What To Do Now

Another Entry in the Mad Jubilado series

It is the always-present never-ending question of life. Sure, we have good intentions and sometimes they work out – as planned or not. Yet each moment is contingent. The future never arrives; it’s always out there because we are always here, in the present. We have our To-Do lists; we have our schedules. And we have our big plans. They all represent the near- and long-term future. We even have our spontaneous impulses, if we have held on to our creativity. But what to do now?

The Mad Jubilado has said many times, mostly to himself, “you could be run over by a truck tomorrow, so what are you going to do now?” It is just a reminder that life – and its length as well – is quite unpredictable and can end at any time, without notice, despite our attempts at stability through habits. So, what really is important?

Will contemplating such a core existential dilemma affect what we do now? Maybe, maybe not. What difference does the certainty of indeterminate termination make? We all know that we will not live forever, but at a certain level we push that realization out into the future far enough that it doesn’t bother us so much. That is easy enough when you are young, which is why so many die young due to feeling invincible.

Risk aversion grows with age, more or less. So grows the awareness of the certainty of death in the much nearer future for this seventy-eight year old Mad Jubilado than for the twenty-eight year old brazen base-jumper. To live well may not require taking high risks, but some risks will arise on their own whatever we do. I was about twenty-two when I barely avoided a head-on crash with a truck on a narrow bridge in central Mexico, with what seemed no more than a couple of centimeters between us as we simultaneously crossed that narrow bridge in opposite directions.

That got my attention. I realized that luck as much as skill allowed me to continue to Guadalajara and beyond to the rest of my life. Of course, I attributed survival to my own skill in “threading the needle” between the on-coming truck and the bridge abutment. Yet it shattered part of my youthful sense of being fully in control. We must play the hand we are dealt. Yet, our play may or may not be enough.

Anyone who has lived as long as this Mad Jubilado has seen others of her/his generation die; s/he usually takes notice. That has happened to me several times in recent years. Since about the time I retired, three of my university colleagues in California have died of pancreatic cancer. What is it about LA?

Then, now already three years ago, one of the most joyful life-loving women I have ever met, the wife of a close friend in Santa Fe, died too young after a shared struggle both of them endured for four years. Throughout that battle with cancer, they both lived life as fully as possible – more so than many do living in comfortable risk-averse habituated routine.

Habits can enhance stability, but they contribute little to “the hero’s journey.” It is always an honor to know people who live their lives creatively and fully. Adventure is the essence of the hero’s journey; it always involves struggle and the resulting unbounded joy in living, which should be a lesson for us all. No matter what happens, there is only one thing to do now: live!

Seeking Sanity in Science within the Medical Establishment

About ten years after being diagnosed with a non-aggressive prostate cancer and narrowly escaping the surgeon’s knife by finding a real prostate oncologist who shared all the treatment alternatives with me, then undergoing non-invasive yet pretty darn effective treatment, something entirely unrelated happened, or so it seemed.

Self-Serving Medical Practice

I recall the urologist who had diagnosed the cancer with strong distain. He was a surgeon and had glibly said, “Don’t worry, it’s not that aggressive; give me a call and we can schedule surgery in the next couple of weeks.” His conflict of interest coincided with a complete lack of objectivity as well as indifference to the risks for the patient – me. He failed even to mention alternatives to surgery. I was lucky to find a prostate oncologist, escape the knife, and find an effective non-invasive treatment.

Then, once again, a decade after that narrow escape from unnecessary surgery, by finding the right information and dodging routine medical practice – the so-called “standard of care” – I was able to choose a better path than passive acceptance of self-serving medical “authority” would have allowed.

After a few years living in Northern New Mexico, what had been rather ordinary springtime allergies gradually morphed into full-blown year-round allergy symptoms. I was tested, and sure enough, I had become allergic to most grass and tree pollens in the area. After about four years of weekly allergy shots, my symptoms seemed moderately reduced, but far from eliminated. Then, following a particularly strong winter flu, I sustained a major sinus infection. My sinuses had become almost fully blocked. Sinus surgery followed; the result was wonderful. I was breathing clearly through my nose for the first time in years. And my allergy symptoms were reduced to occasional minor irritations.

The Arrogance of Authority

However, during the pre-op testing, EEG and EKG measures revealed a small heart valve anomaly. Of course, nobody tells you why you are getting extra tests or what the findings are. Finally, after the pre-op physician’s assistant sent me for a full abdominal ultrasound in search of a non-existent aneurysm, she scheduled me to see a cardiologist. “I don’t know why they did the ultrasound; maybe they thought you had an aneurism. But the good news is, you don’t,” said the cardiologist standing over me with a smug air of authority. He said the heart valve anomaly was minor and simply should be checked once a year. If it didn’t change, no problem.

But the cardiologist insisted that I begin taking Lipitor to keep my cholesterol numbers below their slightly elevated level. When I began to inquire about the “side effects” of statin drugs, he became indignant. “I’ve heard all those arguments. You need to take it to prevent more plaque buildup in your coronary arteries to prevent a heart attack or stroke.” He thereupon wrote a prescription for a strong dose of the generic form – Lipitor’s brand-name patent had expired. The man was over-the-top arrogant. To discuss a patient’s concern was apparently below his self-defined authoritarian dignity. I resolved to never see him again.

I was more concerned about the heart valve anomaly and didn’t like what I knew about statin drugs. So, I decided to visit the cardiologist in Beverly Hills that my oncologist had sent me to for a checkup and stress test over a decade before. He was a very bright guy, affiliated with Cedars-Sinai Hospital, and clearly part of what I would call the “high-end” medical establishment.  Back then I’d had stress tests and imaging a year apart and the year of regular gym workouts with a trainer in the interim had made the initially difficult stress test easy. All clear back then.

Knowledge Overcomes “Standard of Care”

“Oh, we saw that heart-valve anomaly ten years ago; it’s nothing to worry about.” He reported that I’d done perfectly on the stress test. “But you are off the charts on your arterial plaque. You must begin strong doses of Crestor immediately.” He gave me a handful of samples, insisting that I was in serious danger, based on such a strong score on arterial plaque. I did wonder why, if it was so bad, I had performed perfectly on the stress test and the imaging showed no obstructions at all.

Well, as it turned out with further research on my part and consulting with a lipidologist, my puzzlement with the inconsistency between the stress test and the “plaque score,” was well founded. Things were not as they seemed to the high-end cardiologist. So, next time I will report, as Paul Harvey used to say, “the rest of the story.”

The Heart of the Matter: It’s More than Your Doctor May Know

~ ~ ~ Another in the Mad Jubilado series ~ ~ ~

I keep finding myself in conversations of health and illness, as I grow older. The Mad Jubilado experiences by the very course of nature and time more health related situations and conversations than in previous stages of life. In such conversations I have noticed a certain irrationality in searches for “the solution,” where no simple (and also effective) answer can usually be found.

Along with simplicity, too many “patients” rely blindly on the “authority” of various assertions by their doctors. It is so much more comforting to find a simple solution provided by an authority figure, requiring little thought and a one-step implementation, than to pursue diverse sources of information from scientific research.

The denial of complexity is similar to denying that there is a problem. Some folks about as old as this Mad Jubilado would like to live in an age like the ideal pastoral existence they think they remember from childhood. Some things always were more complicated than we remember; many others have become even more so.

Some folks, on the other hand, revert to the no-solution solution. I remember too many conversations about which I do not remember anything else but that they contained a certain attitude of fatalism in the guise of scientific skepticism. This seems to happen less often now since most folks seem to have at least some grasp of how certain things damage people and other living things. Such conversations go something like this:

Mr. A – “Did you hear about the medical studies that show that people who eat X have a 42% greater chance of contracting colon cancer than those who don’t?”

Mr. B – “Oh, well, it seems that every day they claim that something else we eat is going to give us cancer. What are we supposed to do, stop eating? Have they really proved it? I know lots of people, for example, who smoke and don’t have cancer. It’s ridiculous; I’m not going to worry about it. We can’t control everything.”

Defeatism, Denial, and Delusion in the face of complexity: None of these is particularly useful. We do live under historically unique conditions. So many materials and chemical compounds now impinge on our lives every day that were never present in the natural environment before industrial civilization.

We have a sense that so many things just could not all be bad for us. At the same time, those who profit from our ignorance try to convince us that the pollutant their industry emits and we are concerned about is really harmless. Don’t forget, the fossil-fuel companies hired the same public relations company to promote climate-change denial that worked for the tobacco companies to convince folks that cigarettes were safe.

We live in a single-cause-of-evil culture. We want to identify the bad guy and have the Lone Ranger come and take him out. Otherwise, things should just be rosy. Just look at foreign policy; well never mind, that’s another very long story… Fact is, life can be and often is, complicated.

And so it is with our health and its relationship with the medical industry as well as the many industries that pollute our air, water, and land. One small part of the denial of the overwhelming evidence of growing climate chaos is the denial of complexity, even to the extent of imagining vast (necessarily complex) conspiracies by climate scientists all over the world to construct stories of complexity in what deniers insist is a simple world.

Recently, by not believing the standard, simple, one-culprit story of arterial plaque that dominates the thinking and practice of cardiology, I was able to dodge what I call a “standard of care” bullet. What might have induced panic about a “life threatening” condition, was resolved by turning to more data on a variety of factors and a scientific analysis of the complexities of biochemistry.

My plaque score was off the charts. Yet I passed the stress test with flying colors, demonstrating by the performance and by imaging that I had no arterial blockages. Yet the cardiologist insisted that I was in grave danger and urging that I take high doses of a new statin drug. I investigated the facts of plaque beyond the ideology of the high-end cardiologist. I consulted with a lipidologist and learned about the complexities of blood lipids and plaque, apparently beyond what the most cardiologists know.

I discovered that a high score on a narrow measure of arterial plaque was not the final word on the matter. Old plaque is essentially scar tissue, yet retains the calcium that was in the original plaque. So it results in a high score. Scar tissue does not flake off like new plaque in the artery.

Facing complexity and seeking to understand it led to a better more complete understanding of risk management and a better approach to maintaining heart health. The heart of the matter reached beyond the standard of care typical of the practice of cardiology. The same prinicple applies to many areas of risk in our complex world.