“Life’s Work” : A book of life for today

Dr. Willie Parker wants the moral high ground back.Willie in scrubs.full

That ground was seized 40 years ago, to his regret, by those who would deny women control of their reproductive destinies – “when ‘the antis’ adopted words and phrases like ‘pro-life’ and ‘culture of life.’” But Parker, a deeply committed Christian physician who has provided compassionate care – including abortions – to countless women, is out to retake the moral high ground of reproductive justice. With kindness, scientific truth, and scripture. Parker’s book Life’s Work: A Moral Argument for Choice tells his personal story alongside the stories of real women needing to choose abortions and the men and women fighting to preserve their right to do so.

In a recent appearance before a group of residents and other medical/academics at the University of California San Francisco, Parker spoke of his life and work.Life's Work Both encountered a turning point, he explains, on hearing Martin Luther King’s famous last speech which included the biblical story of the good Samaritan. In that story: after others had passed by a man in need a Samaritan stops to help. Those who passed by, Dr. King said, worried, “If I stop to help this man, what will happen to me?” Parker writes in Life’s Work that “What made the Good Samaritan good, in Dr. King’s interpretation, was that he reversed the question, ‘If I do not stop to help this man, what will happen to him?’” Immediately after hearing that, Parker writes, “Once I understood that the faithful approach to a woman in need is to help her and not to judge her or to impose upon her any restriction, penalty or shame, I had to change my life.”

Parker’s life-change led him from a good job as an ob/gyn in an idyllic Hawaiian locale to becoming an expert in abortion care – both the medical procedures and the many and complex needs of women he sees when providing care. His passion now is to keep that quality of care available, especially to poor and underserved women in parts of the U.S. where access is made more and more difficult by restrictive state laws. Which led him to talk of the politics of abortion.

Fran & Willie Parker 6.14.16

Dr. Parker with a fan

“President Trump has an agenda that marginalizes women,” he told his UCSF audience. “But he does not have a mandate. We have to do a deeper dive into engaging politically, and not legitimize what’s happening. It’s most important not to become disheartened – which is a self-fulfilling prophecy.” Parker, who grew up poor in Alabama, the descendant of slaves, says he “draws from the history of enslaved people” – in understanding the women he sees and their need to make their own, personal reproductive choices.

Some 60 years ago this writer, faced with a pregnancy resulting from workplace rape, was forced to seek out a back alley abortion. There was no Willie Parker to defend my choice, or to explain why it was morally and spiritually right. No one should be able to claim some moral superiority that supports sending women back to those dark ages, which is the direction we are headed. Now, though, there is a voice to be reckoned with. To quote Gloria Steinem re Life’s Work: I wish everyone in America would read this book.

Fighting off dementia

DementiaAlzheimer’s – already afflicting well over 5 million Americans – is expected to claim more than 16 million of us by 2050 if a cure isn’t found. Today it is at the top of the Bad News list of potential diagnoses for almost anyone over 50. Justifiably so, since the Centers for Disease Control and Prevention reports than one in three seniors now die with Alzheimer’s or other dementia.

That’s the bad news.

The good news, explained recently by Patricia Spilman, M.S. at a sold-out Commonwealth Club event in San Francisco, is that there are things one can to do lower the risk, and perhaps slow the progress of the disease. Spilman, who is Staff Scientist at the Buck Institute’s Bredesen Lab, should know. She has spent more than two decades researching neurodegenerative disease, and has written and spoken extensively on Alzheimer’s and related diseases.

“Forgetting,” Spilman says, by way of reassurance, “is normal. You don’t need to remember where you put the car keys last week, or a doctor’s appointment last month.” And studies – including one by Buck Institute founding President and CEO Dale Bredesen M.D. that is fascinating even for a lay reader – suggest that cognitive decline can be slowed, or in some cases reversed.

Spilman’s prepared remarks consisted largely of useful, realistic advice about how to delay the cognitive decline most of us will experience at some point. The audience, ranging from 20-somethings to more than a few senior citizens, was furiously note-taking throughout (or furiously jotting down questions for the Q&A session to follow.)

Exercise – particularly activities that combine movement and navigation such as tennis or golf – is at the top of the list. “It’s easier if you have a partner,” Spilman suggests, “because this adds the important element of socialization. Walking, plus climbing, is particularly good if you try new routes.” More than a few audience members nodded knowingly when Spilman noted the increasing, widespread dependence on mindless GPS. “Take the opportunity to look at a map,” she said.

Cognitive decline can also be offset by paying attention to the critical need for plenty of sleep. To help with a good night’s sleep, Spilman advises allowing at least several hours between eating and going to bed, and having a dark room. Chronic stress is relieved by a combination of exercise and sleep, along with those other preservatives of gray matter, yoga and mindfulness meditation.

Also good for the brain: almost any sensory stimulation. Music, smells, touch. Spilman cites Oliver Sacks’ Musicophilia: Tales of Music and the Brain, and Norman Cousins’ Anatomy of an Illness, in which Cousins treated himself with comedy as useful reading.

“Do something new every week,” Spilman suggests; “every day. Have goals in later life. Take classes, volunteer, build intergenerational relationships, pursue spirituality, encourage others to change and to grow.”

Computer games can improve cognition also. Spilman did not mention any specific sites, but this writer has enjoyed BrainHQ, and other brainy items from Posit Science’s Karen Merzenich, as well as introductory games on the Lumosity site. Most fascinating of all is the University of California San Francisco (UCSF)’s Brain Health Registry, in which anyone can participate; it’s free, and your brain might wind up helping someone else’s brain one day.

The Q&A segment following Spilman’s talk was fast and full of both personal stories and pertinent questions: “What’s normal decline?” (The difference between not remembering the movie star’s name and not being able to do a job well. You might keep a diary of cognitive function.) “What about genetics – the father-daughter-son factors?” (Yet unproven.) “How about overexposure to electromagnetic fields? (Don’t have unnecessary radiation.) And enough other issues raised for two or three more hours.

No one’s brain, in any event, was idle. Which indicates that everyone in Spilman’s audience was lowering his or her risk of Alzheimer’s.

Arguing With the Doctor – A plea for end-of-life choice

Dandelion

Does the doctor always know best? And in the case of one’s own precious life and death, is it wise to argue the point?

“No One Here Gets Out Alive” – a quote from Jim Morrison – led the title of a lively (pun intended) debate about aid in dying held recently at San Francisco’s Exploratorium. Part of a series on the intersection of science and politics, the event’s full title was “No One Here Gets Out Alive”: The Science, Politics and Law of Death and Dying. The program sought to address a few issues not easily covered in two hours – but still – including (reprinted verbatim):

Is there a constitutional right to “physician-assisted suicide”? What about a “dignified death” – and what is a dignified death? Should terminally ill patients facing mental incapacitation or unbearable pain have access to fatal ingestion – also known as physician aid in dying? Or would that jeopardize our society’s progress toward more compassionate, comfort-based care?

Participants included John M. Luce, Emeritus Professor of Clinical Medicine and Anesthesia at the University of California San Francisco; Laura Petrillo, MD, a Hospice and Palliative Medicine fellow at UCSF; and program host David L. Faigman, Professor of Law at UC Hastings College of the Law and Director of the UCSF/UC Hastings Consortium on Law, Science and Health Policy.

The program kicked off with a discussion of the science of death itself – defining death being more and more problematic these days. Think Nancy Cruzan, kept alive through a feeding tube in a “Persistent Vegetative State” for nearly a decade until her family managed to convince the State of Missouri that she would never have wanted to be “kept alive.” Or Terri Schiavo, whose PVS ordeal lasted even longer. More recent is the tragic story of 13-year-old Jahi McMath, declared brain-dead by multiple physicians more than a year ago but whose body is still existing somewhere, connected to machines that keep her heart beating.

Those cases are just a few of the markers on the path toward today’s critically important death with dignity movement. This writer’s involvement in the cause began with work as a hospice volunteer in the 1980s, a member of an HIV support group in the ’90s and a volunteer with Compassion & Choices (and its predecessor organization Compassion in Dying) since the late 1990s. C&C is currently leading the fight to make aid in dying legal throughout the U.S., having won significant battles – five states now protect that right for terminally ill, mentally competent adults – with others underway in many areas.

And that issue – should medical aid in dying be legalized in California (and elsewhere) – was the heart of the two-hour program. Of the two physicians, Luce was eloquently in favor, and Petrillo was adamantly opposed. In this writer’s admittedly biased view, Luce’s lifetime of experience as a distinguished physician and professor rather embarrassingly outweighed Petrillo’s credentials, but it is possible to see her emerging-palliative-care-physician status as basis for her absolute certainty that everyone on the planet can experience graceful, pain-free death if only he or she has access to palliative care.

I am less certain. Thus my argument.

In the Q&A period, I posed this question to Petrillo: “If you were my doctor, which is unlikely, and I were dying, which is increasingly likely (I’m 81, for heaven’s sake,) and I have expressly, repeatedly made clear that I do not wish to linger – why should you have the right to insist that I linger?”

Petrillo dodged the question. “I would ask what is causing your pain,” she said. “I would try to determine if you are depressed, and talk about how we can alleviate your pain and possible depression…”

After several abortive attempts to get a response to my question, and figuring the audience had not paid good money to listen to me rant, I gave up. But here are the arguments I had for Dr. Petrillo, questions I wish the minority of physicians who do still oppose aid in dying would answer:

Why should you have the right to insist that I linger, when I am dying?

How can you presume to understand my pain better than I? And why should I have to describe it if I don’t choose to do so?

When I have watched dying people with the very best care and pain control suffer in ways I would not choose to suffer, how can you insist on my going that route?

Why should your conviction about the efficacy of your medical field trump my autonomy?

Dr. Petrillo said she is not religious, so this question would be addressed to others: Why should your religion overrule my religion? Or dictate to me?

It’s my only precious life, after all. Why should I be denied control of its precious end?

 

 

 

Good genetic news for geezers

https://i1.wp.com/upload.wikimedia.org/wikipedia/commons/1/1a/The_Triumph_of_Death%2C_or_The_Three_Fates.jpg

The Three Fates, Flemish tapestry (probably Brussels ca 1510-1520) Victoria and Albert Musem, London. (WikiMedia)

 

Live longer, get smarter? We wish.

And this wish could some day come true, thanks to the gene variant KL-VS, whose friendlier name is the klotho gene. The klotho gene was already known to be associated with longer life. But a team of scientists at UCSF and the Gladstone Institutes, found that it also seems to make people smarter.

One in five of us has the klotho gene. As this writer is definitely older I had hoped to get in on the smarter, although I never cancelled the dementia provision of my advance directives. But in an interview with San Francisco Chronicle health writer Erin Allday Dr. Lennart Mucke, director of neurological research at Gladstone, said, “Klotho increases cognition but doesn’t replace aging-related decline. You’re just coming down from a higher level.” So much for immediate — or personal — optimism.

UCSF Assistant Professor of Neurology Dena Dubal was lead author of the study, findings of which were published recently in the journal Cell Reports. Dubal and Mucke say more studies are needed, but the  hope is that eventually klotho could help old brains — old human brains; so far we’re talking about mouse brains — function better.

This writer, having an old brain far too right-brained to follow neurological research very far, did at least complete several years of Greek at Randolph-Macon Woman’s College some years before Dena Dubal was born. But as my class notes are not handy I turned to Theoi.com, an online encyclopedia of Greek mythology, to find more about Klotho. (For the record, her name is more commonly spelled Clotho in classical texts, but most of all this pre-dates Spellcheck.)

Klotho and her sisters Lakhesis and Atropos where the daughters of Zeus and Themis, and in Greek mythology one couldn’t ask for better parentage. They were known as “The Fates,” or “The Moirai,” the goddesses who determined everyone’s destiny. According to Theoi, “They assigned to every person his or her fate or share in the scheme of things.” Clotho (on the right in the tapestry above) was “the Spinner,” who spun the thread of life. Lakhesis (in the center)  measured the thread of life and Atropos (on the left) cut the thread. Presumably they are arising from Themis; birthing in mythology was somewhat less complicated than today.

(It’s tempting to speculate on what it would mean to have too many Atropos gene variants, but that is going too far with all this.)

No amount of Googling turns up the scientist who named the KL-VS gene variant after Klotho, but he or she had an appropriate understanding of Greek mythology. If Klotho can indeed eventually lead to reactivating old brains, she will have spun us all a golden thread.

 

Live longer, healthier: prospects ahead

More news just in on the health and longevity front. At the University of California San Francisco medical center, which I can see from my studio window but that’s about as close as I will ever come to claiming kinship, a clinical trial getting underway will investigate the telomere factor. You haven’t been worried about your telomeres? Get used to them. It hasn’t been so long since cholesterol and genomes became household words.

Bay Area women who volunteer for a clinical trial at UCSF will be among the first people in the world to learn the length of their telomeres – the protective caps at the ends of chromosomes that regulate cell aging and may help people live longer, healthier lives.

Research has shown that the length of people’s telomeres is related to their “cellular age” – the health and stability of certain cells in their body. Because telomere length helps determine cellular health, it’s also been identified as a possible biomarker that can reveal information about a person’s overall health. Short telomeres have been linked to health problems like heart disease and diabetes.

UCSF researchers say it’s possible that identifying a person’s telomere length someday could become as common as checking cholesterol levels. A handful of private companies already have started advertising telomere testing to individuals. In fact, two of the researchers involved in the UCSF study are looking into starting their own company to test telomere length.

The study, reported by Erin Allday in today’s San Francisco Chronicle, will concern such issues as what relationship your telomeres’ length have to health and aging in general, and whether you even need to know a lot about the little cellular-ites. “The idea of telling people their telomere length is totally new and somewhat radical…,” said Elissa Epel, an associate professor of psychiatry at UCSF and one of the lead researchers in the telomere study. (On a purely personal, though relative note: you just try not to worry about it all when you are overage — they want women 50 to 65 — for an aging study and the lead researcher looks like she’s about as old as your granddaughter.)

Medical ethicists say the UCSF study makes sense – as more attention is drawn to telomere length as a potential marker of overall health, doctors should understand whether it benefits their patients to get that information or not.

If people can’t change their telomere length, there may be no point in telling them. Telomere length may be similar to some types of genetic testing that tell people whether they’re at increased risk for Alzheimer’s disease or certain types of cancer, said Arthur Caplan, director of the University of Pennsylvania Center for Bioethics.

Some individuals may decide they want that information – but it’s not always an easy decision to make, he said. “You might find out that you seem to be a premature or rapid ager, but whether there’s anything anybody can do to stop it or reverse it, that remains to be seen,” Caplan said.

How much our telomeres will tell us, what use we can make of it all, and whether you and I really want to know — these issues remain to be seen. Or at least, to be discovered in  the coming study. I have absolute trust in the folks at UCSF. If you do too, and you fit the parameters (female living somewhere in this lovely part of California, between 50 and 65) and want to volunteer to be a part of it all, whip off an e-mail to knowyourtelomeres@ucsf.edu.

UCSF to look at new longevity, health marker.

'Lesbian Health 101' seeks to open doors, minds

Years ago a lesbian friend, who would soon die of uterine cancer, told me how she hated going to her gynecologist and consistently postponed it. “I’m sitting there in the middle of all those bulging bellies and beatific smiles,” she said, “like some sort of an alien.”

How I wish she were alive, so I could send this clipping from the San Francisco Chronicle:

When Dr. Patricia Robertson held the first lesbian health clinic at San Francisco General Hospital in 1978, she decided to cover the “family planning” signs in the lobby – she didn’t want to deter patients who thought gynecologists were only for dispensing birth control and helping women get pregnant.

“We wanted to put together evidence-based research that would support clinical guidelines, so when we talk about why lesbians are different from heterosexual women we can back that up,” said Robertson, who is a professor in the UCSF department of obstetrics, gynecology and reproductive sciences. “Doctors are going to be able to legitimize their advice after they read this book.”

The article points out that although progress has been made in health care since then, “lesbians are more likely than straight women to suffer depression and drug and alcohol abuse. They may be less likely to get regular health screenings like pap smears and breast exams.

With those disparities in mind, Robertson and Suzanne Dibble, a registered nurse with the Institute for Health and Aging in the UCSF School of Nursing, have put together the first textbook on lesbian health care. ‘Lesbian Health 101’ was released this month.

The textbook is written in medical language and designed for doctors, nurses and other health care providers, although Robertson and Dibble say they’re encouraging lesbians to use it as a resource for understanding their own health issues. Most of the chapters were written by health care providers who are also lesbian.

Chapters in the nearly 600-page book focus on a wide variety of health issues, from heart disease and breast cancer to partner violence and how to decide which woman in a relationship should get pregnant.Some sections focus on the risk factors that affect lesbians more than straight women – higher smoking rates, for example, or what effect not having children might have on breast cancer risks – while others address how doctors can best meet the particular needs of lesbian patients.

Many of the health issues that affect lesbians can be tied to stress related to their sexual orientation, Dibble said. Discrimination, the stress of coming out to family and friends, or feeling ostracized and alone can all lead to health problems.

Dr. Erica Breneman, an obstetrician-gynecologist with Kaiser Permanente in Oakland, said she’s pleased to see such a textbook available to doctors now, even if it’s troubling that the book is even necessary.

“In a perfect world, we wouldn’t need this,” Breneman said. “A woman who happens to be gay shouldn’t need much that’s terribly different than a woman who is straight. But the reality is, because of the particular demographics of lesbian women, they do have other health issues.”

Perfect worlds, it seems, are slow in coming.

‘Lesbian Health 101’ seeks to open doors, minds.