Because it is too beautiful, I cannot stop sharing this picture.

落葉 紅葉


写真は、南禅寺 天授庵です。

Fallen leaves and autumn leaves

Leaves change their colors in Hokkaido, but lots of them change to yellow which is different from Kyoto. I have been to Kyoto countless times but it might be the first time to visit during this season. I have been here many times before and after the fall season though.
I cannot say anything other than beautiful when I see this “Japanese beauty” of autumn leaves especially in the historical city Kyoto.

This is the picture of Tenjyuan at Nanzen-ji
This place is so crowded with people.


ARIA ロタライブ




それ以外は、heat injuryが少ないということ。debulking効果が高いということ。
slow flowの発生については、おなじバータイムであれば、発生は少ないですが、低速のほうが時間がかかるので、その分リスクが増えるので、素早く通過させたほうがいいと判断したときは、高速へシフトする。

ARIA Rotablator operation live

The last time I visited Tsuchiya General Hospital was in 2006 when I took on the role of operator for JACCT. It’s been a while since then.
The concept of this operation live was showing procedures with both high and low speed Rotablator by operators: Dr.Shibata from Miyazaki and I. However, the patient I was in charge of had a sign of UAP. ECG changed just by inserting a wire, and IVUS didn’t go through, so we started from1.5-mm burr sized Rotablator and tried to put the burr-platform in #6, but we could not move it. We ended up controlling the burr from LMT. There’s a lesioned part in #6 as well. We kept the same rotation speed and continued the procedure, and then we found slight increase of ST. It was because of the rupture in #6 which occurred in front of the calcified lesion. Is this because of ACS? Did we do too much plaque debulking and create rapture using low-speed Rotablator from LMT to #6 part? I assume that Rotablator caused this plaque rupture since rotation speed didn’t fall even though we kept low-speed. After that, we completed the procedure as usual using balloon stent. Dr.Sugie came with me to the hospital as an assistant. He seemed to be inspired by this operation live.

It is a great point of ARIA that it has a clear concept of learning from operation live. I hope it will continue focusing “what” they provide without being influenced by political power.
This picture was taken courtesy of a radiological technologist at Tsuchiya General Hospital.  We must learn from his thoughtfulness.

Unfortunately, we couldn’t have much time to show low-speed Rotablator, but I think we could demonstrate how to resolve troubles during PCI.

The biggest advantage of low-speed Rotablator is that pacer is not needed because it rarely causes brady cardia. In addition, it causes less heat injury and has high debulking effect.

When it comes to the occurrence of slow-flow, it doesn’t occur so often if it is the same burr time. However, low-speed Rotablator takes longer which means that the risk is higher. If we think it is better to pass it through faster, we change to high-speed. Its disadvantage is that differential cut towards healthy part may be inefficient and sometimes do debulking healthy-part.






We finally had snow and Sapporo is getting colder and colder. Maybe because of anxiety? The number of night calls from the patients who complain of chest pain, high blood pressure, and palpitation is increasing these days. I have answered those calls to make them feel relieved as much as I can. The 4th of January next year is Sunday. It means our clinic will be closed for 6 days in a row from December 30th.  I thought about opening the clinic on January 3rd, but I’ve heard that some staff expect longer break. Should we open the clinic on December 30th then to decrease the length of closing period? I am still concerned.

Of course, we have 24 hour-service including emergency cases, lots of people hesitate to come when they know the clinic is closed. That is why we need to keep the clinic open officially.

I always want the clinic to be trusted by the patients and our neighbors. I want to spread the recognition that Sapporo Heart Center always try their best for the patients. For that purpose, what can we do besides advertising? I will keep working hard for it. 






As I expected, Work efficiency  is going down because our medical stuff was increasedwe increased . One of the reasons is that one thing has to be checked by several people ,isnt it?

Doctors are, so to speak, engines. Support teams are there to help the engines work more smoothly and efficiently. My teams work on behalf of me to improve efficiency at work.

How efficiently do we work in our limited time? For whom do we work? In our clinic, it depends on how productively the teams can run me as an engine for the patients.

However, the teams make my productivity go down sometimes as a result of trying to finish their work early. This happens when they prioritize working over thinking for whom and for what you work.
To put it the other way round, it must be a proof that they forget to be thoughtful.

I always want to enjoy my work, but we must be really careful not to get our priorities wrong.





いま、当院では人が増えて、いろんな部署が大変な思いを各々しています。お互いに協力しあうべきであるのに、 他人様が気になってしかたない人が多いみたいです。


The grass is always greener on the other side

People often complain that they work really hard but other people in different departments do not.
We all have bad habit: comparing ourselves to others. It is not a big deal whether others finish work earlier or later, but it seems to be impossible to stop caring such things.

Comparison or competition against others does not have much meaning when you work. What is more important is how hard you work.

The number of staff in our clinic is increasing these days, and many departments are having hard time. This is the time we should help each other but lots of staff cannot stop comparing.

There is one thing I want to say. Work is a battle against yourself, and it helps you grow up. It does not matter what others do. You should keep it in your mind.









For whom do you work?

The answer is clear to me. I should work for the patients. For the patients who are from Sapporo and from other cities in Hokkaido. Sometimes, even for the patients from overseas like China and Russia. I always try my best to provide good medical treatment for those patients such as 24 hour service.

To provide good treatment, it is necessary to have the latest knowledge, introduce the cutting-edge technique, and enhance both hardware and software. In addition, we need to move people, goods and money. We must make an effort to improve our hospitality as well.
I also work for our staff.

In conclusion, this is my responsibility to make Sapporo Heart Center a facility that provides good medical treatment.

I will do whatever I can to achieve this goal, but I do not work for something that does not relate to it since I do not want to waste my time. I rather use the time for Sapporo Heart Center.

Life is very short. I will do what I really need to do.

Each person has different tasks to do, but what is important is the same for everyone: working hard for the purpose, whatever it is.




Attending VIVA with Dr. Sugie

Using the three-day weekend, I am attending the meeting in Las Vegas with Dr.Sugie. He is giving a presentation so he will stay longer here until the last day of the meeting.

After arrival, we’ve been walking around the city today. Our hotel Bellagio is famous for its fountain. I’d like to share such spectacular views Las Vegas has at night.