Streak

Getting old, we can deal with. Being old is the problem. That being said, once we reach a certain age, it's hard not to wonder whether our running pace dwindles in opposite direction to the number of birthday candles.

Should you start tempering your running ambitions and accept the setback of going old, please go and read the story of Kevin Webber. He was told aged 49 that both his prostate cancer PSA score and Gleason score were sky high.

"Good morning, Mr Webber. I am looking at your test results. The Gleason score would fall somewhere between six and ten with six being the lowest form of cancer. Your Gleason score is between nine and ten, but let's say it is a nine."

The bad news about his prostate cancer was followed by Q&A. He immediately asked the specialist for a prognosis. "Mr Webber, you have between two to ten years, but you should realistically think you have between three to four years to live. Definitely don't think ten."

After the devastating news of high-risk prostate cancer, Kevin Webber started running – in addition to a brutal regime of chemotherapy and radiotherapy. He became a legendary runner and decided to keep a running streak. That means a personal challenge of running every day. He finished his first Marathon des Sables in the Sahara Desert of Morocco, the toughest foot race on the planet, in 2016. Then race across the snow and ice of the Arctic and the jungles of Cambodia. On his 55th birthday, he ran for 28 km, and celebrated his having survived another year of cancer and one day away from ticking off another ultra-marathon.   

He's still running. And I should, too.

BBC

BBC Wildlife, one of my favourite magazines, is full of breathtaking and masterful photos. From graceful glider devil rays to malachite kingfisher with turquoise-blue feathers, the pictures are powerful reminder for us to slow down and savour the nature.

If you share the same view with mine, you would love the live concert BBC Planet Earth III. This is a superb way to look at the world through different media: the orchestra performance, the score from Has Zimmer, the lens of high-speed cameras, deep-sea submersibles transport viewers, and lightweight drones.     

When my wife bought tickets for this beautiful show, little did we know it would fall on the same evening when many of our friends are under the weather. Our best friend's mum was sick with peritonitis and chaotic electrolyte imbalance. Another friend's daughter had pregnancy complication. I couldn't help but check the phone screen now and then. The struggle between choosing to tiptoe out of the hall and ruining the vibe for other audience by my glowing screen was as embarrassing as farting in the middle of a live show. 

Thank goodness the audience didn't kill me, and the nurse texted me instead of calling me on the phone. Even in the middle of a concert, I was able to orchestrate the cases in hospital – smoother than expected, but still, I have to thank all the angels helping me.

Forest

The bed is empty.

That's the opening sentence in the first and second last chapter of the thriller The God of the Woods by Liz Moore.

In this multilayered story, two children had gone missing in the Adirondack forest. As it turns out, the son disappeared in 1961 and was never found; the daughter went missing in 1975. The terrain of the forest, dense with thick underbrush, was to be blamed. The staggering loss of two children meant involvement and connection of many people spanning over a decade: their parents, the summer camp counselors and staff, the police officers.

That means a plot with characters as complicated and mysterious as the Adirondack forest. To make sure I didn't get lost in the woods, I read the book next to handwritten notes in which I jotted down the character arc.  

With that, I navigated the woods like Aragorn in The Lord of the Rings.

Tango

Medical school teaching on identifying illness prioritises the categorisation of diagnosis. We have been taught to use a funnel approach, moving from a broad list of possibilities to narrow down till a single diagnosis.

With time, I have lost count of patients who behave and suffer in different manners despite sharing a single diagnosis. This week I have been reading the story of an emergency medicine consultant Jonny Acheson who was diagnosed with Parkinson's disease at the age of 41. The life-changing illness led to his realisation how complex a movement disorder can be. As a matter of fact, Parkinson's isn't simply a movement disorder; there are many non-motor symptoms. 

Everyone with Parkinson's disease has a unique and bespoke drug regime. Even if two patients are prescribed the same drug and dose, they may take them at different times. The surest path to understanding the disease is watching Acheson's YouTube video entitled "All the Same But Different." The film showed us stories of ten different people with ten different symptoms.  

The title of his book, When Your Neurons Dance, also reminds us how dance works for different people with Parkinson's disease. More than 20 years ago, researchers from the Einstein Aging Study had published a landmark study in the New England Journal of Medicine to show that dancing can improve brain health and reduce risk of dementia. Few months ago, I read about how neurologists offered tango therapy for patients living with Parkinson's disease in Burenos Aires. Even those who struggle with the stop-and-start motions of walking can benefit from practicing the "slow, short steps" and pauses of tango. The classic move of sanguchito, or "sandwich", in which one dancer's foot slides between the partner's feet and pauses, offer patients clear cues to guide their bodies.  

If you believe that the national dance of Argentina works for patients living with Parkinson's disease, you won't be surprised to find that tai chi exercise, an ancient Chinese martial art, works too to improve postural stability by weight shifting and ankle sway. 

All these observations show how and why national art varies across cultures and yet works similarly.

Phub

The Anxious Generation by Jonathan Haidt and 10 Rules for Raising Kids in a High-Tech World by Jean M Twenge are books for parents who freak out over electronic devices and social media. I'm not sure if Mark Zuckerberg has time to read them yet.

Things are different for our family. Now that my daughter is over 16, the need for parental control of device and bedtime rule is of less concern. Reading about self-control has become teachable moments for myself instead.

I'll admit it: I'm actually the one in the family who screws up mostly. If you haven't heard about the word phubbing, it's a combination of phone and snubbing. If you charge me a dollar every time you catch me phubbing with my wife – and fifty cents for taking out my phone during family dinner – I would have to remortgage my house to cover the cost or go broke.

I feel dumb that I haven't behaved properly with the device myself. I do now.

Fishing

Famed of its Japanese garden and large pond, Ohori Park (Ōhori-kōen) is an attraction that draws me during my Fukuoka stay. I ran there and found many striated herons. They aren't just lively; they are smart and ingenious. 

As I learned from David Attenborough, these herons in Japan are inventive fishermen equipped with bait-fishing skills. You might wonder how a heron can get the hang of catching fish. In his book The Life of Birds, David Attenborough wrote about miraculous fish catching like what had happened in the Sea of Galilee. A few years ago, some herons were living beside a lake where people come to feed ornamental fish. One particularly smart heron as observant as Voltaire's Zadig learned the human behaviour from people watching. It started following what people do, picking up a a piece of bread (or a morsel of edible food that it did not eat but fish did) and taking it down to the edge of the lake. After flicking bait on to the surface of the water, a fish came up to take it – and was itself taken by the heron. That's a smart trick, I think you'll agree.

The habit spread. Other striated herons quickly pick up the bait-fishing skills. But bread isn't that easy to procure. The smart herons have further refined their technique; they have started to use little feathers, instead of bread, for the same purpose. And that too works. 

Aren't we guys using similar tricks for fishing?

Struggle

Qian Julie Wang, a graduate of Yale Law School, wrote a moving memoir of her moving from China to Mei Guo as an illegal immigrant at the age of seven. The direct translation of the Chinese word for America gives clue to the memoir's title Beautiful Country.

If you guess the theme is Qian's harrowing hardship of poverty in America, you could not be further from the truth. Her parents used to be university professors in home town, but ended up working in sweatshops and freezing sushi processing plant in America. Qian struggled with a white frilly dress covered with the yellow-brown of raw eggs and vinegar. And her brown skin.

And if you think Qian should have been made for China, she won't agree with you. The way everyone has to do the same thing at the very same time gives Qian headache: that much was certain. When she was at prekindergarten age, she was required to take a nap for an hour every day, at exactly the same hour as the whole class. She could never follow the ritual, and would rather have rather spent the time dancing, drawing, or playing in the dirt outside. 

The more we parents have overregulation, as most educators will tell us, the more risk you will raise a child who won't take risk. 

Ask Steve Jobs and he will say, "Why join the navy when you can be a pirate?"

Food

I know, I know – Japanese food is a treasure trove of possibilities. It should go without saying, writing about Japanese cooking is to enter the world of Japanese aesthetics, philosophy, and way of life.

The Kamogawa Food Detectives series written by Hisashi Kashiwa, The Menu of Happiness, showed me how the chef Nagare Kamogawa and his daughter enjoyed cooking and serving food. The family of Kamogawa work in a weathered two-storey building with walls of faded grey mortar and no signs indicative of a restaurant. That's where Nagare recreates nostalgia-infused dishes to heal the wounds or unmet childhood needs of the clientele. Instead of five-star Michelin cuisine, he makes dishes like omurice, gyoza, yakisoba, curry and rice.

I'm no cooking expert, but the story reminds me of Itosaisai during my recent Itoshima trip. Itosaisai is a farm stop offering a hybrid between a famers' market and a grocery store. Every morning the locals sell goods directly from farms, just-caught fish, and many other Itoshima-harvested fresh products, bypassing the brokers, wholesalers and distributors.

We arrived few minutes after the opening. Little did we know there were already long waits at the car park entrance, not to mention the long queue inside. We brought Kamo aubergine, water spinach, edamame, and loads of meat that filled our shopping bag (and stomachs) to the top. A fantastic way to capture the joy of food.

Characters

I brought the thriller The Secret History with me during the Beijing trip. That's the recommendation from my daughter who has just read Donna Tartt's novel.

In the first chapter, I met a boy of twenty-eight years old from California; he went to study at New England where he joined a Greek course with four other classmates.

Getting to know five characters seemed tough for me. All of them could be smoking cigarettes and using drugs, and most of them are Greek to me. When I showed my daughter how I drew a table to tell one from another, I was reassured that it's not a must. 

"Don't worry," she winked. "Go on reading. You will know each of them soon."

Of course, my daughter knows very well Donna Tartt is a gifted writer. I shouldn't have to worry about the way a murder story unfolded, about who could die, and who would be the pallbearer. It would be difficult to mistake any of the characters crafted by Donna Tartt.

Great Wall

When Machu Picchu stands as the miraculous citadel in South America, the Great Wall of China is the counterpart, if not more imposing, in Asia. Breathtaking it is. With its pristine watchtowers and multi-function walls stretching thousands of kilometre across the historic frontier, the Great Wall is the ultimate bucket-list adventure for many.

My first out-of-town trip was when I visited the capital city of China at the age of nineteen. The Great Wall is so impressive it's worth a return journey. The second visit, it turned out, happened this summer, when my daughter joined a summer physics course in Beijing.

The Great Wall, being a timeless monument, never fails to surprise. Climbing the gravity-defying Great Wall often makes one wonder about how it was built. The builder of the Jiayuguan fort, as the legend goes, calculated the construction materials precisely. So much so that one brick remained by the time the building had finished. 

We could never verify that piece of history. What we are pretty sure is that the ancient wonder is a never-ending story.

Pear

Life is a busy box of chocolates. Some are sweet, and many are nutty. 

You wake on a Monday morning and stare at the never-ending to-do list. The stifling weather and unanswered emails conspire like a tough examiner. You may be consumed by feelings of the damn busy schedule. Before you can make another complaint or curse, you find out you have a brain tumour. That means a long surgery, after which you can no longer breathe on your own without a tube running down your throat. You can't even swallow. The next thing to keep you alive is a tube to fill your stomach with food goo and water. 

That's the one of the worst Kafkaesque situations we can imagine, as was the case for the American writer Jeannie Gaffigan in 2017. She wrote about her pear-sized brain tumour in the memoir When Life Gives You Pears. That tumour took a massive mental and physical toll on her. Much of the days were spent in the ICU, a no-kid-zone, where you can find the worst germs and bacteria in the hospital. To get herself out of the germ-infested hospital as soon as possible, Jeannie immediately nodded when her doctor suggested a tracheostomy. A scar on her neck or throat was nothing compared to the tube-up-the-nose-attached-to-a-machine-in-the-hospital option. That sounded horrible but was a piece of cake for Jeannie after all the challenging back-and-forth uber-gurney journeys inside hospital.

On reflection, Jeannie found out that she had been wrong to sweat the small stuff before the life-changing crisis. Many of us, like Jeannie, are taking so much time to make sure our garden looked perfect that we  ultimately miss our chance to smell the flowers. 

Name

There is a book Clinical Neurology written by someone called Russell Brain? Seriously. There is one, and people call it Brain's Clinical Neurology.

I heard about this book when I read The Names, a New York Times best-selling debut novel by Florence Knapp. The novel has three storylines, each of which depends on how a mother names her son: Bear, Julian, and Gordon. 

The idea that people gravitate toward areas of work that match their name is known as nominative determinism or aptronym. Think about Usain Bolt, and you know what I mean. Or Amy Lloyd, a neuroscientist who studied amyloid plaques associated with Alzheimer's disease. Another example is an article about incontinence in the British Journal of Urology written by A.J. Splatt and D. Weedon.    

I have to put my hands up here and say that name can sometimes predict destiny. Call me KM and remember the runner. 

Air Mattress

Not infrequently, we start on the area which we are passionate about, and many of us can be single-minded about our forte.

Finding the right niche isn't easy, though. Brian Chesky and Joe Gebbia should have thought so. I've heard about their story from the book Don't Trust Your Gut. These two roommates in San Francisco first met in art school and were jobless. Their problem were really simple: they were broke and couldn't afford to pay their bills. To solve the money problem, two of them rented their spare air mattresses to attendees of a major design conference when hotels were fully booked.  

After stumbling on the idea of air mattress rental and serving breakfast, they had created a website: airbedandbreakfast.com. They were dead wrong. The business wasn't impressive at all. Chesky and Gebbia ended up each accumulating more than 20,000 dollars in credit card debt. They tried their luck elsewhere, where the number of conference guests in Austin might be bigger. But the business remained stagnant, and worse. Ditto for Denver.

As much as Chesky and Gebbia might wish to kickstart their business idea to pay back their debt, they had yet to find the breakthrough.

But – and I'm sure you expected a "but" – the proverbial "aha" moment came after David Rozenblatt, a drummer for American singer Barry Manilow, requested that he be allowed to rent out his whole apartment before going on a tour. The airbedandbreakfast.com founders first said no, noting he would be unable to provide breakfast if David wasn't there. But wait: do they really have to keep sticking to air mattresses and breakfast? The two entrepreneurs then realised the idea of dropping the air mattresses, dropping the breakfast. They could simply ask people to rent apartments when they were out of town. 

Airbedandbreakfast.com was rebranded as Airbnb. And the rest is history.

Pooh

Animals are amazing natural healers. So much so that we have a concept called zoopharmacognosy, a term entirely new to me until I picked up the book Doctors by Nature this month.  

Examples are plentiful to show that animals are innately knowledgeable about their body need and self-medication with natural remedies. As mentioned in the book by Jaap de Roode, humans are latecomers to this earth; millions of animal species were practicing medicine before we even evolved. It also means animals have lots of things to teach us.

Offering our patients antibiotics is an easy way to deal with bacterial infection, but the problem of gut microbiome destruction ensues. Once our patients develop inflammation caused by Clostrioides difficile, the highly contagious and nasty bacteria can quickly take over the human colon. Alas, no patients would thank their doctors for the fever, tummy pain, and diarrhoea as a result of the antibiotic use. 

We have spent a good chunk of time finding treatment of Clostrioides difficile. A healthy gut microbiome seems to be the best answer for our body's defence against the infection. Little did we know that elephant calves have long eaten their mother's faeces at the time of weaning. If you aren't sure the benefit of dung cocktail, the elephants will tell you this meaningful tool of restoring the gut microbiome. Once you learn their insight of restoring ecosystem from pooh-pooh sharing, you will realise why we are now learning to use faecal microbiota transplant, a medical term for "poo transplant", for managing C. diff infection.

Tuberculosis

Tell me what you think of when you hear the name John Green. Most probably his novel The Fault in Our Stars, which has sold more than 23 million copies worldwide. 

I'll tell you what I think of: a boy with multidrug-resistant tuberculosis. His name is Henry. He lives in Sierra Leone, and has got open sores in his neck and shoulder from ruptured lymph nodes, yellow clouds in the white of his eyes – a byproduct of the liver toxicity from the not-too-effective treatment he was on. 

John Green writes books other than novels. His non-fiction Everything is Tuberculosis tells the story of meeting Henry, a charismatic teenager who was nearly killed by the same disease which claimed the lives of John Keats, Franz Kafka, and Henry David Thoreau.

It has taken four years for Henry to be able to get home. During his hospital stay, he was emaciated and could hardly attend school. Why did it take so long for Henry to be accurately diagnosed? Why did he get worse in hospital? John Green captures the trajectory of a disease that continues to kill over a million people every year. Among them, many could not afford the pills. For those who could, they abandoned the pills because the pills made them terribly sick when taken without food, which they could not afford.

John Green came to the inescapable conclusion that the root cause of tuberculosis is injustice. Depressing as it is to utter the word injustice, I do believe he is right.

Decision

If optimism and happiness are twin cherries on a single stalk, a runaway bride and wedding oath are opposite poles of a magnet. 

There is a huge difference between saying yes "I do" and leaving a man at the altar. So much so that it is the theme of the sliding doors-style novel Written in the Stars by Ali Harris. The conundrum, as in most situations, shows how one decision leads us into completely different paths. It's true in relationships. It's true in sports. It's true in business. No matter how great the incentives to negotiate, how great the flexibility – in the end, the choice is an "either / or" decision.  

We can pick only one. Not two.

Dragonfly

For many, dragonfly is just an insect. 

For biologists, dragonfly is testimony to the power of evolutionary adaptation. A careful look at the fossil records confirms that dragonflies have been around for 300 million years, or a hundred times as long as humans. If dragonflies flew above the heads of dinosaurs during the Mesozoic Era and survived when the dinosaurs did not, this is by itself a great piece of evidence for their evolutionary success. The power of evolution, demanding though it is, has made dragonflies one of the oldest creatures on the planet.

With the announcement of the "extremely hot" weather from the effect of severe typhoon Bavi, I heard the forecast of temperature as high as 36 degrees Celsius over the weekend. I can't think of better outdoor activity than field trip of dragonfly watching. I ended up learning the way dragonflies make adaptation for thermoregulation. 

The first lesson from male crimson-tailed marsh hawk is the wax-like coating on their body, known as pruinescence. This beautiful dragonfly has a vibrant red abdomen, and a powdery (or pruinose) blue thorax. The wax-like pruinescence isn’t a pigment, but a “bloom” secreted by the insect’s cuticle to reflect harsh sunlight. So smart is it that it can cool down in hot weather. 

Another tactic is the blue dasher's posture at rest. The characteristic “obelisk” posture reminds me of my daughter’s handstand-like pose. Why does this dragonfly raise its abdomen into an almost perfectly vertical position, pointing the very tip directly toward the sun? Again, that has to do with thermoregulation for the cold-blooded insect. The vertical  body alignment significantly reduces the surface area exposed to direct solar radiation, thus avoiding overheating.

Cool.

STEM

If you've ever asked elementary school students to draw you a scientist fifty years ago, you'd be guaranteed that more than 99% drew you a man in a white lab coat. You could be mistaken for thinking that women are meant for housekeeping, and less good at maths, physics, or engineering.

Has there been a paradigm shift in stereotype portrayals of women in science? More recent research showed that around a quarter of children depicted a scientist as a woman, although these are mostly drawn by girls. 

Now that we saw more females depicted as pioneers on magazines or media (think Rebecca Ahrens-Nicklas who makes CRISPR genome-editing technology breakthrough), the ongoing unevenness of female visibility seems to be making progress. 

Think we're having equality of opportunity? Well, think again. Go read the book Not Just for the Boys by Athene Donald. You shall then find the story of Katie Bouman who took up the position as an Assistant Professor at Caltech and became an international sensation after creating an algorithm to capture the first-ever image of a black hole. The image went viral, followed by anti-feminist internet trolls making angry attacks. 

Unfortunately, the misogynist trolls show us there is a long way to go for women in science.    

Lips

When it comes to censorship, all writers develop skills to minimise risk of accusations. 

Susan Conley, an author who grew up in Maine and lived in Beijing for more than two years, has shown us the style of mealy-mouthed language. In her memoir The Foremost Good Fortune, there are many occasions for touching the "Three T's and the One F" (Tibet, Taiwan, Tiananmen, and Falun Gong), but she prefers to dodge touching the taboo subjects. 

Instead, Conley writes a candid story of her breast cancer during her stay in Beijing. Subjects like mastectomy, mortality, and median survival are better go unsaid. Behind these uncomfortable subjects, Conley faces the difficulty of walking on eggshells. 

Should Conley mention the Camel Lights she smoked in high school? Can she? And what about the answer for her chance of being alive in ten years? And the odds to see her two boys graduate from high school? What about her boy's watching her armpit skin change after radiation? She nodded after her son suggested, "Mum, you've got to put sunscreen on there." For many subjects, Susan Conley chooses to keep her mouth shut. 

Silent tears are mean't to be wiped, not to be heard.

Capsaicin

If the mention of David Julius doesn't ring any bells, it's safe to say you're new to the field of nociceptor or physiology.

If you haven't heard of David Julius, you should at least think about him next time you have wasabi or chilli pepper. He received the Nobel Prize after discovering the first capsaicin receptor – a protein called TRPV1. The compound capsaicin unlocks the secrets what makes chilli pepper "hot". When TRPV1 or capsaicin receptor is activated, a burning sensation results. 

We now realise TRPV1 receptors are abundant in the mouth, lips, throat and tongue; that explains the "burning" sensation of chilli pepper. In the meantime, capsaicinoid molecule is hydrophobic and not water-soluble. If you want to quench the burning by fetching a water jug or a beer, it is unlikely to work. So, a good solution is to reach for milk as it contains the lipophilic casein, which is an important key to remove the lipid-like capsaicins. 

David Julius then showed that mice lacking the gene for the TRPV1 ion channel were impervious to both hot peppers and heat. The same applies to birds, whose TRPV1 channel is not activated by capsaicin. The good news for birds (and chilli pepper, for that matter) is that they can consume chilli pepper seeds unharmed and disperse the viable seeds. 

What about other mammals like squirrels? They do respond to capsaicin in the same way as humans. Therefore, you can coat bird food like nuts with chilli powder dust (or Tabasco sauce) to keep squirrels away from the bird dining table.