RSNA: The greatest show (and lines) on earth!

A popular photo op.

Love it or hate it, you can’t ignore RSNA. No other meeting on the planet, medical or otherwise, can boast that approximately 30% of its attendees purchased a winter jacket solely for the purpose of attending that one meeting. And for those of you who like to queue, RSNA is the place to be. Taxi lines, bus lines, Connie’s pizza and McDonalds lines, the options for endless queueing are… well… endless! My favorite is the bus line at the South building. That combination of toxic exhaust, freezing cold, and the nagging uncertainty of whether I am really standing in the correct line can only be experienced at RSNA. Believe it or not, there is an entire field of mathematics devoted to waiting in line (queueing theory). It’s been around since a Danish engineer named Agner Krarup Erlang published his first paper examining telephone networks in 1909 Copenhagen. Unfortunately, union rules have prohibited the use of queueing theory in the city of Chicago since 1910.

This looks like the line for the "3" bus, but it is really the line for the 1A bus!

The endless taxi line at the South Entrance. Here's a hint that I learned from a door man at the Hyatt. Walk across the street. If the mob dosen't kill you, you'll get a taxi in no time. 

For those of you who don’t like waiting in line, here’s a secret. It turns out that there is actually an underground black market at RSNA for badge ribbons. For the right price, you can get any ribbon you like, from Case of the Day winner to Board of Directors. Some of these ribbons will get you free food (like the RG reviewer ribbon), while others just get you street cred. Why pay $100 for a donor ribbon when you can get one under the table for $5 (unless, of course, you care where the money goes). Anyway, my point is that once you load up your badge with enough ribbons, no one’s going question you when you cut in line. Just pick a person to cut in front of with one or two ribbons who looks puny near the front of the line. Chances are good that they will want more ribbons and won’t want to risk alienating a powerful and influential member of the RSNA ruling elite. Be prepared to make small talk, because they will likely want to network with you. In the unlikely event that they have their priorities straight and don’t care about ribbons, make sure you can still take them in a fight.

If you don’t want to buy your ribbons, don’t lose hope. You can still earn them by toiling away on thankless committees for years while neglecting your family and pets. That’s how I got my paltry few. I’ll know that I’ve finally reached the pinnacle of my career when I have to lift my name badge to use the urinal. Did you ever meet someone at RSNA with wet ribbons on their badge? Well, now you know how that happens. I’m tall and not particularly ambitious, so I figure I’ll be good for a few more years. Some readers are probably unaware that in certain restrooms at McCormick place, there are actually attendants whose job it is to hold the ribbons for members of the Board of Directors while they relieve themselves. If you don’t believe me, just ask Reed Dunnick about it the next time you see him.

RSNA is always crawling with SAR members. Here are just a few at this year’s RSNA…

Marta Heilbrun (Utah), David DiSantis (Kentucky), David's lovely wife Denise, Steve Eberhardt (New Mexico), Me, Brian Allen (Wake Forest)

Cynthia Santillan and Cooky Menias

Drinking Caipirinhas with my evil twin Erick Remer (Cleveland Clinic).

David DiSantis spending quality time with Sadhna Verma (Cincinnati) and Shweta Bhatt (Rochester)

Power breakfast with Mark Lockhart (UAB), Desiree Morgan (UAB), Alec Megibow (NYU), Stu Silverman (Harvard), Eric Tamm (MD Anderson) and Evan Siegelman (Penn). Someone get Evan to join the SAR!!!

 

Duke University: Mediocre athletics, world class radiology

OK, so I admit to brainwashing my children from a young age to hate Duke athletics. It’s my obligation as responsible parent in the non-Duke ACC (and it will save me thousands of $$ in tuition later). But after my recent visit to the Department of Radiology at Duke University Medical Center, I have to admit that I would send my children there for radiology training in a heartbeat.

The Radiology Residents at Duke University

The day started out in the morning with grand rounds, which was extremely well-attended by residents, faculty, and fellows, followed by some interesting discussion. I appreciated that I couldn't see a single person snoozing during my 50 minute presentation, although I suspect it had less to do with my skill as an orator and more to do with the fact that they served enough coffee at the entrance to the auditorium to kill a horse. 

I was whisked away after the presentation (possibly to stem a riot), so I narrowly missed a chance to hang with SAR member and Duke AI Fellowship Director Raj Gupta. But I did have ample time to learn about the radiology residents’ experience from Duke resident Alan Cubre.  I tried torturing him into revealing compromising details about members of the Abdominal Imaging section, but even after an hour of listening to my life’s story, the most he would tell me is that SAR member and vice Chair of Academic Affairs Rendon Nelson secretly roots for UNC (I hope this doesn’t get Rendon fired).

Speaking of Rendon, he was kind enough to host me for dinner the night before my talk along with SAR members Tracy Jaffe (Division Chief) and Mustafa Bachir (Director, Center for Advanced Magnetic Resonance Imaging). Rendon and I go way back to my radiology residency interview at Emory University (my alma mater). Where most residency interviewers saw an undistinguished kid with bad hair and a cheap suit, Rendon saw a future SAR visiting professor with bad hair and a cheap suit. Regardless, he has become a lifelong friend and ally in my attempts to drive mediocrity from my career. Thanks Rendon!

Before I was to give my resident conference on CT of abdominal pain, SAR member and Duke Radiology Chair Erik Paulson took me on a personalized tour of the medical campus (Erik is proof that nice guys can successfully run radiology departments).  Copious green space, accentuated by serene landscaping, makes the Duke medical campus one of the prettiest I've encountered. During my tour, I mentioned to Erik that I was intrigued by the length and detail of my introduction at grand rounds. I was even contacted by e-mail in advance by resident Ben Wildman-Tobriner to ensure that the introduction had the right balance of academic detail and personal touch (he did a terrific job, by the way). Erik explained to me that Duke emphasizes the importance of public speaking to their residents, considering each resident to be a future ambassador for the department. Introducing speakers at grand rounds is considered an important part of that training. What a great concept!

The Medical Center

Not surprisingly, the residents performed well in conference, although they seemed reluctant at first to speak out. No doubt they were familiar with my fierce reputation as a board (aka bored) examiner (Reed didn’t call me “the human marshmallow” for nothing). However, once they were convinced that the bruises would heal, they proved themselves worthy of the Duke reputation. Now if only the Duke basketball team would follow their example and make something of themselves…

P.S. Devils are supposed to be red, not blue.

Scottsdale, AZ- worst weather city on the planet!

THE Mayo Clinic (Scottsdale, AZ)

When SAR member Cooky Menias invited me to speak at Mayo Scottsdale this fall, it was hard to resist. 1) They have a great Abdomen Section; 2) It’s the epicenter for our Society’s journal, Abdominal Imaging, which former SGR president and current Mayo Chair Dan Johnson (2011-2012) runs; 3) It’s a beautiful facility teeming with SAR members and some of the nicest people you’ll ever meet; and 4) It should have been the perfect place to watch the October 8^th total lunar eclipse. In fact, the chance of having bad weather in Phoenix/Scottsdale in October is somewhere between the chance that monkeys will fly out of my butt (slightly more likely) and the likelihood that Fox News will endorse Hillary Clinton for president (much less likely). After all, October in Scottsdale normally boasts 88% sunshine and about 0” of rain. In reality, however, Phoenix turned out to the worst place in the entire country from which to watch the lunar eclipse. I might as well have been at an ARC meeting in Kauai. Phoenix took a direct hit from the remnants of tropical storm/hurricane Simon, bringing 3 days of clouds and rain that perfectly spanned the duration of my visit. As a result, the 30 pounds of camera equipment I hauled with me laid unused in my backpack, and I had to warn my gastroenterologist to expect flying monkeys when he does my screening colonoscopy next month (my insurance won’t pay for a screening CTC, and if you see flying monkeys on a CTC, you can’t remove them).

The satellite image around the time of the eclipse looked like this.

Weather aside, it was a great visit. From the meticulously groomed cactus garden near the entrance to the orchestral music filling the lobby, Mayo Scottsdale exudes class. And speaking of class, they just spawned their first class of radiology residents, both of whom I treated to a morning conference on CT of abdominal pain. I didn't mind the small audience, as Mayo provided enough fruit and breakfast muffins for 30 people. Eventually, the Scottsdale residency will host 4 residents per year, after carefully culling the top of the applicant pool and sending the scraps to the other Mayo programs.* After a brief photo shoot (the halls of the radiology department are graced with the visages of many SAR member speakers), I presented my talk on renal cell carcinoma to a larger audience of residents, fellows, and faculty.

The future of Mayo Scottsdale radiology: Kristen (left) and Courtney (right)

I spent the evening before my talks in the company of members of the SAR and Mayo’s Abdominal Imaging section, including Cooky Menias, Amy Hara, Fred Chen (section Chief), Al Silva, and Scott Kriegshauser. I learned more about the Mayo way of doing things, including their unique system of rotating leadership (section heads and chairs are rotated on a regular basis, although the rumor is that Dan Johnson plans to declare himself “Dictator for Life” as the first stage of his ultimate stratagem to unify the entire Mayo system under his banner*). I expected to learn that the Mayo system was fully IT-integrated, so I was surprised to hear that, like so many other large healthcare entities, parts of their EMR were not consistent across the enterprise. I was also surprised to hear that Mayo Rochester’s only purpose is to serve as a “farm team” to provide a steady stream of top talent to Mayo Scottsdale. According to their Scottsdale colleagues, those who don’t make the cut are “condemned to live out their remaining days in a frozen wasteland somewhere in Minnesota”. I asked them about Mayo Jacksonville, but they were unfamiliar with that particular entity.*

The totally hip members of the Abdominal Imaging Section at Mayo Scottsdale

Cooky was an amazing host, and watching her work, it became clear how fortunate Mayo was to have enticed her away from her beloved Mallinckrodt (Don’t worry Mallinckrodt, she still has a huge soft spot for you). As expected, the case mix at the hospital was diverse and challenging, but the Mayo group was more than equipped to handle it. I was also impressed by the sense of comradery among the abdominal imagers, a hugely important factor in job satisfaction.

Cooky waits with me at the Scottsdale Space Port (airports are so yesterday)

The bottom line… Mayo Scottsdale really is an awesome place with great people, but I hereby declare Phoenix/Scottsdale the worst weather city on the planet!

*The preceding statements are for entertainment value only, are possibly fabricated, and are not necessarily reflective of the opinions or values of Mayo Clinic or its employees. 

Strasbourg, France

I just returned from Radiology International’s CME meeting in Strasbourg, France. Founded by radiologist Beatty Crawford and now run by Operations Director Denise Mora, Radiology International organizes CME meetings at interesting venues around the world. This meeting is distinguished by a remarkably high repeat attendee rate which I attribute to the combination of quality locations, accessible and friendly faculty members, great tours, and the strong bond between attendees that has developed over the years. The attendance per attendee ratio is one of the highest in the industry, meaning that the meeting room was full every day despite perfect fall weather and tempting menagerie of amazing sights and tastes that beckoned from the old city.

With Radiology International's founder Beatty Crawford and SAR members Paula Woodward and Joe Collins 

Strasbourg is an interesting border city in the Alsace region of France, having alternated between French and German “ownership” several times. It is the official seat of the European Parliament, and the old city was classified a World Heritage site by UNESCO in 1988. The last day of the meeting, it seemed that Germany was once again trying to take possession of the city employing an army of tourists armed with cameras. Strasbourg is strategically located near the Alsace wine trail that features many cool little towns and other attractions. 

The town of Obernai on the Alsace wine trail

Mont Sainte-Odile Abbey along the Alsace wine trail

The crown of Strasbourg is the Notre Dame cathedral, and the jewel of that crown is the astronomical clock found near the front of the sanctuary (the third clock on that site dating from 1843). While the automata displays on the quarter hour were underwhelming, the clock is no less a visual feast and engineering marvel.

The astronomical clock of Strasbourg

 If ever you happen to visit Strasbourg, be sure to climb the 332 steps to the cathedral platform for a panoramic view of the old city. As my wife predicted, it is a favorite roosting site for pigeons, providing a less than flattering (i.e. spattering) patina. In 1439, the cathedral was the tallest building in the world.

The view from the cathedral platform

A statue tries to fend off a pigeon

Climbing the cathedral steps would have been easier without a week’s worth of fine Alsatian cuisine under my belt. Because the best I could do with the local language was to laugh with a French accent, I didn’t always know what I was going to get when I ordered food. Regardless of species and organ system (in many cases uncertain) or preparation (usually with a white sauce or sauerkraut), the food was awesome.  I’m determined to learn some travel French before I travel to Paris for ESGAR in June. While it’s hard to get used to the idea of wasting all those perfectly good consonants, I’d like to avoid reenacting the French restaurant scene in National Lampoon’s European Vacation.

This trip was unique in that my wife, Mary, could join me (along with her college friend, Heidi who lives in Switzerland- yes that’s her real name). It’s always more fun to travel with someone.  One of the highlights of the trip was a canoe trip down the Ill river that bisects the city. I expected to see a plethora of artists and young couples in love (and maybe a mime and/or accordion player or two) lounging on the river banks with long crusty baguettes and bottles of wine strewn about. Well, there were plenty of people on the banks, but they were mostly preoccupied with their cell phones. I’m pretty sure some were hoping to capture future YouTube footage of capsizing canoes.  They almost got their wish, as SAR member Paula Woodward (Univ. of Utah) and her companion narrowly escaped being capsized by a large tourist boat, because they apparently didn’t know the words for “keep left” in English.

Waiting for the lock to open on the Ill river. A large tourist boat awaited us on the other side.

Speaking of Paula, the SAR had a small but powerful presence at the meeting. Paula and I were joined by SAR member Joe Collins from Mayo Scottsdale. Paula and I each gave 6 talks over 5 days on a wide range of genitourinary and gastrointestinal topics. If you haven’t had the privilege of hearing Paula speak, I suggest adding it to your bucket list, because her talks are as entertaining as they are informative. As an aside, Paula also plays a mean accordion.

Joe Collins didn’t speak at this meeting but will be a featured speaker at the next meeting in Holywood, Northern Ireland. Go to radiologyinternational.com for information on that meeting and show your support for your fellow SAR member by joining Joe on the Emerald Isle. Like me, Joe is an amateur astronomer, so the next time the SAR annual meeting is in Arizona, we’ll have to organize a “star party” in the desert (bring your snake repellent). More on Mayo Scottsdale and Arizona to follow…

SAR IEC meeting in Veracurz, Mexico (aka Simposium Veracruzano de Radiología Abdominal).

Hola! I was privileged to join a delegation from the SAR that recently participated in the Society of Abdominal Radiology International Education Conference (SAR IEC) in Veracruz, Mexico. Our ambassadors (a.k.a. my entourage) included el Presidente de SAR, Deborah Baumgarten (Emory), this year’s Richard H. Marshak International Lecturer Sudha Anupindi (CHOP), ultrasound guru extraordinaire Ulrike Hamper (Hopkins), GU rock star Cary Siegel (Mallinckrodt), and the remarkably versatile and no less amazing Jane Wang (UCSF). The conference consisted of three days of lectures, primarily provided by SAR members, and a few days of social activities/tours.

The SAR delegation with our Mexican colleagues

This year was somewhat of an anomaly, as I was the only SAR representative possessing a Y chromosome. As far as I can tell, this mix was representative of the pool of qualified applicants and presented no challenges. If anything, the mix was advantageous, as became apparent when Cary used a feminine hygiene product to obstruct a malfunctioning air conditioning vent in our van. I guess that must be the female equivalent of duct tape.

My entourage. They made me stay at least 5 steps behind them at all times. 

They thought I was being weird when I took this one,

I'm queen of the world

Looking fabulous in the old city

Three Amigas

The educational program covered emergency radiology, women’s imaging, oncologic imaging, and a mixture of technique talks at the end. Aside from Jane having to shout one of her talks over the sound of a torrential rainstorm, everything at the meeting ran smoothly. We all felt like rock stars when members of the local radiology society showed up with t-shirts sporting our photos on the back- so much so that Deb trashed her hotel suite during a raucous after party (all of this is speculation, since as usual, I wasn’t invited).

Sudha Anupindi delivers an outstanding lecture on pediatric MRI

Despite the late nights, my colleagues’ talks were nothing short of great, and I left Mexico with so many pearls, I had to pay an import tax in customs. Deb’s talk on thyroid ultrasound was particularly helpful. In only 30 minutes, I went from thinking that all thyroid lesions look the same to understanding that only most thyroid lesions look the same.

I decided to earn some extra money as a street musician during one of many late nights

Speaking of my colleagues, one of the best things about this type of educational program is having the opportunity to get better acquainted with other SAR members. On an ill-fated van ride through Xalapa in desperate search of a restaurant where we were to meet one of our hosts (Dr. Adrian Lopez Contrera) and his wonderful family, we decided to share with one another the most interesting job we held prior to medical school (Cary and Ulrike had both worked in candy factories. I had bused tables, and Deb had worked at a salad bar. I forget what Jane did, but I think it was something like lumberjack or stunt-woman). We also compared notes on strategies to stay in touch with friends and family when overseas (e.g. face time, what’s app, Viber, etc.) and the best way to tell a resident that they smell bad. And yes, with the help of several taxi drivers, we eventually made it to the restaurant 2 hours late (i.e. precisely on time).

The translators were very helpful in providing additional hints for speaking effectively (with translation) to a Spanish-speaking audience. For one thing, there are very few medical acronyms in common use in Mexico. So, whenever someone used an acronym such as MDCTU during their talk, they were on the next slide before the translator could finish saying, “Tomografía computarizada multidetector urografía” or something like that. Furthermore, in English, nouns are commonly preceded by adjectives; however the reverse is true in Spanish. Therefore, when we use a noun preceded by a bunch of adjectives, the translator cannot begin to translate the expression until the noun is spoken (so “big ugly festering liver tumor” is translated as “tumor enconado hígado grande y feo”. In general, we were told to expect the Spanish version of a talk to take approximately 30% longer than the English version. Also keep in mind that the translators need to breathe, so it is a good idea to pause briefly between sentences and slides or be prepared to give CPR.

Most of the members of our group could be classified as type A+ personalities (except for Dr. Siegel who has thus far eluded classification), so slowing down to the pace of life preferred by our neighbors to the south took some effort. Our first day of talks was scheduled for 0800, so we all dutifully arrived at 0730 to upload our talks, only to find the room empty. By 0800, the AV crew had just begun to set up, and by 0830, the first members of the audience arrived. What we didn’t understand is that all of this was factored into the program, and despite starting almost an hour after the published start time, we finished right on time. By the end of the second day (during which we finished dinner at around 11:00 pm), we had acclimated to the local culture and likely added a few days to our lives as a result (although the refried beans may have negated this potentially beneficial effect). By the end of the week, we were routinely doubling every time estimate our hosts provided and expecting things to start approximately 1-2 hours after the scheduled time. I gave some serious thought to the difference between our time-obsessed culture in the US and the more relaxed pace of Mexico and even considered that the difference might be based on the concept of gravitational time dilation; however, when one considers that the earth’s equatorial bulge is approximately 43 km, moving Mexico farther from the center of earth’s gravity, this theory falls apart.

Our hosts were amazing and ensured we had plenty of opportunities to enjoy the rich cultural heritage of the state of Veracruz. Our first day, we visited the old fort San Juan de Ulua (dating back to 1565) where Sir John Hawkins and a young Francis Drake met with defeat at the hands of the Spanish navy. The fortress was also the last point in New Spain to be held by Spain after the Mexican War of Independence. It was surrendered to General Miguel Barragán in November 1825. In 1984, parts of the mediocre movie Romancing the Stone were filmed there. I had to look all these factoids up retrospectively, as our tour guide was almost as unintelligible as James Joyce’s Ulysses. Unlike Joyce, our tour guide made it up to us by singing a traditional folk song at the end of our tour, so we left fulfilled.

Our tour through the fort. Cary wasn't the only one who was confused.

San Juan de Ulua

Cary Siegel

One of many group photos

I can’t be too critical of our tour guide’s English, though, as most of our group spoke little or no Spanish (with the exception of Sudha who did remarkably well and proved herself worthy of the Marshak award). While many of our hosts spoke only limited English we managed to communicate effectively through fragments of Spanish accentuated with hand gestures and smiles. With the help of my $8 phrase book, I could intelligibly convey most basic needs. The only thing I never did successfully accomplish was getting a cup of tea in the morning. For some reason, every version of the word for tea I tried translated into, “yes, I would very much like coffee”.

Cary Siegel gives a Spanish Lesson

The Museo de Antropología de Xalapa (home of the largest collection of colossal heads in Mexico) was a great way to learn about the history of the region and its indigenous peoples. Cultures such as the Olmec, the Huastec and the Totonac were all represented. The building, designed by the architect Edward Durrell Stone and opened in 1986, is itself a work of art and is surrounded by a carefully manicured 40,000-square-meter garden.

One of the colossal heads

More heads. One of them was smirking.

The Museo de Antropología de Xalapa

One indisputable highlight of the trip was our visit to El Tajín, a pre-Columbian archeological site and World Heritage site. The ruins were spectacular, and our host and President of SVRI, Dr. Jorge Herrera Cantillo, arranged for us to have a private showing of Los Voladores de Papantla (the Flying Indians of Papantla) on site.

The "flying indians" of Papantla.

Can you guess which shirts were provided by the SAR?

Our group at the Temple of the Niches.

Lots of photo ops at el Tajin

Panoramic view of the ruins.

Random Temple

Temple of the Niches

After our tour of the ruins, our guide spied a very rarely seen bird known as a potoo. It is rarely seen because it can remain completely still for hours and looks exactly like a tree branch.

Yes, it really is a bird.

The area of Papantla is famous for vanilla, so we voted to take some extra time to visit a landfill turned ecological reserve where we learned about vanilla bean cultivation. Vanilla beans grow from a vine-like orchid (V. planifolia) that is very labor-intensive to grow commercially (it requires pollination by hand). The Totonac people, who inhabit the East Coast of Mexico in the present-day state of Veracruz, were the first to cultivate vanilla and Spanish conquistador Hernán Cortés is credited with introducing vanilla to Europe in the 1520s. Our guide’s discussion of orchid reproduction (complete with revealing photos that would make any botanist blush) would be banned from most network television, but I guess that’s what happens when you spend your days alone in the middle of an ecological reserve surrounded by orchids. Once harvested, the green-colored beans are dehydrated over a period of many days during which they turn the more familiar dark redish brown color. The heavenly-smelling beans can then be used to produce vanilla extract or can be cut lengthwise to reveal the inner parts that can be scraped on desserts. The remaining outer husk can provide a powerful hallucinogenic experience when smoked (I might have made that last part up, but there’s only one way to find out). By the way, artificial vanilla is rumored to be derived from exudate from the castor sacs of mature beavers (a.k.a. beaver butt), so I would stick to foods made with the real thing if I were you.

This man knows more about vanilla than anyone on earth

Vanilla beans before and after processing

Hoping for a prince. 

We were very fortunate to be in Mexico for their Independence Day celebration, and despite a supposed terrorist threat resulting in beefed up security, the Society party at the hotel that night was an extravaganza of music, dancing, and food (in that order!). Jane was about to resort to cannibalism when dinner was served at 11 pm. The wait was well worth it, though; the buffet was as tasty as it was extensive. I would love to share more details of that evening, but as the saying goes, what goes to Mexico stays in Mexico. It is sufficient to say that no one was arrested, and all were present and accounted for during the morning lectures, if only in physical form. I also intend to earn some extra spending money by not posting key photos of our group on the SAR facebook page.

Deb Baumgarten receives a gift from the host society

I didn't know the Spanish word for "smile"

Finally, some men to hang out with!

Viva Mexico! 

Our hosts went to great lengths to ensure we had a great experience. Some notable individuals included our driver and body guard Jairzinho Beckenbauer Perera Velez. He always put our safety first, whether it be on a bumpy rural road or on a city tour. Passing on the two lane Mexican roads can quickly turn in to a lethal game of pollo, but we never once feared for our lives. Dr. Jorge Herrera Cantillo is something of a minor diety in Veracruz, and if Jorge wants something to happen, it happens. Every trip, every meal, and every event was first class, even in the most humble or remote settings. Dr. Rafael Hernandez Gonzalez was the social director and our constant companion for our visit. He is a wonderful person who traded a week’s worth of sleep for ensuring that we enjoyed our stay. Dr. Adrian Lopez Contreras treated our group to a memorable lunch accessorized with hand-made salsas and tortillas and presented each of us with a box of beautifully crafted marzipan creations.

Our body guards never took their eyes off us. Jairzinho Beckenbauer Perera Velez is the gentleman on the left.

Dr. Adrian Lopez Contreras with our own el Presidente Deb Baumgarten.

Dr. Jose Hugo Arredondo and Dr. Rafael Hernandez Gonzalez

The bottom line: This year’s IEC trip was an unqualified success! Thanks to Deb and Catie Duhon at IMM for organizing everything. And for those of you who are still considering smoking vanilla bean husks… don’t.

Stay thirsty my friends!