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.

May 3, 2108--Pornhub

One of the things I try to keep up with is the neurobiology of pleasure. 

What is the nature of pleasure and how does the brain process it? What are the electrical and chemical events that fire when we experience pleasure?

To laypeople (which includes me) it would likely come as a surprise that there is a battle among researchers and clinicians about the nature of pleasure itself. Are all pleasures basically the same or is there a hierarchy of pleasure, with certain ones "higher" than others? 

The disputants, reported the New York Times, are about equally divided.  

One side in the conflict asks if the pleasure we receive from art and other aesthetic experiences is categorically different. In other words, not so between the lines, is the experience of art a higher form of pleasure as contrasted with the less-refined enjoyment we receive from food (particularly sweets) and sex. As a result, the title of the piece--"Mona Lisa and Pornhub as Equals?" Note the question mark.

Taking the other side in this struggle, neuroscientist Julia Christensen, in an article, "Pleasure Junkies All Around!" writes about the responses to ballet in contrast to, say, our addiction to sweets--have we turned into "mindless pleasure junkies handing over our free will for the next dopamine shot" which, she claims, is equally present in the brain as the result of engaging in social media, watching pornography, craving a sugar fix, or attending a dance recital.

This jumped out at me because of the dopamine that is a part of the L-DOPA compound I take for my PD because when I take my pills I am not aware of any heightened sense of pleasure except from the realization that it helps control the slight tremor I have in my right hand. I suspect there is no firing in the pleasure center of my brain, just this awareness and thankfulness. That feels like enough.

Researchers do not agree whether enjoying a da Vinci results in a different neural process than visiting McDonald's or Pornhub.

For those who claim that all pleasures are pretty much the same when it comes to brain function, to quote the Times, "why don't people ever orgasm from pleasure associated with food or art?" 

It turns out that they do! 

According to Debra Herbenick at the University of Indiana's Center for Sexual Health, eating a ripe tomato or reading nonerotic literature have been reported to provoke an orgasm. So too, apparently, does walking barefoot on wood floors and doing pull-ups. Though, in regard to the latter, I have my doubts.