A postcard from Vancouver

I finally returned to Vancouver/Richmond suburb 8 days after Canada opened its border (August 9) to US double vacinees holding a confirmed and uploaded negative PCR test within 3 days of departure, a PCR nasal/oral test obtained in the Vancouver airport lobby upon exiting but no required quarantining (last year 14 days).  My first time in 20 months!  

 

Richmond continues to boom with 11 visible cranes pulling up condos around them and large pits where others will eventually erect.  Visible excess in the more than half of parked luxury cars some never encountered before such as Model Y Teslas, Porche and Lamborghini SUVs.  Richmond is a safe spot, with mandatory and compliant indoor (mall, grocery store, library) masking and requisite QBR confirmation of double vaccination at all indoor venues (restaurant, movie theater, health clubs).  As before, in this area busy with malls, shops, food courts and restaurants, I cross paths with few if any Caucasians and Cantonese > Mandarin > English or all three swirled together rules the communication waves.

 

Two noticeable changes:  a beehive of turquoise-vested, -hatted, -scootered silent electric drivers ferry take out everywhere leading to the consequent rise of obesity in young Chinese males who eat in and couch in.

 

Tai chi class resumed in a new studio as the old one was demolished to make way for yet another condo high-rise.  Vaccination, masks and 9 feet between practitioners allow me to attend 7 sessions/week 1.5-2+ hours each.  The Sifu (teacher-father) has refocused on basic e.g. everyday warm-up exercises for both disciples and longtime students:  horse stance (crouching pain), spiral force (cheen xi ging), shifting weight side-to-side, and ‘walking’ (hang low) sinking low into hips back upright supported by interminably burning quadriceps.  He is reteaching these at a more nuanced, advanced level while demonstrating the martial application.  He or lead disciples Mary or Jack stand adjacent to you and pick apart your inner workings with radiographic clarity.  Although this remedial emphasis may sound boring, I’ve experienced multiple epiphanies this session having traversed a tipping point where I’m now able to perceive previously imperceptible subtleties in Sifu’s movement and even mimic them.  This session has proven to be my most fruitful and both my balance and proprioception have noticeably improved.  But there is no space for egos as he uses me as either an ‘errant example’ or as a punching bag to demonstrate how to generate power!

 

Although my elder friends have been reluctant to eat out in restaurants, we’ve managed to gather in home relying on takeout.  So this fall has not been as isolating as I worried beforehand.  Several have experienced significant health issues including COVID.  Many are artist–friends from whom I acquired five wonderful paintings.  I attended superb movies with one younger Tai Chi-artist friend at the Vancouver International Film Festival both in person and by streaming, she 45, me 13 … recommend Official Competition (Brazilian with Penelope Cruz and Antonio Banderas) and Drive My Car (Japanese) based upon a Haruki Murakami short story.

 

Still making neurons fire.  Have read 51 books this year, recent recommended non-fiction reads:  The Code Breaker (Walter Isaacson) an account of Jennifer Doudna 2020 Nobelist and the race to discover CRISPR, The Premonition (Michael Lewis) a profile of several forward thinking, game-changing physician-scientists during COVID, The Search for John Lennon an insightful foray into the mind of this complex musician, His Truth if Marching On (John Meachum) a biography of the John Lewis, and The Empire of Pain (Patrick Keefe) an expose of the Sackler Family/Purdue Pharma’s incendiary role in the opioid crisis.  Two fiction reads:  My Old Home (Orville Schell) a heart wrenching story of the cultural revolution through Tian An Men and China (Edward Rutherford) a sweeping panorama from the Opium War to the Boxer Rebellion.  And several projects continue with the updating the CVS pediatric guidelines, a NASPGHAN position statement on telehealth, and a prevalence study of microaggressions towards Asian American medical students.

 

Take care of your health and mind,

Cora Li-Leger 'Equisetum' 2016 - reminds me of a feminine bamboo grove

Fanny Tang 'Square Round 30' 2016 - reminds me of an Chinese imperial ball

Fanny Tang 'Connection' 2021 - reminds me of my former intestinal endeavors

Li Jingwen 'Universe' - "from night, daybreak emerges to assure good things"

Teri at 10

 Rachel and Ben’s commemoration

Rachel and Ben have invited all of you to a commemorative celebration on Teri’s 10^th anniversary of her moving on below – if you have not already received an invitation.  It is hard to imagine 10 years have passed … and what has transpired.  This celebration is a do-it-yourselves food exercise, all in good taste.  Rachel has shared Teri’s original recipe for jiaozi (jow zzz) dumplings for you to make by hand as in the ancient days of yore!  These can be boiled or fried as ‘pot stickers’, either way, yummy.

 

 

There is a back story.  Growing up in Iowa City and New York City, there were no frozen dumplings or even premade wrappers.  You had to make the dough, roll it into a long thread, cut them into uniform pieces, and roll each into a thin round wrapper, powdered flour everywhere.  When we landed in Columbus, one of my favorite memories was making them as a family with Rachel and Ben pitching in.  Teri’s instructed me to squeeze all the water out of the frozen spinach and stir the filling in one direction only till thoroughly mixed.  After placing a dollop of filling in the wrapper, we lined the edge with water, folded it in half, pleated one side in both directions, pressed hard, and, voila a jiaozi that stood up in the frying pan!  

 

We made these by the 200s and froze them into our own comfort fast food.  These dumplings are eaten specially during Chinese New Year as their crescent shape symbolizes gold ingots and the wish for wealth in the coming year.  These jiaozi date back to … at least Han dynasty 200 BC as one excavated tomb shown during Exhibition of Archaeological Finds of the PRC in 1974-75 contained a petrified crescent jiaozi.  So yes, our ancestors ate them just the same! 

 

Teri used this recipe for her in-person kitchen tutorial as a fundraiser in various silent auctions over the years.  And Rachel has taken these dumplings a step further with modifications, in-person demonstrations and even catering.  Teri would be proud.

 

Teri Li Award

 

It is heartwarming for me to hear Teri’s name mentioned every year in our professional society.  One can direct their donation to her fund.  Next, applications are fielded for the award and the winner is announced at annual Awards Ceremony.  I add Teri’s touch by sending each winner a bouquet of Teri’s favorite tropical flowers from Hawaii.  And I enclose the following letter to let them know a little about Teri.

 

Letter to the Teri Li Award Recipient

 

Once again, let me offer my heartiest congratulations on your national award for early career educators who have made outstanding educational contributions to pediatric gastroenterology.

 

I wanted to give you a little bit of background on Teri Li so you have a sense of who she was.

 

We met in college, later married and raised two children and three dogs.  Rachel (and John) with 10-year old Jack and 8-year old Naomi in NJ is an active mother who has completed four Ironwoman Triathlons and many other events.  Ben (and Theresa) with 3-year old Flora and 13 month old Juna in Denver is a EM faculty.  Teri was a ‘natural’ Montessori teacher and applied the principles in our home – our children were her number one priority.  She firmly believed in the importance of early education (preschool) and after receiving her 3^rd Montessori certification to include infants, I joked that she would soon be doing prenatal Montessori education.  She responded, “the earlier the better!”  

 

That emphasis on the ‘earlier the better’ inspired the Teri Li Award for early career educators.  Rather than a life-time achievement award, she would have wanted to provide early recognition in order to further your long career in medical education.  And as you well know, educational contributions, despite the lip service, are often undervalued.  As one who shunned the limelight Teri would be utterly flabbergasted to have a national award named after her.  

 

Teri was active in the Unitarian Church, volunteered constantly in Meals on Wheels, food pantries, and the Columbus International Program, and, started an Asian Womyns’ Group.  She advocated for diversity wherever she was.  She was mindful and present before those terms became popular.  She was my full partner, a great mother, my icon of diversity and enabled me to fulfill my potential.  

 

Several months after trips to climb Yellow Mountain in Anhui, China, to Italy and to celebrate Rachel and John’s wedding, she developed aggressive acute myeloid leukemia.  She underwent two rounds of chemotherapy and two stem cell transplants but experienced numerous complications that required nearly a year in-hospital days during her 19-month illness.  Throughout, she expressed attitude (‘Teri kicking butt ’ was her motto), grace and finally equanimity.  She achieved her top two bucket priorities, to hold her first grandchild and to see Ben admitted to medical school.  When she decided to stop all therapy, in a flash we organized a completely unique ‘awake’ wake with her family and friends from east and west coasts who gathered around to honor her in person!

 

Teri’s last teaching moment occurred during her final week of life at our annual welcome party for incoming Asian American medical students.  Although unable to stand, she sat in a recliner.  When she overheard one student criticizing another school, she asked me to bring him over.  She said to him, “It’s not about where your school is ranked [by US News/Report], it’s about what you do with your career, how you demonstrate your passion and compassion! [and you have a ways to go]”

 

Teri was a special individual and would have loved to meet you (and your family) and learn all about your accomplishments.  Keep up the good work!

 

Teri’s 10^th on September 2^nd

 

We all miss her.  Even though she didn’t have a chance to meet her three grand girls, I definitely see her spunk, strength and independence in each of them.  And even for me, her soft-powered lessons continue to mold me.  

 

On Teri’s 10^th, we hope you enjoy a shared memory and send a thought her way.  And, at your leisure, enjoy Teri’s jiaozi dumplings!  And send a picture to Rachel.

Are we intrinsically bad or good?

This is a synopsis of another game changing book entitled Humankind: A hopeful history by Rutger Bregman – a Dutch historian-journalist – that comprehensively addresses this issue. In very readable prose the classic 17-18th Century debate between the pessimistic Hobbes who believed in the wicked human nature requiring many civil rules to keep us from breaking bad vs. the optimist Rousseau who declared that we are all good and it is civilization ruins us. Fast forwarding, he comes down heavily in the Rousseau camp, with quite a salvo of epoch-ranging social psychology stretching from prehistoric man to the present. 

Bregman begins by turning the fictional William Golding Lord of the Flies – in which marooned British schoolboys fend only for themselves with disastrous results – on its head by recounting the little known real-life story of five stranded Tongan school boys who survived for 15 months on an uncharted piece of rock working in teams of two for chores, keeping the fire tended for more than a year, establishing a food garden, forging rainwater storage, building a gym and a time out mechanism for squabbles … and were exceedingly healthy both physically and mentally when rescued. 

 He suggests that humans are the equivalent of the ‘puppy’ humanoids including Neanderthals. That is, we have surprisingly prevailed despite being less smart, considerably weaker and more vulnerable than our forebrethren with larger brains and muscles. Why? Because of enhanced friendliness i.e. social skills that are a segue to broad collective learning. What? This finding of enhanced learning was reproduced in friendly-bred foxes and other primates. As a species we have been bred for this relational quality because it provides a selective advantage in group learning, and therefore for ‘survival of the friendliest’ (B coined). 

Our nomadic hunting-gathering ancestors could neither possess land or acquire property. Later, civilization built on agrarian base begot distinctions in the form of achievement-based inequality. Based upon close examination of skulls for evidence of trauma, violent conflict only began with the advent of land ownership, private property and hereditary leaders about 10,000 years ago. Villagers/farmers now had owned land (to be fought over) and settled life led to a natural xenophobia. In fact, the accoutrements of civilization including the invention of money (for taxation), of writing (for recording debts) and of legal institutions (punishment of escaped slaves) all began as instruments of enslavement! 

Then along comes Enlightenment with Age of Reason with Adam Smith’s ‘every person for themselves, greed is good’ – sounds very contemporary like the last four years. Historians point out that Enlightenment gave us ‘equality’ but also invented racism, which became encoded into law. If in fact we act as David Hume the Scottish philosopher suggest – as if people are selfish, then perhaps the negative nocebo (Golem Effect) response becomes a self-fulfilling prophecy. Contemporary studies in educational settings strongly link positive expectations with higher performance (the Pygmalion effect). 

So why has been there such an abundance of violence – 15% of deaths – extending from Brazilian tribes to World Wars? The good news is that the overall conflict-related mortality appears to be declining: 14-15% amongst land-based tribes (not the still foraging !Kung), 3% in the two 20th C World Wars, and down to 1% today. Counter to what you might think, during the WWII in both Pacific and European theaters, soldiers actually fired only 15-25% of time even in the heat of battle. In the Civil war, after examining 27,000+ muskets, only 10% were actually fired. The famed military historian Sam Marshall concluded that ‘the average health individual ... has such an inner … unrealized resistance toward killing a fellow man he will not of his own volition take life”. 

Bregman debunks many historical events and research findings used to bolster the Hobbesian view of human nature. The decimation of Easter Island population was not from torture and cannibalism but likely due to the exported European epidemics and deportation by Peruvian slavers. He addresses Hitler, Stalin, Mao and Pol Pot indirectly by overturning two famous experimental findings: Philip Zimbardo’s Stanford prison experiment in which students, divided into prisoners and guards, perpetrated serious maltreatment, and, Stanley Milgram’s Yale ‘shocking’ experiment where volunteers apparently shocked unseen subjects to the point of silence (unconsciousness). These studies purported that anyone could do damage, and in the extreme, even genocide. But after delving into the actual transcripts, current academics found that the volunteers were clearly goaded into extreme behavior while concomitantly expressing extreme discomfort, some refusing to continue, but that story was lost. The philosopher Hannah Arendt suggested that it is not simply ‘the banality of evil’ (i.e. unthinking) it is that humans are tempted by evil masquerading as good … which was taken to the death degree by fanatic Adolf Eichmann. 

So what motivates those who carry out evil deeds? Morris Janowitz’s review of 150,000 pages of overheard conversations (not through interrogation) from German POWs revealed that they were not principally motivated by ideology (Hitler) or patriotism. Their motivation came from the same as could be said for our Allied soldiers – courage, loyalty, and solidarity – fighting for their band of brothers. Unfortunately, this applies to terrorists as well. 

So why do leaders turn bad? He discusses Dacher Keltner’s work on how power corrupts (power paradox) or acquired sociopathy. When mere mortals acquire power, they stop mirroring (social responsiveness) and “feel less connected to their fellow human beings”. As they become “unplugged” from fellow citizens, they need to have a complex infrastructure to maintain power through myth, religion, companies, state, nation … police, armies. While egalitarian hunter-gatherers valued traits such as generosity, wisdom, charisma, fairness, tactful, strong and humility’ those have fallen to the wayside as the powerful became entrenched, impossible to unseat, enfolded into structural economic inequity. Even our current American democracy has dynastic tendencies (Kennedy’s, Bushes), that is an elected aristocracy. 

Now for some surprises. That love hormone oxytocin that skyrockets during breastfeeding is a curious paradox where it enhances affection for loved ones and friends but simultaneously enhances aversion to strangers. So that that is what Trump put in the water supply! In addition, empathy is a doubled-edged sword as well. Infants tested at 6 & 10 months of age can differentiate bad from good behavior (by puppets) and almost universally prefer the latter. BUT in a variation, the infant prefers the puppet who likes same food, even if they’re mean. Thus, we are born xenophobes who have a severe aversion to the unfamiliar, with too much oxytocin (not testosterone). Furthermore, empathy can change the calculus by spotlighting a poignant child awaiting transplant which makes one want to allow them to jump the queue. Unfortunately, the digital micronews cycle and advent of social media also spotlights/highlights the negative and overrides the common but unnewsworthy mundane good. 

 Is there hope for change, any approach that can restore the eroded trust in politics? There are several draconian examples in Columbia and Brazil where participatory budgeting involved input from 15,000 people at 500 fora. This has moved the political needle from cynicism to citizen engagement, from polarization to trust over time, from exclusion to inclusion, and from complacency to citizenship – leading to a spending emphasis on education and infrastructure (clean water) – with concomitant eradication of corruption! He laments the loss of the commons (e.g. shared pasture) yet there is an American example – the Alaska Permanent Fund that distributes oil revenues to each citizen – where most ended up in educational expenses and substantially reduced poverty. Andrew Yang proposes the Alaskan way! 

The remedy for hate is contact and dialog in schools, workplaces and elsewhere and in being able to, as Mandela did,“choose to see the good in people who 99 people out of a 100 would have judged to have been beyond redemption”. 

What is Bregman’s prescription: 

 1)  When in doubt, assume the best – perhaps the hardest to do 

 2)  Think in win-win scenarios – not zero sum winner take most 

 3)  Ask more questions – i.e. “Do not do unto others as you would not have them do unto you.’ 

 4)  Temper your empathy, train your compassion (e.g. your child is afraid of dark, you aren’t going to  whimper alongside (empathy), rather you try to calm and comfort (compassion) 

 5)  Try to understand others – even if you don’t get where they’re coming from (Nelson Mandela’s bite your tongue statesmanship) 

 6)  Love your own as others love their own – compassion takes you beyond your enclave 

 7)  Avoid the news (social media) – too skewed, too negative! 

 8)  Don’t punch the Nazis or supremacists – try an outstretched hand (hmmmm) 

 9)  Come out of the closet: don’t be ashamed to do good - doing good is contagious 

10) Be realistic (his most important) i.e. realism is not cynicism 

There is much, much more food for though!

Chinese New Year - OX (my year)

 It wasn’t a year for the faint-hearted.  The unimagined alignment of COVID pandemic, BLM protests and electoral turmoil stripped the façade off American exceptionalism to expose the underbelly of structural racism and the third who are one paycheck away from disaster.  From cabin solitary to virtual huglessness to stir crazy depression.  Yet an opportunity to tap into the ‘adaptation and resilience’ lessons (oral histories) by nonagenarian Mémée (pediatrician mentor) and octogenarian Margaret (avant garde ink painter) gained from through the interminable WWII bombings in Hague/London and Chongqing respectively.

 

Family

I visited Rachel, John, Jack and Naomi and new addition Memee twice, including this past December courtesy multiple negative tests. Rachel placed a lot of energy into rendering virtual schooling home friendly, family-wide recesses outdoor fun, and amazingly, Jack and Naomi resumed 4.5 days of in-class this fall masked behind Plexiglass – with no transmitted cases!  Football and soccer persisted, virtual piano lessons played, and great hikes taken. 

Mendham crew with Memee

I was not able visit in person as planned in November, but FaceTimed Ben, Theresa, Flora and newbie Juna’s – Flora readily calls me Yeye.  Theresa has fashioned their home into a mini Montessori classroom.  Ben in his final year of fellowship was invited to remain as a physician-scientist.  Flora thrives in Montessori project mode and Juna though not crazy about the bottle is an avid on solids.  

The Denver crew

Halloweenies

Newbie foodie

Naturally I traveled and ate out one-fifth of that previously.  Yet, I was so fortunate to have extended family nearby – Steve, Mary, Becca/Josh/Korben/Garrett, Kat/Steph (wedding on Leap Day) – inside my bubble and after May 21^st saw them weekly.  We travelled together to Door County and their upper Michigan camp together.  After quarantining, I spent two weeks with a friend in Brooklyn and walked the Brooklyn Bridge … Coney Island, visited many

stunningly empty (appointment only) NYC museums and galleries, and ate in outdoors-only  heated curbside shelters.  

My highlight was the video birthday card for which Rachel gathered many of you.  Thank you! 

 

Keeping busy

It has been a healthy interlude for me despite the disruption, in part because of complete control over diet and absence of travel.  Instead of intermittent fasting begun in December 2015, in March I converted to 2 meals a day plan and trimmed 5 pounds.  As gyms closed, I began hiking in nearby Pheasant Branch conservancy – saw osprey, eagles, owls, wild turkey pheasants.  Sifu (master) Tam began telestrating Chen Tai Chi by Facebook and Zoom, resumed Zen (scoreless) tennis with Steve and took lessons, and rode the hilly county roads with Steve and new friend Jeff, a total 1656 miles, my most ever.  

I continued to do ‘fun’ academics of editing, mentoring, teaching, guidelines and organizing a 6-hour Telehealth Webinar with 23 energetic young faculty from NYC to SF.  

I read fewer pages but more than overcompensated by binge watching 400% (whoa) more non-sports movies/series episodes than ever – see below) and unexpectedly enjoyed internecine dynastic struggles among Crown Princes.  I became unaddicted to WordJam after completing all 6070 games to the very last word. Finally, it was a belated revelation to be able to connect the dots of structural racisim between housing segregation (in polluted environs), access to only unhealthy foods and lack of fresh foods, vast income/wealth disparity, eduational disadvantage, differential police enforcement/profiling/mass incarceration and finally as we so vividly saw resulting disparities in health and COVID mortality. We have to do better!   

Zoom provided the needed segue to the outside world of social activity, celebrations, planning meetings, courses, conferences, Theater, and my favorite ‘Old Farts’ group AKA ‘Grumpy old gastroenterologists’.

 

It was daily déjà vu, life interrupted, a year to remember (including those needlessly lost) and not to forget … 

 

Get your vaccine and see you when.

 

Addendum – some entertaining and thought-provoking mind candy:

Topical:  Second mountain David Brooks, The system Robert Reich

Health:  Lifespan (body) David Sinclair, Successful Aging (mind) Daniel Levitin, Breath James Nestor

Biographies:  Obama: a promised land, Van Gogh, Splendid and Vile Erik Larson

Biopics:  Be water: Bruce Lee, Michael Jordan, Tiger

Movies:  Bong Joon-ho: Parasite (Academy Award), Snowpiercer, Okja, Mother

Dynastic intrigue:  Rookie Historian (Korean heroine) – 20 episodes, Princess Wei Young (Chinese heroine) – 54, Rising Phoenix (Chinese) – 70, Longest Day in Chang ‘An (Tang dynasty) – 48 episodes

Mysteries:  Bosch (AP), Endeavour (PBS)

Asian American:  Minor Feelings Cathy Hong Park, Interior Chinatown Charles Yu, 

First Vote (movie):  niece Jennifer Ho as one of four main interviewees

Breath, the book

Another book recommendation for the Lunar New Year.  Question:  what do Yogis, Buddhist monks, functional oral surgeons and orthodontists, Stanford ENTs, opera coaches and deep (sea) divers have in common?  As James Nestor tells in his bestseller ‘Breath: the new science of a lost art,’ they are all ‘pulmonauts’ seeking health benefits through practice, study, and science of breathing.  This is a very readable, intriguing and life-provoking account of his journey of self-healing from skull-full catacombs of Paris to pulmonaut practitioners and scientists around the globe – many initially considered to be outside the mainstream.

 

Here are some fun facts:

-       We take 670,000,000 breaths during our lifetime and breathe 30 lbs of air per day.

-       85% of our weight loss occurs through the weight of expired CO₂ in the breath!

-       CO₂ maybe more important than O₂!  CO₂ enhances oxygen release from hemoglobin.

-       In a study of 1000+, the healthiest individuals had CO₂s of 6.5-7.5% whereas normal is considered 5%.  Conversely, the unhealthiest with multiple health problems were at 4%. Hypoventilate!

-       The perfect breathing rhythm – used by yogis, Buddhist chanters, Hindu khechari, Latin rosary, Native Americans, Taoists – was measured to be 5.5 sec inhales, 5.5 sec exhales or 5.5 breaths a minute!

-       Mouth breathing is very detrimental to health – within 10 days it can lead to sinus infections, increased stress (cortisols), snoring, sleep apnea as well as fatigue, anxiety and irritability.

-       Panic anxiety may be induced by CO₂ chemoreceptors in the amygdala – this is for my neuroscience friends.

-       Prolonged exhalation (Andrew Weil’s 4-7-8 inhale-hold-exhale count) increases heart rate variability and enhances the calming effect of the parasympathetic nervous system to counterbalance the sympathetic fight-or-flight system.

-       Today’s breathing problems (sleep apnea, snoring) and crooked teeth go lung-in-mouth, the cumulative effect of lack of mastication from our soft food diet – early man had and all other mammals have perfectly aligned teeth!  We are the humanoid exceptions.

-       Our diet and consequent lack of chewing induces a narrowed jaw and air passages – this can be reversed using gum chewing and palate expanders within a short period even past the age of 70 (documented by CT scans)!

 

So how about a summary:

Breathing/energy may be the unheralded missing pillar of health.  Improved breathing addresses many functional disorders of civilization including stress, anxiety, irritable bowel syndrome, sleep disorders, presumably through calming effects on the autonomic nervous system.  Although it cannot cure cancer, optimal breathing appears to have a beneficial effect on some diseases such as asthma, emphysema and ADHD.

 

Action points:

-       Shut your mouth and breathe through your nose – following 10 days of forced mouth breathing, resumption of nasal breathing resolved sinus congestion, high blood pressure, elevated stress/cortisol levels, snoring, sleep apnea etc.   

-       Exhale longer – Andrew Weil’s 4-7-8 inhale-hold-exhale practice can help one sleep and enhance the calming parasympathetic nervous system.  

-       Hold your breath – it retools your CO₂ chemoreceptors to help deliver oxygen to tissues more efficiently, a technique widely used by elite athletes.

-       Just breathe slower using the 5.5 sec inhale and 5.5 sec exhale (synchronizing apps are available) – 10 to 15 minutes of practice a day has been shown to reduce high blood pressure …

-       For crooked teeth, instead of braces, consider tongue exercises, gum chewing and palate expanders.

 

All in all, a breathtaking tome (couldn’t resist),