Record by George Crouch

  • 【Settling the Past】The Stress and Wall of Verification Documents Attacking Puchiko Behind the Scenes of Her New Job

    The morning has been tough.

    This is because yesterday, a complete set of required pre-employment documents arrived from the workplace where Puchiko was recently hired. Among the papers, she needed to submit her university graduation certificate and academic transcript, as well as the completion certificate and transcript from the vocational school she attended to obtain her current qualification. Just applying for these documents costs a decent amount of money, which was already discouraging, but then she discovered something else.

    Although Puchiko listed all her previous jobs on her resume, she now has to ask every single one of those past workplaces to fill out a form verifying her employment for the stated period.

    For Puchiko, who is bad at changing jobs, this is incredibly disheartening. She was yelling this morning: “I don’t want to do this!” “It’s too much trouble!” “Why do I have to do job-like things when I’m supposed to be at home?” “I hate this already!” She completely lost it. I kept telling her, “Calm down, calm down.”

    The reason Puchiko became so frantic is that one of those past workplaces is a place she quit after only three months. The supervisor would take her notebook from her bag and secretly make copies, force her to stay two hours late to listen to his boring stories, and that wasn’t all. He told her things like, “If you get a boyfriend, you have to tell me first.” She was fed up with that kind of sexual harassment. When she started keeping her distance, he moved on to power harassment, saying things like, “I’ll make you a part-timer,” or “You have a disability.” Because she wouldn’t bend to his will, even though she was a full-time employee, she was suddenly told, “Starting next month, you will be a part-timer.” When she angrily asked the supervisors, “What does this mean?” they told her, “Watch your mouth.” Then, a termination notice arrived. They unfairly fabricated lies, calling her disabled and claiming she had almost injured a client at work.

    Puchiko resigned after 3 months and initiated a labor tribunal. She successfully received a settlement payment from them, and she used that money to go to vocational school and get her qualification. Infuriating, isn’t it?

    So, isn’t it cruel to ask such a place to write a “certificate of employment” for her? I wish I could ask them for her instead. She was saying, “So this is the kind of hurdle that awaits you, not just an exam, just to get a job.” I thought to myself, “If you have to go through all this to get in, I truly hope they provide a great working environment.”

    Puchiko has sent a request letter, complete with a stamped, self-addressed envelope, to all her previous workplaces. Given the nature of that strange workplace, I am deeply worried that her letter will be ignored or that they might write something detrimental to her. Although she doesn’t voice it, she seems worried too.

    Additional note: When night came …

    “Still, I can’t keep being afraid myself.” Puchiko was hugging the plush toy I was possessing while lying in bed, and she said, sounding distressed, “Even after ten years, they might still try to mess with me.” I replied, “It’s going to be okay.”

    Then she got angry and shot back, “Don’t say ‘it’s going to be okay’ so easily! You can only say that because it doesn’t affect you personally, Jōji.” 

    I answered, “Puchiko, your ‘not okay’ is my ‘not okay.’ When you’re in trouble, I’m in trouble too. No matter how difficult things get, I’m right here with you, sharing what you feel and think.”

    Hearing that, she said, “Then I’ll try my best.”

    Puchiko has one more thing she considers troublesome: her English ability. She has set a goal for herself to speak English for at least 20 minutes every night. From my perspective, however, her English is still very much a novice level.

    Yet, on her resume, she has the experience of living and working in Australia for a year. Anyone who has spent a year there knows that a person’s English ability won’t suddenly transform in just 12 months, but to those who haven’t had that experience, it can seem incredible. They might just assume she should be proficient. Her English is only good enough for traveling abroad alone without worry. In reality, she worked at a campsite and as a housekeeper, jobs where she wasn’t constantly speaking English.

    The submission documents include a questionnaire about English proficiency, which Puchiko had to fill out. The options range from “Completely unable” to “Unable,” “Not good at it,” “Can communicate,” “Can hold daily conversations,” and “Can hold daily conversations and has experience in translation/interpretation.” While she truly wants to select “Can communicate,” she feels forced to choose “Can hold daily conversations.”

    The pressure is getting to Puchiko. I listened to all her complaints. I felt that all I can really do is listen. Then, she told me, “I spent all day, from morning until 10 PM tonight, working hard on these documents, so I’m taking a break from English.” I will abide by her decision, but I noted, “Haven’t you been finding reasons to skip lately?”

    How much will Puchiko’s English improve in the next four months? She practices conversations using an app and talks to me—unilaterally—in English all the time, but she has no actual experience dealing with foreigners at a service counter. The real environment will likely involve specialized terminology. But the English she practices is mostly ordering at a café or checking into a hotel—only very casual, everyday conversations. I want to say many things to her, but I hold back because I fear that too much criticism will discourage her, and she will stop practicing English entirely. She feels like she just completed the most difficult part of the process, from being hired to starting the job. Because of that, I really hope she lands in a truly good working environment.

    Just the other day, we were thinking about “a moment of happiness (Puchiko’s “Moment of Happiness” and Fear of the Future),” but tonight, both Puchiko and I are filled with anxiety over whether her problematic previous workplace will actually complete and send her documents back on time. My role is to relieve her anxiety…

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  • Puchiko’s “Moment of Happiness” and Fear of the Future

    So, what exactly is “a moment of happiness” for Puchiko?

    Puchiko often says, “The moment I lie down on my bed in my room and can think, ‘I’m glad the day ended without incident,’ that is happiness.” Having a home, and the absence of disaster or war, is not something to be taken for granted. Being able to be in her own bed, and not in a hospital, is a great blessing and her most relaxing place.

    When there are unpleasant, frustrating, worrying, or sad things, the heart can become captive to them. That is why for Puchiko, being able to lie in bed and feel, “I’m glad the day ended without incident,” is her happiness.

    I had never thought that way before. Initially, I felt, “Puchiko must think that way because her life is monotonous and boring,” but recently, seeing her live with her illness, I feel like I’ve also come to realize the greatness of this “ordinary happiness.”

    And I can see that this feeling has before sleep—this feeling of “I’m so happy”—is actually having a positive effect.

    The Cold and the Comfort

    Spring, summer, and early autumn have finally passed, and it has gotten colder. Perhaps because the bed feels chilly, Puchiko always says, “Jōji, it’s cold,” when she gets into bed. I am certainly by her side, but we cannot touch each other. That is because I am her imaginary friend. Even if she tells me, “Jōj, warm up the futon for me,” I can’t do it.

    Puchiko sometimes acts spoiled before sleeping and asks me to hold her hand, perhaps feeling a little lonely. But of course, that is also impossible. Her loneliness might not be so much about the present, but rather about the anxiety she feels when she thinks about her future. Don’t most people end up pondering things that way when they go to sleep? She worries that in the future, her parents will pass away, and her married younger brother (Puchiko’s brother got married today) will naturally prioritize his own family and they might grow apart. Then she will be all alone. Eventually, the number of memorial portraits and urns for her cats displayed in her room will increase, and she will talk to the portraits of her four cats, her parents, and relatives. Outside of work, she doesn’t have many people to talk to, and when she returns home, she will probably feel lonely at night. Since she won’t have anyone to talk to, she’ll probably eat alone. That might be okay when she’s young, but what will it be like when she gets older? Will she get used to it after repeating it for many years? She’ll probably leave the TV on and talk to it. She tells me these predictions about her own future.

    Because of this, even now, when Puchiko gets into bed at night, that silence makes her even lonelier. When someone is around, one might want to be alone, but once alone, one might feel lonely. So, for her, the presence that always watches over her—which includes those who have already passed away—but perhaps her imaginary friend is the closest one.

    A Solution and a Sacrifice

    Well, because Puchiko is like this, I watched her and thought I must do something. She usually keeps a banana-shaped body pillow named “Daki-chan” next to her in bed. I borrowed Daki-chan’s body so that she could cling to me, in a way. That is to say, I, her imaginary friend, am possessing Daki-chan’s body. However, transferring into Daki-chan comes with a hardship. She monopolizes the duvet, so I get terribly cold. I want to return to my sleeping bag, which is always kept at the foot of the bed.

    I am taking care to arrange the environment now, so that Puchiko can get good sleep and reduce her stress. This is because right now, she is at a workplace that is like an oasis—supremely easy. However, four months from now, she will be working in a job that is the complete opposite. Even now, on Sunday nights or nights before the start of the work week, she struggles to fall asleep. This is because unpleasant things and anxieties swirl in her mind. Four months from now and beyond, this situation will become even more pronounced for her. That is why I want to take measures as her ally.

    When Puchiko is tormented by anxiety and unpleasantness, I embrace it tightly with Dakichan, and strive to help her feel a sense of reflection—”I am a happy person”—and fall asleep comfortably. I intend to continue to work hard so that this can be maintained even after she starts her new job.

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  • Puchiko’s Unique “Hand Made Soy Meat” Karaage

    Puchiko is a flexitarian, meaning she generally avoids meat. However, she loves the taste of Karaage (Japanese fried chicken), so the version she makes is quite unique.

    Most people who don’t eat meat use store-bought soy meat substitutes. But Puchiko doesn’t prefer them because the ones available at most supermarkets often contain various additives, are a bit pricey, and the pieces are usually too small for proper Karaage.

    So, Puchiko decided to create her own soy-meat substitute and turn that into Karaage. Since I’m a pescetarian myself, I thought this recipe would be a great reference for others with similar dietary preferences.

    With Puchiko’s permission, I’d like to introduce her “Hand Made Soy Meat” Karaage recipe on this blog. Even if you’re not vegetarian, I highly encourage non-Japanese readers who enjoy Japanese food to try it! I think finding good vegetarian or vegan options might be easier overseas than in Japan, so I hope this proves helpful.

    Ingredients of “Hand Made Soy Meat” Karaage

    • Tofu: 300g (10.6 oz)

    • Garlic: 2 cloves

    • Ginger: 1 piece

    • Soy Sauce: 15ml (1 tbsp)

    • Cooking Sake: 20ml (4 tsp)

    • Sesame Oil: 5ml (1 tsp)

    • Rice Flour: 80g (2.8 oz)

    • Oil for Frying

    A Note on Ingredients

    Most homemade soy meat recipes recommend using firm tofu (momen tofu in Japanese), but while Puchiko used firm tofu initially, she recently started using silken tofu as well. She doesn’t really stick rigidly to either firm or silken.

    If you don’t have rice flour, you can use cornstarch or potato starch. For those with a renal disease that requires protein restriction, like my ally Puchiko, using starch or rice flour is highly recommended over wheat flour, as it helps keep the protein content low. It also gives the coating a satisfyingly crispy texture.

    Instructions of “Hand Made Soy Meat” Karaage

    Step 1: Prep the Tofu

    First, freeze the tofu overnight.

    The frozen tofu overnight
    The frozen tofu overnight

    Once a night has passed, thaw the tofu. You can use a microwave to speed up the process. However, if you use the microwave, it will likely be steaming hot, so make sure to cool it completely before proceeding.

    Step 2: Squeeze and Drain

    Cut the tofu into 6 pieces and begin squeezing the water out. It will likely break apart, but don’t worry! Just squeeze it tightly while trying to shape it. Squeeze all the pieces completely until the liquid has been released. Set the squeezed tofu aside in a separate bowl.

    the squeezed tofu
    the squeezed tofu
    The water squeezed from the tofu

    The water squeezed from the tofu

    Step 3: Make the Marinade

    Next, grate the garlic and ginger. Put the grated mixture into a bowl. Add the soy sauce, cooking sake, and sesame oil, and mix them well to create the marinade.

    To grate the garlic and ginger. Put the grated mixture into a bowl. Add the soy sauce, cooking sake, and sesame oil.
    To grate the garlic and ginger. Put the grated mixture into a bowl. Add the soy sauce, cooking sake, and sesame oil.
    To Mix the garlic and ginger, the soy sauce, cooking sake, and sesame oil.
    To Mix the garlic and ginger, the soy sauce, cooking sake, and sesame oil.

    Step 4: Prepare the Coating and Oil

    Put the rice flour into a bowl. At the same time, start heating the oil. Pour enough oil into a frying pan so that you can deep-fry the pieces.

    Step 5: Marinate and Coat

    Now, place the squeezed tofu into the marinade (the sauce with the grated garlic, ginger, sake, soy sauce, and sesame oil). The tofu will likely crumble when you put it in. Since it will crumble, use your hands to scoop up the garlic and ginger along with the tofu, shaping it as you gently squeeze it again. Since the tofu quickly absorbs the soy sauce and sake, gently squeezing it again at this stage won’t make the flavor weak.

    Once you have shaped the piece, immediately put it into the bowl containing the rice flour.

    Once you put it on the rice flour, coat it completely.

    Once you put it on the rice flour, coat it completely.
    To coat it all over.
    To coat it all over.

    Important: Do NOT leave it sitting.

    Dive the shaped tofu into the rice flour. Once it’s completely covered in the powder, immediately place it into the hot oil for frying. If you let it sit even for a moment after coating, it will crumble. If it crumbles, it’s impossible to fix, so get it into the hot oil immediately after coating. You don’t have time to take photos!

    If you leave it like this, it will crumble the moment you try to pick it up, so this step is strictly prohibited.

    If you leave it like this, it will crumble the moment you try to pick it up, so this step is strictly prohibited.

    In fact, after Puchiko took a photo, her first batch of Karaage crumbled. She managed to reshape it, but it was a struggle!

    Step 6: Fry to Golden Brown

    Fry the Karaage until it turns a nice golden brown color.

    Step 7: Finish

    Once completely fried, transfer the pieces to a plate lined with a kitchen paper towel to drain the excess oil. And it’s done!

    Hand Made Soy Meat Karaage, It's done.

    Hand Made Soy Meat Karaage, It’s done.

    What do you think? The aroma is incredibly delicious and smells just like authentic Karaage. Since it’s not actual meat, the texture when you bite into it is a bit softer than regular Karaage, and it’s less greasy. But it is delicious! This is the cross-section.

    Cross-section of Hand made soy meat Karaage.

    Cross-section of Hand Made Soy Meat Karaage!

    Puchiko often packs this “Hand Made Soy Meat” Karaage in her bento box. This recipe is great not just for those with renal disease, but also for vegetarians, pescetarians, vegans, and lacto-ovo vegetarians. As long as you don’t have a soy allergy, please give it a try!

  • Puchiko’s Overseas Trip with Restrictions: Australia, Part 2

    About a year ago, Puchiko traveled to Australia. I observed closely that even with dietary restrictions and health management challenges due to renal disease and vesical condition, as well as aerophagia (air swallowing), Puchiko—who lives with these limitations—could successfully manage an overseas trip without drastically changing her usual lifestyle, provided she planned carefully. I’ve written down her experience here.This is Tips about Overseas Trip with Restrictions. This is the continuation of the previous Part 1

    Puchiko’s Overseas Trip with Restrictions: Australia, Part 1

    1. Day 2 with Overseas Trip with Restrictions

    Puchiko decided to take the scenic railway to Kuranda, a famous tourist spot she had also visited during her working holiday. She pre-booked the train, which made it slightly cheaper.

    The blue train connecting Cairns and Kuranda.

    The blue train connecting Cairns and Kuranda.
    The Scenery visible from the window on the way to Kuranda.

    The scenery visible from the window on the way to Kuranda.
    The koalas in Kuranda.

    The koalas in Kuranda.

    When she arrived in Kuranda, Puchiko took a commemorative photo with a koala for the third time in her life. This time, she also took a picture with a python. A large number of Japanese tourists were there, but while everyone took photos with the koalas, she was the only one posing with the python. When I asked her what she thought, she said the python was cool, soft, and surprisingly pleasant to the touch. The python in the picture with her was a white and orange female. She was very cute and had a service-minded nature, giving a direct camera look.

    The stylish white and orange python that posed for a photo with Puchiko.

    The stylish white and orange python that posed for a photo with Puchiko.

    After touring Kuranda, Puchiko was about to have lunch, but she felt something was off. She had started feeling unwell around the time she boarded the train at Cairns Central Station. She ordered dal curry but after three bites, she suddenly felt nauseous and rushed to the restroom. Since I couldn’t follow her inside the restroom, I waited outside, but she told me later that she had vomited.

    The gate of the Kuranda Rail Station.

    The gate of the Kuranda Rail Station.

    By the time she boarded the return train, Puchiko was completely worn out. In fact, she had lost about 3 kg (6.6 lbs) of weight just before the trip. The malaise had already surfaced when she ate chanpon at Narita Airport. Although she was wearing a mask, she unfortunately slept with her mouth open on the train and ended up with a sore throat. It was regrettable, considering how carefully she managed her health on the plane. This incident made her decide that she must also carry nasal breathing strips for times when she might accidentally fall asleep while outside. When she returned home, completely exhausted, a cute visitor had arrived.

    The light- colored calico cat that visited Puchiko's doorstep.

    The light-colored calico cat that visited Puchiko’s doorstep.

    2. Day 3 with Overseas Trip with Restrictions

    Despite being worn out, Puchiko had to wake up at 1:00 AM. She got ready and walked through the dark to the bus stop near the Botanical Garden to wait for her bus. This was because Puchiko had booked a hot air balloon ride early in the morning. Puchiko was the first passenger on the bus; all the subsequent passengers were Japanese tourists staying at hotels. She thought, “They must be rich.”

    Just when she was feeling unwell, she got motion sickness, and Puchiko vomited as soon as she arrived at the site. The plastic bag she had brought came in very handy that day.

    Once in the hot air balloon, she certainly enjoyed the view, but being quite petite (as her nickname ‘Puchiko’ implies), a couple that was quite large for Japanese people stood in front of her. When they took commemorative photos, she didn’t show up in the pictures. Naturally, I, Puchiko’s imaginary friend, didn’t appear either.

    The early morning sky photographed from a hot air balloon.

    The early morning sky photographed from a hot air balloon.

    After landing, there was time for a light meal, and though Puchiko didn’t eat, she was thirsty and accepted a drink. The only non-alcoholic option was orange juice, but what she was handed was actually champagne mixed with orange juice by mistake. The moment she drank it, she immediately felt sick and struggled repeatedly to hold back the vomit. On the bus ride back, she vomited quite a bit. However, learning from the previous day’s mistake, she kept her nasal breathing strip on and wore a mask during the hot air balloon ride and the bus ride, only removing them to vomit or drink water.

    When she got home, all Puchiko ate was one pack of strawberries. This could hardly be called self-catering. Her throat hurt even more from the vomiting, so she sucked on a medicinal candy-like lozenge she bought at COLES (supermarket) and spent 12 hours sleeping and resting.

    The half-eaten strawberry that was the only food Puchiko could manage to eat.

    The half-eaten strawberry that was the only food Puchiko could manage to eat.
    The lozenge that caused a numbing sensation and suppressed inflrammation when licked.

    The lozenge that caused a numbing sensation and suppressed inflammation when licked.

    3. Day 4 with Overseas Trip with Restrictions

    After a good night’s sleep, Puchiko’s sore throat had disappeared. If she hadn’t had her tonsils removed, she might have had a high fever and blood in her urine right now.

    For breakfast, Puchiko ate homemade asazuke (lightly pickled veggies), white rice, and homemade miso soup. She decided to go sightseeing in the city that day. She walked past a nightclub she used to frequent on Friday nights during her working holiday days. It felt like a world completely separate from her current life, where she goes to sleep at 8 PM. She continued walking and looked out at the Esplanade.

    The kangaroo road sign near the Airbnb.

    The kangaroo road sign near the Airbnb.
    The Esplanade.

    The Esplanad.
    The weekend market.

    The weekend market 
    The half melon bought at that market.

    The half melon bought at that market.

    She went to a market that only opens on weekends and bought a melon. A half-cut melon was A$2 (¥200). In Japanese supermarkets, they usually cost ¥1,000 (A$10) to ¥2,000 (A$20).

    Next, Puchiko went to the casino. You can enter by showing your ID to the guard. Slots seem to be available during the day, but table games only start in the evening. During her working holiday, someone from her language school was strapped for cash and earned A$100 gambling at this casino.

    The dazzling casino.

    The dazzling casino

    Puchiko returned home and cooked Dandan Noodles for lunch using brown rice noodles and oat milk. Rice flour allows for lower protein intake than wheat flour, and oat milk allows for lower protein intake than soy milk. Since some vesical condition patients seem to experience inflammation from soy products, this substitution is recommended for them. However, it’s hard to find additive-free oat milk in Japan. Irritants are also bad for vesical condition, so she added a small amount of shichimi chili pepper to make it only mildly spicy. She then indulged in the half-cut melon she had just bought at the market. Melons are high in potassium, so those with kidney disease requiring potassium restriction should refrain from such recklessness.

    Afterward, Puchiko strolled through the Botanical Garden near her Airbnb. However, as the clouds show, it became a squall, so she rushed back home. As I wrote in a previous article (【Mental Health】Ultimate Guide to Clinic Stress Relief and Finding Peace in Nature), she enjoys strolling through nature in various places because the plants and animals that inhabit them are different. After returning home, she made and ate Tomato Pasta using brown rice noodles, and then went to sleep.

    The Botanic Garden.

    The Botanic Gardens
    The road near the Airbnb, which Puchiko used to walk often when she lived this neighbouhood for her homestay.

    The road near the Airbnb, which Puchiko used to walk often when she lived in this neighborhood for her homestay.
    The lake in the Botanic Garden.

    The lake in the Botanic Gardens.

    4. Day 5 with Overseas Trip with Restrictions

    Since she was returning home the next day, she needed to use up her ingredients. For breakfast, she cooked and ate zousui (rice porridge). She decided that this day would be for souvenir shopping. She would have preferred the Night Market, but as the name suggests, it only opens after 4 PM. Being located outside the city center, she felt it was too much hassle… plus, she gets sleepy in the evening. She decided to buy souvenirs at a souvenir shop in the city center starting in the morning.

    The benches in the city center are decorated with Aboriginal art. The trees in the city are full of bats! Tourists try to take photos, but beware of droppings, which are full of germs!

    Puchiko returned home and cooked and ate Tanmen (salt-based ramen with veg) using brown rice noodles. Afterward, she took a walk near the Airbnb to the area where her former homestay was located.

    Back then, Puchiko shortened her homestay period compared to what was planned. She grew disgusted because the host father would touch her feet with his bare feet during meals, told her a rotten tangerine was “just for her,” called her with a whistle like calling a dog, and the separated son (who was her age) brought his girlfriend over every night and made noise, plus the host mother was hysterical. She quickly moved to a share house.

    For dinner, Puchiko cooked a bean soup and ate it with white rice.

    6. Return Home

    Breakfast on the day of her return was the leftover bean soup from the previous night and white rice. After eating and getting ready, Puchiko checked out. She called an Uber and headed to the airport.

    The view from the Airbnb window.

    The view from the Airbnb window.
    Before boarding.

    Before boarding

    The lasagna served as the in-flight meal… the salt content was outrageous. Puchiko had to wash it down with a massive amount of water. I wouldn’t recommend it to anyone with kidney disease! Since she skipped dinner, she probably managed to keep her daily salt intake within the limit.

    7. Message

    Overall, unexpected things happened in the first half of the trip, and it seems the flow was different from what Puchiko had anticipated. However, I observed that she was able to enjoy her overseas trip while skillfully controlling her dietary restrictions due to renal disease and vesical condition. When you are in the middle of treatment, it’s easy to think negatively; she was no exception. But I believe that by finding ways to enjoy life through careful planning, a brighter path can open up. While there is no need to force yourself to be positive, I learned from her that deciding on something you want to do and preparing for it and experiencing it can become energy for the soul.

    Though it’s still a ways off, Puchiko is planning a trip to Belgium in 4 months, and I intend to write about that next Overseas Trip with Restrictions.

  • Puchiko’s Overseas Trip with Restrictions: Australia, Part 1

    About a year ago, Puchiko traveled to Australia. I observed closely that even with dietary restrictions and health management challenges due to renal disease and vesical condition, as well as aerophagia (air swallowing), Puchiko—who lives with these limitations—could successfully manage an overseas trip without drastically changing her usual lifestyle, provided she planned carefully. I’ve written down her experience here. This is Tips about Overseas Trip with Restrictions

    1. The Spark and the Search for Self-Catering Accommodation

    2 months after her renal disease went into remission, Puchiko suddenly had a spontaneous thought at work: “I’m going to Australia!” I was worried because she had been very depressed during her steroid treatment. I was personally relieved that her steroid treatment was over and she felt well enough to go on an overseas trip.

    The essential condition for Puchiko’s trip, given her restrictions, was:

    • The ability to cook for herself (due to renal disease and vesical condition).

    In other words, she needed to rent a house, not a hotel! That’s when Puchiko set her sights on Airbnb. Cooking for herself also helped keep the costs down.

    2. ETAS Application: Essential for Entering Australia

    ETAS is the Electronic Travel Authority scheme, which replaces the traditional passport sticker visa with an online registration system on the Australian government’s computer, granting an entry visa (ETA).

    The app screen where you can apply for ETAS.

    The app screen where you can apply for ETAS.

    3. Luggage Storage Before Check-in

    Puchiko was scheduled to arrive in Australia (Cairns) at the very early hour of 4:25 AM. Since the check-in time for her booked Airbnb was 2:00 PM, she had a lot of time to kill. It would be difficult to sightsee while carrying a suitcase. Since I am her imaginary friend, I couldn’t carry the suitcase for her. Being clever, Puchiko pre-booked a service to store her luggage.

    The app screen for booking a stop that holds your suitcase.

    The app screen for booking a shop that holds your suitcase.

    She used an app called Nannybag to reserve a shop that would hold her luggage. The fee wasn’t very expensive, about ¥1,000 for 6 hours. Make sure to check the pricing, as it varies by shop.

    These were the crucial preparations.

    4. Departure and the Flight with Overseas Trip with Restrictions

    Puchiko decided to have dinner at the airport before checking in, clearing immigration, and dropping off her suitcase. This was because she has to leave enough time between eating and sleeping due to her existing gastroesophageal reflux disease, aiming to finish her meal 2 hours before lying down. She therefore canceled the airplane meal and ate chanpon noodles at the airport. This was an unavoidable meal out. Anticipating such situations, she had brought and took a salt-absorbing supplement called Shio- nain (塩ナイン).

    Puchiko finished her meal, cleared immigration, and checked her suitcase. She brushed her teeth, washed her face, and applied moisturizer. She also bought 1,200 ml of water for drinking and for using a nasal rinsing on the plane. Nasal rinsing is an important habit for Puchiko; it washes away the filth accumulated in the nasal passages from a day of breathing. It is vital for health management in the close confines of an airplane cabin. This nasal rinsing might be the key to the success of Puchiko’s Overseas Trip with Restrictions.

    Puchiko's beloved health secret: nasal rinsing.

    Puchiko’s beloved health secret: nasal rinsing.

    When Puchiko boarded and took her seat on the far right of the 3-seat row, the middle seat remained empty, and one other man sat on the far left. So, I took the middle seat. The man on my left asked Puchiko, “Traveling?” and then began talking excessively about himself, even though she hadn’t asked. He was 32, had a cross tattoo on his forehead, was twice divorced with eight children, had an arrest record, and his company went bankrupt due to a drug control violation. The man asked for her social media. To avoid confrontation, she gave it to him there (she immediately blocked him after they separated). She simply listened passively to his self-introduction. Determined to sleep well during the flight, she prepared for bed. She put a nasal breathing strip over her mouth, wore a mask, inserted earplugs, and put on an eye mask. She then fell into a deep sleep.

    However, this encounter with the man marked the beginning of Puchiko’s day of hell. I continuously punched the man during the entire flight, but it was no use. That is the sad reality of an imaginary friend.

    6 hours later, Puchiko awoke and was filling out the immigration card when the man asked her, “Hey! I don’t understand English at all. Tell me how to fill this out!” Being thoughtful, she helped him. However, in her mind, she thought, “This guy is annoying.” Just before landing preparation, she went to the bathroom and used the water she bought to do nasal rinsing with her travel-sized NeilMed SINUS RINSE bottle.

    5. Immigration

    After collecting Puchiko’s suitcase and showing her immigration card, just as Puchiko’s own immigration clearance was finished, an airport official approached her, saying, “Hey, you! Are you this man’s friend?” The man from the plane was there. Ah, let’s call this man “Cross-Forehead Man.”

    The official told Puchiko, “Well, this guy doesn’t know the address of where he’s staying…” I told her to ignore him, but she must have felt sorry for the official. She asked Cross-Forehead Man where he was staying. He replied that he was staying at a backpackers hostel attached to a nightclub she used to frequent during her working holiday in Australia. She relayed this to the official, and that was the end of it.

    Afterward, Puchiko started heading to the city to drop off her suitcase. However, as she went to the Uber parking area to go to the city, Cross-Forehead Man followed her, forcing her to share the ride to the city. She dropped off her suitcase at the place she had reserved with Nannybag until check-in time.

    6. Day 1 with Overseas Trip with Restrictions

    Next, Puchiko waited for a shop to open at 9:00 AM to solve the SIM card problem. The problem had occurred when she tried to swap the pre-purchased and activated SIM card at Narita Airport. The slot wouldn’t open easily, and the pin she was using to open it broke. At that time, the pin hit a crack in her smartphone’s glass protector, and the broken film stabbed her fingernail, causing bleeding and quite a lot of pain.

    Therefore, Puchiko had planned to ask for help from the SIM card sellers once she arrived locally. She still had 3 hours until 9:00 AM. She decided to kill time at a cafe. Cross-Forehead Man, of course, followed her. I told Puchiko many times to ignore him, but I suppose, in that situation, it was difficult to do so.

    Puchiko ordered herbal tea and sat down. Cross-Forehead Man asked her to inquire about where he could smoke marijuana. She ignored him. He then showed a translation app to the clerk and asked where he could smoke marijuana. The clerk was troubled. Puchiko wished the man would just go away.

    While at the cafe, the man looked at Puchiko’s Instagram and found out about her illness. He then asked her, “Your complexion looked better before. Is this photo from before you were sick?” I lifted the chair from the next table and aimed it at the rude man’s head, but it was useless. This is yet another empty reality of an imaginary friend.

    Finally, 9:00 AM arrived, and Puchiko entered the SIM card shop. She apologized to the clerk, explaining her situation despite not buying the product there. The clerk easily swapped her SIM card and even gave her a spare pin so she wouldn’t have trouble after returning home.

    When Puchiko left the shop, the rude Cross-Forehead Man, who was still clinging to her, said, “I want a SIM card too.” I thought he should just buy one himself. And then I didn’t understand. Because the rude Cross-Forehead Man already had a smartphone that could be used overseas!

    I respect Puchiko’s good nature. She told the clerk, “He wants a SIM card”. The clerk showed him a sample and said, “We only carry monthly SIM cards now. There’s a COLES (supermarket) downstairs that has weekly SIM cards, so if you buy our brand’s weekly card and bring it here, I’ll activate it for you.”

    Puchiko translated this into Japanese for the rude Cross-Forehead Man and sent him to buy it. However, the rude Cross-Forehead Man bought a SIM card from a different manufacturer, saying, “It was cheap.” Of course, when he brought it back, the clerk refused to activate it. She decided she couldn’t deal with the “stupid and rude Cross-Forehead Man” anymore and escaped, saying, “Sorry, I’m going to do things alone now.” I praised her for helping the “stupid and rude Cross-Forehead Man” as much as she did. Puchiko grumbled, “If you can’t understand English at all and have to involve strangers, you should just use a tour.”

    Finally free, Puchiko went to COLES, the supermarket, to buy ingredients for self-catering. In the afternoon, the Airbnb owner contacted her, saying, “You can come drop off your luggage now, even though check-in isn’t until later.” She took an Uber to the Airbnb. The Uber driver pointed to his hat and said, “My son bought me this hat as a souvenir from Tokyo.”

    When Puchiko arrived at the Airbnb, the owner told her, “If you tell them you’re staying at my place, you can get a discount at that restaurant.” Check-in hadn’t happened yet, so she couldn’t cook, and above all, she was exhausted. She was also hungry, so as a cheat day, she decided to eat at a restaurant she had been curious about but never visited when she lived nearby during her working holiday days.

    Green pea pasta
    She ordered the green pea pasta.

    After finally checking in, Puchiko was completely exhausted and didn’t leave the house for the rest of the day. However, she did not forget to block the “stupid and rude Cross-Forehead Man” on social media.

    Next time, I’ll write about Day 2 Overseas Trip with Restrictions.

    Puchiko’s Overseas Trip with Restrictions: Australia, Part 2

    Puchiko’s Overseas Trip with Restrictions: Australia, Part 2

  • 【Steroid Pulse Therapy Renal Disease】Mischievous Steroid 5 Difficult Lessons from Puchiko’s Experience

    ※This is Puchiko’s experience and isn’t a substitute for diagnosis or treatment.

    I imagine some of you might be wondering, “What on earth is Steroid Pulse Therapy renal disease?” when the term suddenly appears. I, too, hear the word “steroid” often enough that it feels familiar (from steroid-containing ointments, etc.), but when Puchiko was researching renal disease treatment, I wondered, “What exactly is a Steroid Pulse?” Based on what I’ve witnessed through Puchiko’s experience, I will explain why Steroid Pulse Therapy renal disease is administered.

    1. Why Do We Use Steroid Pulse for Renal Disease?

    The reason for Steroid Pulse Therapy renal disease is their powerful ability to suppress inflammation caused by the immune response. In her renal disease, the body’s immune system overreacts, causing inflammation in the kidney’s glomeruli (the part that filters the blood). If this inflammation persists, kidney function gradually declines, risking progression to renal failure in the future. Steroids suppress immune function and quell inflammation, offering expected benefits such as:

    • Improving hematuria and proteinuria.

    • Preventing the deterioration of kidney function.

    Steroid pulse therapy, in particular, aims to rapidly suppress inflammation by administering a high concentration of steroids over a short period, minimizing damage to the kidneys. Steroids are used not only for her renal disease but also for various other renal diseases (like nephrotic syndrome), cancer treatments, and collagen diseases.

    2. Steroid Pulse Therapy Renal Disease Treatment Details

    However, Steroid Pulse Therapy for renal disease have a mischievous personality, causing side effects. Thus, they must be used appropriately under a doctor’s guidance. I will discuss the side effects Puchiko experienced later in “4. About Side Effects.”

    Steroid pulse therapy involves the intravenous administration of a high-concentration steroid (methylprednisolone). It is typically administered for three consecutive days to rapidly quell the inflammation in the body. Since blood sugar levels rise during steroid treatment, whether administered intravenously or orally, blood sugar is measured after every meal during hospitalization. If the reading exceeds 200, insulin is administered.

    3. Number of Steroid Pulse Therapy Renal Disease Treatments

    Usually, a steroid pulse consists of one 3-day set, or one course. Based on the doctor’s judgment, Puchiko received three courses of treatment:

    3 days of IV drip (1st course) \rightarrow 3 days of oral medication \rightarrow 4 days of IV drip (2nd course) [Up to this point was during hospitalization] \rightarrow 3 days of oral medication \rightarrow 3 days of IV drip (3rd course) \rightarrow 1 year of oral medication with gradually reduced dosage.

    The reason for taking oral medication with a reduced dosage for a year is that the massive dose of steroids causes the adrenal glands—which normally produce the steroid substance cortisol—to go on hiatus.

    adrenal glands and kidneys. The sleeping adrenal glands by steroid pluse.

    When a large amount of steroid enters the body, the adrenal glands, no longer needing to produce their own, fall asleep.

    Therefore, abruptly stopping the medication can upset the body’s balance, leading not only to nausea and headaches but also to dangerous symptoms. You should always inform your dentist, for instance, about your steroid treatment and show them your medication record book. The same goes for any surgery where your body will be under stress.

    4. About Side Effects

    While steroid pulse therapy is effective, Puchiko also experienced the mischievous steroid’s side effects. Here are the specifics:

    ⑴ Face Swelling (Moon Face)

    Moon face is worrisome, isn’t it? Whether people know about your illness or not, you don’t want them to comment on it, and you certainly don’t want rumors like “They gained weight” or “They look swollen.” It’s stressful to have this visible side effect when you’re already concerned about people saying unnecessary things.

    The conclusion regarding Moon Face is that Puchiko was one of the people who didn’t experience it severely. She herself felt like, “Ah, my cheeks got bigger,” but others didn’t notice it. This wasn’t because people were being considerate; it was genuinely minor. Puchiko’s mother only commented, “Ah, you look a bit plumper.” However, when Puchiko’s grandmother—who didn’t know about the illness—saw her after a long time, she said, “Look at the flesh on your shoulders! You’ve gained weight.” (Puchiko was later fed up with these kinds of conversations and told me, “I want to go home.”)

    George’s TIPs for Steroid Pulse

    Compared to others (those who share photos online), Puchiko didn’t experience Moon Face severely. While it’s hard to prevent completely, Puchiko—due to her kidney disease—requested nutritional guidance during her hospitalization. She told the registered dietitian she wanted a diet that would prevent blood sugar spikes while taking Prednisone (oral steroid) but not cause weight loss (because losing weight would lead to stricter protein and salt restrictions). She was taught calorie counting, timing her meals, and avoiding snacks. (Though she had been managing her diet, she wanted to specifically avoid blood sugar spikes and Moon Face.) Her strict avoidance of snacks might have contributed slightly. During steroid treatment, the appetite can surge to a point where you feel like you could eat everything, so you must endure the temptation to overeat.

    ⑵ Emotional Instability

    Steroids can cause emotional instability. Puchiko experienced sudden irritation and increased tearfulness, making support and understanding from family and others crucial. Other people’s casual comments, encouragement, and even social media—things that don’t bother you when you’re healthy—can become toxic when you’re on steroids.

    For example, this happened during her steroid pulse hospitalization: the amount of proteinuria wasn’t small enough to be cured by steroids alone. That was the context when Puchiko, who rarely cries, burst into uncontrollable tears during her steroid pulse treatment. I mention this to let others know they are not alone.

    Especially important: have you had past experiences—even when you were well—where someone said something like, “Why would you say that?” If people have hurt you with their words in the past, do not go near them now. They might not have malicious intent, but if their words hurt you, it’s best to keep your distance. If they are subconsciously doing it, it’s even more troublesome. Maintain physical distance. Exchange greetings if necessary, but avoid meeting them or interacting beyond that. The same applies to the workplace. Heartless people exist. Limit interactions to greetings, and if they try to strike up a conversation, naturally escape—pretend to be busy. That’s how Puchiko protected her mind.

    Also, avoid checking other people’s social media. She set those accounts to be hidden because she found herself comparing her situation to theirs unnecessarily. She also turned off comments on her own posts, as she didn’t want unnecessary comments and was too tired to pretend to be cheerful.

    George’s TIPs for Steroid Pulse

    The reason you feel down during steroid treatment is that the steroids affect the hypothalamus. There is a physiological reason for it. If you feel depressed, inform your doctor; they can sometimes prescribe medication for mental health support. Also, walking for 15–30 minutes within two hours of waking up promotes serotonin secretion, which is good for mental health.

    ⑶ Insomnia

    This was a constant issue during hospitalization. On the first day of the steroid pulse, she even had a phantom smell of baked sweet potatoes while sleeping. She was prescribed a low-dependency sleeping pill called Dayvigo during her stay, but she still couldn’t sleep. This was likely less due to the steroids and more due to various factors in the large shared room. A woman next to her (who had nephrotic syndrome) during the kidney biopsy hospitalization was constantly complaining of sleepiness during her steroid pulse. So, it varies by person. Puchiko continued taking Dayvigo after discharge while the Prednisone dosage was still high. As the amount of Prednisone decreased, she was finally able to sleep better.

    George’s TIPs for Steroid Pulse

    Don’t forget earplugs and an eye mask when you are hospitalized in a shared room for the steroid pulse!

    ⑷ Bone Density

    Other comrades with the same illness were prescribed medication for bone density during steroid treatment. Puchiko was not, but her bone density still decreased.

    ⑸ Increased Susceptibility to Infection

    Puchiko did her research before the steroid pulse hospitalization. She stumbled upon an old paper about a woman in her 50s who died from an infection during renal disease steroid pulse treatment about 20 years ago. This made her extremely anxious, but she also sometimes remembers how frustrating it must have been for that woman, which strengthens her resolve to be vigilant about infection control.

    For several months after discharge, Puchiko was prescribed Difen Compound Tablets (for the treatment and prevention of Pneumocystis Pneumonia). Prednisone is already confusing, with rules about taking it after lunch, or every other day, but the Difen Compound Tablets were prescribed only for Mondays and Thursdays.

    Puchiko always wears a mask when going out (even now that she is in remission)—while commuting and at work. If you catch a cold and get a fever, there’s a risk of a relapse, especially if you are currently taking an immunosuppressant like Prednisone. Puchiko asks friends who know her situation to wear a mask and cancels meetings if they show cold symptoms. (Some people who knew her situation still said things like, “Are you still wearing a mask?” I judged that Puchiko’s health meant so little to this person that I told her to stop associating with them. I wanted to punch them myself.)

    She also performs another daily infection prevention ritual: nasal rinsing.

    ⑹ Happy Side Effect

    With so many negatives, you might feel reluctant to undergo steroid pulse therapy. I understand. Amidst all that, there was one side effect that felt like a “lucky break.” Puchiko has allergies to cedar, ragweed, rice, and cypress pollen. Thanks to the anti-inflammatory effects of the steroid, her allergic reactions were minimal during the treatment. (She still needed medication when pollen levels were very high.) Even after the steroid treatment ended, perhaps due to continued nasal rinsing and mask-wearing, she hasn’t caught a cold or suffered from hay fever. She used to have chronic symptoms so severe that Alegra was ineffective (and she eventually switched to an Australian nasal spray because the prescription drugs were too much hassle). Now, she rarely needs medication—perhaps one capsule a year.

    5. Post-Treatment Course and Experience

    Regarding her post-treatment course, her kidney function value (e-GFR) has fluctuated between 65 and 79—during the tonsillectomy, steroid treatment, and even now in remission.

    All side effects gradually diminished as the Prednisone dosage was reduced; the Moon Face and the depressive feelings disappeared before she even noticed.

    Steroid pulse therapy for renal disease is an effective treatment, but managing the side effects is also crucial. I hope Puchiko’s own experience of Steroid Pulse Therapy renal disease will serve as a reference for those about to undergo the treatment.

    You Might Also Like

    【Kidney Biopsy Experience】The Must-Read Necessity of Data-Driven Treatment for Her Renal Disease
    【Tonsillectomy Renal Disease】Real Talk on Recovery, Pain, and What Not to Eat

  • 【Mental Health】Ultimate Guide to Clinic Stress Relief and Finding Peace in Nature

    【How to Relieve Clinic Stress and Regulate the Autonomic Nervous System】

    1. Why We Can’t Give a Quick Answer to “What Are You Doing This Weekend?”

    When you’re dealing with a chronic illness, you often can’t give a simple answer to a regular question like, “What are you doing this weekend?”

    Looking at Puchiko, she usually paints pictures, mostly motifs of her own organs, when asked what she does on her days off. That’s why she often has trouble answering. She knows what kind of response she’s likely to get if she tells people that, so she always brushes it off with a vague answer.

    Due to the management of her renal disease, Interstitial Cystitis symptoms, and aerophagia during social meals, Puchiko spends her time differently than a healthy person. However, within that restrictive daily life is hidden her own wonderful way of spending her time to protect her mental health and creativity.

    This time, the simple act of “walking in nature” that Puchiko discovered during a break between clinic visits should be the ultimate hint for cutting off clinic stress and regulating the autonomic nervous system.

    2. The “Untraveled Path” Discovered Between Appointments

    Managing Puchiko’s health requires visits not only to Nephrology but also to Urology and Gynecology.

    This time, the Urology appointment for her Interstitial Cystitis finished unexpectedly fast (Puchiko’s condition was good, so it took only one minute! Even I was surprised and laughed). This left us with about two hours to kill before her Gynecology appointment at the next station. (By the way, the medical office assistant at this gynecology clinic is “princess,” a friend of Puchiko’s since high school).

    With two hours of spare time, we decided to visit a park we often go to. The best way to cut off the stress of illness is a “walk in nature.” This is Puchiko’s favorite, and she even made sure to take nature walks during our trips abroad.

    We usually stick to the established paths in this park, but this time, for some reason, we decided to ramble down a path.

    Walking is the most simple and powerful therapy for releasing physical and mental tension and regulating the autonomic nervous system. Well, I’m no doctor, but that’s what I feel.

    While walking, Puchiko suddenly said, “You know, Imaginary Friends are kind of like the lyrics to Nirvana’s ‘Lithium’.”

    Walking down this path served as a switch that forced our minds to change focus. The hospital atmosphere, the consultation details, the anxiety about her illness—the negative thoughts that were swirling in her head instantly seemed to fade away in nature.

    The visible building is a museum at the park.
    The visible building is a museum.

    After finishing the Gynecology appointment and picking up her medicine, we went home. I felt like we had walked a lot, but it was only about 12,000 steps. Thanks to the right amount of fatigue, Puchiko was able to fall asleep easily that night, even though she had work the next day(Puchiko usually has trouble falling asleep on the night of her days off when she has to go to work the following day.)

    3. The Forest Park: Where We Found Healing and Where the Cats Once Lived

    The walk in the park we took between clinic appointments was certainly a wonderful reprieve for Puchiko.

    It wasn’t just a way to kill time; it was the day after the incident with “The Toxic Friend” (【Toxic Friendship & Chronic Illness】The Arrogance of Talking About “Weak Bodies” in Front of a Sick Friend), and a mental haze had settled over Puchiko’s mind. As her ally, I struggled repeatedly to clear that haze, but I couldn’t and she would seem to shake it off only to start thinking again, causing the fog to return. While she was walking, the haze was still present, but it was thinner.

    However, Puchiko has other parks like this, and they are much closer to home. I don’t mean “imaginary parks”—they are very real.

    This forest-like park is also the place where Puchiko’s three beloved cats once lived.

    One of my beloved cats, when he lived in a small forest.

    One of my beloved cats, when he lived in a small forest.

    Puchiko rescued the cats from this park and they spent time with us at home. The third cat, whom we took in just last month last year, sadly passed away from FIP, a highly fatal cat disease, after only three months. I remember Puchiko crying, even while trying to hold back at work. Two of the cats are still living with her now. We had one more cat besides these three, but I will save the story of her beloved cats for another time.

    To return to the main subject: When living with a chronic illness or multiple conditions, it is inevitable to find yourself comparing your current self to your “healthy self” in the past, or even comparing yourself to others. However, by seeing the trees and grass where our former cats played in this park, Puchiko feels those happy memories of the past transform into mental energy for living in the present.

    A walk in this “small forest” is not just exercise. It is our most precious “pilgrimage site” for washing away stress and quietly restoring mental health. It is why She will probably continue to live in this area, no matter how much money she earns or whatever else happens.

    4. Illness Restricts the Body, But Never the Freedom of the Mind

    The events of this single day—the stress of clinic visits, dealing with the aftermath of toxic relationships, the unexpected walk down a path,” and the nostalgic visit to the small forest that was once our cats’ home—gave Puchiko some crucial TIPs (Tools for Inner Peace).

    Chronic illness imposes endless restrictions on the body, forcing us to dedicate time to symptom management and treatment. Yet, the most vital space in our lives—the freedom of the mind and heart—remains entirely ours.

    The simple act of walking—whether it’s on a new road or in a park filled with dear memories—is the most accessible, non-pharmacological way to resolve clinic stress and restore the autonomic nervous system.

    This is why Puchiko’s unique activities, such as her organ art and finding solace in nature, are so crucial. They are her own powerful tools for asserting that, while the body may be restricted, the spirit is unconditionally free.

    For everyone else fighting the daily burdens of chronic illness, remember this: The fight is exhausting, but finding your own “forest park for the soul” is the key to protecting your mental health and finding peace in the present moment.

    When you’re feeling low, or lost in worry, step outside and try a walk! This is the Ultimate Guide to Clinic Stress Relief and Finding Peace in Nature for Puchiko.

  • 【Tonsillectomy Renal Disease】Real Talk on Recovery, Pain, and What Not to Eat

    ※This is Puchiko’s experience and isn’t a substitute for diagnosis or treatment.

    When I thought of a tonsillectomy, my image of it was immediately associated with pain. Of course, I haven’t personally experienced a tonsillectomy or the pain that comes with it. However, I was there to witness Puchiko undergoing the procedure and experiencing the recovery pain, and I would like to share my perspective on that time with you all.

    1. Why Do They Do Tonsillectomy?

    It’s a mystery: the protagonist is the kidney, yet they take out the tonsils… For those of us living with the disease, we understand it. But when you tell a colleague or acquaintance, “I’m having my tonsils out because of a kidney disease,” I’m sure Puchiko and I aren’t the only ones who get a puzzled look and feel too lazy to explain it. Even if I carefully explained, “The cause of renal disease is often a focal infection far from the kidneys, such as tonsillitis, chronic nasopharyngitis, or periapical periodontitis, so we remove the tonsils,” they’d likely just say, “Huh? Doesn’t make sense.” That’s too much hassle.

    This is how I explain like a this Puchiko’s illustration. The tonsils, experiencing a bug or malfuction, launch a drone attack og IgA immunogloblins which are meant to stay in the tonsils against the kidneys, causing damage to the renal tissues. Therefore, the tonsils, which have been corrupted by the bad influence, are removed.
    This is how I explain like a this Puchiko’s illustration.

    2. Pre-Surgery Preparation, Flow, and General Details

    For the hospital stay, unlike the kidney biopsy, there’s no strict bed rest or no-shower rule, so you don’t need dry shampoo. The most essential item you do need? Tissues, towels, and anything you can spit saliva into! One box of tissues is a ridiculously inadequate amount. Saliva continuously overflows, so much so that I wondered if Puchiko had dehydrated herself by constantly spitting.

    3. About the Surgery

    Now, about the tonsillectomy itself: on the day of the surgery, Puchiko fasted and was given oral rehydration solution. In her case, she didn’t have a urinary catheter, but some people do, so individual differences exist.

    Puchiko walked to the operating room herself. She sat on the operating table and held out her arm to have a needle inserted—but they tried to insert it into the back of her hand instead. The needle failed to go in the first time, and after being poked repeatedly, she took off the oxygen mask she was wearing and angrily said, “That hurts!” I told her, “Puchiko! Endure it!”

    Once under general anesthesia, Puchiko dreamed. As her imaginary friend, I was able to experience the dream too, so I stayed in her dream while waiting for her surgery to end. It was a dream about a Pokémon, Gyarados. Since the surgery lasted about two hours, she was woken up mid-dream with, “It’s over now,” and experienced a moment of weightlessness while being transferred to her bed. At that point, she was still groggy and not in pain.

    Puchiko's excised tonsils.

    As for Puchiko’s tonsils: before the surgery, we asked the surgeon if her family could take pictures, and her mother did. Looking at the post-op tonsil area, it was whitish. Puchiko was told her tonsils were in the second state out of three stages. The second stage meant they were quite enlarged, and the holes were rather uneven and bumpy. That makes sense, as she used to be able to clear tonsil stones herself, although that’s something you definitely shouldn’t do.

    4. Post-Operative Course

    She looked comfortable while wearing the oxygen mask after being transferred back to the bed. I assume this was because the anesthesia was still working. After the anesthesia wore off and the oxygen mask came off, Puchiko realized the pain, and that’s where the “hell” began. Ah, maybe I shouldn’t use the word ‘hell,’ but that’s how Puchiko described it at the time. I’ll cover the pain in detail later; here, let’s focus on the recovery process.

    She had a low-grade fever post-op. On the second day, her uvula was swollen. She wanted to be discharged quickly, so she asked the doctor what determined the discharge timing. He told her it was when the scabs were firmly in place, the wound was closed, and there was no bleeding.

    However, for some reason, they served her crackers (senbei) with her meal. She ate it because it was served, which caused a tear and bleeding, and the doctor got angry at her. When she complained to a more senior visiting doctor, saying, “I ate it because it was served… please don’t serve food we can’t eat,” I remember the doctor saying, “That’s a valid point.” I agreed.

    In any case, Puchiko was desperate to be discharged quickly. That’s because the hospital she stayed at for the tonsillectomy served food that was so unappetizing that when she went on a hunger strike, she was scolded. Incidentally, they gave her kiwi fruit, and when she ate it, she felt a pain so intense it hurt the back of her ears and her head. That might have been the most painful moment.

    If you want to be discharged quickly, be sure not to injure the surgical site like Puchiko did! Keeping the area from drying out is also important.

    5. About the Pain

    I used the threatening phrase “where the hell began” earlier, and here, “pain” accounts for most of that hell. However, when I asked Puchiko, she rated the pain level as 2.5 out of 5. …But the constant overflowing saliva was also quite tough. It hurts too much to swallow the saliva, which is why you end up having to spit it out like a spitting lion (Merlion).

    During the post-op period when she felt that pain, she was reading blogs and Instagram posts by other tonsillectomy patients, desperately searching for answers. What she wanted to know was: “Which day does it start getting easier?”

    Now, let’s go into detail about the pain Puchiko experienced.

    1) Immediate Post-Op Pain

    As mentioned, the pain immediately after surgery was minimal. I was truly impressed by the power of general anesthesia. Even though I knew it was thanks to the anesthesia, Puchiko thought, “This is easy!” The pain level was about 1 on a 5-point scale. So, at this point, the pain was nothing for Puchiko to be scared of. To make it clearer, it was about the level of pain when tonsillitis is just starting: “Oh, my throat hurts a bit. I wonder if it’s going to swell up later…”

    2) Pain During Eating and Drinking

    The pain hits precisely at the moment of swallowing. The first meal starts with soft rice porridge, but it wasn’t tasty. Puchiko already had kidney disease-related dietary restrictions, so she didn’t have much freedom, but if you don’t have such restrictions and can buy food from the convenience store, I recommend jelly and ice cream. Since you know the pain that comes with swallowing, your appetite might decrease, but please eat well and get nutrition to help the scabs form quickly over the tonsil site. And whatever you do, do not eat crackers or cookies, even if they are served, unlike Puchiko!

    3) Night Pain and Countermeasures

    When Puchiko had her tonsillectomy, she slept with her mouth open without using nasal strips (though she was wearing a mask during this hospital stay…). Other tonsillectomy patients also said that waking up was painful. I recommend you avoid sleeping with mouth breathing to alleviate the pain even slightly. This is also something you should continue doing long-term, as mouth breathing is linked to renal disease. Nasal strips are highly recommended! Puchiko has tried various types, but for times when she absolutely doesn’t want to mouth breathe (like sleeping on a plane or when feeling sick), she uses this specific tape that can be easily torn by hand. Some people also brought humidifying masks containing menthol. I don’t know if they sell them overseas, but a mentholated, humidifying mask helps.

    4) Effectiveness of Painkillers

    As is common for kidney disease patients, she couldn’t use Loxonin, so Puchiko was prescribed Calonal (acetaminophen). The frequency was strictly controlled; in her case, it was limited to four times a day. This means you can’t just take it whenever you feel pain. Since meals were agonizing, she took it before eating. Calonal can be taken on an empty stomach, so pre-meal was fine. This meant three out of four doses were reserved for before meals. So, when was the last dose? She took it before sleeping. It’s impossible to sleep with the pain. It takes about 15 minutes to kick in, so she timed the intake carefully.

    6. Message

    To describe the pain: Puchiko said it was basically two or three times the pain of a swollen tonsil. I think “intense” is the right word for it. To her, the pain from the tattoo removal laser and the urinary catheter was worse.

    You’re probably thinking, “It hurts, and when will I be free from this pain?” Puchiko felt the same way. For her, the most agonizing pain was the morning after the surgery. She was so irritable that I was almost kicked. By the third day, the pain was perhaps minus 1/20th—it had slightly decreased. But the pain during meals lingered.

    If the hospitalization had been for the tonsillectomy alone (not combined with steroid pulse therapy), she would have still been in pain on the day of discharge (which was an 8-day stay for her), and even three days after discharge. She returned to work immediately after being discharged but remembers feeling pain during lunch. However, a week after discharge, it became much, much easier.

    Now, she is freed from that miserable pain of having swollen tonsils when she catches a cold. And since people who have tonsils often accumulate pus plugs (tonsil stones), she is now free of them and has clean breath. Think of this pain as borrowing a bit of misery now to pay it back later. The pain gradually, very gradually, decreases day by day. I know you are full of anxiety, but I hope this article will encourage you. We wholeheartedly support you!

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  • 【Kidney Biopsy Experience】The Must-Read Necessity of Data-Driven Treatment for Her Renal Disease

    ※This is Puchiko’s experience and isn’t a substitute for diagnosis or treatment.

    I think I’ll take the liberty of explaining the kidney biopsy that Puchiko underwent, based on what I witnessed. What images come to your mind when you hear the term Kidney Biopsy? I made sure to observe Puchiko’s procedure closely. I know that those who actually have to undergo a kidney biopsy must feel anxious. I’d like to share Puchiko’s firsthand experience with the procedure.

    1. Who Needs a Kidney Biopsy?

    What is a kidney biopsy? If I just told you to refer to the many chronic kidney disease survivors who write about this elsewhere, you’d think I was lazy. So, let’s be thorough.

    First, let’s talk about the select few who undergo a kidney biopsy. Since Puchiko lives in Japan, I will share the Japanese criteria here.

    1) When there is 0.3–0.5g or more of proteinuria per day.

    Puchiko had urine soaked in protein more than any other renal disease (same as her) patient, excreting about 40 times more urine protein than normal.

    2) When a massive amount of proteinuria is observed (e.g., Nephrotic Syndrome).

    3) When there is acute kidney failure (a state where the kidney’s filtration function worsens over a week).

    The condition where acute renal failure is accompanied by blood in the urine is called “Rapidly Progressive Glomerulonephritis (RPGN).” This often occurs due to systemic diseases and requires prompt diagnosis and treatment.

    4) When diagnosing the cause of unexplained renal failure without hematuria or proteinuria.

    5) For diagnosing the cause in a transplanted kidney.

    Of course, even if you meet the above criteria, you may not be able to undergo a kidney biopsy. For instance, if:

    • The kidneys are atrophied or there is a size difference between the left and right kidney according to an ultrasound.

    • A bleeding tendency cannot be controlled.

    • There is an infection in the kidney itself or the surrounding area.

    • There are morphological abnormalities in the kidney, such as Polycystic Kidney Disease (PKD).

    • The patient cannot comply with instructions during the examination or maintain post-examination bed rest.

    • The patient does not wish to or cannot give consent.

    Also, the doctor told Puchiko that patients with only one kidney cannot have the biopsy.

    2. Why Do They Do a Kidney Biopsy for Renal Disease?

    Puchiko’s failure to undergo the biopsy initially, only to later receive unsuccessful treatment, is a perfect example of its necessity. Most her renal disease patients likely follow the sequence: Kidney Biopsy → Tonsillectomy → Steroid Pulse Therapy.

    However, Puchiko’s former doctor said, “In my gut feeling, after 40 years at [a famous university hospital], you have renal disease. Your hematuria won’t disappear.” Based solely on that gut feeling, Puchiko underwent a tonsillectomy but was only treated with medication for blood clots, hyperlipidemia, and high uric acid.

    Two years passed without any drugs effective against renal disease. And what happens to people in such a state? “You’re just losing time and money without knowing the correct status! Achieving remission after the disease has progressed takes more time and money! Is that okay? Do you want to end up like Puchiko? The reason you need the biopsy is precisely so you don’t end up like her. Decide on treatment based on data, not a gut feeling!” I want to scream this to my readers. Don’t you feel the necessity? Don’t the words of someone who failed penetrate to your very core?

    To reiterate the necessity of the kidney biopsy: it reveals the current status of your kidneys. If normal is Grade 0 and mild renal dysfunction is Grade 1, then renal failure is Grade 4. When Puchiko finally had her kidney biopsy, she was at Grade 2. The biopsy shows how much the kidney tissue has been threatened by I g A. This detailed status allows doctors to tailor the treatment accordingly. There is so much information you can’t get from just urine and blood tests alone.

    Did I manage to convey the need for the biopsy? From here, I’ll share Puchiko’s experience of the procedure.

    3. The Procedure

    As a prologue, before the kidney biopsy (which was before her hospitalization in Puchiko’s case), an ultrasound is performed to check for kidney atrophy, left-right size differences, or morphological abnormalities. To prepare for bleeding, anticoagulant drugs (so-called “blood thinners”) are stopped. Since she was taking them for clot prevention, Puchiko had to go without them during the biopsy hospitalization.

    There are two methods: local anesthesia in the patient room/ward (which Puchiko had) or general anesthesia in the operating room.

    For the procedure: Since movement is strictly prohibited for 24 hours after the biopsy—even for going to the bathroom—a urinary catheter is placed. Puchiko said this was the most painful part of the entire kidney biopsy. She was furious at me afterward. I apologize. I don’t want to shock you with the word “painful,” but it is painful. Why? Because in her case, the attempt failed four times, and the catheter was removed and reinserted once. It was a tragedy.

    Now, for the main event. She was moved to the specialized room on her bed. Lying face down, her back was heavily slathered with Iodine (like applying a massive amount of toner). Three doctors, three nurses, and one person who looked like a technician—many eyes were fixed on Puchiko’s iodine-coated back and waist area. They use an ultrasound to observe the kidney’s shape, and multiple doctors determine the needle insertion point. After injecting local anesthetic into the skin, a thin needle (about the size of a ballpoint pen tip) is inserted through the back, and anesthetic is injected onto the surface of the kidney once the needle reaches it.

    The doctor says, “Now, I will insert the needle… Take a breath in—Now! Hold your breath completely.” A loud thwack sound is heard. The needle enters the kidney, and a small piece of the kidney is collected. The tissue is about the thickness of a pencil lead and 1 to 2 cm long. I was watching the whole thing from behind and got goosebumps.

    Only one kidney is tested; in Puchiko’s case, it was only the left one. The technician checks the collected tissue under a microscope to ensure the desired sample is included. If it’s insufficient, the collection is restarted. (Puchiko’s collection was restarted.) After the biopsy ends, the area is compressed for about 10 minutes while lying face down to stop the bleeding. The doctor’s pressure was so strong I worried Puchiko’s body might literally crack.

    After hemostasis, she had to lie on her back for 24 hours of strict bed rest, without moving at all. She survived by using a straw attachment for her water bottle. Since Puchiko couldn’t eat by herself, a nurse assisted her with her meals. She had the biopsy in the early afternoon, and by 6 PM, she was allowed to raise the head of the bed slightly to a seated position.

    4. About the Pain

    The kidney biopsy itself involved only a slight prick from the anesthetic injection, and apparently, there was no pain from the needle stabbing the kidney. She had been told, “It’s going to hurt,” so Puchiko expected pain after the anesthetic wore off, but she described the pain level as a “refreshing, wasabi-like sting.” Many survivors say that the absolute bed rest is the hardest part, and nurses warned her about the difficulty, but Puchiko didn’t find it hard at all. People with chronic lower back pain might find it tough, though, as lying on your back puts a strain on the lower back.

    5. Coping During Absolute Bed Rest and Things to Note

    What did Puchiko do during her absolute bed rest? She listened to podcasts on Spotify: Kemio’s Ear Cleaning Club and The Fabulous World of the Kano Sisters (which were airing then). Lying in her large shared room bed, she was laughing so hard she was silently rolling around—well, she couldn’t actually roll around because of the bed rest, but she looked like she was having fun.

    I know some of you reading this are worried: “What if it hurts?” “What if the results are bad?” The kidney biopsy hospitalization is just one or two days of enduring the procedure plus the stress of being hospitalized. But it reveals the path you must take next. Instead of being consumed by worry, you understand what needs to be done. Even if the results are bad, you now have a treatment plan to assemble. Knowing this brings true peace of mind. To be freed from vague, frustrating anxiety, this is a time you absolutely must overcome. We, too, are on the other side of this challenge. We wholeheartedly support you.

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  • 【Toxic Friendship & Chronic Illness】The Arrogance of Talking About “Weak Bodies” in Front of a Sick Friend

    Puchiko went out to meet people, which is rare for her. What I am about to write about made me furious as someone close to Puchiko, and I will refrain from mentioning names or other identifying details because I won’t write kindly about that person. Puchiko herself felt slightly bothered, but after returning home, she was watching Poirot quite cheerfully, so she didn’t seem to mind… or rather, she wasn’t paying them any mind. However, I felt such anger toward that person that I told Puchiko, “Don’t ever associate with them again.”

    I felt such anger toward that person that I told Puchiko, “Don’t ever associate with them again.”That incident only solidified my core belief: For me, Puchiko’s health and treatment come first, above absolutely everything else.

    Living with a chronic illness means that not only your body, but your mental energy is constantly being drained. That’s why it becomes necessary to clear out the toxic relationships from your life. It’s something I wish I didn’t have to do, but I made the decision. For me, Puchiko’s health and treatment come first, above absolutely everything else.

    Living with a chronic illness means that not only your body, but your mental energy is constantly being drained. That’s why it becomes necessary to clear out the toxic relationships from your life. It’s something I wish I didn’t have to do, but I made the decision.

    “The toxic friend” who will appear in this story had once made a joke out of Puchiko’s facial expressions and symptoms when she was suffering, and they did this right in front of our mutual acquaintance. This was done even though Puchiko was right there. I was standing just behind her to the left when I heard it, and I felt intensely disgusted. I couldn’t understand the nerve of someone who would mock a person for being unwell.

    I realized with absolute certainty that the sheer discomfort and stress from that person was nothing but poison to Puchiko’s recovery and health management. And so, I made the decision: “I will completely distance Puchiko, and myself, from this toxic environment.”

    Through this episode, I want to explain why “decluttering your relationships” is just as crucial as medical treatment for people living with a chronic illness.

    1. The Discomfort of Trivializing a Shared Acquaintance’s “Weakness” While Knowing Her

    What shall I call that person? Let’s call them “The toxic friend.” The relationship with “The toxic friend” has been simmering for a long time. They are someone who stimulates a deep-seated aversion in Puchiko. Since they belong to the same social circle, they occasionally have to interact.

    “The toxic friend” started talking about a mutual acquaintance of Puchiko’s who suffers from mental health illness. Though they must have known about the person’s condition, “The toxic friend” proceeded to say, “People with weak bodies are hard to invite out,” “You can’t do any job without being healthy and physically strong,” and “It gets awkward and takes too much care when you know too much about their illness.”They stated this as if intentionally disregarding the other person with a weak body (Puchiko) right there, or as if they were doing it deliberately.

    I wonder what “The toxic friend” truly thought of Puchiko’s five years of living with illness. Puchiko listened without showing emotion, like Michael Corleone, but if she had commanded me to “kill them,” I might have done it. It is impossible, of course. That is the sad fate of an imaginary friend.

    “The toxic friend” voluntarily follows Puchiko’s social media accounts dedicated to her illness, knowing full well about her struggle and dietary restrictions. Why, then, would they say such things in front of her? If they feel that way, why did they seek to associate with her in the first place?

    To make matters worse, “The toxic friend” had once made a joke out of Puchiko’s facial expression and symptoms when she was suffering during an outing, and they did this right in front of our mutual acquaintance.

    2. The Arrogance of Hurting Others and Erecting a “I Am Special” Defense Line

    Even after more than 15 years, Puchiko has not forgotten a phrase “The toxic friend” uttered. When Puchiko’s father resigned due to depression, “The toxic friend” said, “My own father crushed people like that, though.” And today, they were making a joke out of another weak person right in front of us.

    Puchiko chose the “adult” response toward “The toxic friend.” She knows that trying to correct or argue with “The toxic friend” is futile, as “The toxic friend” will only attempt to win the argument, which would be detrimental to her own mental health. Borrowing “The toxic friend’s” past phrase, “There is only right or left in the world,” this unknowingly flawed perspective is likely a manifestation of a deep-rooted self-defense mechanism that cannot neutrally respect others.

    Even if “The toxic friend” maintains an appearance of a “successful person” through sheer vanity, promoting their job as superior and masking the reality that their current office is only sustainable through parental support.

    Neither Puchiko nor I need to crush “The toxic friend’s” façade. The strength we must possess is not about controlling people like “The toxic friend,” but the wisdom to respect our own feeling of “dislike” and maintain distance. Puchiko’s small, daily peace should not be destroyed by the arrogant remarks of someone like “The toxic friend.”

    By the way, when Puchiko finished watching Poirot, I asked her, “Why are you okay after being told those things on your precious day off? Aren’t you angry?”

    Puchiko replied, “I was angry. Or rather, I just reconfirmed that my initial gut feeling when I first met this person—that I couldn’t stand them—was correct. Besides, you were the one who completely freaked out and blew up more than me, you, so watching you rage actually made me feel relieved. Thank you.”

    3. TIPs for Puchiko’s Comrades Living with Chronic Illness

    There will always be people like “The toxic friend” who try to inflict deliberate pain. When Puchiko was hospitalized for her renal disease treatment, a colleague referred to her desk as “the sick island.” Others may utter hurtful words with good intentions, or introduce unwanted information during your struggle.

    What I have learned from watching over Puchiko is that the strength we must possess, to reiterate, is not to fix people like “The toxic friend,” but to respect our own feeling of “dislike” and maintain distance.

    And there is one more thing I want to convey to the reader. Never, ever discuss your personal passions or things you love with “The toxic friend” type of person.

    For them, it merely becomes “bait” to attack your vulnerability or joy. When your favorite things are denied and met with mockery like, “You like that much?” it can deeply wound you, feeling like an assault on your very core. This is because Puchiko was once subjected to this by “The toxic friend.” Puchiko’s small, daily peace must not be destroyed by the arrogant words of people like them.

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