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    Sunday, October 07, 2012

    DIY: Idle Air Control Valve

    Someone once said, "when you're poor, your save money and pay for it in time. When you're rich, you'll save time and pay for it in money."

    Well I'm poor.

    Lately my 1994 Honda Accord (4 door LX 4 cylinder) has been idling low - I mean really low - somewhere around 300-400 RPM. Besides the incredible shakes that make you think it will die at any minute, it has started dying as I back out of parking spaces. This problem happened when the engine is warm - starting in the morning with a cold engine got a decent response until the radiator fan came on.

    Unable to pay for someone to diagnose and fix this for me, I scoured the internet. I found this post on Honda-Tech.com. People smarter than I had ran into the same problem.

    **Now, sometimes all you need to do is turn the idle control screw on top of the throttle body and adjust the idle speed, but I figured my problem was deeper than that given my car's 260K + miles.

    This post described how to clean your Idle Air Control Valve (IACV) which adjusts the amount of air let into the engine (if I understand it correctly). A clean IACV gives you better idling RPM and more fuel efficiency.
    I'm not going to recreate the excellent "How-To" on Honda-Tech.com, but I will give you some thoughts.

    There it is waaayyy in the back
    A closer view
    On opening the hood, I spotted the IACV well in the back. This made it incredibly difficult to get to - especially from someone like myself who's passably good with tools but not even remotely experienced with cars.

    Yes, that's a battery

    First, I disconnected the battery because 1. electricity runs through the IACV and you need to reset it after cleaning it, and 2. I don't want to die.

    Darn black tube in my way
    Ah! Much better!
     Second, I had to take the top off the air filter and disconnect the intake manifold.  I tried for too long to disconnect the IACV without doing that, and I couldn't reach it. It's WAY too crowded and small back there. Taking that big black tube out of the way made it MUCH easier.

    Soiled shut

    Once I got it off, I easily saw how right I was about the etiology of my problem.

     I bought IACV cleaner from Autozone (although I've read that Carburetor cleaner would work fine .. don't know if there's even a difference) and this is what it looked like afterward (O-ring removed during cleaning so it wouldn't get damaged. Don't forget to put it back in!).

    After putting it back in, I almost didn't check the radiator fluid. The resevoir was almost dry, because of the lost fluid from the tubes that run through the IACV. Topped it off after another trip to Autozone, and it's idling at 750 RPM like a champ!

    The whole experience was awesome, because I realized I can fix a car without breaking it more, I saved tons of money, and it reminded me again how similar car repair is to surgery - without the malignant residency to go through...

    Saturday, September 15, 2012

    Congratulations ASPCA!

    This post is rather late in coming, but I would be remiss if I didn't acknowledge the results of our last "TBE Play For a Cause" March Madness pool.

    Congratulations, Andres, and the ASPCA. They sealed the deal after the Elite 8, when UNC went down. Once the Final Four was set, nobody could up end them.

    I asked Andres what made him play for the ASPCA this year. A love of pets? A soft spot for those less fortunate or unable to care for themselves?

    "No," he replied. "I saw an advertisement on the ESPN website as I went to register."

    Well, whatever your motivations, people and animals everywhere are thankful to all who played, and those who played are in awe with his great prognosticating skill. Until next year!

    They will bark your name for years to come, Andres!

    Saturday, July 21, 2012

    Vietnamese Communal Street Culture

    A typical small street in Saigon with mom-and-pop shops
    One of the amazing parts of Vietnamese culture is the "night scene." As in many societies - perhaps because of a lack of air conditioning and lighting - people typically take to the streets in the evenings and then retire early. In Vietnam this daily routine is codified as arising one or two hours before sunrise, starting to work about 6 - 7 am (sunrise), taking a siesta in the middle of the day, returning home about 5 - 6 pm, and hitting the streets. Because of the now "stable" electricity (rolling blackouts are the subject of another day), people often stay out past dark, but in general, the country goes to sleep about 9 or 10 pm.

    Saigon stays out a little later than the rest, maybe due to the expatriate influence, greater electric stability, westernization - who knows. Anecdotally, the majority of people in the city still go to sleep at 9 or 10 pm like the rest of the country, but their are enough people in the city that a vibrant culture from 10 to midnight still exists.

    A "hẻm" (small alley) during the day where most people live 
    This street scene is enhanced by the communal nature of Vietnamese family culture and the living proximity of people in the country. Vietnamese society, like most Asian societies, live in large family structures. Typically three or four generations in a household. This creates a large network of closely related people to interact with on a nightly basis. Also, it manifests itself in gastronomical ways: family dinners are usually social affairs where many dishes are placed in the center of the table for people to share as they talk and joke.

    Vietnam has a population density of 280 people per square kilometer, according to the World Health Organization. Ho Chi Minh City has an even higher population density - 9450 in 2006 - and according to Vietnamese research, the inner city (old Saigon) has approximately 30,000 people per square meter!*

    The same alley alive around dusk as everyone comes home 
    *In comparison, the United States of America's density of 34 people/sq. km, and the two most dense cities - Washington D.C. and Los Angeles - have densities of 3886 and 2750, respectively.

    What all this close living does is create not only a "night scene" as thought of in America - clubs, bars, restaurants, etc. - but a small community "night scene" with local alleys (hẻm) alive with children running and playing, women gossiping, families and friends eating, and old men drinking coffee or beer and playing chess. These "micro-communities" are the true social structure of Saigon, and any visitor would be remiss to not experience it.

    Vince and Linh

    Travel blogs are nothing new, but I do enjoy perusing ones dealing with Vietnam to see other people's perspectives on my second (third?) home. In this case, the travel blog happens to include a good friend of mine, fellow white-boy-speaks-Vietnamese, adopter of Viet culture, Vince and his girlfriend Linh. So, if you want a fresh, biased-only-by-America, virgin view of Vietnam, this is for you. I'm too old and jaded now...

    Check out http://vinceandlinhinvietnam.wordpress.com/ and tell them hi from me!

    Monday, July 09, 2012

    Lang Co Clinic

    Three days of working in a rural clinic went by like a whirlwind. This is incredibly different than my previous medical experiences in Hanoi and Ho Chi Minh City (HCMC), but, it really is about what I expected. The disparity in care (and life) is amazing here. Some stats from a Vietnam News article I read yesterday:

    1. HCMC accounts from 21% of the nation's GDP (this is an improvement, I think, because it used to be 75%. Now Hanoi and Da Nang have grown tremendously, siphoning this off) including 44% of tourism dollars.
    2. Average income is 2.4 times higher in HCMC than the rest of the country.
    3. The city has an average economic growth rate of 11% over the last 25 years - 1.5 times the national average.

    What does all this mean? It means if you live outside of HCMC (and definitely outside of it plus Hanoi and Da Nang) you are markedly poorer than the rest of the country. It logically follows that your health care will also suffer, since all the major hospitals are in HCMC or Hanoi, and you will have little if any ability to travel for medical services.

    Consequently, clinic saw both run-of-the-mill malnutrition and parasites (probably 80-90% of cases) mixed with really interesting cases that had little to know previous medical follow-up.

    In the three days I was in Lang Co, I saw an average of 40 patients per day. One young boy, about 2 years old, came in with his mother who complained about a large lump behind his left knee. On examination, I noticed he had a rather large (7cm by 5cm), non-tender, immovable, solid mass behind the right knee. Nothing noticeable on the left. Mother stated that the mass had been there since at least 3 months of age, and had gotten bigger as he had grown. A local physician had seen the child early in the course, performed no tests, and said it was totally normal.*

    *(aside: this is common in Vietnam, where medical tools are scarce and money to pay for them more so - to do almost no tests, except an ultrasound of the abdomen which is done for everyone regardless of chief complaint because ultrasounds are so prevalent - and not explain to the patient anything. Although, in America we explain everything and the patient never hears or understands what we say, so perhaps that is just universal...)

    So, I ordered some xrays of the bilateral knees and femurs and told the mother to return the next day. Early the next morning, in she walks with xrays in hand, showing growths on both femurs (left markedly greater than right). Luckily, one of the other physicians on the team, Mark, is an orthopedic surgeon, so I walked next door to get a specialist consult. He had the child walk, looked at the xrays, then declared it was most likely an osteochondroma - a benign tumor of the bone. It's monitored through periodic xrays and removed if it impacts function (walking in his case) or grows rapidly (small chance of becoming malignant).

    Mother went away happily knowing a diagnosis, and knowing what to look for, and I moved on to the next patient - more worms.

    In all, I saw probably three or four cyanotic heart lesions, a previously undiagnosed brain mass, juvenile idiopathic arthritis, hodgkins lymphoma not receiving treatment because of no money, cleft lip, and - jewel of the diagnosis crown - Russell-Silver Syndrome (stories for another day). Sleep was welcome each night. It's amazing how much good you can do with so little.

    Wednesday, July 04, 2012

    My First Clinic

    Lang Co is a small hamlet between Da Nang and Hue.
    This month I have two different medical experiences designed to let me see the disparities of care between rural and urban Vietnam. For four days at the beginning of the rotation,i will work in a small rural clinic in Lang Co, Vietnam with an organization called Vets With A Mission. They are a nonprofit organization that provides medical missions to Vietnam with a Christian background.

    Today was my first day in the clinic. VWAM had their in country representative contact local leaders who sent flyers ands invitations out ahead of time to residents advertising them that we would be providing free medical care over four days. Of course the prospect of American physicians and free care is incredibly popular, and we saw 153 patients between four doctors: family practice, orthopedic surgery, chiropractor, and myself ( pediatrics).

    A typical house in rural Vietnam near Lang Co
    A clinic like this provides unique challenges. Many parents being their children just because we are American, even though their children have already seen doctors and received medications. Usually the normal Vietnamese doctor takes the week of because we make crowded and siphon patients. We also see children incredibly sick, who have not received care because their families cannot afford it.

    The rural clinic where we practiced
    Today was a "get the hang of it day," so I only saw 29 patients. Most children came for two reasons: inadequate weight gain and horribly rotten teeth. The chief complaint was " my child is a lazy eater." I am very good now at explaining that milk is not healthy in Vietnam when they mix sugar with it. This causes cavities, which cause pain, which leads to decreased eating and poor weight gain.

    The communist government provides free care "in theory," but in practice those doctors are not respected, wait times are so long, that people don't see them. They go instead to private physicians, but often do not have the money to buy the medicines prescribed. So, in practice the Vietnamese have a very capitalistic health care system with two tiers, similar to the USA system, and very low access for the poor.

    The waiting area on the morning of day 1

    Monday, July 02, 2012

    The flight over

    Korean airlines is the best airline in the world. I hear that Singapore Airlines is wonderful also, but Korean Air is top dog. My wife says I love them because the stewardesses are hot. She is correct ( they employ incredibly good looking people), but that is not all. What sets them apart from the rest is their customer service.

    Flying over this time was as enjoyable an experience as 37 hours of travel can be. I had an aisle seat near the rear of the plane and received prompt service for all my needs. More to the point, a few rows ahead sat two families with small children about the ages of my two. One family was just a mother and the kids, and I couldn't help remember my wife's ordeal with bringing our two to Vietnam just two sort months earlier, and how it was made light by the helpful staff.

    Many times I saw a steward or stewardess sit with the children while mother stretched her legs or use the restroom. Nobody complained when the toddler got tired and cried. Instead, they immediately brought games, things to help the child sleep, and offered in any way possible to help the young mother in her defensive efforts.

    Consequently, thirteen hours later, an entire plane unloaded happily, and with sanity and hearing intact.

    Years ago, when taking my son as a baby, Korean Airlines helped us with formula after an idiotic Vietnamese official read a poorly translated copy of international flight requirements. Then, when his bad parents let him fall out of the bassinet, they helped us get to see a physician in the airport to make sure he was OK and not have to worry about flight arrangements.

    So yes, Korean Airlines is the best airline in the world ... and it doesn't hurt that they're pretty too.

    Saturday, June 30, 2012

    In-N-Out Burger and LAX

    There are few things in life as amazing as a hamburger from In-N-Out. Anyone who has lived in California understands what I'm talking about. I think they secretly put drugs in the burgers because how else could they be so addictive? Seriously, part of the draw is the fresh - almost HEALTHY - taste of their burgers, and another part is the secret menu. It's so secret that even the menu posted online doesn't have everything that they actually offer. Each time I go, i invariably learn something new on the menu.

    Well, when I booked my ticket to Vietnam, i realized that I would have about five hours at LAX before boarding my flight for Korea. This had me wonder on Facebook if it was possible to grab some delicious grub while waiting. Thanks to my friend Daniel, who pointed me to a forum about this exact subject, i realized I'm not the first ( and surely not the last) to think these same thoughts.

    It looks like there's actually a pretty established way to get there. Following these tips, i walked about 25 minutes with my carry-on, to reach In-N-Out. On arrival, i found the line out the door, and the line of cars out the parking lot. Seems everybody loves In-N-Out. A little ahead of me in line was a middle aged Hispanic woman with a suitcase - i want even the only airport denizen there! LOL.

    Of course the food was delicious, and I couldn't have asked for a better finals meal in America. I hear In-N-Out has finally reached Texas. Perhaps I'll be so lucky as to one day see it in Louisiana. We can only hope...

    Tam biet,

    Global Health Vietnam: An Overview

    I have had this blog for quite some time, and have written extensively about my experiences in vie team. However, this trip marks another first: the first time i am an actual physician and responsible for treating people here. As a third-year pediatric resident, i have had many "firsts" medically over the last two years. Now i am the first resident from my program, Our Lady of the Lake Children's Hospital (OLOL), to do an international elective.

    I set this rotation up in collaboration with my boss, Dr. Roberta Vicari, with the hope of establishing a perpetuating global health experience that helps those less fortunate, develops resident medical skills and empathy, and furthers the mission of OLOL.

    So, over the next five weeks, i hope to blog various posts about my experience. Perhaps we will all learn about the Vietnamese, their culture, and their medical care together. I look forward to sharing this time with you, and maybe next time our roles will be reversed. Feel free to comment, question, or pontificate on my posts. Social collaboration is key!

    Tam biet!

    Thursday, March 22, 2012

    TBE Play For A Cause 2012

    March Madness is here, and it is definitely mad.

    This year the "TBE Play For A Cause" charity pool is larger than ever before, yet at least 5-6 stalwarts from years past are absent. Think how much we could have raised for charity if life wasn't so hectic this year right around Selection Sunday?

    The tournament has had its share of upsets and fantastic moments, but not the "usual" upsets - the 5 vs 12 seeds and 7 vs 10 seeds upsets have been few and far between. Yet, this year we saw TWO 15 seeds beat 2 seeds when in the past 28 years (since the tournament was expanded to 64 teams) number 2 seeds were 106-4. Yes, that's a 96.4% winning percentage. Now it's 94.6%.

    And so, with the first two rounds of March Madness in the books, the world took a collective breath over the last couple days awaiting the Sweet Sixteen and Elite Eight.

    So, this is a good time to introduce this year's charities:

    ASPCA (Andres)
    Children's Advocacy Center (Chrissy)
    Diabetes Research and Wellness Foundation (Dennis, 2009 Champion)
    Harvesters (Nathan)
    Invisible Children (David)
    Make-A-Wish (Sara, 2008 Champion for Heifer International)
    Ovarian Cancer Alliance (Julie)
    Pan Can (Michael)
    Red Cross Japan (Nahoko)
    Shared Hope International (Triet)
    Texas Children's Child Life (Marc)
    Vittana (Matthew)

    Worthy causes, all. After two rounds, these are the standings (points in parentheses):

    1. Ovarian Cancer Alliance (440)
    2. ASPCA (430)
    3. Harvesters (410)
    3. Invisible Children (410)
    3. Texas Children's Child Life (410)
    6. Diabetes Research and Wellness Foundation (400)
    7. Red Cross Japan (390)
    8. Shared Hope International (380)
    9. Children's Advocacy Center (360)
    10. Make-A-Wish (350)
    11. Vittana (340)
    12. Pan Can (330)

    Most people have Kentucky as champions, but Michigan State, UNC, and Syracuse are all picked as well, so it really is still anyone's game.

    And THAT is what makes March Madness so mad. The Sweet Sixteen starts tonight. Let the games begin!

    Thursday, February 23, 2012

    ESPN, "Linsanity," and Acceptable Racism in America

    Recently, ESPN made headlines in a new sort of way - by firing an employee who made a headline with a racist double entendre. By now we mostly know the story.

    Anthony Federico, 28, made the far more stupid gaffe of the two on Saturday night when he posted the following headline on ESPN’s mobile website: "Chink in the Armor: Jeremy Lin's 9 Turnovers Cost Knicks in Streak-Snapping Loss to Hornets." The headline was posted at 2:30 in the morning, and then removed slightly more than a half an hour later when someone (finally) realized that it may be construed as an offensive remark. (link)
    One interesting take says that,
    By acknowledging this gaffe to such a degree, ESPN increased the social damage exponentially. ...

    From a public relations standpoint, the response from ESPN was a no-brainer. Yet, we ought to care more about the public's continuing recognition of fake words created by hate-mongers. By ignoring pre-existing definitions and acknowledging ridiculous slurs in an effort to not be considered racist, the media does the exact opposite.(link)

    That got me thinking about the collateral damage done by ESPN versus just quietly taking down the headline, and the phrase "the response from ESPN was a no-brainer." Everyone agrees that if "chink" is used in a racist manner, this is a horrible gaff and disciplinary action must be taken. But can we say it was meant that way? "Chink in the armor" is a common phrase used to describe a weakness in a previously perfect person.

    Do media outlets have to fire people who make mistakes with ambiguous intent because they could be deemed racist?

    What if the employee was African American? Asian? Does that change things?

    Recently, the African American community in Dallas, TX protested a gas station owned by a Korean man.
    The customer, complaining that the price of gas at the station was much higher than at other stations, demanded he be able to buy gas by smaller amounts than what the owner set as the minimum sales unit. The owner refused and told him to go to another station, to which the customer responded by telling the owner to go back to his country. The owner responded by telling the customer to go back to Africa.

    That triggered a boycott of the gas station by the black community in the region, followed by them speaking out against Korean and other Asian immigrant communities....

    The gas station owner publicly apologized on a Dallas radio program, attended by African American civic leaders like city councilman Eric Johnson. The Korea Society of Dallas also donated 500 winter coats to NAACP as a gesture of goodwill.(link)
    It's ok for the Black customer to tell the Korean man to go back to his country, but it's not ok for the Korean to tell him to go back to Africa?

    You can say it if you're black, but not if you're Asian?

    I am incredulous that the Korean and the Korean community had to apologize, but the African American community did nothing in kind. I don't think you should get a free pass if you're African American or Asian. Both people were in the wrong here. But clearly society doesn't feel the same way. A person seems to be given more latitude to say hurtful or racist statements if they are a minority - whether by race, gender, or sexual orientation - and perhaps certain minority groups get more latitude than others.

    So why does society do this?

    I don't know the answers. Racism is hurtful for everyone involved, and should not arise from anyone's mouth. But it does seem like - at least on a cursory read - when dealing with racist sayings, in American culture not all speakers are created equal.

    Sunday, February 19, 2012

    FBI Confiscates Websites

    A few short weeks ago, the internet came to a stop - at least in some corners - and the very foundations of internet freedom shook because a small group of very greedy Hollywood men and women sought to keep yet another copper for themselves. SOPA became a rally cry, unleashing a firestorm of frustration by the masses who see the MPAA and other media moguls in Hollywood as out of touch, lecherous, avaricious elitists who prey on old women because their grandchildren downloaded a song or two from Pirate Bay.

    Luckily, this sortie was repelled.

    Prior to this, however, the FBI started a practice that has gone relatively unnoticed but is - in my opinion - just as unnerving ... it shuts down websites for illegal activity with warrants and without waiting for a verdict. A few years back, right before the super bowl, the FBI shut down ten websites that streamed live sporting events illegally. This year, it shut down 16 more.

    *Now, I could go on about the morality or immorality of both the act of streaming illegally and the act of shutting them down, or the market forces and the need to evolve, but I will save that for another post...

    But now, the FBI has moved to shut down file sharing websites such as megaupload.com. While the FBI used the pretense that the owners are part of “the Mega Conspiracy, a worldwide criminal organization whose members engaged in criminal copyright infringement and money laundering on a massive scale," other file-sharing sites have severely restricted their services - offering only file-hosting - showing, therefore, that they see it instead as an attack on file-sharing.

    Which is truly a shame, because if the internet can be a place where the virtual storage unit is liable for what you or I place in our units, that jump to make sites liable for what we say (a la SOPA) is not too far off. And if they can regulate online before a case has even seen court, then how long before they move into the offline world? And all for what? So filmmakers can keep a few extra dollars?