October 15, 2019--Life Expectancy

When a couple of years ago a neurologist told me that the tremor I was experiencing in my right hand was not an "essential tremor" but evidence of Parkinson's Disease, I asked him how long it would be before I turned into Michael J. Fox.

He asked how old I was. I told him and with a dismissive wave of his hand said I didn't need to worry. 

When I asked why, he said because at my age, before the symptoms became severe, I would be dead.

I told him that I then had something to look forward to. 

He asked what that was. 

I told him to being dead.

He didn't smile. In his business I suppose it isn't easy to have much of a sense of humor.

Thinking the other day about the intersecting curves of my slowly-developing PD symptoms and my age, in other words how I was doing on the dying scale, I thought to quantify it and so I looked up my actuarial life expectancy--how much longer I have to live.

For a white man my age it is 7.82 years. 

Not that bad, I thought, but then again, if I look back 7.82 years to 2011, as I did, it seems as if that was but yesterday.

Obama was in his second year as president--that was a good thing--and Osama bin Laden was killed--another good thing. Also, it was the year of the massive earthquake in Japan, the resulting tsunami, and the death of North Korean tyrant Kim Jung-Il. 

Domestically, in January, Gabby Giffords was shot, The King's Speech won the Academy Award for best picture, and the Packers defeated the Steelers in the Super Bowl. The Dow Jones average closing price was 11,958. Today it's 26,842.

Get what I mean? Doesn't it feel like just yesterday?

As you can see, I got carried away with this. 7.82 years. I couldn't get it out of my mind. It seemed like an OK number, but . . . King's Speech? Didn't we see that only two or three years ago?

I know life expectancy calculations are the heart and soul of how insurance companies operate. If they get it right, they make money. If not, their bottom line is effected. So traditionally considered, life expectancy is a big deal.

As I struggled with this, I wondered if this is the right way to think about life expectancy--not actuarily, calculating how much time is left, but to ask what I should expect from life. How am I doing in the living, not dying business.

Some days fine when the sunsets are especially vivid because I open myself to seeing them in their full display.

Or when dinner is particularly savory, again if I slow down and let myself experience the flavors and textures that way.

When I concentrate enough to hear the inner dynamics of a Beethoven string quartet. When I revisit some of Hemingway's stories and tune in again to his muscular prose. When the heat crackles in the pipes. When the birds, not anxiety wake me. 

When I notice how wonderful Rona looks in her red sweater. If I take the time to see even though I am colorblind and red often looks like dull gray to me. But in those moments when Rona fires my imagination and passion, red blazes and life is good.

If I manage to live this way, 7.82 years, or the time that remains for me, seems like just the right amount. 

September 18, 2019--The Man Who Mistook a Chipmunk for His Wife

A friend asked me to repost this. So here it is. It first appeared in June, 2018--

Neurologist and author Oliver Sacks was an acquaintance who wrote widely for lay readers about the complex world of mental "disorders." 

I put disorders in quotation marks since in his writing he challenges many of the traditional paradigms that classify many mental conditions as abnormal and as cognitive deficits. 

In my favorite of his books, The Man Who Mistook His Wife for a Hat, in four sections Sacks presents a series of brief case studies focused on aspects of neurology. 

In the first part he discusses neurological conditions that are usually construed to be deficits in normal brain function. Taking a very different tack, he argues that the medical community tends to define almost all divergent neurological conditions as some kind of deficit.

But, he claims, this paradigm is too narrow because it marginalizes these conditions, making it difficult to understand their full range of function, and that the traditional medical classification system also underestimates individuals' abilities to find ways of compensating for atypical mental function. 

In other words, the deficit model often leads to a lack of empathy and nuance and gets in the way of a full understanding of what is almost always characterized as illness and thus impedes effective ways of working with individuals who present unusual behaviors. Including behavior experienced by Dr. P., someone Sacks worked with for a number of years who had a rare form of "face blindness" that left him unable to distinguish between his wife's face and his hat. The man who mistook . . .

I thought about Sacks and the book late last week while standing in the road with George Lindberg, a close friend, who was asking me how my Parkinson's is progressing.

"The meds seem to relieve much of the tremor in my right hand," I said, "It's my only symptom thus far. So I'm feeling optimistic about the situation."

I extended my hand to show him. "That looks pretty good," he said, "Do you notice any things that cause increased tremoring?"

"When I have any anxiety, which I am prone to have, it does increase the tremor. In fact, it's happening right now. Maybe because we're talking about it." 

To show him I extended my arm again and my right hand was shaking quite visibly. "It stops right away if I tell myself to calm down." I showed him how that works. In a few seconds my hand completely calmed down.

"Does your neurologist say what might be in the offing?"

"In fact the last time I saw him I asked about that--'How long will it be before I'm like Michael J. Fox?'"

"I like that and I like Michael J. Fox," George said.

"I do as well. The doctor asked again how old I am and when I reminded him he said, 'In your case you'll be long gone before that happens.'" Liking how that sounded he smiled. Which is unusual for him.

"So I have something to look forward to," I said.

"What's that?" he asked.

"I said, also smiling, 'Being dead.'"

"That sounds good to me," George said, playfully referring to me.

"One thing, though," I added, "There's this commercial on TV for a med that claims it can lessen the delusions and hallucinations that supposedly 50 percent of people with PD will experience. That doesn't sound so good to me."

"Again," George said,"before that happens maybe you'll be fortunate enough to be long gone." He's a good kidder, which I like about him.

"What's that?" I said to him with my hand flapping.

"What are you pointing at?"

"Down the road, all the rustling in those bushes." I indicated where with my steady hand.

"I can't see what you're referring to," he said, "It would be strange since there's no wind."

"Rona's doing a lot of pruning. Maybe that's her in those bushes." I pointed again down the road where it looked to me like she was working. "But that would be unusual since that's really not on our property, though the owner of the log cabin, who's rarely here, likes it when Rona neatens things up."

George and I stood there peering at the bushes that were in rapid motion. At least they looked that way to me.

"Maybe it's a bear," Kidding, George said.

"Do we have bears here?" I asked taking him seriously.

"Not usually" he said, "Though strange things happen all the time. The berries are starting to set so bears could be lurking."

With that there was increased movement in the bushes. I clutched the shovel I had with me, getting ready for I knew not what.

And just as quickly, all movement ceased and popping out from the bushes was not Rona or a bear but a chipmunk that preceded to bounce across the road.

I'm not sure what George made of all this, but I was thinking about Oliver.

June 18, 2018--Midcoast: The Man Who Mistook His Wife for a Chipmunk

Neurologist and author Oliver Sacks was an acquaintance who wrote widely for lay readers about the complex world of mental "disorders." 

I put disorders in quotation marks since in his writing he challenges many of the traditional paradigms that classify many mental conditions as abnormal and as cognitive deficits. 

In my favorite of his books, The Man Who Mistook His Wife for a Hat, in four sections Sacks presents a series of brief case studies focused on aspects of neurology. 

In the first part he discusses neurological conditions that are usually construed to be deficits in normal brain function. Taking a very different tack, he argues that the medical community tends to define almost all divergent neurological conditions as some kind of deficit.

But, he claims, this paradigm is too narrow because it marginalizes these conditions, making it difficult to understand their full range of function, and that the traditional medical classification system also underestimates individuals' abilities to find ways of compensating for atypical mental function. 

In other words, the deficit model often leads to a lack of empathy and nuance and gets in the way of a full understanding of what is almost always characterized as illness and thus impedes effective ways of working with individuals who present unusual behaviors. Including behavior experienced by Dr. P., someone Sacks worked with for a number of years who had a rare form of "face blindness" that left him unable to distinguish between his wife's face and his hat. The man who mistook . . .

I thought about Sacks and the book late last week while standing in the road with George Lindberg, a close friend, who was asking me how my Parkinson's is progressing.

"The meds seem to relieve much of the tremor in my right hand," I said, "It's my only symptom thus far. So I'm feeling optimistic about the situation."

I extended my hand to show him. "That looks pretty good," he said, "Do you notice any things that cause increased tremoring?"

"When I have any anxiety, which I am prone to have, it does increase the tremor. In fact, it's happening right now. Maybe because we're talking about it." 

To show him I extended my arm again and my right hand was shaking quite visibly. "It stops right away if I tell myself to calm down." I showed him how that works. In a few seconds my hand completely calmed down.

"Does your neurologist say what might be in the offing?"

"In fact the last time I saw him I asked about that--'How long will it be before I'm like Michael J. Fox?'"

"I like that and I like Michael J. Fox," George said.

"I do as well. The doctor asked again how old I am and when I reminded him he said, 'In your case you'll be long gone before that happens.'" Liking how that sounded he smiled. Which is unusual for him.

"So I have something to look forward to," I said.

"What's that?" he asked.

"I said, also smiling, 'Being dead.'"

"That sounds good to me," George said, playfully referring to me.

"One thing, though," I added, "There's this commercial on TV for a med that claims it can lessen the delusions and hallucinations that supposedly 50 percent of people with PD will experience. That doesn't sound so good to me."

"Again," George said,"before that happens maybe you'll be fortunate enough to be long gone." He's a good kidder, which I like about him.

"What's that?" I said to him with my hand flapping.

"What are you pointing at?"

"Down the road, all the rustling in those bushes." I indicated where with my steady hand.

"I can't see what you're referring to," he said, "It would be strange since there's no wind."

"Rona's doing a lot of pruning. Maybe that's her in those bushes." I pointed again down the road where it looked to me like she was working. "But that would be unusual since that's really not on our property, though the owner of the log cabin, who's rarely here, likes it when Rona neatens things up."

George and I stood there peering at the bushes that were in rapid motion. At least they looked that way to me.

"Maybe it's a bear," Kidding, George said.

"Do we have bears here?" I asked taking him seriously.

"Not usually" he said, "Though strange things happen all the time. The berries are starting to set so bears could be lurking."

With that there was increased movement in the bushes. I clutched the shovel I had with me, getting ready for I knew not what.

And just as quickly, all movement ceased and popping out from the bushes was not Rona or a bear but a chipmunk that preceded to bounce across the road.

I'm not sure what George made of all this, but I was thinking about my friend Oliver.

August 8, 2017--The Believing Brain

Some of us the other morning were talking about the speech Donald Trump gave last week at a campaign-style rally in West Virginia.

He trotted out his best red-meat one-liners, including how everything going wrong in America is Hillary Clinton's fault. He also took undeserved credit for the run-up of the stock market. Then, he didn't fail to mention that he won the election by "the biggest" margin in American history. This in spite of the fact that Hillary received about 3.0 million more popular votes than he. And he didn't stifle the "lock-her-up" chants. It was like September 2016 all over again.

Ed wondered, "How can he get 20, 30 thousand people to turn out for this silliness?"

"And," Rona said, "to be able to get away with the lie that he won in a landslide?"

I said, and by doing so stirred the pot, "In the spirit of fairness, how does Bernie Sanders still attract tens of thousands to his rallies where his very-educated followers let him get away with proposing policies like free colleges tuition even though anyone having taken Economics 101 knows his numbers don't add up?"

"I'm not fond of the comparison," Ed said, "But I get your point." He is politically progressive but not an ideologue.

"I am coming to conclude," I said, "that it's all about belief. How people are substantially hardwired to believe. To believe myths and religious teaching, ideologies, the supernatural, the paranormal, conspiracy theories, fake news, and even flying saucers."

Ed said, "I've heard you opine about that late night radio talkshow you listen to, Coast to Coast, which is amazingly on more than 600 stations, where guest frequently talk about being abducted by space aliens."

"Again," I pushed, "it's not just the less well educated who have strong beliefs not based on facts or evidence. That's why it's interesting to read about how cognitive scientists, including neurologists, are coming to conclude that all humans have a built-in propensity to believe things that are not verifiable."

Rona said, "You're not talking about those who think there are anatomical differences in the brains of liberals and conservatives?"

"Not this time," I said, "I had done some reading about that last year but, though it was in its own way engaging, especially to liberals because it made us seem by nature smarter than conservatives, ultimately it wasn't persuasive. But I recently read Michael Shermer's The Believing Brain, and that marshaled a lot of credible evidence that is both biological and cultural."

"Sounds interesting," Ed said, "I should take a look at it."

"You can borrow my copy," I said, "But in the meantime, when I get home I'll send you a blurb about it and then you can decide if you want to read it."

When I got home I sent Ed the following from Shermer--

We form our beliefs for a variety of subjective, personal, and psychological reasons in the context of environments created by family, friends, colleagues, culture, and society at large; after forming our beliefs we then defend, justify, and rationalize them with a host of intellectual reasons, cogent arguments, and rational explanations. Beliefs come first, explanations follow. [My italics]  

Then from a review--

Dr. Shermer also provides the neuroscience behind our beliefs. The brain is a belief engine. From sensory data flowing in through our senses the brain naturally begins to look for and find patterns, and then infuses those patterns with meaning. The first process Dr. Shermer calls patternicity: the tendency to find meaningful patterns in both meaningful and meaningless data. The second process he calls agenticity: the tendency to infuse patterns with meaning, intention, and agency. 

We can't help believing. Our brains evolved to connect the dots of our world into meaningful patterns that explain why things happen. These meaningful patterns become beliefs. Once beliefs are formed the brain begins to look for and find confirmatory evidence in support of those beliefs, which adds an emotional boost of further confidence in the beliefs and thereby accelerates the process of reinforcing them. Round and round the process goes in a positive feedback loop of belief confirmation. Dr. Shermer outlines the various cognitive tools our brains engage to reinforce our beliefs as truths and to insure that we are always right. [Italics added]

The next time I saw Ed he asked if he could borrow the book.

June 16, 2017--Midcoast: Colonoscopies

It used to take at least a half hour before any of us would mention colonoscopes. Now we get to it right away. Even before we are served our first cup of coffee.

Just yesterday we not only talked about them but also bladder infections, melanoma, detached retinas, atrial fibrillation, shingles, abscessed molars, Hashimoto's Disease, and kidney stones.

And of course we share health insurance, doctor, and hospital stories. Few of them good.

My colonoscopy story was about my recent visit to a new internist. After taking my medical history and giving me a thorough examination, including a cardiogram, when he was done, he told me things look pretty good except for a heart murmur and my right hand tremors.

Ignoring that for a moment, I asked him about a colonoscopy. "I haven't had one in a few years," I said, "So maybe it's time . . ."

Before I could complete my thought, he said, "At your age we no longer recommend colonoscopies (he's a gastroenterologist no less) because no matter what we might find, at your age, you'll die of something else."

In a way that sounded good, but in truth, on reflection, not really.

I said, "I guess that gives me something to look forward to. Dying soon."

He doesn't have much of a sense of humor, or maybe his waiting room was full of patients and he didn't have time to schmooze, and so he barely smiled.

The cardiologist and neurologist he referred me too said pretty much the same thing--about the murmur, something else will get me before it becomes a problem; and the same for the tremor--"I'll write you a prescription for L-Dopa," he said, "And we'll hope for the best." He hardly needed to add, "that you'll die before . . ."

I stopped listening.

When I told the story to friends at the diner yesterday, one said, "This reminds me of a joke." We all groaned. Lou is not known to be a good joke teller. Undeterred though, he began, "Morty goes to his doctor who gives him his annual physical. When he's done, Morty asks, 'So how did I do?'

"The doctor says, 'Ten.'

 Confused, Morty asks, "'Ten what?' Years? Months? Days?'

"The doctor says, 'Nine, eight, seven, six . . .'"

Not that bad a joke from Lou.

And of course everyone either has a new set of hearing aids or is about to get them. And so there's a lot of breakfast talk about that.

"Why do we always seem to be talking about medical issues?" Rona wondered. We were driving to the pharmacy to get my L-Dopa prescription refilled.

"Isn't it obvious?" I said. "We're all getting on in years and stuff happens."

"Wouldn't you think . . ." she began.

"And don't forget that Maine has the oldest population of all the 50 states. And our county, Lincoln, demographically, has the nation's oldest residence."

The next time we were at Deb's Bristol Diner, when even before the waitress arrived to take our order, Jim began to talk about his diabetes numbers, I said, "Not to sound unsympathetic, but maybe we should try to talk about something not medical."

Jim who is not the sensitive type, without attitude, said, "What would you recommend?"

"A book, gardening, or maybe Donald Trump."

He said, "I rather have a colonoscopy."

Deb

April 6, 2017--Human Mutations

I have been thinking recently about my hand.

My right hand since it has developed a tremor. My doctors, particularly my neurologist is attempting to figure out its cause and to suggest ways both natural and medicinal to calm it.

I tell him I have come to like it. It to me is a sign of animal vitality, a kind of second heart that trembles rather than beats.

He tells me I'm crazy.

I tell him I have another doctor for that. And tiny crumbs of klonopin.

We both laugh. I need to laugh.

But the thinking about my hand has me thinking about human evolution. What a wondrous thing the human hand. How did it evolve from a fish's fin to become, over 600 million years, this most wonderful of appendages?

Slowly and, considering its complexity and anatomical differences from our aquatic ancestor, it required at least millions of steps, imperceptible mutations. Some led our proto-hand down some not helpful branches to so-called "bad mutations" that the struggle for survival between the fit and less fit were resolved in bloody ways.

How many modifications were needed to bring us, it, to this remarkable point? How many countless rolls of genetic dice?

And, as I ponder my trembling fingers, I wonder what else still might be occurring. Is Nature's job completed or are there still more surprises awaiting? Some of which might turn out to be beneficial?

Perhaps a sixth finger? Would we have use for that? Would one more digit make us less vulnerable, additionally able to survive? Perhaps a second thumb? Sprouting next to the pinky that also would be opposing and in tandem with our current thumb make us more powerful and adaptable?


Do geneticists have their eyes on mutational developments underway about which we should be concerned . . . or hopeful?

Surely we cannot be at the end of the evolutionary road.

And so with my fluttering hand I did some research. And found there are mutations occurring that we could well do without--the gene called Titin, for example, that can trigger heart failure--as well as others that hold the promise of progress.

For example, Apolipo-protein AI-Milano. Surely you've heard of this.

In case not, here is the detail from Adam Lee's "Four Beneficial Evolutionary Mutations Underway Now"--

Heart disease is one scourge of industrial countries. It's the legacy of an evolutionary past which programmed us to crave energy-dense fats, once a rare and valuable source of calories, now a source of clogged arteries. But there is evidence that evolution has the potential to deal with it. 

All humans have a gene for a protein called Apolipo-protein AI, which is part of the system that transports cholesterol through the bloodstream. Apo-AI is one of the HDLs, already known to be beneficial because they remove cholesterol from artery walls. But a small community in Italy is known to have a mutant version of the protein, named Apolipo-protein AI-Milano, or Apo-AIM for short. 

Apo-AIM is even more effective than Apo-AI at removing cholesterol from cells and dissolving arterial plaques, and additionally functions as an antioxidant, preventing some of the damage from inflammation that normally occurs in arteriosclerosis. People with the App-AIM gene have significantly lower levels of risk than the general population for heart attacks and stroke, and pharmaceutical companies are looking into marketing an artificial version of the protein as a cardio-protective drug. 

There are also drugs in the pipeline based on a different mutation, in a gene called PCSK9, which has a similar effect. People with this mutation have as much as an 88% lower risk of heart disease.

I know that with my hand nothing beneficial is going on that, in evolutionary terms, is "adaptive." But my doctor is happy that I am dealing with it so well. Or about which I am, in my more familiar mode, in denial.

December 3, 2014--Car, Cat, Tree

Aunt Madeline liked attention. Including occasionally checking herself into hospitals to make sure her nieces and nephews would visit. Otherwise, they made their way to Brooklyn maybe once or twice a year.

One time, she was having real issues. From the panicky phone call to us, seemingly psychiatric ones. She called to see if we could meet her at Beth Israel's admitting office. Out of consideration for us, she picked the hospital nearest where we lived so we wouldn't again have to schlep to a Brooklyn hospital.

It took 15 minutes for us to get there and we waited nervously nearly an hour until the ambulette arrived. Madeline was frazzled and disheveled. Not her usual state and so we were concerned.

From her appearance alone it was clear we needed to get her to psychiatric admitting.

When we did, Madeline asked the nurse who took her history if we could sit with her. "Of course," she said with compassionate understanding.

Among other things, the nurse administered a brief cognitive test--"Can you repeat," she asked Madeline, "car, cat, tree?"

"Car-cat-tree," Madeline shot back full voiced.

"Very good. Can you also repeat car, cat, tree in reverse?" Madeline looked puzzled. "Backwards."

"Oh, that, yes, tree-cat-car," Madeline, proud of herself, smiled as if to say, "I'm not that crazy."

"If I may," I asked the nurse, "what are you trying to determine?"

"If your aunt has dementia, Alzheimer's."

"And?"

"From how she did, I think not."

"You see, I told you," all smiles Madeline said, "I'm not crazy. I'm just having a nerve attack." And from that I felt her hospitalization would be brief. Which indeed it turned out to be.

We visited every day, which gave our wonderful aunt great pleasure; and from then on, for more than 20 years, whenever either Rona or I have been confused about something, not able to recall a name or date, I say car, cat, tree and Rona responds with the more challenging tree, cat, car. This assures us we're still all right. No need yet to get checked into Beth Israel.

Though at 4:00 a.m. yesterday, fitfully sleeping and lying wide awake staring at the ceiling, I could have used a little help and assurance that I hadn't overnight caught a case of Alzheimer's.

For some inexplicable reason--but that's the middle of the night for you: inexplicableness--I couldn't for almost an hour remember who wrote "It's De-Lovely."

I know, crazy. But not being able to remember Cole Porter made me really crazy.

Sweating and tossing, I went down the list of songwriters from that era I could remember--Rodgers and Hart, Rogers and Hammerstein, George and Ira Gershwin, Johnny Mercer, Irving Berlin. None of them I knew wrote "It's De-Lovely."

At least that was something. My memory of songs and composers was still partially intact. Those PET-scan images of brains of old folks with Alzheimer's that show shadowy hollows and vacancies must have just begun to eat away at that part of mine where the names of songs and songwriters are retained. So maybe, I thought, tomorrow night at 4:00 a.m. I no longer will remember who wrote "Thou Swell." At my age, who cares about songwriters.

But try me--Rodgers and Hart.

And of course cat, car, tree.