You’ve got some nerve!

It’s Saturday, the 19th of November in 2022, and I’m going in to the office today, so I’m writing a blog post as well.  I’m using my laptop to do it, and that’s nice—it lets me write a bit faster and with less pain at the base of my right thumb, which has some degenerative joint disease, mainly from years of writing a lot using pen and paper.

The other day I started responding to StephenB’s question about the next big medical cure I might expect, and he offered the three examples of cancer, Alzheimer’s and Parkinson’s Disease.  I addressed cancer—more or less—in that first blog post, which ended up being very long.  So, today I’d like to at least start addressing the latter two diseases.

I’ll group them together because they are both diseases of the central nervous system, but they are certainly quite different in character and nature.  This discussion can also be used to address some of what I think is a dearth of public understanding of the nature of the nervous system and just how difficult it can be to treat, let along cure, the diseases from which it can suffer.

A quick disclaimer at the beginning:  I haven’t been closely reading the literature on either disease for quite some time, though I do notice related stories in reliable science-reporting sites, and I’ll try to do a quick review of any subjects about which I have important uncertainties.  But if I’m out of date on anything specific, feel free to correct me, and try to be patient.

First a quick rundown of the two disorders.

Alzheimer’s is a degenerative disease of the structure and function of mainly the higher central nervous system.  It primarily affects the nerves themselves, in contrast to neurologic diseases that interfere with supporting cells in the brain*.  It is still, I believe, the number one cause of dementia** among older adults, certainly in America.  It’s still unclear what the precise cause of Alzheimer’s is, but it is associated with the development of “cellular atypia made of what are called “neurofibrillary tangles” within the cell bodies of neurons, and these seem to interfere with normal cellular function.  To the best of my knowledge, we do not know for certain whether the plaques are what directly and primarily cause most of the disease’s signs and symptoms, or if they are just one part of the disease.  Alzheimer’s  is associated with gradual and steadily worsening loss of memory and cognitive ability, potentially leading to loss of one’s ability to function and care for oneself, loss of personal identity, and even inability to recognize one’s closest loved ones.  It is degenerative and progressive, and there is no known cure and there are few effective treatments that are not primarily supportive.

Parkinson’s Disease (the “formal” disease as opposed to “Parkinsonism”, which can have many causes, perhaps most notably the long-term treatment of psychiatric disorders with certain anti-psychotic medicines), is a disorder in which there is loss/destruction of cells in the substantia nigra***, a region in the “basal ganglia” in the lower part of the brain, near the takeoff point of the brainstem and spinal cord.  It is dense with the bodies of dopaminergic neurons, which there seem to modulate and refine motor control of the body.  The loss of these nerve cells over time is associated with gradual but progressive movement disorders, including the classic “pill-rolling” tremor, shuffling gait, blank, mask-like facial expression, and incoordination with tendency to lose one’s balance.  There are more subtle and diffuse problems associated with it, including dementia and depression, and like Alzheimer’s it is generally progressive and degenerative, and there is no known “cure”, though there are treatments.

Let me take a bit of a side-track now and address something that has been a pet peeve of mine, and which contributes to a general misunderstanding of how the nervous system and neurotransmitters work, and how complex the nature and treatment of diseases of the central nervous system can be.  This may end up causing this blog post to require at least two parts, but I think it’s worth the diversion.

I mentioned above that the cells of the substantia nigra are mainly dopaminergic cells.  This means that they are nerve cells that transmit their “messages” to other cells mainly (or entirely) using the neurotransmitter dopamine.  The term “dopaminergic” is a combination word, its root obviously enough being “dopamine” and its latter half, “ergic” relating to the Greek word “ergon” which means to do work.  So “dopaminergic” means those cells do their work using dopamine, and—for instance—“serotonergic” refers to cells that do their work using serotonin.  That’s simple enough.

But the general public seems to have been badly educated about what neurotransmitters are and do; what nerve impulses are and do; and what the nature of disorders, like for instance depression, that involve so-called “chemical imbalances” really entails.

I personally hate the term chemical imbalance.  It seems to imply that the brain is some kind of vat of solution, perhaps undergoing some large and complex chemical reaction that acquires some mythical state of equilibrium when it’s working properly, but when, say, some particular reactant or catalyst is present in too great or too small a quantity, doesn’t function correctly.  This is a thoroughly misleading notion.  The brain is an incredibly complex “machine” with hundreds of billions of cells interacting in extremely complicated and sophisticated ways, not a chemical reaction with too many or too few moles on one side or another.

People have generally heard of dopamine, serotonin, epinephrine, norepinephrine, and the like, and I think many people think of them as related to specific brain functions—for instance, serotonin is seen as a sort of “feel good” neurotransmitter, dopamine as a “reward” neurotransmitter, epinephrine and norepinephrine as “fight or flight” neurotransmitters, and so on.

I want to try to make it very clear:  there’s nothing inherently “feel good” about serotonin, there’s nothing inherently “rewarding” about dopamine, and—even though epinephrine is a hormone as well as a neurotransmitter, and so can have more global effects—there’s nothing inherently “fight or flight” about the “catecholamines” epinephrine and norepinephrine.

All neurotransmitters—and hormones, for that matter—are just complex molecules that have particular shapes and configurations and chemical side chains that make them better or worse fits for receptors on or in certain cells of the body.  The receptors are basically proteins, often combined with special types of “sugars” and “fats”.  They have sites in their structures into which certain neurotransmitters will tend to bind—thus triggering the receptor to carry out some function—and to which other neurotransmitters don’t bind, though, as you may be able to guess from looking at their somewhat similar structures, there can be some overlap.

dopamine

Dopamine

serotonin

Serotonin

epinephrine

Epinephrine

Neurotransmitters are effectively rather like keys, and their functions—what they do in the nervous system—are not in any way inherent in the neurotransmitter itself, but in the types of processes that get activated when they bind to receptors.

There is nothing inherently “rewarding” about dopamine, any more than there is anything inherently “front door-ish” to the key you use to unlock the front door of your house, or “car-ish” to the keys that one uses to open and turn on cars.  It’s not the key or the lock that has inherent nature, it’s whatever function is initiated when that key is put into that lock, and that function depends entirely on the nature of the target.  The same key used to open your door or start your car could, in principle, be used to turn on the Christmas lights in Rockefeller Center or to launch a nuclear missile.

Dopamine is associated with areas of the nervous system that function to reward—or more precisely, to motivate—certain behaviors, but it is not special to that function.  As we see in Parkinson’s Disease, it is also used in regions of the nervous system involved in modulating motor control of the body.  The substantia nigra doesn’t originate the impulses for muscles to move, but it acts as a sort of damper or fine tuner on those motor impulses.

Neurotransmitters work within the nervous system by being released into very narrow and tightly closed spaces between two nerve cells (a synapse), in amounts regulated by the rate of impulses arriving at the bulb of the axon.  Contrary to popular descriptions, these impulses are not literally “electrical signals” but are pulses of depolarization and repolarization of the nerve cell membrane, involving “voltage-triggered gates****” and the control of the concentration of potassium and sodium ions inside and outside the cell.

synapse

A highly stylized synapse

The receptors then either increase or decrease the activity of the receiving neuron (or other cell) depending on what their local function is.  It’s possible, in principle, for any given neurotransmitter to have any given action, depending on what functions the receptors trigger in the receiving cell and what those receiving cells then do.  However, there is a fairly well-conserved and demarcated association between particular neurotransmitters and general classes of functions of the nervous system, due largely to accidents of evolutionary history, so it’s understandable that people come to think of particular neurotransmitters as having that nature in and of themselves…but it is not accurate.

Okay, well, I’ve really gone off on my tangents and haven’t gotten much into the pathology, the pathophysiology, or the potential (and already existing) treatments either for Parkinson’s or Alzheimer’s.  I apologize if it was tedious, but I think it’s best to understand things in a non-misleading way if one is to grasp why it can be so difficult to treat and/or cure disorders of the nervous system.  It’s a different kind of problem from the difficulties treating cancer, but it is at least as complex.

This should come as no surprise, given that human nervous systems (well…some of them, anyway) are the most complicated things we know of in the universe.  There are roughly as many nerve cells in a typical human brain as there are stars in the Milky Way galaxy, and each one connects with a thousand to ten thousand others (when everything is functioning optimally, anyway).  So, the number of nerve connections in a human brain can be on the order of a hundred trillion to a quadrillion—and these are not simple switching elements, like the AND, OR, NOT, NAND, and NOR gates for bits in a digital computer, but are in many ways continuously and complexly variable even at the single synapse level.

When you have a hundred trillion to a quadrillion more or less analog switching elements, connecting cells each of which is an extraordinarily complex machine, it shouldn’t be surprising that many things can go wrong, and that figuring out what exactly is going wrong and how to fix it can be extremely difficult.

It may be (and I strongly suspect it is the case) that no functioning brain of any nature can ever be complex enough to understand itself completely, since the complexity required for such understanding increases the amount and difficulty of what needs to be understood*****.  But that’s okay; it’s useful enough to understand the principles as well as we can, and many minds can work together to understand the workings of one single mind completely—though of course the conglomeration of many minds likewise will become something so complex as likely to be beyond full understanding by that conglomeration.  That just means there will always be more to learn and more to know, and more reasons to try to get smarter and smarter.  That’s a positive thing for those who like to learn and to understand.

Anyway, I’m going to have to continue this discussion in my next blog post, since this one is already over 2100 words long.  Sorry for first the delay and then the length of this post, but I hope it will be worth your while.  Have a good weekend.


*For instance, Multiple Sclerosis attacks white matter in the brain, which is mainly long tracts of myelinated axons—myelin being the cellular wraparound material that greatly speeds up transmission of impulses in nerve cells with longish axons.  The destruction of myelin effectively arrests nerve transmission through those previously myelinated tracts.

**“Dementia” is not just some vague term for being “crazy” as one might think from popular use of the word.  It is a technical term referring to the loss (de-) of one’s previously existing mental capacity (-mentia), particularly one’s cognitive faculties, including memory and reasoning.

***Literally, black substance.

****These are proteins similar to the receptors for neurotransmitters in a way, but triggered by local voltage gradients in the cell membrane to open or close, allowing sodium and/or potassium ions to flow into and out of the cell, thereby generating more voltage gradients that trigger more gates to open, in a wave that flows down the length of the axon, initially triggered usually at the body of the nerve cell.  They are not really in any way analogous to an electric current in a wire.

*****You can call that Elessar’s Conjecture if you want (or Elessar’s Theorem if you want to get ahead of yourself), I won’t complain.

Some discussion of cancer–not the zodiac sign

Yesterday, reader StephenB suggested that I write about what I thought might be the next big medical cure coming our way—he suggested cancer, Alzheimer’s, and Parkinson’s diseases as possible contenders—and what I thought the “shape” of such a cure might be.  I thought this was an interesting point of departure for a discussion blog, and I appreciate the response to my request for topics.

[I’ll give a quick “disclaimer” at the beginning:  I’ve had another poor night.  Either from the stress of Monday night or something I ate yesterday (or both, or something else entirely) I was up a lot of last night with reflux, nausea, and vomiting.  So I hope I’m reasonably coherent as I write, and I apologize if my skills suffer.]

One hears often of the notion of a “cure for cancer”, for understandable reasons; cancer is a terrifying and horrible thing, and most people would like to see it gone.  However, my prediction is that there will never be “a” cure for cancer, except perhaps if we develop nanotechnology of sufficient complexity and reliability that we are able to program nanomachines unerringly to tell the difference between malignant and non-malignant cells, then destroy the malignant ones and remove their remains neatly from the body without causing local complications.  That’s a tall order, but it’s really the only “one” way to target and cure, in principle, all cancers.

Though “cancer” is one word, and there are commonalities in the diseases that word represents, most people know that there are many types of cancers—e.g., skin, colon, lung, breast, brain, liver, pancreatic, and so on—and at least some people know that, even within the broader categories there are numerous subtypes.  But every case of cancer is literally a different disease in a very real sense, and indeed, within one person, a single cancer can become, effectively, more than one disease.

We each* start out as a single fertilized egg cell, but by adulthood, our bodies have tens of trillions of cells, a clear demonstration of the power of exponential expansion.  Even as adults, of course, we do not have a static population of cells; there is ongoing growth, cell division/reproduction, and of course, cell death.  This varies from tissue to tissue, from moment to moment, from cell type to cell type, under the influence of various local and distant messengers, ultimately controlled by the body’s DNA.

Whenever a cell replicates, it makes a copy of its DNA, and one of each copy is sent into each daughter cell.  There are billions of base pairs in the human genome, so there are lots of opportunities for copying errors.  Thankfully, the cell’s proofreading “technology” is amazingly good, and errors are few and far between.  But they are not nonexistent.  Cosmic rays, toxins, other forms of radiation, prolonged inflammation, and simple chance, can all lead to errors in the replication of a precursor cell’s DNA, giving rise to a daughter cell with mutations, and when there are trillions of cells dividing, there are bound to be a number of them.

The consequences of such errors are highly variable.  Many of them do absolutely nothing, since they happen in portions of the genome that are not active in that daughter cell’s tissue type, or are in areas of “junk” DNA in the cell, or in some other way are inconsequential to the subsequent population of cells.  Others, if in just the wrong location, can be rapidly lethal to a daughter cell.  Most, though, are somewhere in between these two extremes.

The rate of cell division/reproduction in the body is intricately controlled, by the proteins and receptors in that cell, and the genes that code for them, and that code for factors that influence other portions of the genome of a given cell, and that make it sensitive or insensitive to hormonal or other factors that promote or inhibit cell division.  If a mutation in one of the regions of the cell that is involved in this regulatory process—either increasing the tendency to grow and divide or diminishing the sensitivity to signals that inhibit division—a cell can become prone to grow and divide more rapidly than would be ideal or normal for that tissue.  Any given error is likely to have a relatively minor effect, but it doesn’t take much of an effect to lead to a significant increase in the number of cells in a given cell type eventually—again, this is the power of exponential processes.

A cell line that is reproducing more rapidly will have more opportunities for errors in the DNA reproduction of its many daughter cells.  These new errors are no more likely to be positive, negative, or neutral generally than any other replication errors anywhere else in the body, but increased rate of growth means more opportunities** for mistakes.

If a second mistake in one of the potentially millions (or more) of daughter cells of the initial cell makes it yet more prone to divide rapidly than even the first population of mutated cells, then that population will grow and outpace the parent cells.  There can be more than one such daughter populations of cells.  And as the rate of replication/growth/division increases in a given population of cells, we have an increased chance of more errors occurring.  Those that become too deleterious will be weeded out.  Those that are neutral will not change anything in the short term (though some can make subsequent mutations more prone to cause increased growth rates).  But the ones that increase the rate of growth and division will rapidly come to dominate.

This is very much a microcosm of evolution by natural selection, and is a demonstration of the fact that such evolution is blind to the future.  In a sense, the mutated, rapidly dividing cells are more successful than their more well-behaved, non-mutated—non-malignant—sister cells.  They outcompete for resources*** against “healthy” cells in many cases, and when they gather into large enough masses, they can cause direct physical impairments to the normal function of an organism.  They can also produce hormones and proteins themselves, and can thus cause dysregulation of the body in which they reside in many ways.

Because they tend to accumulate more and more errors, they tend to become more dysfunctional over time.  And, of course, any new mutations in a subset of tumor cells that makes it more prone to divide unchecked, or that makes it more prone to break loose from its place of origin and spread through the blood and/or lymph of the body will rapidly become overrepresented.

This is the general story of the occurrence of a cancer.  The body is not without its defenses against malignant cells—the immune system will attack and destroy mutated cells if it recognizes them as such—but they are not perfect, nor would it behoove evolution (on the large scale) to select for such a strictly effective immune system, since all resources are always finite, and overactive immunity can cause disease in its own right.

But the specific nature of any given cancer is unique in many ways.  First of all, cancers arise in the body and genes of a human being, each of which is thoroughly unique in its specific genotype from every other human who has ever lived (other than identical twins).  Then, of course, more changes develop as more mutations occur in daughter cells.  Each tumor, each cancer, is truly a singular, unique disease in all the history of life.  Of course, tumors from specific tissues will have characteristics born of those tissues, at least at the start.  Leukemias tend to present quite differently from a glioblastoma or a hepatoma.

Because of these differences, the best treatments for specific cancers, even of classes of cancers, is different.  The fundamental difficulty in treating cancer is that you are trying to stop the growth and division—to kill—cells that are more or less just altered human cells, not all that different from their source cells.  So any chemical or other intervention that is toxic to a cancer cell is likely to be toxic to many other cells in the body.  This is why chemotherapy, and radiation therapy, and other therapies are often so debilitating, and can be life-threatening in their own right.  Of course, if one finds a tumor early enough, when it is quite localized, before any cells have broken loose—“metastasized”—to the rest of the body, then surgical removal can be literally curative.

Other than in such circumstances, the treatment of cancer is perilous, though not treating it is usually more so.  Everything from toxic chemicals to immune boosters, to blockers of hormones to which some cancers are responsive, to local radiation are used, but it is difficult to target mutated cells without harming the native cells to at least some degree.

In certain cases of leukemia, one can literally give a lethal dose of chemo and/or radiation that kills the bone marrow of a person whose system has been overwhelmed by malignant white blood cells, then giving a “bone marrow transplant”, which nowadays can sometimes come from purified bone marrow from the patient—thus avoiding graft-versus-host diseases—and there can be cures.  But it is obviously still a traumatic process, and is not without risk, even with auto-grafts.

So, as I said at the beginning, there is not likely to be any one “cure” for cancer, ever, or at least until we have developed technology that can, more or less inerrantly, recognize and directly remove malignant cells.  This is probably still quite a long way off, though progress can occasionally be surprising.

One useful thing cancer does is give us an object lesson, on a single-body scale, that it is entirely possible for cell lines—and for organisms—to evolve, via apparent extreme success, completely into extinction.  It’s worth pondering, because it happens often, in untreated cancers, and it has happened on the scale of species at various times in natural history.  Evolution doesn’t think ahead, either at the cellular level, the organismal level, or the species/ecosystem level.  Humans, on the other hand, can think ahead, and would be well served to take a cue from the tragedy of cancer that human continuation is not guaranteed merely because the species has been so successful so far.

Anyway, that’s a long enough post for today.  I won’t address matters of Parkinson’s Disease or Alzheimer’s now, though they are interesting, and quite different sorts of diseases than cancers are.  I may discuss them tomorrow, though I might skip to Friday.  But I am again thankful to StephenB for the suggestion/request, and I encourage others to share their recommendations and curiosities.  Topics don’t have to be about medicine or biology, though those are my areas of greatest professional expertise.  I’m pretty well versed in many areas of physics, and some areas of mathematics, and I enjoy some philosophy and psychology, and—of course—the reading and writing of fiction.

Thanks again.


*I’m excluding the vanishingly rare, and possibly apocryphal, cases of fused fraternal twins.

**There are also people who have, at baseline, certain genes that make them more prone to such rapid replication, or to errors in DNA replication, or to increased sensitivity to growth factors of various kinds, and so on.  These are people who have higher risks of various kinds of cancer, but even in them, it is not an absolute matter.

***Most tissues in the body have the inherent capacity and tendency to stimulate the development of blood vessels to provide their nutrients and take away their wastes.  Cancer cells are no exception, or rather, the ones that are do not tend to survive.  Again, it is a case of natural selection for those cell lines that are most prone to multiply and grow and gain local resources.

Blow, winds, and crack your cheeks…yadda, yadda, yadda

Well, it’s Wednesday morning, and it’s sloppy and wet, but the trains are running on time and so is most everything else here in southeast Florida, though the wind is a bit irritating.  Because of it, I was only able to write that first sentence while at the train station, then I had to close up the laptop to protect it from water damage, even though the train stations have roofs.

I’m sure it was a sensible decision for them to make the Tri-rail stations basically open-air with only an overhead covering.  This is south Florida, where it’s rarely so cold that heating is an issue, but on days like today—when it’s wet and windy because a hurricane is approaching the other side of the state*—I do curse the decision.  But I only curse it half-heartedly, because I can’t in good conscience really hold it against someone for doing something efficient and long-term sensible.

There are almost no courses of action, even ones that are clearly the best choices in the long term, that don’t have occasional drawbacks.  Life is complicated.  The universe is complicated, at least if you look at it very closely.  Actually, I guess you don’t have to look all that closely.

I thought about not riding the train today, but I couldn’t justify it.  The Tri-rail is running, and at a normal schedule, so I could hardly give myself an excuse for slacking off in any way.  Also, given the weather, there are a certain percentage of other people who will not go to work today, and that means the trains will be less crowded than usual—which, so far, mine is—and that’s kind of nice.  It’s not as though one gets any kind of extra service, since there is no “service”, but there’s less worry about not getting one’s usual seat, and it’s just generally less crowded.  I don’t know if this will be the case on the way home, but it is right now.

I was weirdly pleased to have a reason to get out my rain jacket, which is designed to be worn while riding on a motorcycle, and so is quite snug and water-repellant.  I don’t wear it much anymore.  I came close to wearing my long, black duster, which is also quite good against the rain (contrary to its name).  But the duster is cloth, and it’s heavier, so it’s likely to have been hotter to wear.  It is a very nifty coat, though, and I’m slightly sad that I don’t get to use it more often.

I got a slightly better sleep last night than the night before—maybe as much as four hours, though not continuous.  There were no issues with power or with cable, but then again, I didn’t honestly expect any.  This is south Florida.  The state and its utilities are far from beyond criticism, but rainy, windy weather—yeah, they’re pretty well used to handling that.

It’s a bit like Houghton, Michigan, which is on the upper peninsula of the upper peninsula of Michigan, and is where Michigan Tech is located.  They get absurd amounts of snow and cold every year, jutting as they do out into Lake Superior, but I’m told that Michigan Tech never closes for snowy weather, despite a reputed more than 16 feet of snowfall every year on average.

I can only imagine what would happen if any significant snow fell down here in the Miami area.  If any snow at all fell, it would be remarkable, but if it was a lot, well, it would be stunning in many ways.  One thing it would also be would be a problem for heating, since, basically, houses down here don’t have furnaces of any kind.  There are a few days early in most years where that actually becomes an issue, and it honestly gets too cold at night.  This is made worse by the fact that many of us don’t really have extra-warm blankets or the like.

And, again, here I am “talking about the weather” like the absolute cretin that I am.  I suppose that it can be excused a bit, given that there’s a hurricane passing near, but I’m embarrassed.  Still, embarrassment is a fairly normal state for me.  I’m almost always tense and anxious and uptight.

Twice in my life, while I was still a teen, I was given Valium, the actual name-brand pharmaceutical, for medical procedures—once for a heart catheterization, once when I had my wisdom teeth taken out.  I remember feeling ever so remarkably at ease and comfortable, even with my mouth full of gauze and blood, or with a wire going into my femoral artery and snaking up to my heart.  I wondered—and still wonder—if this is how some people feel all the time, or more of the time.  I basically have never felt anything like that way except on those two occasions.

I almost hit on the hygienist at the dentist’s office after my procedure.  I didn’t, but the fact that I even had the urge and would have been able to do it if I had so chosen is so unlike me that it’s astonishing.  And while I was having my catheterization, apparently the catheter bumped against some part of the conduction system of my heart and I had a very powerful double-beat, one so strong I could literally feel it up into my neck.  The cardiologist was plainly mortified and apologized sincerely, but I just smiled and said, “That was cool!”

This is how I knew I must never, ever get a prescription for Valium, despite chronic anxiety and stress.  It would simply be too easy for me to become psychologically dependent on it, for one thing, and for another, I know it would inevitably have diminishing returns, and stopping it would then make me feel worse than before.  That would be a true, ironic Hell.  No, thank you!

Drugs in general seem to affect me differently than most people, which may be a good thing.  I took opioids for chronic pain for some time, and they definitely worked to help the pain, but never for as long as hoped, and the side-effects were trouble, so eventually I had to wean myself off them, though not without some regret for the worsening pain.

I also do enjoy a rare alcoholic beverage—someone as tense as I am would be prone to, wouldn’t he?  However, I tend to feel rather unpleasant almost immediately after, and since my back problem, I’ve noticed that alcohol intake makes my pain flare up afterwards.

And I think I’ve mentioned the time I tried a hit of a friend’s marijuana hoping it would help my pain, but instead it left me vomiting for about two hours (and still in pain, though I was at least distracted).  THC is supposed to suppress nausea most of the time, for most people.  I really am alien, it seems.  At least, I’m atypical.

I will admit that mindfulness meditation does help my tension and anxiety in the short-term, but it seems to make my dysthymia and depression worse.  Maybe being too aware of my own thought processes makes me realize how unlikeable I really am, I don’t know.  It’s weird, but apparently there is some literature about Vipassana not being too useful for actual depression, though it may decrease the risk of relapse in people who are in remission.  I’m not up to date on the latest research, but it does disappoint me, because I’m fairly natural at meditation and self-hypnosis and the like.

Anyway, that’s enough for today, I think.  I’m getting close to my stop, and that seems like a good indicator that I should stop writing.  No, not for good—don’t get your hopes up—but for today, anyway.  I’m also, by the way, going to try to stop commenting at all on other people’s blogs and websites, after something that happened yesterday.  Apparently, I give minor offense or am rude, even when I certainly don’t mean to be, and then I feel both stressed and mortified as well as angry about being misunderstood.  Oh well.  Life is hard, but there are alternatives.  At least there’s one.  It becomes more enticing by the day.


*I added this footnote later to note that, as I walked from the train to the office, the clouds overhead were all moving consistently and rapidly west-northwest, which seems to indicate, if my reasoning is correct, that the center of the hurricane is still southwest of here, probably out in Gulf of Mexico for the moment, though I haven’t checked the reports yet this morning.

[Added note:  Since there’s a hurricane a-blowing, I decided to embed my cover of the Radiohead song “How to Disappear Completely” below, because the third verse includes the words, “Fireworks and blown speakers, strobe lights and hurricanes.”  I’ll also embed the original below that; it’s one of Radiohead’s most beautiful songs.]

Imagine this post to have a title with a quote from a song about eyes.

I’m not sure how well this is going to go today.  Last night, sometime not too long after midnight, maybe, I must have done something to scratch the conjunctiva of my right eye behind the middle of the upper eyelid, and it wasn’t long before I woke up with real, sharp pain.  I haven’t been able to see anything in there, such as a foreign body, despite mirrors, lights, and bright flashlights, and a complete lack of squeamishness about looking around under my own eyelid.  All I can see is that it’s irritated, though it feels as though there’s a needle in it.  But, of course, I can’t see very well in there even with lights and flashlight and lack of squeamishness, because the eye in question is impaired by the irritation, so there are limits.

I would offer to take and include with this post a picture from my cell phone camera, but I don’t see how that would help.

It’s so bad that I was tempted just to stay home from work, but the problem is, there are too many things in and around the house that are irritating to my eyes in and of themselves—dust from work that’s being done, residual cat dander from the people who used to live in the room in which I’m currently staying (and who had two cats), the general feeling of being annoyed because of where I live…these are all reasons not to want to lie around the house.  Anyway, I would probably just feel guilty, even if I had a good reason—which I I do, in a way.

I suppose I could claim to have—or fear that I have—“pink eye”, but even if I had it, it would be bacterial conjunctivitis, since it’s entirely unilateral; the viral form spreads so easily that it frequently occurs in both eyes.  Also, I just don’t have any other signs or symptoms that go with pink eye.  I am shedding a lot of tears—ironically, not because of my mood—but they are not tainted with pus.  Conjunctivitis tends to produce a greenish discharge.  Mine is as clear as more ordinary tears.

Nevertheless, those tears are annoying, as is the process itself.  And it’s not as though I could just pop into my primary doctor’s office to get it looked at, and maybe get some prescription eyedrops; I don’t have insurance, and I don’t have a primary doctor.  This is what comes from a combination of apparent “neurodivergence”, dysthymia, possible other neuropsychiatric issues, chronic pain, a completely ruined life, a comparative lack of higher-level self-preservation drive*, and a near-total lack of social supports (a complete lack, locally speaking).

So it’s not as though anyone else is going to take care of me when I’m not feeling well.  That’s not surprising, really, and it’s probably no more than I deserve; I’m not the sort of person other people seem to want to take care of, and I usually have been better at (and preferred) taking care of other people than the reverse.  I’m still the one to whom people at the office always come if they need band-aids, or antiseptic, or Tylenol, or to have an MRI report explained to them, all that kind of stuff.  I’m a bad patient, but I’ve almost always been considered a good doctor by those who are qualified to judge.

Anyway, my eye is really annoying me, and I want to give it a rest, so I’ll draw to a close here for today, and also for this week.  If this post is too short, well, at least yesterday I wrote a longish one, with pictures and video and everything.  Feel free to check it and/or any of my other, older posts out.  Have a good weekend.


*Though, as I’ve commented before, here and on Twitter, even if one is intellectually okay with the fact that one is going to die, it’s hard to ignore the fear of death that evolution has baked into us.  “And thus the native hue of resolution is sicklied o’er with the pale cast of”…well, instinct, not thought, in this case.  But terminologies change over time, and I think Hamlet was basically saying what I mean.

Who would fardels blog, to grunt and sweat under a weary life?

[The initial part of this blog post was meant to be published a week ago, as will become clear.]

Hello, good morning, and good Thursday (it’s also the day before “Good Friday”).  I’m feeling rather poorly this morning, and I am, in fact, going to the doctor before work today.  Yes, I’m planning to go to work afterwards.  It’s not as though I have health insurance or anything, so if I’m going to go to the doctor—ironically—I needs must pay for it out of mine own pocket, even though I’m a qualified medical doctor myself.  This is the eminently sane and rational society in which we live.  Isn’t it grand?

As per last week’s posting, I’ve been focused almost entirely on editing this week, so I’m making significantly faster progress than before, though the road is long.  Also, I’ve just not felt well at all for a while, now, and it’s taking some of the wind out of my sails.  Ordinarily, it’s difficult to get me to slow down and shut up, and I can’t completely rule out the possibility that I’m being subtly poisoned by someone (or more than one) who finds me too annoying.

I’m kidding.  I really don’t suspect some nefarious plot.  It’s just the sort of thing that crosses my mind when I think of myself, so I occasionally imagine that other people might feel similarly.  Actually, other people tend to be more patient with me than I am with myself, but then again, they can get away from me, can’t they?  No matter where I go, as they say, there I am.

I have a few things in the works for IoZ, which might or might not be interesting.  I have an audio blog still to post, and I’m trying to write some posts long-hand (in first draft) to see if that makes me produce them more often.  I also have plans for another post that began its life as a response to a Facebook meme about the tides, stating that, since the moon affects the oceans, there’s no reason to think it wouldn’t affect us since we’re 70% water.  This meme was so misguided and riddled with misunderstandings about basic physics that I couldn’t resist going through the whole Newtonian universal law of gravitation, why there are tides, why they are not dependent upon water, and how tiny the tidal differences due to the moon are from one end of any given person to  the other end.  Yes, I did the math, and shared all the numbers (to significant figures, or thereabouts).  And I’m going to post a version of it on Iterations of Zero once I tweak it a little.

That notion of someone poisoning me doesn’t quite sound so crazy and paranoid now, does it?

I haven’t been promoting my already-published books much lately.  I’ve felt a bit of aversion to Facebook and so haven’t much wanted to give them money, but they really are the best venue I have through which I can promote, unless anyone out there has any better suggestions.  I ought to get back into it.  I just feel kind of obnoxious pushing my own stuff overtly.  I suppose this is why people hire agents and advertisers and marketing firms, but I don’t have that kind of money to spare.

Anyway, the editing of Unanimity and on Free-Range Meat is going well.  As far as short stories go, I still plan both to publish the stories from Welcome to Paradox City as individual Kindle editions and to eventually release a new collection, in hard copy and Kindle, of such “short” stories, so that’s something for you all to look forward to.

Always assuming I live long enough, of course.

TTFN

 

***

 

Okay, well, as you might have noticed, I didn’t, in fact, publish my blog last week, so I’m just going to do a follow-up now and continue the story, as it were, where I left off.

The reason I never posted last week was because, after going to the walk-in clinic and telling them my symptoms and my history, and after the doctor there gave me a once-over, he said (more or less), “Look…I can do some tests here and charge you for them, but unless they show a clear and easily treatable cause of your symptoms and problems, I’m going to recommend that you go the emergency room anyway.  So, let’s skip a step, I won’t charge you for this visit, and I’m going to give you a referral to the ER.”

I thought this was, perhaps, a little alarmist, but I was persuaded—not happily—to follow his advice, and I went.  I guess the ER agreed with the clinic doctor’s assessment, because they admitted me for about thirty or so hours, ruled out heart attack and DVT/pulmonary embolism, and did an echocardiogram (among other things).  They also, thankfully, gave me some antibiotics for a chronic/recurrent ear infection, which quite temporarily relieved it…though it’s already recurring even as I write this.

Then, at the beginning of this week, after a reasonably restful holiday weekend in which I neither celebrated any of various potential causes for celebration nor had any interactions with those with whom I would have wanted to celebrate, I got calls from both the cardiologist who read my echocardiogram and from the attending physician who managed my care during my brief hospitalization.

Before I get into what they said, let me give you a bit of back story:

When I was eighteen, I was diagnosed with an atrial-septal defect, secundum type (read about it here if you like), quite a good-sized one, with a greater-than-two-to-one shunt.  This was promptly evaluated, and I had open-heart surgery to close it, performed at Children’s Hospital in Detroit by the man who wrote the textbook on the surgery.  This experience, which was quite painful but at least interesting, was influential on my decision eventually to go to medical school.  Subsequent follow-up was unremarkable, the surgery was a success, I was discharged from ongoing care, etc., etc., etc.

Anyway, it turns out, based on this new echocardiogram, that my previous defect did not remain completely closed through the intervening years, and that I have some equivalent of a patent foramen ovale with, apparently as indicated on the echo, a shunt that is sometimes reversing…i.e. some blood from my pulmonary circulation is shifting to the systemic circulation without having passed through the lungs to blow off CO2 and get oxygenated.  This is why (as was the case before my initial surgery) I seem to have a high resting heart rate (or did when checked at the clinic and the hospital) and now tend to have a lowish oxygen saturation, at least in the right circumstances.

This is all not imminently life-threatening, but as I know, the fact that there is even occasional right-to-left shunting means that there is a potentially serious problem.  And the attending internist recommended that I start seeing the cardiologist before even coming to her for general medical follow-up, with plans for eventual intervention and closure of the defect.  But, of course, as stated above, I don’t have health insurance right now, and as it is, I’m going to be paying for this hospital visit for quite some time to come.  It is true that closure of such PFO’s nowadays is much less of an undertaking than it was thirty years ago, but I still don’t think it’s going to be cheap.

And, finally, what’s the point?  Apart from the inherent drive to stay alive that’s been beaten into my genes by hundreds of millions of years of multi-cellular evolution, I honestly don’t have any compelling reason to try to improve my health and/or prolong my existence.

I have neither colleagues nor close friends with whom I can really have any enjoyable conversations, or with whom I ever do anything fun…mainly because the things I think are fun are rarely what those around me find enjoyable, and vice versa.

I have a housemate who’s a good guy, and we get along well, but we don’t have a great deal in common (though I’ve bought some great guitars from him).

I’m a divorced, ex-con, MD who can’t practice medicine anymore, whose son won’t talk to him, and who is only able to interact with his daughter through Facebook and similar venues, who works merely to stay alive so he can write and publish sci-fi/fantasy/horror stories that few if any people will ever read, and who occasionally diddles around with writing, producing, and sharing songs, and drawing pictures, and stuff like that.

Oh, and I also make blog posts like this one.

I come from a line of people who tended to be somewhat socially restricted, by nature and choice, but my mother and father at least had each other through their natural life-spans, as was the general rule in the past.  I, however, am a card-carrying inhabitant* of the easy divorce era, bereft of my chosen and beloved family by the will of the love of my life.  I have no strong desire to go through the gauntlet of trying to find some replacement love who is no more likely to have a sense of enduring commitment than the one who came before her, especially when I have so little to offer anymore.

I’m inclined to think that this story’s gone on well past any reasonable degree of interest.  I guess I might change my mind; who knows?  But for now, it’s hard to see the point of bothering to go through all these medical processes again, even if the interventions are less severe and relatively less expensive than they were in the past.  What, as they say, is the point?  I’m basically a weird, weary, and alone person in a world in which the forces of stupidity seem not only to be ascendant now but always to have been so.

It’s enough, I’m thinking.

TTFN


*I don’t actually carry a card

The Treatment Trap

In America today, we rely far too much on pills and on procedures–on would-be “cures” for our problems–than we really should.

It may seem strange for a medical doctor like me to be saying this, but I have insight into the issue from multiple perspectives.  I’ve been one of the doctors who falls into the trap of trying to “treat” every issue rather than prevent or solve it, and I’ve been a patient who approaches things the same way.

The irony is that a great many of the health problems we face in the modern world–especially the most rampant and devastating ones, such as diabetes, high blood pressure, heart disease and their related problems and consequences–are governable simply by modifying our lifestyles.  Indeed, for many of us, these health concerns’ very existence AS problems is only CAUSED by our modern lifestyles.  I’ve already discussed in some earlier entries the mechanisms and effects of type 2 diabetes, a disorder which is becoming more and more endemic in our nation, and at younger and younger ages.  It’s absolutely clear why this is happening:  We are more sedentary and more overweight and we eat more rapidly absorbed carbohydrates than humans have ever done before in our existence.  What’s more, thanks to public health interventions and control of infectious diseases, we live long enough for these habits to matter more than they could have in the past.  We also know, quite well, many of the things that we can do to counter diabetes and its close relatives, hypertension and heart disease. Yet, instead, we allow our health to deteriorate and then rush to modern medicine to seek “cures” or at least treatments for the outcomes of our bad habits.

I suspect that this trap of habits was set for us, to some degree, by the brilliant innovation and success of antibiotics.  These are the quintessential medical cures:  When used against an infection caused by a sensitive bacteria, antibiotics actually CURE the problem (with the help of our own immune system).  To some degree anti-virals do the same, though they are more recent, and anti-parasitic agents are also analogous.

Unfortunately, most other kinds of medicines–unless you count the occasional Tylenol or Motrin to treat a tension headache or muscle soreness–don’t actually cure anything.  They simply “treat” it, governing the symptoms and consequences to some degree or other, but not addressing whatever underlying processes might be contributing to the issues.  In addition, they give the patient the illusion that the problem is now under real control.

There are, of course, times, when health problems are not soluble or easily controllable, and managing the symptoms and consequences is the very best we can do, at least for now.  So PLEASE do not think that I am advocating the elimination of Western medicine or that those being treated for chronic health conditions should just give up their pills and let nature take its course.  Yet with so many health problems, even if we have to resort to medication, we can also make lifestyle and behavioral changes that will mitigate our problems and decrease, though not always eliminate, the need for medications (and surgery, when applicable).

We all know, or should know, that taking medicine can be a double-edged sword.  Medications sometimes create new issues of their own.  The human body is an incredibly complex system–arguably the most complicated thing in the known universe, especially when you count the human brain–and when you manipulate such a  system in one way or location, unexpected consequences almost never fail to arise.  This leads to the horrible spectacle of patients receiving medication for one problem, but developing side-effects, which then need to be treated by other medications, and which cause toxicities and interactions that later have to be addressed.  The whole affair can become a vicious cycle of increasing biological chaos, like a metabolic Rube Goldberg machine.  In the elderly especially, it can sometimes be all but impossible to be certain whether new health problems are intrinsic or are caused by earlier treatments.

We try, of course, to mitigate and avoid this conundrum by studying medications as carefully as possible and learning what their possible side-effects are…but every human body is different, and that’s going to continue to be the case, since the number of possible genetically unique humans is vastly greater than the number of human beings who have ever lived.  So we can be guaranteed that the one expectation we can reliably entertain is the UNEXPECTED.

It is better by far to avoid developing problems whenever possible rather than trying to treat them.  This is true because it is simpler and more predictable, and also because it makes life better.  Rather than being a person who identifies themselves by their litany of ailments, for which they build their house-of-cards treatment regimens, we can work to maintain lifestyles that are GOOD for our health, that work with our natures, and that help us to think of ourselves as–and to feel like–healthy, vital and thriving human beings.

Medicines are indeed wonderful products of modern science and technology, and I strongly suspect that they have saved and improved many more lives than they have harmed, even despite what I’ve said above.  If I didn’t think that, I wouldn’t have gone into medicine.  Yet, it would be even better if we could avoid having the need for medications as often as possible in the first place.

I’m going to discussing more of this in future entries.  I’ll go into some fairly obvious lifestyle issues such as exercise and diet, but I’m also going to explore philosophical and psychological aspects of health that can make a great difference in not only how long you live, but also in how much you enjoy the time you have.

A life of a hundred years can be a tragedy and a life of a single day can be a triumph.  It all depends on what kind of life it is.

“I Am” (Soy) Isoflavones, and I (probably) Decrease the Risk of Prostate Cancer

I recently had a friend ask me whether eating and drinking soy products can increase the risk of prostate cancer; he had heard that it can, and that all men should avoid soy “like the plague.”

This question really surprised me, because most of the medical information I have encountered has tended to point in the opposite direction…and for reasons that made good, sound biological sense.  However, I know that good, sound, biological sense doesn’t always pan out.  This is why we have to do actual experiments.  After all the Universe is complex, and the human body is arguably the most complex thing we know of in it.  Often an expected biological effect of some dietary or medical intervention, that seems inescapable on its face, can turn out to be utterly undetectable or at least thoroughly confounded by other consequences.  So, bearing this in mind, I did a little reading, and I learned about at least one source of data that might have been behind what my friend had heard.

First, though, to get back to the believed protective effects of soy:  Soy products contain chemicals called flavones and isoflavones, which are part of a group of biological chemicals called phytoestrogens.  Now, “phyto-” is just a word root that means “plant,” and estrogens are, well…estrogens.  I think most people in America are at least passingly familiar with estrogens, especially given the current controversy over the required coverage of birth control pills.  So phytoestrogens are just estrogens from plants.  In human females (we often refer to them scientifically as “women”), estrogens are among the hormones that control fertility and related processes, and they are quite abundant.  However, in the male body–including that little devil, the prostate–estrogens tend to counter the natural effects of testosterone.

Testosterone is also, I suspect, a hormone of which most Americans are aware.  It is the substance, to paraphrase Dave Barry, that makes men take league softball seriously.  Its actions produce such male secondary sex characteristics as increased muscle mass, facial hair, deeper voices and bar fights.  It is also the hormone responsible for the fact that almost every man who lives long enough–if he isn’t testosterone deficient–will develop prostate enlargement (so-called “benign” prostatic hyperplasia, or BPH), with its lovely constellation of maddening symptoms.  The presence of testosterone can also stimulate the growth of many kinds of prostate cancer, and in fact some treatments for testosterone-sensitive tumors include drugs that directly block testosterone, such as bicalutamide (the name isn’t really that important).

It is thought that the effects of phytoestrogens in soy products are responsible for the protective effects that they may have against prostate cancer.  These effects are not tremendous, nor are they absolutely demonstrated, but they are probably real and the science is sound.  So whence comes the idea of soy actually increasing the risk of prostate cancer?

Well, I found out about a study in Japan that covered a number of different dietary sources of soy and its isoflavones on the risks of development of several subgroups of prostate cancer, including localized and advanced cases.  This was a good country in which to study those effects, because the traditional Japanese diet includes a number of soy staples, including tofu, miso and natto (a kind of fermented soybean concoction).Not too surprisingly, this study actually generally supported the idea that soy intake in foods (not necessarily supplements) reduces the risk of prostate cancer overall…but there was ONE little peculiar exception.

The study found that increasing intake of miso soup may be associated with a small increased occurrence of advanced prostate cancer in men 60 years of age and older.  Now this reallyis peculiar, because it seems very specific to miso soup, which raises the question of whether there’s something ELSE in miso soup that’s causing this measured increase.  Also, such studies are always inexact because there are so many potential variables that could be influencing the outcomes by other means.  In addition, the number of cases of advanced prostate cancer in this study, compared to the size of the study, was VERY small, which means the statistical connection is quite a bit less robust than it might be.

Nevertheless, I can at least tell my friend this:  Unless he’s eating a LOT of miso soup (and is over 60), he probably doesn’t need to curtail, let alone avoid, soy products.  In fact, he can probably indulge in all the soy milk, tofu and natto he wants, and if anything, it may decrease his risk of prostate cancer a little bit.  It’s even possible (though not clearly demonstrated) that it might reduce his future problems with prostate enlargement.  Of course, the trade-off is that he may find himself caring a little bit less about who wins a particular sporting event.  Still, having treated a good number of men suffering from prostate problems of various kinds, I can assure you, that would be an extremely small price to pay.