Otaru Furukawa,hokkaido ryokan review

Otaru is a beautiful town. Fours years ago, I went to Otaru for a one day round trip. A lot of people take a one day trip to Otaru. It is easy with the Otaru Welcome Pass that provides 'Sapporo-Otaru round trip JR ticket' + 'Sapporo subway one day ticket'. The ticket buyer should use it for one day. So, four years ago I thought that I should go and return the same day. However, then I thought it deserved a one night stay.
Anyway, because a lot of tourist select 1 day trip, most shops close at 7 p.m. I stayed in Furukawa, ryokan in Otaru.



I booked a Japanese style twin room for 41,100 yen for one night which included dinner and breakfast. Depending on the size of rooms and the quality of Kaiseki, dinner in a ryokan, the cost varies a lot. The location was far from Otaru station, about 800 meters. You can get there either by walking or on bus, though I had walked there.




▲ Check in here, and take welcome drink. If you have spare time to check-in, go out and look around the town after keeping your luggage.


▲They sell some souvenir at the lobby.


▲A bathroom is so narrow. However, it doesn't matter.  There is a bath hot spring.


▲ Room No. 701-705 are canal view rooms.

▲The letters mean 'canal terrace'. You can take dinner watching the canal.



▲Standard Kaiseki menu. It satisfied me.


▲Lemon jelly was fantastic.





▲After getting back to room, bedding was set by ryokan.


▲I booked cypress bath. It charges 2,200yen 50minutes. It is rental bath and partial open air bath. There are severe lemons in the bath.

▲The breakfast. People can take it watching the canal. The breakfast also satisfied me.

Otaru Furukawa was the best ryokan to enjoy night view and canal. The breakfast and dinner was nice also. Next time, I want to stay at the room overlooking canal.

What is the proper position when you work?

What is the proper position when you work?

Proper positioning is important to reduce the prevalence and prevent aggravation of the disease. Employees work with certain position for a long time. If the position is inappropriate, some kinds of musculoskeletal disease can be occurred. On the contrary says, proper positioning can improve that kinds of diseases.

Patients with cervical disorders should consider their proper positioning at the work station. Sustained spinal posturing out of the neutral zone can lead to further aggravation of the affected tissues and a perpetuation of symptoms.

The sedentary worker spending most of the day seated at a desk is more likely to encounter proper positioning challenges.

In general, the patient should be instructed to avoid those positions that typically aggravate his or her cervical or limb pain.

<Proper sitting position>

The recommended positioning at the desk or computer station is usually prescribed with approximately 90 degrees of hip, knee, and elbow flexion.

Proper distance from the computer monitor is an arm’s length measurement, which is unique to each individual. The upper 1/3 of the computer screen should be situated at eye level.

<The workers with prolonged phone use>

If workers use the telephone while working for a long time, one side of neck muscle can be stressed. Headset use can help eliminate this provocative position. 

<People who wear bifocal eyeglasses>

Individuals that require bifocal eyeglasses should be instructed to position reading materials in such a fashion as to avoid sustained cervical extension postures.  

In addition, the wrist or elbow, and preferably both, should be maintained in a supported position. This support contributed to total neutral positioning of the body and ultimately can lead to decreased stresses on peripheral nerves passing through the elbow and carpal tunnel. And proper back extension position is also important. Slight lordosis of lumbar spine can reduce of the pressure to nucleus purposus in lumbar spine. Small size of cushion or specific chair back mimicking physiologic shape of human spine can help to maintain that position.

"heneymooner's palsy", if your arm paralyzed after your honeymoon...

Wrist drop, "Saturday night palsy"

As you wake up, if you feel weakness of wrist movement, just think about peripheral neuropathies.

Among the series of neuropathies, one of the most common neuropathy is the radial nerve neuropathy, so-called Saturday night palsy. Typically, the individual lies with the upper limb in an awkward position such as over a sharp ledge/back rest of a chair, or rests the head on the lateral surface of the arm. A particular form of radial nerve insult may occur when a person allows another to rest his or her head on the middle third of the arm whle caressing that person. In this instance, the radial and forearm extensor muscles against the shaft of the humerus, the so called heneymooner's palsy.

Arm extensors (triceps brachii) are usually spared. However, for the neural branches to the medial and possibly lateral heads of the triceps muscle to be injured, producing some elbow extension weakness. Weakness of brachioradialis is a particular important sign in radial nerve injuries.

Superficial radial nerve (sensory nerve, cutaneous nerve) can be injured. However, it can be also spared if the lesion is below the point of seperation of superficial radial nerve. (In this case, only motor branch is injured.)

Radial nerve lesions in the arm also produce wrist drop and inability to extend the fingers because of denervation to the extensor carpi radialis longus/brevis and extensor carpi ulnaris, and the extensor digiti communis, extensor indicis proprius, extensordigiti minimi, and extensor pollicis longus/brevis muscles, respectively.

The diagnosis should be performed via electrodiagnostic medicine. With nerve conduction study and electromyography, the examiner can diagnose the exact site of lesion, amount of neural damage, and kinds of involved muscles.

The electrodiagnostic diagnosis should be done at least 3 weeks later from the time symptoms arise. During first 3 weeks, the change of the nerve can't be detected with electrodiagnostic medicine.

(Physical exmaination for radial nerve palsy. In this video, the patient is being requested to extend his wrist and finger, but he can't do that movement. The examiner should fix the patient's forearm to isolate the arm movement. This patient was diagnosed with peripheral neuropathy of radial nerve, at the arm level.)

Treatment of the wrist drop depends on the causes of the disease. If there is no traumatic lesion or bony abnormalities, initial treatment is splinting of the wrist. Medications may include analgesics, anticonvulsant medicines or tricyclic antidepressants to reduce stabbing pain. Also, steroid injection around nerve to reduce swelling may help some patients.

Physical therapy help maintain the range of motion of the wrist and increase the muscle strength. Electrical stimulation of radial nerve, passive movement of wrist joint, and isometric exercise of wrist extenor can be included.

Don’t sit over 1 hour at once

Don’t sit over 1 hour at once.
Take a break of at least 10 minutes, in a standing position. 

Sitting is the worst position that increases pressure in the lumbar disk.

Biomechanically, the activity of the lumbar muscles correlates well with intra-disk pressure. When back muscles contract, there is an associated increase in disk pressure.

These pressures change depending on spine posture and the activity under taken.

(Don’t maintain your posture like the picture in RED RECTANGLEs)

Numbers depict the intra-disc pressure. When you pick up something in a sitting position, the disc pressure is increased by double.

Adding rotation to the already flexed posture increases the disc pressure substantially.

Comparing lifting maneuvers, it has been shown that there is not a significant difference in disk pressure when lifting with the legs (i.e. with the back straight and knees bent) versus lifting with the back (i.e. with a forward flexed back and straight legs).

What decreases the forces on the lumbar spine is lifting the load close to your body because the farther the load is from the chest, the greater the stress on the lumbar spine.

If you have to work in a sitting position, don’t maintain it for a long time. Take a break of at least 10 minutes, in a standing position. It is very important to protect your lumbar disc.

If you already have lumbar disc disease, don’t maintain a sitting position for more than half an hour.

Deadlift is one of the worst exercise for patients with lumbar disc disease. If you feel pain on your back, stop that exercise immediately.

Protect the health of your disc with a good posture.

Medical fees in South Korea

How much have you spent to get medical treatment if you were to get sick while traveling Korea?

First, let’s check the national insurance system in South Korea.

When patients pay for medical services at clinics or hospitals, the National Health Insurance Service (NHIS) covers 70% of the deductible services, such as the outpatient medical consultation cost. Patients pay the balance (30%). For non-deductible services, such as MRI, costs are variable depending the clinic or hospital. Most essential examinations and treatments are deductible.

In clinics for primary care, about $13 is the cost for one outpatient. NHIS covers 70% of the $13, so patients who receive benefits from the national insurance system spend only about $4. The deductible services are fixed, due to the control of NHIS. Some non-deductible services are somewhat expensive compared to deductible services. Emergency room visits require additional fees, as emergency room management fees (about $40-50.)


In the cases of foreigners, none of the costs are fixed, so it does not matter whether a service is deductible or nondeductible, because it is not a fixed-price system for them. However, most clinics provide medical services at reasonable prices. E.g. $13-20 for an outpatient medical consultation.

Of course, there are some especially expensive medical services for medical tourists. Because they demand high quality medical services, hospitals prepare specialized medical services. One of the medical check-up services provided from a university hospital costs $10,000.

As compared to private clinics, hospitals require a higher cost for deductible services. (Non-deductible services vary in cost. Nevertheless, the medical fees in South Korea are not expensive at all, compared to other OECD countries. I’ll attach the table of comparisons of medical fees.)

As such, don’t worry if you get sick when you are traveling South Korea. Just knock the door of a private clinic.

VFSS Excel Template. Simplified Checklist

The Videoflurographic swallow study (VFSS) is the standard evaluation tool in dyphagia diagnosis and management. The procedure is performed and interpreted by a speech language pathologist and physician, jointly.



During the VFSS, the patient swallows radiopaque foods. Oral and pharyngeal stages of swallowing physiology are observed. (Esophageal stage can hardly evaluated due to field of radiologic view.)

The purpose of VFSS is
 1. To identify anatomical or functional abnormalities as swallowing
 2. To identify the degree of safe and efficient swallowing

It is not just a 'pass or fail' examination. The examiner should find the proper food consistencies and compensatory swallowing method for patient. (even when a patient aspirates)

The VFSS protocol should include simple evaluation about speech, and swallowing stage with liquid, semi-solid(nectar), and solid food.

After performing VFSS, an examiner should write a report about the result of VFSS. The report should include as following;

Oral phase (drooling, bolus formation, residue in the oral cavity, oral transit time)
Pharyngeal phase (swallowing reflex, velopharyngeal function, laryngeal elevation, etc)
If you write a report with Excel, you can reduce time to write it.

VFSS Excel Template

VFSS is the best instrumental assessment tool, because it allows for observation of the oral, and pharyngeal phases of swallowing. After procedure, physician should interpretate about the procedure, and the interpretation should be recorded.



I'll attach the template i use. It is the format for my convenience, so other people can alter the template for their convenience, I think.

Heterotopic ossification

A patient with complete tetraplegia feels pain on his hip joint.

Before that time, he couldn’t feel any sense below neck area.

What happened? Does the spinal cord recover?

If a patient with spinal cord injury feels sudden pain on his/her hip joint area, we have to consider about heterotopic ossification. Heterotopic ossification (HO) is a common complication occurring after traumatic brain injury, and spinal cord injury. HO has been reported to occur in 20-30% of persons with SCI.

Why does HO occur? It is poorly understood yet. Just we suggest that CNS processes facilitate HO bone formation. Bone remodeling is subject to central control through the sympathetic nervous system. Pluripotential mesenchymal cells in soft tissues differentiate into oeteoblasts and other cell lines involved with bone formation.

Plain radiography or CT scan can be helpful to evaluate HO. However, the definitive diagnostic test is a bone scan. It show HO 7-10 days earlier than a plain x-ray.

If detected, treatment of established HO should begin promptly. It is aimed at halting the ossification process. Intravenous etidronate, 300mg/day, followed by oral etidronate, 20mg/kg/d for 6 months, has been shown to be effective. However, there is no evidence that 6 months of treatment with etidronate is more effective than 3 months. Radiation therapy or surgical resection of HO can be done. Surgical resection is done only to restore joint motion and functional skills.

Pain control is also an important issue. Because, most patients with SCI already take some pain killer, just NSAIDs or acetaminophen are not useful for pain management. One of my patient who has taken Oxycodone twice a day, can relieve his pain after applying Fentanyl patch.

Gentle ROM exercise is also important physical therapy. It prevents restriction of joint ROM. I want to emphasize the word ‘gentle’. Because aggressive ROM exercise can make hematoma or soft tissue injury, so that HO can become aggravated