LITTLE THINGS ARE A BIG THING

At my last eye exam my eyes were unchanged in spite of several years with Diabetes II, which was diagnosed by an eye exam. The life of my eye doctor, however has been turned upside down, not by medical conditions but by the health business. He has left the big clinic where he practiced for years, just as my previous eye doctor left that same clinic and then left the town. This is not unusual. I have only a dim understanding of what is going on, but I don’t think I’m far wrong. Being a physician is no longer a profession: it is a profit-making enterprise and the docs are being squeezed and managed with the rest of us.

Obamacare is beside the point. Doctors have made a devil’s bargain to get rid of the burden of paperwork and other management chores. They have lost their autonomy. Some have lost their morality. Whether they have lost their skill is irrelevant since that’s not what counts anymore. In fact, the nature of disease and the protocol for handling it is has changed, esp. in the case of something chronic like diabetes. One monitors with tests, notes the results, and runs one’s finger down the list of prescriptions indicated, and that’s it. No wonder people are disintermediating their doctors by simply going to the lab for the tests. If the doctors didn’t have control of the prescription pad, why would we need them?

The science of “omics,” which is the goofy name for the study of how operating genetics run the body, happened upon something very fortunate. Their main “lab rat” is a Ph.D. whose entire genome is recorded and studied. Not just that but also an integrative Personal "Omics" Profile, or iPOP. The word "omics" indicates the study of a body of information, such as the genome (which is all DNA in a cell), or the proteome (which is all the proteins). Michael Snyder's iPOP also included his metabolome (metabolites), his transcriptome (RNA transcripts) and autoantibody profiles, among other things. They saw that he had a vulnerability to diabetes though no one else in his family had ever been diagnosed with it.

Then one day he caught a virus and that actually GAVE him diabetes II. file:///Users/maryscriver/Desktop/omics%20&%20viruses ScienceDaily (Mar. 15, 2012) The team watched and learned.

When I was at seminary, one of my classmates (a woman in her twenties) caught the flu and then she had diabetes I. That meant injected insulin and constant monitoring. I’m happy to report that she’s maintained well and -- thirty years later -- serves a church happily. One does not have to die of diabetes IF one can maintain the protocol, which is rigorous.

I’ve only been diagnosed a few years but thanks to Internet contact, mostly Dave Lull (the cross-pollinating librarian) and Jenny Ruhl http://www.phlaunt.com/diabetes/bio.php I’m able to stay in control with one metformin a day plus food changes. Since I live alone, I cut my intake way back, lost fifty pounds, eliminated sugar, most carbs, white bread, corn fructose, processed food, and so on. I’ve always eaten a lot of veggies, salad and nuts. I read a newsletter about foods that convert to sugar slowly -- it comes out of Australia -- and another sort of rah-rah column about getting exercise. (I don’t do well on that one.) The point is that I’m in charge of myself, though it has meant major changes. This town is in a place where people interact through food: benefit barbecues, pie socials, candy on desks, coffee and cookies after church, and so on. Restaurant meals are high sugar, high process, big portions. But I’m a solitary anyway.

Most people who have lived here all their lives and who are diagnosed with diabetes, esp. on the rez, either become dependent on meds or simply sicken and die. Changing the way they eat, the way they cook, the way they interact with family and neighbors is too much. They find it impossible to lose weight. The ecology is changing too fast for them to evolve.

When I went for a refill on one of my two prescriptions (my high blood pressure med), the big Medicare website said I could not have any more until April 4. The local pharmacy records show one more set of meds was sent to me than I evidently received. We can’t figure out where the error is. I’m going to take advantage of this to run an experiment: I’ll not take any pills until April 4 and I’ll record my blood pressure every day. Today it’s 134/79. If it starts getting too high, I’ll buy enough pills out of my pocket to last until April 4. Assuming I have the money.

The point is not my blood pressure. The point is that our ailments have become very differently envisioned. Dr. Snyder’s diabetes onset involved 40,000 genes, all interacting in unique ways. A look at the names of the researchers reveals many countries of origin and the study itself was supported by Stanford University, the National Institutes of Health, the Spanish Ministry of Science and Innovation, the European Union, the European Research Council, the Korber Foundation, the Fundación Marcelino Botín and Fundación Lilly and the Breetwor Family Foundation. Snyder undoubtedly caught his trigger-virus from his small children who interact with the other children of the Stanford academic community, people who constantly travel and host other academics.

Many of us know and admire medicins sans frontieres. Now we have (we always did) diseases sans frontieres with frequent flier miles. Most are not dramatic. (Fatigue, malaise) Many are antibiotic tolerant. Some have been triggered by our constant invention and ingestion of peculiar molecules never seen in nature, much less in bodies. So far our water here is nearly pure, off the Rocky Mountains and traveling underground about thirty miles to our aquifer. That may not last since frakking means injected unnamed chemicals into the ground. Our wheat crops, which are grown right up to the town limits, are genomically altered to be Roundup Ready, meaning high levels of herbicide can be applied. The pigeons that hang around the granaries in town are all gone. No one will say how they were eliminated. Our cancer rates are high.

Years ago I used to have a poster in my kitchen that said, “Faithfulness in little things is a big thing.” It’s attributed to St. Francis, who advocated being as basic and interwoven with nature as possible. I wonder whether there’s a gene for that. It would probably take more than a few.

CAUGHT DIRTY HANDED

“Wash your hands!” cry flu epidemiologists, mothers, nurses, and Tim Barrus.  That last because he cares for boys with HIV, meaning they have no immunity to germs and no ability to develop immunity.  When I took a job at a nearby county nursing home as ward clerk, I thought that since I sat in an office at a computer, hand-washing was not so crucial.  I bristled and balked at the infection control nurse whom I thought was a bully and took her position as an excuse to target and persecute people.  

My neighbor thought I was funny when I described my feelings about this nurse.  When she took a job as a nurse’s aide in the same place, she had the same class in hand-washing and she liked it, thought it was very worthwhile.  One looks at statistics and microscope photos of germs.  One puts red indicator stuff on the hands and then tries to wash it off to illustrate that it takes a lot of careful scrubbing with systematic effort and time.  One is supposed to scrub hands for as long as it takes to sing “Happy Birthday.”   Then one day my neighbor discovered that an unknown aide had stored a wheelchair with feces caked onto it.  She quit.

The best protection is human effort.  Only motivation can protect us.  But there is a webwork of forces in play.  One of the most unexpected and difficult to address has been antibiotics, the miracle med that changed everything for childbirth and war trauma.  They were such an effective force that it was thought justifiable to be more casual about surgery sterility or ordinary patient care.  But antibiotics became a blunt-force weapon, used even for viruses, which antibiotics do not affect.  They are useful only for bacterial germs.  And the fact that when given to livestock as a preventative, they released energy in the animal that let them grow larger faster, meant that they crept into meat.  A third force was that people took their pills casually, not completing the full span of what the doctor prescribed and giving their leftovers to friends or children with the thought of doing a healing kindness.  On the rez they became a political element with patients who were refused antibiotics by doctors who said they were wrong for the diagnosis becoming irate and demanding them, thinking that they were being denied a magic element out of racism.  All these things left germs opportunities to mutate resistance.  

Leland Ground was in my original English class of seventh graders when I was first hired in Browning, Montana, in 1961.  His family is distinguished (some will recognize the name of Mary Ground as a ceremonialist and matriarch) and that particular class was also identified as high achievers.  (In those days we weren’t afraid to say so.)  Decades ago Leland was in an auto accident that badly broke his leg.  Surgery mended the bone with rods and screws.  Over the years the screws worked loose, so about five years ago Leland went back for more surgery.  A veteran, he used the VA hospital.  

His leg became infected with a MRSA -- methicillin-resistant Staphylococcus aureus.  The next four years were hand-to-hand combat on the part of both Leland and his dedicated doctor to save his leg from amputation.  Antibiotics, even the ones that are reserved for worst cases, failed.  Installing ports through his skin for dripping antibiotics directly into Leland’s system, which he did daily himself at home, failed.  Except that it caused nausea and memory lapses, general fogging of thought.  Re-opening the incision to clean it out failed.   Radioactive tagging of the infection so as to follow it into the bone failed.  The doctor did not give up.  He finally won.  The whole VA system has been struggling with this and now the media are beginning to report success.

Another person in that class of seventh graders was Mike McKay -- from another distinguished and achieving Blackfeet family.  For some years a while ago he was in charge of cleaning and maintenance of the Browning Indian Health Service hospital.  Once he said something offhand to me about it not being a very high status job (one brother is a lawyer and  a sister is the superintendent of the Browning Public Schools).  I jumped all over him!  He had one of the highest responsibilities on the rez!  He was a crucial partner of the doctors!  Since then he has gone back to college for graduate degrees in science.

Among the things the VA tried -- besides hand-washing -- was changing protective gowns between rooms, wearing masks, and more completely sterilizing rooms.  No matter what they tried, it was effective EXCEPT that people wouldn’t do it.  They were in a hurry, they didn’t really believe it mattered, they forgot.  It was expensive.  The experts could get maybe eighty per cent compliance, tops.

Another strategy was to test patients as they came in to see whether they were carrying MRSA germs, so as to isolate them for treatment.  This is controversial and opinions differ about how effective it is, but everyone was surprised to see the results of the tests -- so many germs!  So wicked!  The best result was that when people could see the extent of the problem, they bought into the solution and tried harder.

But there is another entirely different school of thought out there.  Immunity results from an interaction with the environment.  Medical interventions like vaccination are only an imitation of responses normally triggered by mild infections.  They are good because some of the infections are NOT so mild, in fact, deadly.  (There is backlash even against  vaccination from people who fear interventions with nature.)  Apart from the major diseases that sweep around the planet, killing people in pandemics that keep populations within previously unexceeded limits, there is constant daily interaction between creature and ecology that “teaches” the body how to live there.  Scientists who are thinking along these lines think we don’t get enough dirt in our systems to connect our bodies to the web around us.

Small wonder.  Chemical companies are making fortunes by promoting fear of germs and contamination and then selling us potent “sterilizing” molecules that go to work on the cells of our own bodies, interfering with the systems that control our functioning.  Now we’re beginning to fear those substances and move to “steam cleaning.”  It seems like a better alternative though it means yetanother expensive appliance.

That bossy nurse with her bar of soap was right.  Wash your hands.  But no need to get phobic about it.  No need to boil the patient to cure disease.  Though Leland, who has a strong sense of the ridiculous, laughed when I suggested he unscrew his leg, boil it, and then reinstall it.