North Pole Weather 8/12/13

The sun rose this morning at 5:29; and it will set 16 hours 51 minutes later, at 10:20 this evening. Solar height at noon is now below 40°, we are still losing almost 7 minutes a day, and in a few days we will start having nautical night (sun more than 12° below the horizon) again.

We’re still running warm and dry for the season, with 3 more 80 degree days since last week, and only a trace of rain. Tuesday and Wednesday might hit 80 again, but mid-70’s are still pretty warm for this time of year in Alaska. I really hope we get more precipitation than the isolated showers predicted; I’m tired of smoke.

Those lilies not badly stunted by the lack of water early on are opening, the zucchini is growing faster than I can eat it, and the mint is running riot in the raised bed, thanks to my hauling the hose around. This is increasingly difficult; my balance has deteriorated until I don’t dare water without a cane.

No pictures of me this week; the volunteer at the cancer center wasn’t there Friday. I need to go in again for labs today, so maybe today. My sister thinks I should go for red hair. I’m going to have little enough of my own by the end of the week!

Update 2:30 pm: My hematocrit and cell count have changed enough I won’t have to have a transfusion, and the volunteer at the support center was in so I spent the time between blood draw and results trying on wigs. Red and blond just didn’t work with my skin tone, but I now have a highlighted brown that I rather like. I took my laptop and photographed several I tried, so I’ll have a “chemotherapy fashion snow” on the blog Thursday..

Cancer, Chemo and Quilts

The chemo seems to be following the same pattern as last time. Maybe I can at least count on it to stay consistent.

Friday is infusion day. All five hours of it. Not so bad, if boring.

Saturday I feel fairly well, but my basal insulin goes crazy, up to twice normal. My balance is getting shaky, but I feel well enough to spend a few hours at the fair, with the aid of a rolling walker. Took in the quilt show, but the horse show grounds were too rough to handle.

Sunday the need for basal insulin crashes – 90% normal. By 7 I’m ready for bed, and I sleep until 9 Monday morning, and crash again after breakfast.

Not that I have an appetite, but I drag myself out of bed for an unwanted snack and nausea meds by 1. Joints and feet hurt. If I continue to follow the pattern of the last round, my insulin needs will rise again Monday, but I won’t feel like getting out of bed until Thursday. I did get dressed this morning, though — it has not rained, the forecast is close to 80 today, and I have to water.

Anyway, here are a couple of quilts from the show.

North Pole Weather 8/5/13

The sun rose this morning at 5:06 am, and will set 17 hours and almost 40 minutes later, at 10:45 this evening. We’re still losing a little more than 6 minutes a day, but the noon altitude is starting to decline faster – it will be down below 42° today. Civil twilight (sun more than 6° below the horizon) has been back for about a week, though we still have no nautical twilight.

It’s been a warm summer after our cold spring, and while not a record, so far we’re in second place to 2004. We have, however, set a new record for the number of days with temperatures of 80°F or warmer during the summer: 31 as of Thursday, August 1. Friday and Saturday were also above 80°, though it now appears to be cooling off with some showers expected. I hope so; things badly need water and I’m not going to be feeling up to watering for the next few days. In spite of the heat, blooming is behind last year; none of the lilies have opened yet and the delphiniums are just coming into full bloom.

ADA kerchief

My favorite (though very old) gardening hat

This one was purchased for a boating trip. Looks nice, but not as comfortable.

The pre-meds knocked me out when I intended to try wigs while in for chemo Friday, so I don’t have any pictures of wigs. I am including a few with the head coverings I have, and one of me au natural

Current appearance without head covering.

(though I expect it will be very temporary, both in terms of what hair I have left right now and of the overall loss.) It might even come back curly.

Other Uses of DNA

A schematic of a DNA molecule. (Public Domain image from Wikimedia commons.)

So far I’ve been talking strictly about my results from the genographic project. This project is aimed at clarifying the history of the human species, but this is far from the only way human DNA sequencing is used.

Genographics focuses on mutations that are relatively old and allow us to track the spread of the human species around the planet. There are two other commercial DNA testing services that use a similar method of testing but are focused on slightly different uses. All use y-chromosome and mitochondrial DNA as well as the 22 sets of autosomal chromosomes, and all look for mutations specific to specific groups. But Ancestry.com uses a set of relatively recent mutation that are most useful for finding recent relatives, while 23and me puts more emphasis on testing for genes know to be associated with health conditions. All three are useful adjuncts to conventional genealogical research, especially for those who have hit a “road block” with a known ancestor of unknown background.

But genealogy is far from the only use of DNA analysis. At the other extreme of price and usefulness is whole genome sequencing, where all 23 pairs of chromosomes are sequenced, letter by letter. This is expensive and rarely done, though the price is dropping fast. We are still talking thousands if not tens of thousands of dollars, not something to do for curiosity alone! However, such sequencing may be useful in finding an abnormal gene in a person with a health problem that cannot be pinpointed, and through knowing what the normal gene does even leading to a cure.

A far more common approach to health studies using DNA is based on the fact that many diseases are closely associated with specific genes. Finding such genes may aid in diagnosis, or (if the genes are found in prospective parents) may lead to counseling about the advisability of having children.

I’m running into this right now. There are a couple of variants of the BRCA gene that lead to an increased chance of breast and/or ovarian cancer, especially in relatively young women. I’ve had breast cancer, though at an age where it’s common. My recent (like this month) ovarian cancer has no obvious relationship to that breast cancer, from which I appear to have recovered, and the ovarian cancer was caught early enough (stage 1) that the chemotherapy I’ve been prescribed is mostly precautionary. But could I have a general susceptibility to this class of cancer? If so, would it be worthwhile removing my remaining breast tissue?  This is why genetic counseling should accompany or even precede this type of testing.

Finally, there are all kinds of forensic genetic tests. Like the genealogical tests, these are generally incomplete and depend on markers—regions where the DNA is known to vary markedly among people. I am no expert in these tests, but they have cleared more than one person on death row.

Vitamin D

I know. You’re supposed to get your vitamins and minerals from your food, rather than pills.

But ….

I live in Alaska. The only time I can get really fresh produce is in summer, from my own garden and the farmers’ market. The rest (most) of the year I have to get “fresh” produce that has traveled a loooong way, or frozen food. Being lazy (and suspecting that the frozen stuff may actually be more nutritious than the “fresh” food by the time it gets here) I all too often stick a frozen dinner in the microwave. I doubt seriously that I am getting all the vitamins and minerals I need in my food, so I take a variety of supplements.

Some are subject to a good deal of controversy; some, like Vitamin A, can actually be toxic in large quantities. But I got a surprise on one recently: Vitamin D.

Vitamin D is one that most people can make for themselves if they get enough sunshine on bare skin. Without sunblock. There are foods that have Vitamin D naturally, notably fish and the marine mammals that eat them. This is why the native population, eating a subsistence diet, can survive in Alaska. Believe me, we don’t get much sun on bare skin. Even at the height of summer the sun doesn’t get very high in the sky — about 45°, where I live.

I figured this out years ago. Problem was, at that time vitamin D as a supplement by itself was extremely hard to find. Most often it was combined with vitamin A, as in cod liver oil. Since I eat a lot of carrots I get plenty of vitamin A, and I didn’t want to risk toxicity by taking more — but you wouldn’t believe how hard it was to find vitamin D by itself in those days. I finally found one store that carried it — and it went out of business. Then GNC opened a branch in Fairbanks, and I was able to get vitamin D from them. But the recommended dose was still just enough to prevent rickets.

Now all at once, or so it seems to me, vitamin D is being touted as a miracle pill, needed by the body for a lot of things never heard of in my day. I just knew I wasn’t getting much sunlight, and the light skin of people who’d lived many generations in northern climates was hard to make sense of unless vitamin D was pretty important. But I was still a little worried that my 2000 units a day (possible now without a handful of pills) might be too much.

Apparently it’s not.

Last week I went to the cancer doctor for a follow-up on my breast cancer. The check-up went fine, but he’s had me on Femara for about 4 years now. Apparently one of the possible side effects is reducing bone density, so I got a bone density scan and a blood test of vitamin D (important in keeping bone strong) as part of the check-up. I’ve been taking 2000 units of vitamin D a day for several years now, so I thought my blood vitamin D would be normal to high.

The bone density was a little low, but no lower than it was two years ago. Vitamin D — would you believe at the lowest end of normal? I was actually advised to increase my dose to 4000 units a day, and keep up the calcium supplements and the yogurt and cottage cheese that are a normal part of my diet. So this seems to be a supplement that is needed. Especially for us older folks.

Three Approaches to Health Care

There are three ways of approaching less than optimal health: prevention, treatment and cure. All have their strong and weak points; all are political hot cakes at the moment.

I think most individuals and societies would agree that the best solution is to stay in good health. It is also a solution that is not always possible. It is, however, the approach that is responsible for the dramatic drop in childhood death in developed countries.

Prevention measures are generally lumped as public health. Clean drinking water, proper sewage disposal, nutritious food, clean air and immunizations all fall into this category. So do measures intended to reduce accidental injury or death (such as seat belts) and those encouraging a healthier life style. Prevention would also include such highly controversial measures as not passing on genes known to have a deleterious effect on health.

In general prevention measures are good for the population, but affect individual choice. They may also affect the bottom line of corporations with a great influence on public policy, such as the food industry.

Some of what I need for treatment of diabetes. I want a cure!

By treatment I refer to ongoing treatment — the pill (or shot) for everything or treatments such as dialysis which must be repeated regularly for the life of the patient. Certainly it is better to have a treatment than not! I am alive today thanks to insulin. But treatment is generally expensive and is often lifelong. Further, treatment of this sort almost always has undesirable side effects. In my case, insulin can produce hypoglycemia which can kill. It should be noted that some “cures,” such as organ transplants, may then produce a condition in which lifelong treatment (anti-rejection drugs) is needed.

A cure implies a return to normal health. In some cases (such as the common cold) a cure is mainly a matter of time, with supporting treatment to prevent secondary infections or ease symptoms. Some cancers are curable with surgery, especially if caught early. Broken bones or other traumatic injuries can often be cured, especially in the young. A number of conditions, however, have no cure. Research on cures is ongoing, but the profit from a true cure is usually not as great as from lifelong treatment. Given that most health research today is profit-driven, research on cures tends to take a back seat to research on treatments.

I’ll probably return to this in the future, looking at one of the three approaches at a time. For right now, how would you order the importance of the three approaches?

Health

One of the things I blog about is health and health care. Here are links to posts on this topic. This post will be linked from the Index page, and I will add new posts as they go live.

General
A Pain in the Back 8/12/11
Pain Gel 10/1/11
The Cost of Health Care 10/8/22
Cranberry Recipes 11/24/11
Three Approaches to Health Care 1/21/12
Vitamin D 10/4/12

Cancer
Breast Cancer part 1 2/12/11
Breast Cancer Part 2 2/19/11
Breast Cancer 3: Mammograms 2/27/11
Radiation Therapy for Breast Cancer 3/12/11
Chemotherapy and Quilts 8/6/13
A Chemotherapy Fashion Show 8/15/13
Chemo, Hair Loss and Wig 8/22/13
Happy News: CT Scan 9/24/13
A to Z Reflections 5/8/14
Cancer Survivor 6/14/14
More cancer 10/6/14

Diabetes
Insulin Pumps 5/20/10
Cataract Surgery Complications 1/29/11
Diabetes and Blood Sugar 2/5/11
Complications of Diabetes 5/27/11
Diabetes: What’s in a Name 7/15/11
Conversation Piece (fiction) 10/20/11
Measuring Blood Sugar 11/12/11
Your Mileage May Vary 11/26/11
Continuous Glucose Monitors 12/3/11
Award and Medicare 3/3/12
Meals With Diabetes 5/19/12
Diet Sleuth: A Useful Meal Planning Tool 5/26/12

Indexing Blog Posts

500+ posts is too many for me to keep track of, and quite a few are “reference” posts, such as the ones on planet building or horse coat color genetics. So I’m putting in a new feature, an index page that links to posts linking to the posts on a given topic. (Sound confusing? Try doing it!)

These indexing posts start today (see below) and will appear occasionally until the reference posts are all indexed. After that I’ll just be updating the index posts, which will be accessible from the Index tab above.

Why an Index?

With 550 posts as of today, I’ve started to have problems remembering what I’ve already put on here. This is particularly a problem with posting existing content such as poems, short pieces from the Summer Arts Festival, or science explanations originally written for the Alaska Science Forum. I can’t remember which books or DVDs I’ve posted reviews on. It also is starting to be a problem when I want to link to a previous post and can’t remember when it was put up or what the title was. And there are posts on this blog that have permanent information, like the series on planet building and the one on horse color genetics, or the book and DVD reviews. I want to make it easier for my readers as well as myself to find things.

I made a start some time ago by adding an index page, which can be accessed from the menu at the top of any page. Right now, the only links are to index pages on my author site. This takes you out of the site and sometimes back in, which is rather clumsy. The index list is also incomplete.

I’m going to start posting an occasional entry which is strictly an index of past posts on a particular topic. These posts will be linked from the index page, and will link forward to the individual blog posts. As it takes a while to find all the posts that belong together, this will be a slow process—probably extending over the next few months. The first in this series, on DVD reviews, is already queued for January 3. Others will follow, most on Thursdays.

I probably won’t be indexing every post. Some, like those early posts which were simply glossary entries for my books, are on the author site and really belong there. Others, like the regular Monday updates on North Pole weather starting in November 2010, can be found easily enough just by using the calendar on the site. But I hope that by the time I have finished this, older posts of interest will be easier to find.

The Cost of Health Care

Why is health care growing steadily more expensive?

Well, there are quite a lot of reasons. But the most obvious to me, the elephant in the room (and I’d don’t mean the GOP elephant) is something never mentioned by politicians. What’s more, we all cheer it on.

I mean the advances in medical science.

Face it. One of the man reasons medicine is costing more and more is simply that doctors can do more and more.

Take my own case. A century ago, I would have died before getting my Ph.D., and the most a doctor could have done was tell me that I had diabetes and it would kill me, painfully, probably within a year if not a few weeks. Oh, my life could have been somewhat extended by a starvation diet, but I wouldn’t have lived long, and I probably would not have stacked up much medical cost.

42 years ago, when I was diagnosed as having diabetes, there was a treatment, insulin. It was cheap—a slaughterhouse byproduct. Hypodermics were glass, and my fingertips were often scalded because those glass syringes had to be taken apart and boiled before each use. Blood sugar tests? Those were carried out in a laboratory, and took several hours. Urine tests were available, but it didn’t take me long to realize that I could have urine sugar so high the tests would scarcely read it while I had every physical symptom of blood sugar so low I almost passed out. The medicine of the time kept me alive, but my diabetes was not exactly well controlled. Probably my eye problems today can be traced in part to this poor control.

Since then I have gladly discarded the glass syringes for disposable plastic, swapped beef-pork insulin for genetically engineered (and much more expensive) human insulin, learned to test my blood sugar with a finger prick, begun using artificial insulins genetically engineered to act faster and slower than human insulin, started using an insulin pump, and added a continuous blood sugar monitor. My diabetes is under far better control, and in fact my blood sugar is usually within the normal range. Thank goodness I have good insurance, because all of this is appallingly expensive.

Diabetes is by no means the only disease to see this kind of improvement in care at an increase in cost. Many cancers that were once fatal or “curable” only by gross mutilation can now be treated with far less invasive surgery, drugs and radiation. More and more conditions that were once a death sentence can be treated, even if few can be really cured.

And as one result, medical costs have skyrocketed. People for whom nothing could be done are now treatable.

Greater possibilities are not the only reason medical costs have climbed, and I’ll touch on some of the others later. But we have to recognize that at least part of the cost increase is simply because doctors can do something other than just tell a patient, “You’re going to die soon.”