R’il’nian Teeth

My science fiction is based on two species, the R’il’nai and Humans, and their crossbreds, the Ril’noids, living together. One of the major differences between the two parent species is in life span. The Humans have what we would consider a normal life span. The R’il’nai, while not immortal, do not age beyond maturity. A number of my characters have been alive for millennia. Crossbreds can show either pattern.

This leads to all kinds of interesting situations in the society. How do the two species interact, for instance? How many Humans would want to marry someone who would never grow old? How does a R’il’nian act toward someone he or she knows will grow old and die while the R’il’nian is still young? This is in the background of all of my plots.

Here, however, I am addressing a different problem.

Most of the cells in our bodies are constantly turning over. I can imagine a creature that looks and acts human with a near-infinite life span, except for one thing. Teeth.

Tooth enamel wears, and unlike skin, it is not constantly replaced from within. Modern dentistry can do a lot to repair wear, but I’m having to have enamel repairs already. Young mammals are born with two sets of tooth buds, one that grows into teeth suited for the small jaw of a juvenile; the second set adult sized, and that’s it. People who lived thousands of years would wear out their teeth. How to handle the problem?

The R’il’nai would have to have an essentially infinite number of replacement teeth. When a tooth was worn out, it would be shed much as a child sheds its milk teeth, and replaced by a new tooth. How? They must have some tooth stem cells in their jaws, just as we have blood stem cells in our bone marrow. Assuming that a tooth would last for 50 or 60 years, this would mean that the R’il’nai and non-aging R’il’noids are teething roughly every two or three years. I don’t think I’ve actually mentioned that, but if a R’il’noid seems to be in a particularly bad humor, he or she may be teething.

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

A Pain in the Back

I’m not a great fan of alternative medicine, and as a general rule I classify treatments sold at the Fair with snake oil. At the same time, I’m not really enthusiastic about the pill-for-everything approach of some doctors – and acupuncture did seem to work for my dog, once, when the more conventional vet said she’d be paralyzed for life. Besides, my back hurt, after walking all over the Fair. It usually does, when I’m standing or walking for any length of time (like over 5 minutes.)

So when I saw an outfit that comes every year with chairs urging passers-by to sit down and have a demonstration of their pain relief, I thought, “Why not? It probably won’t do anything, but just sitting will help.”

Well, it did help. I put it down to sitting and resting my back (though the electrical stimulation did feel good) and fully expected my back to be hurting again by the time I’d walked back to my car.

It didn’t.

In fact, it didn’t really start bothering me until I’d been walking around the fair for an hour the next day. So I went back for another demonstration. By the third day I’d decided to phone my doctor about this, and actually dropped off the company’s brochure at her office.

She confirmed that TENS therapy was a viable method for pain relief, but that Medicare probably wouldn’t cover it. (Many other insurance plans do.) The Fair price sounded reasonable to her, and I wound up buying a unit.

The unit works by applying a small electrical stimulus through pads you stick on your body. The pads must be in pairs so that the small current can flow between them —  not much currant, as the thing operates on 3 AA batteries. For my back, 4 pads are used – 2 on either side of my back, above and below the waist, with the current between the right and the left side. The result is a forced muscle vibration, leading to increased blood flow. It feels very much like massage – not like an electric shock at all.

I’ve used it a couple of times at home, now. The pads (which are reusable many times) are incredibly sticky when new, and so far I’ve used it mainly on the backs of my thighs, which tend to cramp badly at night. Warning: don’t try to change the position of the pads without turning the unit off! Hands do feel the electrical stimulation as a shock!

How does it work? There seem to be several theories, none of them thoroughly proven. But it does seem to help.

All in all I think this will be far better for me than pain-killers, which I’m leery of anyway. I’ll let you know what I think after a couple of months of use.

The unit is produced by Home Care Technology Co. and the people at the fair have a website.

Diabetes: What’s in a Name?

Two hundred years ago, a myriad of diseases were known by a single term: fever. We still use the word as a part of some disease names today – yellow fever, scarlet fever – but more often today the word “fever” is used to describe a symptom: body temperature above the narrow range that is normal for a human being. We have inoculations and other measures to prevent or cure many of the diseases once grouped as “fever,” and if those diseases had not been separated, this could never have happened.

Diabetes melltus, as defined today, is an elevation of blood sugar – more accurately, of blood glucose. Like body temperature, the human body needs a particular amount of sugar in the blood. Too much, and there are all kinds of long-term consequences to blood vessels and all that depend on them – kidneys, wound healing, eyes, the nervous system …. Too little and the brain, which more than any other organ requires glucose as a fuel, shuts down. (I’ve used this as a basis for esper shock in Homecoming and Tourist Trap.)

The body of a healthy person has a number of feedback mechanisms to keep both body temperature and blood glucose within the ranges necessary for life. Blood glucose feeds the cells of the body, but the use of blood glucose by the cells requires a hormone, insulin. If the blood glucose goes too high, the islets of Langerhans in the pancreas pump out more insulin. This allows the cells either to use the glucose for themselves, to store it short-term in muscles and liver, or to store it long-term as fat. If the blood glucose goes too low, glucose is released from the liver or used as fuel by the muscles which have stored it.

When these mechanisms go awry, the result is diabetes. But there are many ways they can go awry. You can treat a fever with aspirin, cold cloths, or ice, but to prevent or cure the fever, you need to know what is causing it. And there are many ways the regulation of blood sugar can go awry.

When I was first diagnosed with diabetes, 42 years ago, there were assumed to be two types of diabetes: juvenile and adult. On age, I fell in the crack. Juvenile diabetes required insulin, which must be injected into the body, and one simply does not get over this type of diabetes. Adult diabetes could often be treated with oral medications or even with diet. Since I did not respond to medication, I was assumed to have juvenile diabetes.

Today we have type 1 (defined as autoimmune destruction of the ability to produce insulin) type 2 (often considered due to overweight and lack of exercise, but there is evidence that fairly thin people can present with type 2) LADA, gestational diabetes (which may disappear immediately after the baby is born but may go on to develop into type 1 or type 2) and even a type that looks like type 1 but clears itself up. Not to mention the fact that the islets of Langerhans can be destroyed or damaged by things other than autoimmunity, such as chemicals or actual removal of or injury to the pancreas.

Why can’t we accept that diabetes is not in itself a disease, any more than fever is, but a symptom of a large number of diseases?

It is true that there are two major intermediate causes of diabetes, which may occur together or separately.

The more common cause, often associated with a modern sedentary lifestyle, is insulin resistance. There is plenty of insulin available, but the cells seem unable to use it to metabolize sugar. In fact, the body may overproduce insulin in an effort to make up for the insulin resistance, ultimately leading to the death of the insulin-producing cells and the need for insulin therapy. But this is an intermediate cause. The chances are that there are several underlying disease states that produce insulin resistance, some of which may be hereditary, dietary, lifestyle or chemicals. But we’re not likely to find them unless we quit lumping all insulin resistance as type 2 diabetes.

The rarer intermediate cause is an inability to produce insulin. If this inability is due to an autoimmune attack on the islets of Langerhans, the result is type 1 diabetes. That of course leaves the cases of insulin-dependent diabetes due to actual injury or destruction of the pancreas by other than autoimmunity, or the inability of the islets to produce insulin for reasons other than their destruction, out of the definition, though as far as treatment goes, they are type 1. Even the autoimmune destruction may have many triggers. Things as far apart as viruses and cows’ milk have been suggested.

Treatment is insulin – first obtained from beef and/or pork pancreases, but now biologically (bacterially) produced using the chemical structure of human insulin. Some insulins further modify this structure to give faster or slower action. Because insulin is a protein which would be destroyed by the digestive system, it must be given under the skin using a hypodermic, an insulin pen or an insulin pump. Without insulin, death can occur within days.

I’ll probably visit this subject again – it’s a favorite rant of mine. Meanwhile, the symptom of diabetes is increasing in frequency worldwide. Why? And which underlying diseases are actually increasing?

Breast Cancer 3: Mammograms.

I meant to cover radiation therapy this week, but I was tripped up by a blizzard. With 18 inches of fresh snow in the driveway, I couldn’t get out for the mammogram (X-ray of the breasts) scheduled Monday, and the radiation oncologist needed that before he saw me Thursday. I wound up getting the mammogram Friday, and have a new appointment with the radiation oncologist next Thursday. I hope I can get a photo of the radiation machine to use with the blog next week.

Business all over Fairbanks sponsor ice carvings as winter outdoor sculpture. The hospital imaging center has this skier, complete with goggles.

There are two types of mammograms: screening (to see if anything looks suspicious enough to look further) and diagnostic (once something else looks suspicious or worse.) Once you’ve been diagnosed with breast cancer, all the mammograms are diagnostic.

Three years ago, I got a diagnostic mammogram (which confirmed my doctor had indeed felt a lump), a biopsy (which involved shooting a sampler into my breast) to confirm that the lump was cancerous, and then surgery to remove the lump and the “sentinel node”—the lymph node most likely to be cancerous itself. If the sentinel node had been positive, all of the lymph nodes would have been removed. I was lucky; my sentinel node test was negative. But since I had chosen a lumpectomy rather than a full mastectomy, I had to follow chemotherapy up with radiation therapy.

Mammograms are uncomfortable but not really painful. Nipples and scars are marked with band-aid-like beads and tape with a metallized line. You stand next to the machine, your breast is squeezed between two plates, and when you are positioned to the technician’s liking you are told to hold you breath for a couple of seconds while the x-ray is taken. Generally they take one picture with the breast squeezed horizontally and one with it squeezed vertically. I think the most uncomfortable part of the process is getting my arms, chin, shoulders and ears out of the way and holding them there. I always finish a mammogram with a stiff neck.

They don’t have to develop film any more. The mammogram comes right up on a computer screen, and can be read at once. When I had mine done Friday, a couple of whitish areas showed up on the good breast, which led to a repeat of the X-rays with a different and smaller compressed area, and a few moments of worry on my part. Turned out to be calcium deposits that had been there all along. And this time I was told to come back next year, instead of 6 months from now.

I still wish Roi (one of my Homecoming characters) was real.

Breast Cancer (Part 2)

As I mentioned last week, my primary concern was that my treatment for breast cancer had as little impact as possible on my diabetic control while having maximum effect on the cancer. I was well aware that chemotherapy would involve stress, and any kind of stress affects blood sugar. So when the oncologist gave me a choice of two types of chemotherapy drugs, I chose the milder but slower regime, 5-FU plus Methotrexate.

It was a mild regime in the sense of minimal side effects, but I had to get an infusion weekly for close to 5 months. And even with this regime I was warned that there was a good chance of nausea, losing my hair or anemia.

Luckily, I could get the infusions in Fairbanks, within driving distance of my home, and between the cancer center and VanTran I had a good chance of getting a ride if I got too sick to drive.

Remember I said that the diabetes actually helped me deal with the breast cancer diagnosis? It wasn’t all psychological. One of the things I have learned in my years of trying to keep my blood sugar under control is that I have to have regular exercise. I’m not much good at walking any more, but I have an exercise bike, a rowing machine and a treadmill all set up facing my television. About the only time I watch TV or a DVD without exercising at the same time is when my blood sugar is dangerously low.

I kept that up throughout the chemotherapy, with at least an hour a day of aerobic exercise. (I have an adult tricycle, too, but I didn’t ride that much the summer I was getting chemo.)

I honestly think that continuing to exercise throughout chemotherapy and radiation treatment had a lot to do with how few side effects I had. It may be that I was simply lucky, that I would have had few side effects from the chemo regardless. I can’t help but believe that some of my generally good health throughout the chemo was due to the fact that I continued regular exercise.

Having the rather large needles inserted into my hand was painful and annoying, especially as they always used the hand on the unoperated side, but I never had to have a shunt. Even my hair, while thinning, stayed on my head. I had to get blood tests before every session, and my white and red cell counts did get low enough I had to get some shots to build my blood back up, but I never really felt sick. I lost some weight I could well afford to lose, though unfortunately it didn’t stay off.

Most of the summer and early fall of 2008 I was driving to the cancer center every week for chemo. I did stretch the space between appointments once, to attend a family reunion. I’m glad I did, as it was my last chance to see two of my aunts, both then in their 90’s, who passed on a few months later.

I’ll talk next week about the radiation therapy.

Note—the Sunday blog would normally be about the genetics of the white splash gene in horses, but February 19 is Writing in the Dark, a writers’ conference held annually here in Fairbanks. Instead of the normal horse genetics, I’ll be blogging on the conference next Sunday. I’ll also encourage attendees to put samples of their writing at the conference up as comments. Our leader and inspiration will be Peggy Shumaker, our state writer laureate, and I’m really looking forward to it.

Breast Cancer (Part 1)

Fairbanks Cancer Center

A breast cancer diagnosis is a downer—no question about that! I think the doctor who had to give me the news that my biopsy was positive was expecting—well—hysteria? Horror at mutilation? Panic at the C-word?

I’ve lived with diabetes for more than 40 years. Of course I was unhappy at the diagnosis, but the prospect of losing a breast worried me far less than the prospect of losing my vision or legs, and I’d lived with both for years. As for fear of cancer, I was already aware that breast cancer, caught early, is one of the most treatable of cancers. And mine was caught early.

Yes, I was worried—I am still worried—about the possibility of recurrence, of metastasis. (I have a mammogram and a follow-up visit with the oncologist a week from now.) But the lump in my breast was caught early, in a regular visit to my doctor’s office. (As a diabetic on an insulin pump, Medicare requires that I see my doctor every three months.) After my doctor found the lump I had what would have been my annual mammogram a couple of months early. The mammogram led to a biopsy, which was positive. Surgery was indicated. (Not that I didn’t wish Roi’s Healing ability was real.)

Because my cancer had been caught early, I had a choice of mastectomy (removal of the affected breast) or lumpectomy followed by radiation therapy. Being lopsided didn’t bother me, but the possibility of surgery affecting the diabetes did. I chose right through to go for the options that might take longer, but would have minimal impact on the diabetes. For surgery, that meant a lumpectomy followed by radiation therapy.

I expected to be miserable after the surgery, but compared to a knee replacement a couple of years earlier it was a breeze. I don’t think I even used the pain prescriptions after the first day or two. I did have a drain, and that was the major annoyance connected with the surgery. I needed to raise my basal insulin for a few days, but aside from that my insulin pump kept my diabetes under control very nicely.

I think my main problem came from the fact that I had two oncologists, one for the radiation therapy and the other for chemotherapy, and they weren’t communicating very well. There was some question as to whether or not I needed chemotherapy, the genetic makeup of my tumor, and which should go first. They finally got it sorted out that chemotherapy should come first.

One thing I should say at this point. Fairbanks Memorial Hospital added a cancer center not too long before I was diagnosed. Before that, I would have needed to go to Anchorage, 350 miles of mountain roads away, for either chemotherapy or radiation therapy. As it was, my therapy was within driving distance of my home.

I’ll get into the post-operative therapy next week. For now, I’ll just say that the diagnosis really woke me up to my own mortality. It was the final push that determined me to go ahead with assisted self-publication for Homecoming. Maybe if I had really kept at it I could have found an agent or a publisher. Certainly the book has garnered some fine reviews and is currently a finalist in one contest. But the cancer diagnosis was the final push.

A few breast cancer links:
Breast Cancer Organization
National Institute of Health
Susan G. Koman Foundation
National Cancer Institute
National Breast Cancer Foundation
Breast Cancer Detection Center of Alaska
Fairbanks Cancer center

Cataract Surgery Complications

Sometimes I wish Roi and his Healing ability were real, rather than a creation of my mind. Still, ordinary doctors can do quite a lot.

This week, it was complications of cataract surgery. I had the lens replaced in my left eye over a year ago, with stunning results. A few days after the surgery, distant vision in my left eye was back very close to 20/20, though I still needed glasses to read. I’m getting to the point where my arms just aren’t long enough, but my overall vision was wonderful.

Then, so slowly that I was hardly aware of it, my vision began to fog up again.

I found it harder and harder to read. First, words on paper. I had to use a magnifying glass to read the phone book, but then ordinary type in books became more and more difficult. The computer screen was still readable, but more and more often I was having to zoom the text and set things I was writing to half again normal size. When I started having problems reading my insulin pump and glucose meter, I spoke to my eye doctor.

I’ve had problems with diabetic retinopathy for almost twenty years. The treatment for that is what is called pan-retinal coagulation. The outer part of the retina is killed with pinpoint burns from a laser. Effectively, the periphery of the retina—which gives peripheral vision and low-light vision—is sacrificed to save the inner part, which gives sharp focus and color vision. I’ve had lots of experience with that kind of laser treatment. It’s somewhat painful and vision afterward is blurry and pink-tinged for a while. (The laser is green.)

What I had now was posterior capsule opacity. The eye doctor explained that the laser was less intense than what I was used to, though from my point of view the procedure was much the same—eye dilated, a lens inserted in my eye, and several minutes of holding my head motionless against a frame while I fixed the gaze of my other eye on a small target light.

I could hear the clicks as the doctor used the laser to cut a small hole in the thickened capsule, but I could not feel it. After I was released from the chair, my vision was blurry and pink-tinged, as I expected. What I did not expect was that by the time I got home, about an hour later, I was able to see much better than I could only that morning.

Today, forty hours after surgery, my vision is bright and clear, and if I understand correctly what the surgery did, it should stay that way. Yes, the Healing ability of a few of my characters would be nice—but medicine today can do some wonderful things—if you can afford it.

Psi and Morality

What happens when loyalties and responsibilities conflict? What is the moral thing to do?

I’ve been exploring morality to some extent in my writing. I won’t say I have the answers—there really aren’t any. But here’s an excerpt from a story set years after Homecoming was over:

“My folks hadn’t been able to teach me the morality of using my esper talents–rules don’t arise about things that are assumed not to exist.  But they had ingrained some general principles into the fiber of my being, and those general principles worked quite well with what Roi had taught me and, more recently, with what I had found in the files my mother had left behind.  Put yourself in the other person’s shoes.  Remember that ‘human’ is not just you and your relatives, or those who look like you, or who share common beliefs.  Ask yourself, ‘what would life be like if everyone behaved this way?’

“It wasn’t as easy as rules-based, black and white morality, because it required thinking.  And there had been times, both home on Earth and here on Central, when the accepted morality was immoral by the principles I believed in.  Slavery as it was practiced here on Central, for instance.  Did I even have the moral right to walk away, if I could really stop it?”

What widely accepted moral rules might be immoral in a different society or environment? Or even in our own, if looked at closely?