march 9,2014

Dear everyone,

It’s after 5, and I am at work waiting for a frozen section.  Since I am on call this weekend, and Monday too, I thought I would use some of this time to start a letter.

The big event of my week was traveling to San Diego last Friday for the USCAP (US and Canadian Academy of Pathology http://www.uscap.org/ ).  This is the big annual pathology meeting that most of the academic surgical pathologists go to (how fitting that I did not start going to this until I had left academics).  The CAP meeting (College of American Pathologists), which I have only gone to once, is geared toward the community practitioner a bit more. There are a couple of other large meetings, for instance, there is one for the American Society of Clinical Pathology (for laboratorians) that I have never been to.

USCAP is a bit of a bore for me.  The first couple days of the meeting are short (3 hours) seminars presented by companion societies, for instance, the American Association of Neuropathologists had a very good meeting Saturday evening (see below).  The next three days are poster and platform presentations of current research, mostly performed by residents.  20 years in pathology, and more in biological sciences and I am pretty jaded about what I see.  The last few days are special courses on a variety of organ systems that you need to pay extra to go to.  I am not a big fan of these relatively short courses; if I am going to go somewhere to learn about pathology in an organ system, I would rather take two-three days, and really get an in-depth view.  But USCAP is good for catching up with old Hopkins friends, and also seeing some of the new products by exhibitors.

Anyway, my flight was a bit delayed, but Jeff was still able to easily pick me up at the airport.  Kevin trotter was supposed to fly down from San Francisco later that evening, but his flight was cancelled because of storms along the pacific coast. Selena and baby Soleia had already been in San Diego for several days.

Jeff put me up in the upstairs guest bedroom that had a twin fold out bed. (Kevin, Selena, and Soleia were in the larger guest area downstairs.)  The fold out mattress was exceptionally comfortable.  If you are on the lookout for a fold out couch, you should definitely contact Joan to find out who makes these!

Saturday morning I got up and got my first Uber taxi ride.  Uber (https://www.uber.com/)  is a smart phone car service.  The drivers are just ordinary people who do this as part time work.  They drive their own cars, but are linked up to the Uber network.  Pretty much all you have to do to enroll as a passenger is give Uber your ID and a credit card number.  When you need a ride, you turn on the app, and it tells you who your driver is, what kind of car they have, and how long you will wait.  You don’t need any cash.  You get in the car, tell your driver where to go, and your credit card is automatically charged.  No tip necessary!  Afterwards, you have the opportunity to rate your ride, and the drivers can rate you as well.  If you get a bad rating (for instance, throwing up drunk in the car), you may find that no driver wants to pick you up, and you may wait a long time before you get a ride…Anyway, if anyone is interested in getting the app, tell me, because I have a code that will give you $20 off on your first ride (you need to use the code when you sign up).

I was using Uber to go to the San Diego Aikikai ( http://www.sdaikikai.com/ ).  One of the benefits of travelling by myself is the opportunity to take in some aikido.  The dojo is not in the nicest part of town.  We passed by some thrift shops and some strip clubs.  Another establishment was called the ‘belching beaver’, but apparently, this is a brew-pub.

The dojo was about 20% larger than the one in Chicago, and had lots of black belts, so I got pretty pounded.  In the first class, a couple brought their 18 month old child who was fantastically well behaved.  The last class (of three) we did some weapons work.  I felt pretty sore for several days after – I hope this is not a harbinger of how I will feel after the seminar coming up shortly.

I took Uber back to Jeff’s house, and hung out for the afternoon.  Joan was making a tremendous number of sugar cookies (maybe 10 dozen?) for Ayyam-i-Ha.  Jeff and I took a walk around the expensive homes of Hillcrest and banker’s Hill, as well as a pedestrian suspension bridge over one of the many San Diego canyons.  Jeff also showed their large (by California standards) back yard, with lemon, avocado, loquat and other fruit trees.  There are a lot of homes designated as ‘historic’, which is more than 100 years old.  If you can prove that your house is old and important enough, you can get a big tax break, although you are now restricted from changing the façade of your house.  San Diego is a late comer as a modern city.  Alonzo Horton (http://en.wikipedia.org/wiki/Alonzo_Horton) was an important San Diego booster starting from around 1860, but the city didn’t really become a megalopolis until WWII brought in a lot of naval contracts.

Later, Cora, Ariann and Sasha came over, and we all had a lot of fun decorating cookies.

Some of the cookies

Cora also enjoyed eating them!  Jeff and I went to a Mexican restaurant in the pouring rain (Friday and Saturday were the wettest days in San Diego for several years) to get dinner.  I had a delicious homemade tamale, and a mole enchilada.  After dinner Sasha used his car2go (http://en.wikipedia.org/wiki/Car2Go) membership to drive me to the convention center.  This is car sharing like a zip car, but they have small electric powered cars (seats two adults) that are parked anywhere, not in lots.  You can leave the car anywhere when you are done driving it.  Your smart phone app tells you where the nearest car is when you need one.  You can get credit if you leave the car parked at a charging station.  Pretty convenient and useful if you live somewhere with sufficient population density.

Anyway, Saturday night was spent at the convention center at the AANP companion meeting.  The highlight talk, I thought, was Dan Brat’s discussion of molecular signature of different gliomas.  Dan was a resident with me at Hopkins, and now is a professor at Emory.  In any case, the talk was about how our visual interpretation of tumors is insufficient information, and that you need to use molecular techniques to distinguish between tumors.

Saturday was the last day of Ayyam-i-Ha, and so Sunday was first day of Ala, the month of fasting.  This is similar to Ramadan, in that those who participate need to get up before sun-up to eat and drink, and then can’t do either until sundown.  I was still on Central time, so it wasn’t too hard for me to get up with Jeff and Joan (and Selena and Kevin on Sunday).  We ate some breakfast, and then said a Baha’i prayer, with some discussion afterwards.  Of course, Selena was allowed to eat later as she was nursing Soleia, and later on Cora, Sasha and Ariann came over to open a bunch of Ayyam-i-Ha presents.  Cora opened most of these, which were either presents for her, Soleia, or Ariann’s ‘Baby Goo’.  

Joan got a framed picture of Cora (frame modified by Cora), and Jeff got some kind of big industrial sized juicer.  

We hung out at the house for a while, and then Jeff and I went for a walk to the El Prado museum area (buildings originally put up for the Panama-California exhibition of 1915 http://en.wikipedia.org/wiki/Panama-California_Exposition_(1915) )while Sasha and the girls went to buy fruits and vegetables to try on the juicer.  

The bell tower, the dome of the anthropology museum, and the west gate

A museum

Another museum in the central square

San Diego is 'dog crazy'!

Busty carytids

 Planes fly right past the downtown on landing

We made several different juices:  cucumber-parsley-apple (too green for me),  strawberry-mango-blueberry (you lose too much mango, better to eat it, and the blueberries are too small and bounce out),pineapple-apple (good), and carrot-lime (would be better with more carrot, and maybe some ginger thrown in). I don’t recall dinner that well, other than a special kale dish.  Later I played with Cora in the living room and Jeff watched the Matrix.  Even later, after Joan took the San Franciscans to the airport, we watched an awful Jody Foster movie called “Flight Plan”.  This is an idiotic thriller with tremendous plot holes.  Other than an excuse to see Jody Foster go crazy, I wouldn’t recommend it.

Monday morning Jeff drove me to the convention center, where I sat in on some presentations on breast pathology, and then wondered around the poster area.  I met up with my friend Chris Pillar, now a community pathologist in Charlotte NC (she specializes in blood disorders), and we had lunch in the nearby Gaslamp district (http://en.wikipedia.org/wiki/Gaslamp_district) at a Greek place. In the afternoon I went through more posters, and then a big lecture about the future of Pathology, where we expect to combine the anatomic data with molecular insights.  Afterwards I went to the Hopkins reception where I saw some old friends, and Chris and I went out to a Thai restaurant.

Jeff took me to the Convention center again Tuesday morning.  I sat through some presentations on Gyne pathology, and then wandered through the poster and exhibitor area.  I met up with Chris and Anne Riopel, a community pathologist from Austen TX, and we went to an Indian restaurant.  After this, I went to some presentions on Neuropathology.  The most interesting of these was looking at the autopsy brains of young-ish people who died of non-neurologic causes.  The researchers were also looking at these patient’s apoE phenotypes. ApoE is a protein that is important in shuttling lipid and cholesterol around in your body.  There are four slightly different variants: ApoE1…ApoE4.  Each chromosome has one variant or another, so human beings can be homozygous (e.g. ApoE2 – ApoE2) or heterozygous (e.g. ApoE3-ApoE4) for the expression of this protein.  ApoE2 is protective against Alzheimer’s disease, while being homozygous for ApoE4 puts you at pretty high risk for developing dementia.  Anyway, when they looked at brains of non-demented young people, those who were E2-E2 had very rare plaques and tangles (the stuff we look for to make the diagnosis of dementia), whereas E4-E4 folks had a decent amount.  This could mean several things, but the take of the investigators was that we need to know the serotype of people, and if they have E4, it would be a good idea to start treating them with something before they develop signs of disease.

After this I looked at some more posters, and then went to a big presentation given by Ralph Hruban.  Ralph is the interim chair of Pathology at Hopkins, and is an expert in pancreatic pathology.  He was an assistant professor when I was a resident there.  Guess what – his lecture was about the interface between anatomic findings and molecular/genetic  diagnostic techniques in pancreatic pathology.  This is an area where pathologists are pretty worried about for several reasons.  Clearly, there is a lot of information in the patient’s genes that will help tell us the prognosis of a tumor, as well as how it will respond to drugs.  Also, it is a new field of diagnostic science opening up for clinical use, and pathologists want to be in charge of it instead of other specialties - - for both intellectual and financial reasons!

I took Uber back to Jeff’s, avoiding the Mardi Gras celebration in the Gaslamp district, and Jeff took me back to the airport Wednesday morning for a problem free flight back to Chicago.

Love, H.