the market for kale products.  Last year I said McDonald finally caught up with Dr. Liang; now Panera bread also jumps on the bandwagon.  Jefferson would be pleased. Like it or not, kale is coming to the restaurant near you.

Lucinato kale (right front one is Curly kale)

Curly kale

The almost forgotten Taiwanese cucumber (小黃瓜 小刺瓜)

On April 11 we realized that we haven’t germinated Taiwanese cucumber (小黃瓜  小刺瓜)—an important resident in our garden.  Fortunately, they seemed to know we’re running late and germinated in a hurry; we’re able to move them to the cups on April 15 (see photo below).

小黃瓜 harvested in 2013

Our good friend, Esther, a seasoned gardener, came to rescue and gave us two seedlings of Japanese 小黃瓜; one is cold-resistant, but we dare not to move it out to the garden yet, instead, we moved them to the bigger pots, where will be their home until the end of May. 

We gardeners tend to exchange seedlings at this time of the gardening season, just like Thomas Jefferson did with his garden friends.  The photo is the Taiwanese cucumber (小黃瓜) we harvested in 2013 (see photo above).

How does heart attack happen? It is not as simple as you thought

A good friend (Lily Chen) sent me a YouTube, saying “myocardial infarct is not caused by obstructing coronary artery after all” (原來心肌梗塞不是心臟血管太狹窄堵塞血不流通).  This is the most important discovery in cardiology the past 15-20 years.  I have mentioned this in my blog shortly after the TV journalist, Tim Russert, had a sudden death while recording voice-over in 2008.

http://doctorjytsai.blogspot.com/2008/06/untimely-death-of-tim-russert.html

But, the statement of “myocardial infarct is not caused by obstructing coronary artery after all” (原來心肌梗塞不是心臟血管太狹窄堵塞血不流通) is not the whole truth; I will elaborate since it is such an important, almost revolutionary concept.

The evolutionary concepts of heart attack

Some of the material of this post comes from an article (with a title of “Coronary Thrombosis”) in June 1, 1950 issue of Scientific American, written by Dr. Paul White, a cardiologist at Massachusetts General Hospital, a Harvard Medical School professor.  Dr. White was most famous for being the doctor for President Eisenhower when he was stricken by heart attack in 1955.

The sudden death of a seemingly healthy man/woman was considered an act of gods over the age; he or she must have done something terribly bad to evoke the wrath of gods.  Back in 1700 a French physician, Theophile Bonet, had proved complete blockage of coronary artery in one person who died suddenly.

Lancisi, Pope Clement’s physician, also proved those who had a sudden death all died of natural causes by doing post-mortem examinations in 1707.  President Eisenhower had a first-rate physician, so had Pope Clement.

The artery is more animated and dynamic than a pipe

It is logical to think the cause of heart attack (myocardial infarct) is caused by the progressive narrowing (stenosis) of coronary artery until complete blockage, just like the clogging of the pipe under the sink.

Doctors had the second thought when it was discovered that most of the heart attacks occur in the setting that there was less than 50% blockage.  Subsequent studies learned that the plaque builds up in the inner lining of the coronary artery over the years or decades, and it is the rupture of the plaque, leading to formation of clot (thrombus) that completely blocks the artery.

The cardiologists are dealing with a more animated and dynamic coronary artery, not a pipe; they would prefer leaving the "honor" of being called a "plumber" to urologists.

The blocked artery cuts off the blood supply to the heart muscles (myocardium) distal to the point of blockage, leading to the necrosis/infarction/death of the heart muscles; the ischemia (compromise of circulation) may trigger the lethal ventricular arrhythmia.

Plaque, and the plaque only, is the thing

Atherosclerosis (hardening of arteries) begins at the build-up of the plaque in the inner lining of coronary artery many years or decades before the heart attack strikes.

(The above photo is taken from an article in New England Journal of Medicine)

The top panel shows most of the plaques initially expand outwardly, causing little or no narrowing of the lumen of the artery.  But, given enough time it will grow inward causing the stenosis (narrowing) of the lumen.  As a matter of fact, most of the plaques rupture when they cause some degrees of narrowing, all be it less than 50% stenosis in most cases.  The rupture leads to clot (thrombus) formation that blocks the artery.

The bottom panel shows a large inwardly grown plaque significantly narrows the lumen of the artery and a tiny clot (thrombus) will completely blocks it.  A disruption of the endothelial cells in the inner lining is called “erosion” that produces the same effect of “rupture”.

The middle panel shows if one survives the rupture/erosion of the plague, a scar will be formed, constricting the artery, causing narrowing of the lumen (stenosis).  A fibrotic (with deposition of calcium) plaque may be more stable, not vulnerable to rupture. But one will be symptomatic with chest pain upon exertion; for exercise will increase the demand of more oxygen for myocardium that a narrowed artery cannot meet.

Why a non-obstructive plaque is more dangerous than an obstructive one?

If a growing plaque pushes inward causing the narrowing of the lumen of coronary artery, thus compromising the circulation, in which case one may develop chest pain upon exertion (called angina) and seeks medical attention.

If an outwardly expanding plaque ruptures before causing the narrowing of the lumen, then one will never have any symptoms (chest pain/tightness/pressure or shortness of breath) until the heart attack strikes.

Cholesterol, plaque and statins (cholesterol-lowering drug)

Lipids (cholesterol) are the major components of the plaque.  The benefits of taking statins, the likes of Lipitor, Pravachol, Crestor and Zocor, are not only lowering the LDL (bad cholesterol) level, but “stabilizing” the plaque as some theories suggest.

From 2003 to 2013, the death rate from heart attack fell about 38% according a CDC data.  One cannot say doctors are not doing good jobs.  The reasons are multifactorial, but statins should get the most credits in my view.

Mild disease of the coronary artery may not be a good thing

So if a plaque is present (i.e. one has atherosclerosis or hardening of artery), what matters is not how much it blocks the artery, but how stable it is.

If one does cardiac catheterization (with injection of contrast the coronary arteries can be visualized) it shows “mild” disease, say showing 15% or 30% or anything less than 50% stenosis, one needs to be treated as aggressively as the more severe cases.  One school of thought is that a larger plaque that causes more narrowing of the lumen may be more stable, thus less vulnerable to rupture.  Unfortunately one cannot tell a plaque is a stable one or not on cardiac catheterization.

That is not to say the more narrowing of the artery the better.  If one has a large plaque that causes severe stenosis, say greater than 75%, if it were to rupture, a small clot (thrombus) will completely block the artery easily.  Conversely a small stenosis, say less than 15% will take a relatively large clot to block the artery.

(The above photo is taken from Dr. Paul White’s article, “Coronary thrombosis” in Scientific American)

This is to show prescient Dr. White was.  There is a heart disease called Wolff Parkinson White (WPW) syndrome, that “White” is Dr. Paul White.  Keep in mind that Dr. White wrote this article in 1950.

Dr. White wrote,

“It is always in a diseased, badly narrowed, atherosclerotic coronary artery that a thrombus, or clot, rather suddenly forms one day to present the clinical picture which we call coronary thrombosis.”

What he wrote in 1950 is still 100% correct today.  He knew the clot forms rather suddenly on top of a “diseased, badly narrowed, atherosclerotic coronary artery” that built up over the years or decades.

A disease free coronary artery is one clean without plaque.  A coronary artery that has plaque is not disease free even though it has no narrowing/stenosis of the lumen.  Thus no plaque, no narrowing, no rupture, no heart attack!

Dr. White wrote,

“. . . The stage is all set before the thrombus is laid down in the diseased artery.  Just how the blood is triggered to clot is not yet fully clear. Most often, perhaps, a thrombus begins to form on a roughened bit of the inner lining of the artery, or at a very much narrowed place in the vessel. Within minutes or hours the thrombus grows large enough to block the blood flow and to cause the various symptoms and signs that follow.”

What Dr. White described in 1950 was similar to what we call plaque rupture leading to clot.

How the blood clot (thrombus) forms after plaque rupture?

The mechanism of how clot was formed that triggered heart attack was not fully elucidated in Dr. White’s time (1950s), but it is well understood now.  We even had thrombolytic therapy (medicines to dissolve the clots). One needs the full knowledge of coagulation cascades to fully understand the mechanism; it is beyond the scope of this writing.

Suffice it to say that platelets play a crucial role in clot formation; that is why anti-platelets aggregation (preventing platelets to lump together) drugs, such as aspirin and Plavix (clopidogrel) are so important in treating and preventing heart attack.

The following is the YouTube that Lily Chen sent to me.  Dr. 洪惠風 did a good job, telling the complicated story in less than five minutes.  This writing is to further explain; less people would misunderstand and take “narrowing of coronary artery” (心臟血管太狹窄) out of equation in causing heart attack.

In fact, about 5 to 15% (depending on which report one reads) of the heart attack are caused by steadily progressive narrowing of the lumen to the point of complete occlusion by plaque that never ruptured.

為什麼心臟病總是突然發作洪惠風主任

http://m.youtube.com/watch?feature=youtu.be&v=Ab5DpN8hNNk

Take me out to the ballgame: A day of "passion"

Pirates beat Milwaukee Brewers 5 to 0 yesterday.  We went to PNC Park this afternoon and Pirates routed Brewers again 9 to 3.  McCutchen had his first homer of the season yesterday and added another solo-homer today; the two photos below showed the fans responded to it.

victory ritual

With 9 to 3 win and having 16 hits, there are many contributors other than McCutchen including Rodrigues who had a two-run homer.  This is healthy for a winning team, which cannot depend on a few stars.

I like to see the “victory ritual” of the Pirates 3 outfielders at the end of the game when the jolly rogers flag was raised.  They are the gestures of happiness and pride with a sense of accomplishment.

We also bought 10 bags of Miracle-Gro Potting Mix (64 dry quarts each) today; we have used 3 bags; the 4^th bag is nearly gone.  After having sizzling chickens with Strawberry Passion fruit tea at TGI Friday’s, we called it a day.  A day of “passion”—baseball, gardening, and even ice tea.

Andrew McCutchen at bat

When is the luckiest moment?

The British Danny Willett wins the Masters after epic Jordan Spieth collapse.  But it is no surprise according to a Taiwanese saying: The luckiest moment is before one gets married or after one’s wife delivered a baby.

Spieth’s hope of another wire-to-wire victory or back-to-back master was doomed when Willet’s wife gave birth to their first son on March 30, even though the due date is April 10.

It must be a painful moment when Spieth had to present the green jacket to the new Master, Willett, after leading the first three rounds.  I wonder who is to present the green jacket to Spieth had he become the Master back-to-back?

What we need is a green house

Most of the Luffa (絲瓜, 菜瓜), bitter melon (苦瓜) and Taiwanese pumpkin (台灣南瓜) have outgrown the spaces under the plant fluorescent lights.  They move from the cups to the pots with a post several feet tall.

Our house faces east, thus having sunshine for the front windows in the morning and back windows in the afternoon.  We are almost exhausting all the precious window spaces in the house, which is not small by any measure.

What we need is a green house.

Outdoor garden season is nearly two months away, but these photos show indoor activities have been going on in earnest.

Take turns to eat 輪流吃飯

We germinated these ox heart (牛心) tomatoes on Feb. 29 and planted them in cups March 13 and within two weeks, their sizes are double or three times difference:  Those direct under the plant fluorescent lights grew the tallest; the further away from the light, the smaller.

Our solution is to change their positions, putting the smallest direct under the light, and moving the tallest further away.  They take turn to “eat” (輪流吃飯). 

The tallest are direct under the plant lights

The further away from the plant lights, the smaller

move the smallest to be direct under the plant lights

Big yellow tomato: Give us a proper name

Last year we planted both large and small (cherry tomato) yellow tomatoes, but forgot to write down their names.  Katy likes it and germinated them first before thinking about the ox-heart tomato.

We now call them “Big Yellow” (大黃) and “Little Yellow” (小黃); affectionate, but unprofessional; one of these days we need to find out their proper names.

By the way all varieties of tomato plants look the same, even a professional gardener cannot tell the difference. Labeling them is the only way to tell one from the other.

"Big Yellow" tomatoes"

Ox heart tomatoes