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Wanna Hear About My Colonoscopy?

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Image courtesy of Flickr.com

Probably not. If you’re reading this, you are either a) one of my very loyal readers, in which case I am most grateful for your perseverance; b) interested in all things medical, no matter how icky;  c) a catastrophizer like me, who always goes to the darkest possibility in terms of health; or d) just plain curious to find out what this strange woman is up to. 

Why do I want to tell you about my colonoscopy? March is Colorectal Cancer Awareness Month, so I figure if Katie Couric could have had a colonoscopy live on the Today Show in 2000 (after her husband died of colon cancer in 1998), it doesn’t take much courage to write this post for my blog. She also accompanied Jimmy Kimmel to his first colonoscopy, and you can find that amusing and instructive episode in this YouTube video. 

The purpose, of course, is to encourage screening among those who either don’t think about it or just can’t bring themselves to do it. Colonoscopy screening is one of the indisputable ways to save lives. But even if you have one regularly, I hope you’ll continue to read this because I’ve learned some important information that I don’t think is widely known, and perhaps you can spread the word to others. As Jane E. Brody, who writes the Personal Health column in The New York Times, stated:

“Although I usually refrain from columns linked to national health observances, I believe that Colorectal Cancer Awareness Month, in March, is too important to ignore. There are simply too many people who are still getting and dying from this preventable disease because they failed to get screening for it, including people with no excuse like ignorance, lack of health insurance, or poor access to medical services.”

I am close to two people who have lost loved ones to colon cancer in their early 50s. One was a beloved childhood friend; the other a treasured younger brother. Although any young death is a tragedy, both of these people were terrific, warm, loving individuals who left grieving spouses and children—and whose deaths were totally preventable. 

In addition, I think about the vibrant young woman, mother of two, whom I met when I took a mindfulness-based stress reduction course last year. She had had colon cancer once, had a recurrence, but was then doing well, she said. Her purpose in taking the course was to find a way to ease her anxiety while she awaited subsequent test results. She wept briefly as she described her circumstances, regained her composure, and for the rest of the eight-week course, was a delightful, wry person who dealt silently with what must have been a huge psychological burden. I think of her fondly, hoping her health is stable.

Here’s the important point that I’m not sure is well known: Last year, the American Cancer Society (ACS) lowered the proposed age for first screening (for people with no known risk factors or family history) from 50 to 45. That’s because so many younger people have been struck with the disease. 

And 45 probably isn’t low enough. In contrast to a drop in the overall death rate, attributable to greater detection and removal of precancerous polyps, an ACS study found that since the 1980s, colorectal cancer rates have increased by 1.0% to 2.4% each year in those aged 20-39, and since the 1990s, by 0.5% to 1.3% among those aged 40-55. Oncologists are seeing the disease even in adolescents. Those statistics should make us all sit up and take notice. 

It’s not clear why these rates are increasing, writes Patricio Polanco, MD, of the UTSouthwestern Medical Center. He and others say the factors considered include genetic mutations, low fiber diet, obesity, smoking, heavy drinking, and ulcerative colitis.

But conflicting conclusions emerge from other reputable sources. In a 2018 discussion among experts in an  OncLive Peer Exchange,  Michael Morse, MD, of Duke University Hospital said the data suggest neither obesity nor mutational differences are significant. He suggests “something environmental or habit-based…but until we can collect enough data from a large enough number of people, I just don’t see how we’re going to tease it out.” 

This is clearly a societal issue that requires greater awareness on the part of the public. Primary care physicians may need additional education as well, experts have suggested. As there’s no screening for those under age 45, younger people with questionable symptoms may have no time to waste, as noted below.

In my case, as an adherent patient and catastrophizer, there was no way I’d procrastinate in having the procedure right when I was told I should:  at age 50. That first one was fine, but the next one showed a few polyps, as did the following one. And since one polyp was precancerous, I was advised to have another colonoscopy after only three years. I’ve never had root canal, so I can’t use that comparison, but for the uninitiated, the experience is neither a walk in the park nor the worst thing imaginable.

The instructions are that three days before, one should eat only cooked fruits and vegetables. That eliminates about 2/3 of my diet, so right there, I’m at a disadvantage. No blueberries in my morning cereal; no huge salad with dinner, containing five or six of my favorite veggies; not even a small banana. For some reason, a line from Carl Reiner and Mel Brooks’ “2000-Year-Old Man” came to mind: “I’d rather eat a rotten nectarine than a fine plum.” I would have been happy with either—or both.

On the Day-Before-the-Day, I started the liquid diet. Fantastic options there: broth, apple juice, Jello (but nothing red, the only flavors I like), soda, coffee (neither of which I drink), sherbet (but not with milk and also not red, precluding my favorite raspberry). So using a wellspring of creativity, I came up with my day’s menu:

Breakfast: mug of chicken broth, glass of apple juice

Lunch: mug of chicken broth, glass of apple juice

Dinner: mug of chicken broth, glass of apple juice

Dinner was at 3 pm, because at 4 it was time to begin THE PREP.

As many of you may know from experience, the prep involves imbibing a truly noxious-tasting substance—a combo of ingredients designed to flush the system, in my case with a soupçon of lemon-lime flavoring to tickle the palate—all mixed with luke-warm water and then refrigerated, allegedly to make it more palatable.  

Suffice it to say, I got a lot of exercise over the next several hours running back and forth until my system was “clean as a whistle.” That’s all the scatology I’m going to inflict upon you.

On The Day, fortunately, my appointment was at 7:30 am. All the medical history review and pre-procedure steps went smoothly.

Then, with the anesthesia dripping into my vein and oxygen in my nose, I drifted off. What was probably 10 minutes later, I was awake. (The electronic schedule board in the waiting room had shown that my gastro had already done 4 of these before my arrival, and had 2 more in the works before he got to me.) I lay there for a few minutes, chose my post-procedure food and drink—cranberry juice and a blueberry muffin—finished them off in a nanosecond, and that was that.

The news was better than the last time: one small polyp, the gastro informed me—definitely not cancerous; he could tell that clearly. Tonight, just minutes before publishing this post, I got a call from the gastro telling me the biopsy report showed that the polyp wasn’t even precancerous. And because there was only one small one, I now have a five-year respite from this procedure, rather than only three years. So hooray for that!

I am telling you all this in the hope that it will be beneficial. In terms of cancer deaths in the US, colorectal cancers come in second; this year, according to Jane Brody, 51,000 people are expected to die of the disease. 

In addition to colonoscopy, there are less complex tests available; see Jane Brody’s column for a description of them. Colonoscopy, though, is considered the best test, as it can both detect cancer and remove polyps that may well develop into full-blown cancer in time.

The fact that an increasing number of those cancer deaths occur in people in their 20s, 30s, or 40s weighs heavily on me. Polanco, of UT Southwestern Medical Center, says it’s important for young people to be aware of the symptoms: abdominal pain, blood in the stool, constipation, diarrhea, decreased appetite, and weight loss, “and never assume they’re too young to get colorectal cancer.” 

Younger people tend to attribute their symptoms to something less serious, he writes, such as hemorrhoids or irritable bowel syndrome, and therefore don’t seek medical help until they have late-stage disease. Though I don’t want to generate panic on this issue, it is clear that changed circumstances require a new mindset to better protect younger adults. And the rest of us need to do the prudent thing to protect ourselves as well.

As always, I welcome your opinions, insights, stories, additional sources. And thank you for staying with me to the end of a post on a topic that I really didn’t want to write about at all, but felt compelled to do so.

Annie

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Then, a 20% Chance; Now…

“The purpose of life is to live it, to taste experience to the utmost, to reach out eagerly and without fear for newer and richer experience.”

   ——–Eleanor Roosevelt

A mini-celebratory brunch is in order: the doctor reported both heart and aorta are sound.

“We’ll take you out,” we say.

“You’ll come here,” she insists. “The best bagels, fresh eggs, delicious fruit, plus quiet and lots of room.”

We relent.

Four years ago, the collapse—after a symphony hall concert.

She attended concerts often—multiple subscriptions, with friends and alone. And the art galleries, the library lectures, the thrice-weekly swims, the scheduled trip to Macchu Picchu…

That evening, she was alone. 

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Ambulance rides to three separate hospitals. Number one: ill-prepared for such an emergency. Number two: heart attack—quick; give her blood thinner. But then the correct diagnosis: a ruptured aorta, meaning the blood thinner was a clearly awful decision. “Won’t operate,” said the head doc. “Too old; too risky.”

But three’s the charm. “Bring her here,” said the vibrant young female surgeon, expert in repairing damaged hearts and valves, at a larger affiliated hospital.

Afternoon next day: We—in-laws and daughters—met with the surgeon, a tall, slender, soft-spoken woman whose brown eyes were at once warm and riveting. She minced no words.

“Without surgery, she will soon die.

“With it, a 50% chance she’ll die during surgery or within the next three days.

“A 30% chance she’ll survive the surgery but then suffer a stroke or other event that would seriously impair her functioning and quality of life.

“There’s a 20% chance she’ll walk out of the hospital and resume her life.”

What would you do?

“What do you think?” we asked the surgeon, who also happened to be kind and empathetic.

“She’s come through all this time, and two moves by ambulance, and her color’s still good,” the surgeon said. “She’s been leading an active life until now—I think it’s worth a try.”

When asked about the prior surgeon’s reluctance to operate, she said: “The patient is 81, with a ruptured aorta—clearly in extremis. It was not surprising he [the surgeon] wanted to head for the hills. But the family members come in and say she swims 3 times a week, is very independent, very functional. That sways away from ‘let the poor old lady go…’”

Shortly after 9 pm, nearly a full day after the collapse, the surgeon came to see us, her lovely face looking tired but illuminated. “It went very well,” she said. “We repaired the aorta, the aortic valve, and the mitral valve.”  The patient, she said, “is a picture: most people after surgery are pale and puffy. She looks like herself.”

Later, she acknowledged: “I had major doubts, but one of the great benefits of a large hospital system like this was that I spoke with my chairman and another specialist in aneurism repair. I said, ‘I know what you’re going to say, but…’ Both felt it was reasonable to operate.”

Three days after surgery, when the patient was speaking and demonstrating an understanding of commands, the surgeon pronounced her, in highly technical terms, “a miracle.”

When we first saw her, she greeted us with a big smile. But when the nurse told her she was about to swab her mouth and make her more comfortable, the former school principal uncharacteristically replied: “Bull s—t!” The surgeon expressed delight: “Profanity and criticizing breakfast are two excellent prognostications,” she said wryly.

“This was a Type A dissection,” she explained to me. “The pipe has burst. You sew in a piece of material, being careful not to leave gaps and not to miss a stitch. It’s like sewing a sleeve into a jacket. It’s not difficult, but you have to be meticulous. If you miss one stitch, you spend a lot of time regretting.”

As the patient prepared to leave for a rehab center at the end of her hospital stay, the surgeon said she expected her to resume her life and live for a number of years more. The surgeon has already been proven right. 

That brings us to today’s brunch, served on china—no paper plates. images-17A nicely arranged platter of cut-up fruit sprinkled with almonds forms an edible centerpiece. After brunch, I have to fight her to let me do the dishes.

She tells us about the concert she’d been to the night before, and the gallery visit the day before that. Her eyes are bright, her face unlined and attractive without a touch of makeup. Her mind totally sharp—despite a stroke some months after her surgery, which minimally damaged her vision in one eye.

She explains—without complaint—that she needs to rest a lot more than she once did. And she’s more concerned about walking about the city in the winter, fearing a fall that might hurt her fragile back (she’s had several fractured vertebrae). “I feel somewhat isolated,” she says.

She can’t keep up with the group of women nearby who meet daily to pursue one cultural event after another. One, in her 90s, lives on the 13th floor of her building, and walks up and down the stairs twice a day in addition to her other activities. I am exhausted just hearing about her.

She talks about my blog, describing the posts she most enjoys. She asks me how I feel about it. “I love it,” I tell her. “It’s so freeing to be able to write about anything I choose, and I enjoy the dialogue with my readers. It’s a source of great satisfaction for me.”

“That’s the way I feel about this,” she says. And she points out her new response to that sense of isolation. Once an art teacher, she has painted and sculpted—both before moving to special ed, then becoming the principal of two schools for autistic children—and since retiring. But those art forms require space and effort expended to clean up. Now, in her 86th year, she has found the ideal medium for her present circumstances: paper collages. 

She points to her “studio”: a corner of her dining area holding scissors, Elmer’s glue, pieces of cardboard and styrofoam for backing.

Suddenly, we see the works, positioned throughout her apartment. Each one is a visual delight—demonstrating a keen esthetic sense and a creative mind channeling itself in a wholly new direction. 

A large one features Eleanor Roosevelt, the Statue of Liberty—its torch the highest point on the collage—and other images and references to that era: Social Security, the UN, the WPA.

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Another—also large—is a replica of her favorite concert hall, pieced together from performance programs and advertisements. One depicting penguins and divers in the ocean is a work in progress. And on and on.

Her sources of inspiration? She combs through discarded magazines and the detritus of junk mail, finding things that strike her just the right way. That sea bird that hovers over one work? “He just caught my eye and spoke to me,” she says.

And so she meticulously pieces together from multiple sources all kinds of stuff, building new and larger stories than the ones she’s extracted—at the same time enlarging her world and, as we look at these works from all angles—ours as well.

I am in awe of this remarkable woman, who spends almost no time complaining and a great deal of time creating. How many of us will move beyond our limitations and find new ways to reach within ourselves for personal satisfaction and growth—regardless of our ages?

As I think about the doctor who refused to operate on her four years ago because she was “too old” and it was “too risky,” I find myself pondering those nearly impossible decisions about how much to do when an older person is “in extremis.” 

A 20% chance didn’t seem like much, but we in the family are forever grateful to the wise surgeon who felt it was worth the risk, guided us accordingly, and then used her brilliant skills to make that decision the best one.

 

As always, I welcome your thoughts, experiences, stories, and in this case, philosophy about how to confront these difficult decisions.

Annie

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Getting Into the Weeds of the Marijuana Debate

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First, sorry about that title; I couldn’t help myself.

When I was in grad school, a sheltered 21-year-old living on her own in the Big City for the first time, I had a friend I’ll call Bo. An English major like me, Bo was a wildly creative character who scavenged through garbage cans and transformed odd stuff he’d found into some very interesting works of art.

He was also eager to share some of the things he regarded as life’s gifts with his friends. And so one day he offered me—a non-smoker, rule-abider, and rather fastidious sort—a dirty-looking piece of hemp. Despite myself, perhaps swept up by his enthusiasm, I took a few puffs. I coughed several times and waited for the mind-altering experience to sweep across me. Nothing.

Then Bo said, “Close your eyes and open your mouth.” Again despite myself, I did so. I bit down on what I realized were a couple of cherry tomatoes. But these weren’t just cherry tomatoes. They were the purveyors of what felt like thousands of tiny, glorious seeds that danced through my mouth, spurting forth and swirling among the juicy streams, evoking delight on a sensory journey I can still vividly recall.

That was my one and only experience with pot. I didn’t like smoking or the smoke, and I returned to my law-abiding self. Had I even had enough of the drug to create that euphoria, or was it a pot-cebo effect attributable to the circumstances and my friend’s delight? I’m not sure, but I think it was due to that puff, the magic drag-in. (It appears even the remembrance is making me giddy; could bad puns be a side effect of cannabis use?)

In fact, my admittedly blog-sized study of this very complex topic has led me to believe that the legalization of marijuana is no laughing matter. For one thing, the substance today is not, as some have said, “your father’s marijuana.” It’s also not my friend Bo’s. It’s far more potent, and the potency is one factor that can get people into a heap of trouble. 

“Today’s marijuana plants are grown differently than in the past and can contain two to three times more tetrahydrocannabinol (THC), the ingredient that makes people high,” states the American Academy of Child and Adolescent Psychiatry (AACAP). “The ingredient of the marijuana plant thought to have most medical benefits, cannabidiol (CBD), has not increased and remains at about 1%.”

Marijuana, I’ve learned, is a complicated substance, containing over 100 distinct chemicals. In addition to THC and CBD, it’s comprised of other elements that also have specific effects on the central nervous system. According to an article in the Annual Review of Medicine, 

“The concentration of these compounds can vary substantially, making it difficult to characterize the specific positive or negative health effects of marijuana, especially in uncontrolled and epidemiological studies.”

As this movement toward legalization seems to be gaining ground, I’m extremely conflicted about its implications. Though I lean toward the civil libertarian approach to life, I have worries about whether we as a society have sufficient data at this point to know the safest and wisest ways to proceed. 

I’ve concluded that it’s irrelevant for me to decide whether or not I support legalization because I assume it’s inevitable: 10 states and the District of Columbia have already passed laws legalizing recreational marijuana, and 33 states have legalized medical marijuana. Thus, I’m focused here simply on raising some of the issues that give me pause.

There’s no doubt the financial incentive is strong. When John Boehner, former Republican speaker of the House, spends his time leading events to woo cannabis investors, you can bet there’s gold in them thar weeds.Unknown-12

 

According to a leading analyst, the current US market opportunity is between $40 and $50 billion, and may increase by 2030 to $80 billion if there’s national availability.

Whether that’s enough to snatch the market away from the drug cartels is problematic.

Opponents of legalization argue that there’s no way these people will pack up their bags; they’ll simply focus on building up their clientele for even more dangerous drugs. There’s also concern about synthetic marijuana, which can be considerably worse than the natural variety.

The emphasis on medical use of marijuana, which I had thought was an easy issue before I began my research, is considerably less so. The authors of the study cited above point out that in many cases these substances have been legalized by voters in state elections or by state legislators, bypassing the scrutiny of the traditional FDA testing/approval process. 

These researchers said (in 2015) that “the evidence for the legitimate medical use of marijuana or cannabinoids is limited to a few indications, notably HIV/AIDS cachexia [wasting syndrome], nausea/vomiting related to chemotherapy, neuropathic pain, and spasticity in multiple sclerosis,” with other potential uses showing promise but lacking robust data.

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Web MD added to those conditions Alzheimer’s, Crohn’s disease, eating disorders, epilepsy, glaucoma, mental health conditions (eg, schizophrenia and PTSD), muscle spasms, and pain.

That’s a pretty impressive list that could mean relief for many people, but the issues apparently aren’t so clear. James Beck, PhD, the Chief Scientific Officer of the Parkinson’s Foundation, said in a brief video called “Neuro Talks” that use of marijuana might help relieve anxiety, appetite loss, and pain in Parkinson’s patients, but the increased potency might mean it would exacerbate slowness of thinking, cognition, balance, and hallucinations. (For the video, click on the James Beck hyperlink above.)

Beck pointed out that the Parkinson’s Foundation was committed to research to help identify the different formulations, potencies, and components of cannabinoids and how they might affect patients at various stages of illness.

One of my major concerns involves the use of marijuana in young people, whose brains are apparently more greatly affected than those of adults. AACAP points out that many teenagers believe that marijuana is safer than alcohol or other drugs, possibly thinking it’s natural, non-addictive, or won’t affect their thought processes or grades.

But AACAP warns parents about the various difficulties arising from short-term use (such as problems with memory and concentration, increased aggression, car accidents, increased risk of psychosis); regular use (leading to Cannabis Use Disorder, involving cravings, unintentional heavier use, and interference with other activities); and long-term use (creating breathing problems, lower intelligence, and mental health problems, including risk of suicide). That’s a partial list.

The authors of the previously cited study say:

“Early and greater quantity of marijuana use results in greater cognitive deficits. This is particularly true for adolescents who begin smoking marijuana in their early teens.”

They refer to a finding that those who began between 14 and 22 years old and stopped by age 22 had significantly greater cognitive deficits at age 27 than those who’d never used marijuana.

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How can we protect our young people from the potential harm? Surely parents and schools who warn against drug and alcohol abuse must be similarly open about marijuana, since young people may find its new legality confusing.

One positive aspect of legalization is that it may help address the clear racial disparities in this issue. In a 2012 NPR Intelligence Squared debate on the legalization of drugs,  Paul Butler, a former prosecutor and current law professor at Georgetown whose expertise is in criminal law, especially involving race, advocated for legalization. 

Butler noted that, growing up in all-black neighborhoods, he’d had no contact with marijuana. His introduction came as an undergraduate at Yale College and at Harvard Law School (!).

In the war on drugs, he observed, about 90% of those arrested have been black, though people of color make up only 12% of drug users. Legalization, he said, “will stop the counterproductive practice of treating kids like seasoned criminals.”

But that’s not happening yet. According to Vox, the racial disparity in arrests continues, even in states that have legalized marijuana.

The Colorado Department of Public Safety reported in 2016, four years after Colorado legalized the drug, that the drop in arrests hadn’t occurred across the board equally.

“The decrease in the number of marijuana arrests by race is the greatest for White arrestees (-51%) compared to Hispanics (-33%) and African-Americans (-25%).”

To counteract these disparities, activists say that “legalization must include a change in how drug laws are enforced by police officers,” reports Vox. This issue will be addressed as part of the widening scrutiny of racial justice and policing.

[For more on that topic, see my earlier post, “How Do We Talk About Race in America? (Part 2) Meet Doug Glanville.”]

And an important driving factor in this effort, Vox observes, will be the activism of black women.

I would like to think that the arguments of proponents of legalization will actually prevail: that there will be stricter regulation leading to safer marijuana; that legal resources will be freed up to be deployed where they’re really needed, and people can be spared unnecessary police records and damaging prison time; and that we may even see a drop in adolescents’ use of marijuana, as well as harder drugs. That would be wonderful. 

But we simply don’t know. We’re at the beginning of a complicated path as we increase access to marijuana. We live in an age of anxiety, and it’s not surprising that people are eager for substances that help them relax.

And, in my one, extremely brief encounter, I certainly got a hint of the pleasure that cannabis can provide.

I don’t worry about adults’ feeling comfortable with the occasional weed, freed from concern that they may soon find themselves involved in the criminal justice system.

I just hope that we as a society are up to the vigilance, research, and regulations needed to help us ease our way into this new era, ensuring that marijuana users have access to carefully regulated products so that excessive potency, bad processing, or dangerous synthetics doesn’t take them by surprise and/or damage them.

I hope that all users are as responsible and aware on the road as they would be after having alcohol—surrendering their keys to a designated driver before the high becomes “too high.”

And I hope, especially, that everyone protects and educates the children.

This is a controversial topic, and I’m sure many of you have strong opinions. Please let me know your thoughts, stories, insights, and other resources in the comments box below. Many thanks.

Annie

The Constitution: Can It Help Us “Replace the Jeering With Productive Conversation”?

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No matter what your politics, you may well be troubled, as I am, by the efforts on college campuses—as well as in many other arenas—to stifle dissent by preventing people with unpopular views from being invited to speak—or interrupting them so that they can’t be heard. Short of falsely shouting “fire!” in a crowded theater, the First Amendment to the US Constitution should be a protected and revered part of all our public dialogue—from colleges to the White House.

And it seems the College Board, the organization that administers the SAT and Advanced Placement (AP) college entrance exams, has decided to do something about that problem, reports Thomas Friedman in The New York Times. They determined to ensure that the next generation really learns what the Constitution is all about. 

It was part of an effort to define the skills and knowledge that best correlate with success in college and beyond. “Their answer: the ability to master ‘two codes’—computer science and the US Constitution,” states Friedman.

The emphasis on the Constitution came about because the folks who run the College Board concluded, Friedman writes,

“that if you want to be an empowered citizen in our democracy—able to not only navigate society and its institutions but also to improve and shape them, and not just be shaped by them—you need to know how the code of the US Constitution works.”

As David Coleman, president of the College Board, put it:

“Our country was argued into existence—and that is the first thing that binds us—but also has some of the tensions that divide us. So we thought, ‘What can we do to help replace the jeering with productive conversation?”

And Stefanie Sanford, the College Board’s chief of global strategy, said:

The First Amendment lays the foundation for a mature community of conversation and ideas—built on the right and even obligation to speak up and, when needed, to protest, but not to interrupt and prevent others from speaking.”

I read their comments shortly before watching a highly informative One Day University lecture titled “The Constitution: Enduring Myths and Hidden Truths.” The speaker: Andrew Porwancher, an associate professor at the University of Oklahoma who teaches constitutional history. 

Porwancher set the stage for the Constitutional Convention in 1787: the delegates were trying “to salvage a country whose very existence was mired in doubt.” (Some have expressed the same concerns about the US today!)

The Continental Congress was “impotent”; “the Articles of Confederation were failing.” Americans who were wary of centralized government had gone too far in the opposite direction: there was no executive branch or judiciary, and a single state had veto power over any actions.

This document the framers came up with wasn’t all that popular; in fact, an effort was under way to throw it out and start from scratch. As the ratification effort proceeded, there were pro-Federalists on one side and anti-Federalists on the other.

(The Federalist Papers, a group of 85 essays, had been written by James Madison, Alexander Hamilton, and John Jay, using the pseudonym Publius, the Roman statesman who helped establish the republic. More on their impact on us today follows.)

So the vote went to New York. Though there were already nine votes, ostensibly enough for passage, Hamilton knew that New York’s prominence meant its position was critical to passage—and thus to the continuation of the republic.

When Hamilton began to speak, two of the three members of the New York delegation were opposed. But, Porwancher reported, “Hamilton spoke with eloquence and passion and moved them to tears.” Still, the vote for ratification was 30-27—pretty close to ending this American experiment.

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Alexander Hamilton

I won’t go into all the common myths that Porwancher covered in his talk, but here’s one relevant to our discussion:  the Bill of Rights was an integral part of the Constitution from the start. Not so.

In fact, it was ratified years later. There was worry—and Hamilton was one of the worriers— that if certain rights were enumerated, others might be considered unimportant; without specific mention, they might later be encroached upon. 

But Porwancher says the American people did want fundamental rights enumerated. Patrick Henry disagreed: he opposed the Constitution because he feared a strong central authority, and he fretted that the Bill of Rights would, Porwancher says, “sweeten that bitter pill.” The Bill of Rights was finally ratified four years after the Constitutional Convention.

Interesting fact: The First Amendment we revere—guaranteeing freedom of speech, press, religion, assembly, petitioning the government—often cited as our most significant freedoms, actually started out in third place. It followed two amendments that failed to be ratified: one to determine the size of Congressional districts; the other pertaining to Congressional salaries. So it’s by default that those critical freedoms moved up two notches to their current place of prominence.

Another interesting fact: The Federalist Papers were not important in their day. Porwancher says there’s no evidence “they moved the needle back then.” But in the last few generations, they have played what many consider an outsized role in the selection of judges at all levels of government. Consider that President Trump operated almost solely from a list provided by the Federalist Society in determining his Supreme Court picks. 

Says Porwancher:

“We can debate the merits of whether they should be so important today.”

Indeed, many who are concerned that the federal judiciary is becoming far to the right of the majority of Americans’ views believe this debate is overdue. See, for example, Jane Mayer’s discussion in her book Dark Money about the role of the Olin family (whose fortune is tied to DDT), working with the Federalist Society to create a conservative agenda at law schools throughout the country to turn back federal regulations against toxic pollutants.

In many of the major questions that divide us, such as the separation of church and state and the implications of the Second Amendment, some are always asking: What was the framers’ original intent? But Porwancher points out that we can’t always know. “There were big gaps,” he observes. “The framers disagreed on the meaning of their own words, and on clauses they themselves wrote.”

On the question of whether originalism is possible, he says partial originalism is—on matters pertaining to freedom of the press, speech, rights of accused, free exercise of religion, and balance between liberty and national security. (I would imagine many people may find this view debatable.) “The framers understood the threat to national security but still valued liberty,” he says. 

Disagreement concerning original intent versus a living Constitution adaptable to its time began with the framers.  Hamilton posited that the Constitution must be adaptable so that it can be relevant when unanticipated circumstances arise. Madison’s view was more limited: we have the amendment process to address such issues; they shouldn’t be decided by judicial fiat.

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James Madison

Of course, we want the Constitution to provide clear guidance, not to harp on conflicts but to remedy dilemmas. But “The framers’ time was as toxic and fragmented as our own,” Porwancher says. They suffered no illusions that human beings were without flaws. 

Porwancher points out that there’s always been tension between the role of the state and the role of its citizens, and that tension will go on.

“We are a young country, but no other nation has such extraordinary longevity—not in resolving conflicts, but in institutionalizing them. As long as debate endures, the Constitution has succeeded.”

”What they [the framers] understood was that when debate ends, carnage begins. When people stop yelling, violence begins. They drafted the Constitution to keep the conflicts going. When politics ends, violence begins.”

But today, we are hearing political speech that seems to encourage violence. We appear to be witnessing a blurring of the lines between politics and violence that the framers probably also experienced, but don’t seem to have offered guidance about handling. So how do we react? How can we ensure everyone’s right to be heard while keeping everyone else safe?

Several questions from the audience concluded with one from a woman who identified herself as a descendant of slaves. She said she is optimistic in general, but asked: “Will we survive this [the years of Trump] also?” 

Porwancher’s response:

“Our remarkable resilience: a republic with little chance of surviving becoming the greatest superpower in the world. I can’t help but be optimistic about our future.”

After viewing Porwancher’s lecture, I reread Friedman’s article about the College Board’s efforts. And I checked the changes being made in the AP curriculum. In addition to focusing on college skills such as analyzing, comparing, interpreting, and communicating political information, there will be

  • More emphasis on the U.S. founding documents and other primary sources. A specified set of 15 Supreme Court cases and 9 foundational documents—including the Declaration of Independence and the Constitution—is now required study.

In a clear demonstration that this effort is already bearing fruit, Friedman writes:

“Kids are getting it. An AP US Government and Politics class at Hightstown High School in New Jersey was credited in a Senate committee report with contributing content to a bill, the Civil Rights Cold Case Records Collection Act, which was signed into law last month.”

Reading that gave me chills. Once again, as I have in the past, I was buoyed by hope that the next generation of Americans will do far better than we are doing now.

An important related question: Should we be pushing to ensure that all students in American high schools receive training in civics classes?

Please let me know your thoughts, stories, other resources, and anything else that this post brings to mind. I love to hear from you.

Annie

Thoughts Engendered by Pajamas With Feet

NOTE: Gazing at a lovely picture of a friend’s daughter with her two kids–a newborn and a toddler–I found myself advising her, in full cliche: “Enjoy every minute of this time; it goes so fast!” 

That made me wistful about my own daughters’ younger years. Even though I realized then the flight of time, it still slipped past me far too quickly. 

So I dug out a poem I wrote decades ago, which was published in a local anthology. Here ’tis:

We cleaned out the closets yesterday,
Disposing of the children’s Infancy
   and Toddlerhood
in just a few, brief hours.

We stacked the memories in cardboard boxes
and placed them in the basement,
Where they will remain until my charitable 
   heart,
Massaged by the Internal Revenue Service,
Calls the Salvation Army to
take them away.

There went the Winnie-the-Pooh shirt,
Gently folded by the thin ten-year-old
Whose face is hidden now behind a
  thicket of heavy curls,
Like a small cottage attacked by overgrown shrubbery.
“How tiny it is,” she smiles.
How tiny she was, I remember, seeing her again
As she was then, the nicely shaped head
   covered
With thousands of tight little ringlets 
She let me cut at will.

I tried to wring those early years
of all I could,
Taking to heart the wistful warning from those
Who’d already passed this way that
“You’ll never know where the years went.” 

But
Here’s the evidence of my failure, the
Footed pajamas worn first by one daughter,
Then by the other.

In the accordion of my memory, the years are
   pleated 
Close together, almost superimposed
one on the other. I see
The girls, leaning back against their pillows,
Fragile arms folded behind their heads with 
Comical sophistication, as they listen
To a story they both treasured and selected
bedtime after bedtime.
“Goodnight stars, goodnight air, goodnight noises
everywhere.”

I recite the words from memory now. My six-year-old,
Deciding which books she is ready to surrender to a
Younger child, replaces GOODNIGHT MOON
On the shelf.  I am grateful to her
For allowing us to retain our shared memory just
a little longer.

Next time, I know, GOODNIGHT MOON will go the way 
Of the footed pajamas and the Winnie-the-Pooh shirt.
Another book, which she now reads to me, will mark
these years for us.  My daughters will grow
Less attached to their childhood memories, 
As I grow more so.

I am too young to be living in the past, I think,
But still, in what I know is a gesture more to myself
Than to the future, when the time comes to dispose
of GOODNIGHT MOON,
I shall pack it in the special box, the one set apart
   from 
The goods for the Salvation Army.

There it will join the hand-knit garments woven
With love by aunts and grandmothers intent on
Warming my daughters with their 
crocheted caresses.

And I shall hope that the mildew of indifference
Spares it
For the next generation.


I hope this poem resonates somewhat, and I’d love to hear your thoughts and stories. WordPress people, if you like it, please remember to click on Like. Cheers!

Annie

 

2020 Foresight: Looking Beyond Our Dysfunctional Government

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For now, at least, 35 days after it was foisted upon us, what’s been called “the Seinfeld shutdown—it’s about nothing”—is over. That would be amusing if it hadn’t wreaked such terrible damage on so many people. It will take a while to understand the larger impacts on our economy, national security, and more, but we may never know the devastation it caused some of the most vulnerable government workers and private contractors.

Both Republican Senator Rob Portman and Democratic Senator Mark Warner have introduced bills to ensure that there are no more government shutdowns. Warner’s bill is being called the “Stop Shutdowns Inflicting Damage in the Coming Years, otherwise known as the Stop Stupidity Act,“ reports The New York Times. I’m for that.

I want to reiterate what I’ve said previously: I would not be taking such a clearly partisan stance if I didn’t feel our democracy demands it now. We do not have a functioning two-party system. We have a chaotic President who has captured the GOP with little obvious opposition from its leaders and most of its elected officials, and has forced many of the more thoughtful people in that party either to leave it quietly or to denounce it and him—loudly and often. 

(If you disagree, please feel free to express your views. I would love to hear from Republicans–those who continue to support the President and those who don’t but have other thoughts about how the party can revitalize itself.)

February 15 is the next deadline. The Democrats appear united in viewing the wall (as I do), as an attempt to demonize immigrants of color, a huge waste of money, a clear disruption to the people and businesses on both sides of the border, and a woefully ineffective response to a problem that has actually lessened, and is remediable by other, less expensive methods. 

(Remember the Caravan? We were all supposedly threatened by that poor bedraggled group of people fleeing for their lives and hoping for a better future. And don’t get me started on the families torn apart—a national disgrace that is continuing, and may well rank with the internment of Japanese-Americans in our history books.) 

If the Democrats introduce a bill that is widely viewed as a rational method for strengthening border security, but doesn’t include any money for the wall (as they have previously), will the President withstand the drumbeat of the rightwing media? He’s hinted at another shutdown or other ways to get what he wants. Call a national emergency? Send the army to the border? 

The key will be Senate Majority Leader McConnell, and whether the public’s distaste for this shutdown has impressed enough Republican Senators to override a potential veto.

If you feel as I do, here’s where we must all do our jobs as citizens: to persuade our legislators to vote for immigration reform that, while providing some funds for realistic border security, also addresses the crisis the President has created and the need for orderly, humane treatment for those seeking asylum or simply a better life.

And that must set the stage for true, lasting immigration reform that upholds the values of our nation, which is—after all—a Nation of Immigrants.

OK. Now that I’ve gotten that out of my system, I’d like to update an exploration of an issue I first raised in “Here’s Why I’ve No Intention of Discussing the Elephant in Our National Room”: What are we looking for in leadership in 2020? It’s going to be a wild ride as more than a score of Democrats seek the party’s nomination. 

I invite you to don your citizen-pundit hats and tell me what you think. Feel free to name names: those you either like or don’t like at this point, but please tell me why. (A couple of people offered Mitch Landrieu and John Hickenlooper in that earlier post—two thoughtful potential candidates who don’t get much publicity.) 

But I’m equally interested in the issues you think are paramount and the qualities you’re looking for in a President—and whether you think that type of person/persons would be viable in the general election.

In these hyper-partisan times, are you looking for someone who expresses commitment to reach across the aisle? How do you think such a person would fare in the primaries?

I’d also like to refer you back to my post “OK; The Dems Won the House, Now What?,” in which I quote the very astute Michael Tomasky, who emphasizes that the Democrats need “to construct a story about how the economy works and grows and spreads prosperity, a story that competes with—and defeats—the Republicans’ own narrative.” He stresses that this story must unite the various factions of the party. (That’s always a concern. Remember Will Rogers’ quotation? “I am not a member of any organized political party. I’m a Democrat.”)

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Will the Dems agree on workable programs to promote economic equality?

Another important question is which voters may decide this election. Many say we need a candidate who appeals to the “Rust Belt”—a term that Ohio Senator Sherrod Brown finds demeaning, as it connotes deterioration. (He is seriously considering a run, and he has some compelling qualities, including his longheld emphasis on “the dignity of work.”)

Based on the 2018 election results, there’s reason to pay careful attention to the views that former Maryland Congresswoman Donna Edwards expressed in a Washington Post Op-Ed: “The 2020 election will be decided in my hair salon. Here’s why.”

“For Democrats, the quest to win the 2020 primary and general election flows through the vibrant conversations of black women on a Saturday morning—a time and place of unvarnished truth among women of all classes and life experiences.”

“Since the 2016 defeat, it has been the strength of the black women’s vote that has driven victories in statewide and down-ballot races for Democrats—including the much-celebrated record number of diverse women in the new Congress.”

“Why are these facts so important for a crowded 2020 Democratic presidential primary field? Simple—the numbers clearly show the real juice for Democrats rests with women of color. No candidate can ignore black women in the primary season and still hope to engage them after winning the party nomination—that won’t fly. Black women are the most reliable base of the Democratic Party. To win this base in the primary, and then fully mobilize it in a general election, the candidates will need to listen to the women in the hair salons.”

Noting that “some may write off identity politics,” Edwards writes: “but for many women/women of color/black women, identity is politics.” She cites the wage gap, health care disparities, far greater college debt, etc. “Those are the politics of a black woman’s identity.”

Does Senator Kamala Harris have a formidable advantage? Harris wowed the Iowa Democrats attending CNN’s recent Town Hall. Here’s an interesting video of her conversation with a man who asked how he could “mansplain” to other men who tell him a man would be a better candidate than a woman in 2020. (There’s a brief ad first.) And conservative columnist David Brooks practically endorsed Harris in this New York Times Op-Ed.

Edwards is quick to state that it would be a mistake to think that Harris has already sewn up the votes of black women. “These voters are listening,” Edwards writes. And “Women/women of color/black women are not a monolith—they are individuals, and they want to be fought for. Every candidate must wage that battle.”

I think Edwards is right, but clearly the rest of us, as the saying goes, are not chopped liver. If we learned anything from 2016, it was that every vote, in every precinct, matters. Young people will also be a crucial factor in the outcome. We’ve seen their power in those remarkable, brave Parkland shooting survivors.

Speaking of the young, how important are fresh faces? If Joe Biden decided to run, would he have a chance? Or Bernie?

On the other extreme, does the charismatic but inexperienced and not yet obviously knowledgeable Beto O’Rourke have viability—assuming he softens his propensity to pepper his speech with sturdy Anglo-Saxon verbiage—which some voters might find a needless distraction?

Then there’s Amy Klobuchar, who speaks quietly but was known as a tough prosecutor. (And, according to some reports, is even funnier than her former Minnesota Senate colleague Al Franken;  a good sense of humor could be a valuable asset in today’s environment.) Conservative columnist and former Republican George Will believes Klobuchar “is perhaps the person best equipped to send the current President packing,” as he discusses here.

Can great ideas introduced by flawed candidates catch on? Did Elizabeth Warren (who has some creative and valuable ideas) ruin her chances when she took Trump’s bait and released her DNA test results, thereby feeding into the white supremacists’ touting of the false importance of blood lines? 

Actually, there probably isn’t a candidate without flaws, and I think we all have to get better at figuring out which ones matter and which ones don’t—and not let the media decide for us.

Now that Cory Booker has announced his candidacy, we’ll see how his emphasis on love plays out in today’s environment. And his performance as Mayor of Newark will justifiably receive scrutiny.

I can’t see Michael Bloomberg getting traction at this time, but I’m glad he’s in the race because he’s been emphatic that anyone running for President must have, and express, well-thought-out ideas. Let him give his (he’s especially strong on gun safety legislation and climate change), and let’s make sure that all the other candidates give theirs: solid, workable goals for what they’d bring to the office—not just platitudes or attacks on Trump. 

I’m not discussing Howard Schultz’s proposed independent run at this time, but I found Paul Krugman’s Op-Ed, “Attack of the Radical Centrists,” persuasive.

Foremost in my mind: we need someone who’s thinking and talking about how to unite a divided country, restore faith in our institutions, pursue economic equality, and try to heal the wounds after all the deliberate divisiveness that will be Donald Trump’s sorry legacy.

Please let me know your thoughts in the “Leave a reply” box below.  We’re all in this together, and it’s not too soon to be thinking about how we should approach this important decision.

And if you’re registered through WordPress, and you like this piece, please take a moment to click on “like.” I’ve learned that in the blogosphere, these things really matter. Thanks!

Annie

How Do You Train a Butterfly? The Same Way You Train an Orthopedic Surgeon!

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Photo courtesy of pixels.com

Ken Ramirez, a world-renowned animal trainer, was offered quite the challenge. In the midst of some tall buildings in London, a botanical specialty group had built a large garden—a garden that was home to thousands of butterflies of varying species, as well as many other types of flora and fauna. Its purpose: to show the “symbiotic relationship between plants and animals,” wrote Ramirez, describing the task ahead.

“The director of the project, Lucinda Bartholomew, had envisioned a fundraising gala presentation that would include an orchestra in the middle of the garden playing beautiful classical music while butterflies flew from one part of the garden to the other.”

They wouldn’t just fly willy-nilly, mind you. The idea was to design and implement a plan to train more than 10,000 butterflies to traverse the garden, on cue, in unison. Now if someone offered me an assignment that seemed like an impossibility, I’d at least think long and hard about it.

But the fact that Ramirez hadn’t ever worked with butterflies before and knew little about their sensory mechanisms didn’t deter him at all. Ensured help from the group’s butterfly experts, he enthusiastically agreed. ”What a unique training opportunity!,” he wrote.

Key to the plan’s success was knowing what and how the butterflies were fed—and how often. And who knew that butterflies could be bullies? Ramirez learned that they were highly territorial, and prone to inter-species warfare over their locales: they were already occupying three different spaces in the garden.

He determined that by using various types of food and different sounds for the three groups, he could enhance the original plan by training “different groups to fly at different times.”

For the details, please read Ramirez’s account.  He describes the breathtaking, successful dress rehearsal, as the symphonic music swelled—and first the red and orange butterflies took off and flew in unison, landing on one side of the garden.

“Then there was another swell of music and about 2,500 purple and blue butterflies fluttered in a similar manner from the far left to another location on the far right. Just as the second group settled, close to 5,000 butterflies of multiple colors…fluttered over my head, settling into their trees and bushes far behind me. There were tears in my eyes, and I was speechless…With the addition of the music, the butterflies appeared to undulate to the rhythm of the music—it was incredible!”

Though Ramirez found this an extraordinary experience, he says: “I always teach that training is the same, and works equally well, for all species, ‘whether training an earthworm or a Harvard graduate!’”

What’s the common methodology? Here I owe a debt of gratitude to my younger daughter, a highly regarded professional dog trainer who from the very start of her career has stressed that positive reinforcement—and avoiding coercion, intimidation, and physical punishment—are the most humane and most successful ways to train dogs and other living beings.

My daughter was recently telling me about the work of Karen Pryor, who revolutionized animal training, including training large animals. When I expressed interest in the topic, she graciously did a search that yielded the information in this post. (I realize the butterflies hardly qualify as large animals, but I found that story irresistible.)

I stress that both my daughter and I would rather see animals in the wild than in cages, but we also recognize that there are good zoos doing good works, including conservation education and prevention of species extinction.

We won’t be looking at earthworms here, but I’d like to introduce you to some fascinating work being done with marine mammals, nonhuman primates, tigers, river otters, and orthopedic surgeons.

You read that right: They may not all be Harvard graduates, but some orthopedic surgeons are being trained in accordance with Karen Pryor’s discoveries—the same principles that Ramirez uses.

In the 1960s, Pryor began working with those wonderful creatures, dolphins, in Sea Life Park in Hawaii, which her husband had developed. Her approach evolved from Pavlov’s work with dogs (classical conditioning), and B.F. Skinner’s operant conditioning, based on rewards and punishment.

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Photo courtesy of Pixabay.com

But importantly, Pryor found some of the training she observed abusive, so she went in a different direction.

She took the idea of food as a reward and added a sound to it: at first, a whistle. As she said in an interview on NPR’s Hidden Brain:

“The whistle is the signal that, at this very instant, you’re doing absolutely the right thing, so you’re going to get a prize…the identification for the learner…that acoustic message, whatever form it comes in, is actually a thrill.”

Pryor then employed the clicker that is now the cornerstone of a great deal of animal training. Between food rewards and clickers, the wonders take place.

We all know about the marine mammals that have been trained to perform. But thanks to Pryor, they, and their counterparts in other species, are being trained to participate in their medical care.

The positive reinforcement techniques she employed, Ken Ramirez has written,

“minimized or eliminated the use of coercion and punishment to gain the animal’s cooperation and created a trusting relationship between the keeper or trainer and the animal…As these relationships grew, the types of medical behaviors that could be trained also grew.”

So through patient and persistent training, killer whales (now verboten in marine shows), walruses, sea lions, and penguins have been taught to calmly present themselves and accept the needles necessary to take blood samples from them.

They learn to urinate on cue to provide urine samples, to exhale onto a plate to provide cultures from their airways, and even to ensure the effectiveness of eye drops and ear drops by keeping their heads above water long enough for the drugs to be absorbed.

Nonhuman primates have been similarly trained to accept such medical procedures, thereby reducing the incidence of injuries to handlers and stress on the animals by encouraging “a human-animal relationship that is based on trust rather than fear,” according to an article published by the Animal Welfare Institute.

This is, indeed, true of all animals so trained. Studies have actually shown a drop in the animals’ blood cortisol levels, indicating reduced anxiety.

Picture a baboon calmly offering his arm through a porthole in his cage to receive an injection. Or a female gorilla who has been providing urine samples for years while sitting on a potty. “She is so committed,” the author wrote,” that occasionally, she would go and get a drink of water when asked for a sample at a time when her bladder was empty.”

Now that’s commitment! Makes you question the phrase “dumb animals,” doesn’t it?

It’s clear that such techniques improve the animals’ welfare. And it should also be clear that they make the lives of the trainers and handlers much more interesting, safer, and less tense.

Here are links to several videos I really enjoyed; I think you will too.

River otter preps for ultrasounds. (Cincinnati Zoo.) “It may look like the trainer in this video is just having fun giving high fives and belly rubs, but there is a good reason that the otters have been taught these and other behaviors.” (You can skip the ad and go right to the starring cutie.)

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Photo courtesy of en.wikipedia.org

Dental care for gorillas. “Dental care is just as important for gorillas as it is for humans!” (Santa Barbara Zoo.)

The tiger-turned-pussy cat, or what I imagine might be called: “Do you need this for some reason?” (Copenhagen Zoo) To learn what “this” is, you must watch the brief video to the end!

And now we turn to training the species known as homo sapiens, specifically, that subgroup called orthopedic surgeons. For years, Martin Levy, MD, who directs the residency program for orthopedic surgery at Montefiore Medical Center in the Bronx, has successfully used clickers in agility training his border collies.

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“Over time,” he told Scientific American writer Lindsey Konkel, “I started to realize that we had better tools for training our dogs than our residents.” So, Konkel writes, “Levy decided to use these tools to help new doctors learn the tricks of the trade.”

The “tricks’ were the basic skills that orthopedic surgeons needed: “tying knots, positioning surgical instruments, and handling power tools.”

Levy sought out Karen Pryor to help him develop a program leading to mastery of these techniques. As the residents accomplished tasks that had been broken down step by step, their performance was noted by the instructor’s marking the event with “a click, the flick of a flashlight, or simply the word ‘good’ spoken in a neutral tone,” Konkel observes.

Others have pointed out that this kind of training removes the emotional component, so the effort is strictly on task mastery, not worries about approval, failure, or other complicating factors. This has upended what Levy said was a traditional teaching method of criticizing residents for mistakes, rather than noting their success.

“It’s true that a clicker cannot inspire or play the role of a mentor,” says Shankar Vedantam, host of NPR’s Hidden Brain. “…And yet the clicker, when it is the right tool, can fix one of the most detrimental parts of the teacher-student relationship—when students start to care more about getting praise and avoiding criticism than learning.”

(This Hidden Brain episode, “When Everything Clicks: The Power of Judgment-Free Learning,” is accessible in both audio and transcript.)

From all the above—from butterflies to baboons to otters to tigers to orthopedic surgeons—it seems obvious that positive reinforcement and patient attention to marking tasks reap large benefits. Equally important, physical punishment and harsh treatment appear to be counterproductive.

To bring all of this closer to home, I’ll quote my daughter’s emphasis on the positive, as she describes “dog-friendly” training:

“‘Dog-Friendly'” is sometimes confused with permissive, but that is inaccurate. It means focusing on how to teach our dogs how to get it right, instead of focusing on how to punish them for making mistakes.

It also means being aware of our dogs’ limits, so that we can do our best to set them up for success. We often unwittingly put our dogs in situations they don’t have the skills or ability to handle, and then get angry and frustrated with them for acting out.

In my opinion, just as much–if not more–emphasis should be on adjusting what the human side of the equation is doing.”

And, notably,  positive reinforcement also works in training children, especially those with learning or behavioral difficulties.

*****

As always, I’m eager for your comments—your reactions, opinions, stories. (You can also let me know your opinion about this post by clicking on the stars below: from left to right, click star 1 for awful; star 5 for excellent. WordPress folks have the option to “like” this post further below.)

_________________

I dedicate this post to the memory of my sister, who died on December 29th, 2018—just 43 days after being diagnosed with pancreatic cancer. Her stoicism and bravery in the face of the devastating diagnosis, and her determination to live each day well, were extraordinary. She loved nature, reveled in identifying the birds in the vicinity of her Florida home, worried about the fate of the Manatees off the Florida coast, and cared gently and lovingly for her little Shih Tzu. She was very supportive of my blog, and I like to think she would have especially enjoyed this post. The loss is profound.
_________________

Annie

How Do We Talk About Race in America? A Serendipitous Part 3

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Greetings, welcome back, and best wishes to everyone for a very happy and healthy New Year.

I hadn’t planned this additional post on race, but I came across what I feel is a wonderful piece of Op-Art on the topic in The New York Times. Some of you may recall it, but even if you do, I hope you’ll use the link above to revisit it. It’s worth several readings, I believe.

And it’s followed by another serendipitous example that I find enriches the topic.

Writer and illustrator Henry James Garrett has created a wise and amusing morality tail/tale that’s titled “The Kernel of Human (or Rodent) Kindness.” I’m pretty sure the fair use police will prevent me from reprinting the piece in its entirety, as I would love to do, so I’m including a few screen shots (if they work–I’m getting better at this technical stuff, but each new challenge is fraught with the fear of mishap).

Please keep in mind that this is just a sampling, probably unfair to the creator because it doesn’t capture the richness of the artwork and messaging in its entirety. But here we go…

 

 

 

 

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Please do click on the green New York Times link above to see Garrett’s entire work. It will just take you a minute, and I really think you’ll enjoy it.


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Before we leave the topic of race for now, I’d like to add the second serendipitous piece. One of a number of special friends I’ve reconnected with as a result of this blog is a Master Gardener. I was unfamiliar with this term, but I’ve learned that Master Gardeners are volunteers who have undertaken considerable training in the science and art of gardening. They, in turn, share their expertise by educating the public on gardening and horticulture.

My friend had the additional responsibilities involved in serving on the Board of Directors of the Master Gardeners organization in the area in which he lived. He had a lot of experience in organizational work as well, having had a long and successful career as a Manufacturing Manager for a major US corporation, where his responsibilities included diversity training.

But my friend, who is African-American, grew tired of his fellow board members’ failure to listen to his ideas (as well as impatient with their lack of organization).

He was comfortable with what he had to offer but felt his presence on the board was that of a “token”: he was there for show, but not for substance. So he resigned his position–and received a very gracious letter from one of the few board members who clearly recognized that his absence would be felt.

In an email explaining to me what had happened, he wrote of the other board members: “I really don’t think they know the difference between Affirmative Action and Diversity. Gardeners generally practice diversity every time they plant a flower, but they probably wouldn’t make the connection. There are a number of reasons we plant a diverse garden.”

I found his words both poetic and a fine metaphor for why our society is strengthened by our growing diversity.

So from rodents to gardens, I feel we’re surrounded by lessons about how much we have to gain by being empathetic toward one another and celebrating both our differences and our commonality as human beings.

I hope to hear from you about whether my serendipitous finds resonate. As always, I depend upon your thoughts, experiences, and stories…For those of you who are new to this blog, you must go way down the page to find the comment box in which I hope you’ll enter your response. Thank you!

Annie

 

 

 

 

 

 

 

 

 

 

Zen and the Art of Vacuuming: A Near-Fable

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Introductory Note:

I have been practicing mindfulness meditation for quite a while, and I am very serious about it; it’s had a beneficial effect on my life. But in my description of my blog, I speak of “seeking dialogue to inform, enlighten, and/or amuse you and me.” The emphasis here is on “amuse.” I realize things have been pretty heavy in Annie’s blog world, with focus on climate change, the political scene, and race relations, so I thought it was time to lighten up a bit in this holiday season.

What follows is a piece I wrote some years back, which was published in a now-defunct humor magazine. It still amuses me, and I hope it will elicit a smile from you as well. Perhaps it will also evoke feelings in concert with my desire to find common ground…

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Joyce Carol Oates, it seems, is positively nuts about housework. She claims if she were to let someone else do her housework for her, she would feel alienated from her own life. Cleaning one’s house, she says, is like “Zen meditation.”

Because I, too, would like a clean house, inner serenity, and best-selling novels, I decided to apply Ms. Oates’s philosophy to my own life. I first endeavored to wash the kitchen floor while seated in the middle of it meditating in the zazen, or cross-legged, position. As one might imagine, this was a rigorous exercise, requiring great self-discipline and flexibility. I felt myself stretched beyond what I had earlier assumed to be my limits. After fifteen minutes, I had grasped a Higher Truth, which I quite willingly share: Life Must Provide Us With a Longer-Handled Mop.

One of the foci of Zen is the koan, an unsolvable riddle or nonsensical proposition. Surely, housework provides us with the ultimate koan: Why Dust? Why devote time and energy to casting motes into the air, only to watch them reconvene above one’s head tauntingly in anticipation of their certain descent?

Vacuuming, on the other hand, puts one in touch with the Cosmos. It is the practice of piecing together disparate elements of nature in one location as a cohesive whole. However, the vacuum cleaner is an artificial device, separating the true Zen student from the kind of self-reliance necessary to approach enlightenment.

The serious Zen-cleaner uses masking tape wrapped around the fingers to effect the same essential unity. This process, painstaking as it is, leads to contemplation at close range of the complexity inherent in what had appeared to be a superficial layer of carpet debris. William Blake saw the world in a grain of sand and heaven in a wildflower. The Zen-cleaner sees contemporary civilization in a piece of sticky tape.

Sorting clothes provides another koan, elegant in its simplicity but profound in its implications. Whither the Other Sock? I leave the reader time now to meditate on this Universal Question…

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 Like Zen, housework poses the kind of paradoxical problems that will shock the student out of dependence upon ordinary logic. No other human accomplishment is apparent only when it is not accomplished. All is process. The devoted Zen-cleaner knows never to seek the sense of satisfaction other mortals derive from their work when the job is done. One operates with constant awareness of an Eternal Verity: The Cleaning of a House Will Lead, With the Passage of Time, to a House That Must Be Cleaned.

The practitioner of Zen incorporates a love of nature into one’s life. It is important, then, that the house be properly aired and smell of the great outdoors. When I had completed my tasks and felt myself approaching Nirvana, I flung open the windows, inviting the world into my home. A small brown sparrow accepted my invitation. It flew across the living room, swept into the kitchen, and lighted briefly in the middle of the freshly waxed floor, almost precisely on the spot where I had meditated not long before. It then departed, leaving behind a tiny organic reminder of our transcendental experience.

With that symbol, I had reached satori, the ultimate insight. I now had a penetrating vision of the value of housework. Thank you, little brown sparrow. Thank you, Joyce Carol Oates.

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Happy holidays, everybody! See you in a couple of weeks. In the meantime, please feel free to browse through the posts you may not have seen yet. Backstage in My Blog World, written immediately after I experienced a frenzy resulting from an early technical snafu, may also make you smile.

I hope 2019 brings us a calmer, more unified, and democratic nation in a more peaceful world. And, in the mindfulness tradition, I offer this message, which I learned from renowned mindfulness teacher Jack Kornfield:

May you be filled with lovingkindness;

May you be safe and protected;

Well in body and mind;

Strong and healed;

May you be happy.

Annie

Navigating “The Wild West” Marketplace of Consumer Genetic Testing–and Other Needed Information About Our DNA

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In an article in The New York Times Sunday Review, genetics counselor Laura Hercher described a man named Matthew Fender, who—after searching for heredity data through 23andMe—had placed his genetic test results into Promethease, a DNA search engine that probes such data for variants cited in the medical literature. 

Fender had sought to learn his risk for developing a pulmonary embolism, the condition that had killed his sister, a seemingly healthy young woman of 23. The report didn’t mention that, but it did provide the alarming news that he carried a mutation (PSEN1) strongly associated with early onset Alzheimer’s, as well as two copies of a gene variant (ApoE4) that indicates greatly increased chances of developing late-onset Alzheimer’s.

After getting no satisfactory guidance from his primary care doctor and other professionals, Fender checked out a competing genetics company, Ancestry DNA,  to see what his results there would say about the PSEN1 variant. They said nothing. He then persuaded his doctor to order the test, which proved negative.

End of story for Fender, although he said the experience led him to improve his diet and to consider using his technological skills to develop an app to assist people with dementia through voice-activated devices such as Siri and Alexa.

It’s worth noting that both companies claimed their tests were 99.9% accurate. Yet a 23andMe representative told Hercher that “a 99.9% accuracy can still mean errors.” And apparently, not every variant in their chip is even validated for 99.9% accuracy.

“The direct-to-consumer genetic testing marketplace is a regulatory Wild West,” wrote Hercher, who is the director of research at the Sarah Lawrence College Graduate Program in Human Genetics.

She’s also the host of an informative and entertaining podcast, “The Beagle Has Landed,” (named after Charles Darwin’s ship—not Charles Schulz’s Snoopy), designed for both professionals and “curious patients,” according to its introductory press release. One of her interviewees was Matt Fender.

Hercher explained that FDA Commissioner Scott Gottlieb announced in November a new regulatory approach that will allow companies like 23andMe to market some tests to determine health risks without premarket review. That change, Hercher observes, “is expected to usher in a rapid expansion of the consumer genetics industry.”

That means we consumers will need to better prepare ourselves to function in this new ”Wild West” by getting a better education on the important topic of genetics and the role it plays in our health—even as the field itself is changing all the time.

With that backdrop,  I spoke with Hercher to elicit her opinions on how to view all these genetic data at this stage. 

First, to her, the quest for information about one’s heritage, which she calls the “ancestry craze,” is a “mixed bag.” The positives she underscores are that people enjoy and are intrigued by learning about their forebears, and the process brings science and genetics into people’s lives.

But when people ask her if these quests yield legitimate information, she responds: “It’s accurate-ish. People think of this as their genealogy, but once you get past Mom and Dad, there’s a lot of randomness—you could inherit something important, or not.”

“People like to tell a story they can understand, a narrative that can explain why people turned out certain ways. Genetics also tells a story, but the risk we run is that when hearing it, we put aside other stories—involving culture and heritage, for example.  It’s very hard to weave it all together.”

If we’re interested in our predecessors’ story, then their story is ours, she notes, and that’s valuable to us. “Genes are a part of that, but not all of it. Even among siblings: one person could have 34% Southern European heritage, while his brother registered 15%. Would that make sense? No. The tests don’t gather with that level of precision.”

Hercher analogizes a swimming pool, with some blue substance for African ancestry, red for Chinese, etc. “The testers scoop a sampling from a spot of genomes into a net, and they’ll get red, green, yellow,” she says.  “Different tests reach down and get the same mix, but it’s not identical.”

To Hercher, the ancestry tests also tend to encourage a kind of tribal thinking and ignore the overriding message: 99% of our DNA identifies us as human and is genetically shared among us. “The DNA story is our commonality as a people—as well as with other living things. I wish these companies presented the data in a way that made that clear.”

And this commonality has great implications for the subject of race. “No quality geneticist will tell you that the concept of race does a good job of describing our shared genetic ancestry. Race isn’t a scientific grouping; it’s defined culturally. There’s more mixture within groups than between groups.” In a point that is probably obvious to all but the most rabid white supremacists, she says: “Racial purity is a myth.”

Those in the genetics field are disturbed by the current efforts to bring back eugenics, or “scientific racism,” which was once believed even by serious scientists who felt they could, by controlled breeding, create an increase in desirable heritable traits and a decrease in undesirable ones, thereby improving the human race. 

The concept was easily manipulated and became discredited after its use by the Nazis in Germany. “Now all these things are widely talked about,” Hercher laments. “The white nationalist movement has adopted the language of hate ideology and put a scientific gloss on it.”

This is the background for the hot water that Massachusetts Senator Elizabeth Warren has gotten herself into by taking a DNA test to prove her Native American ancestry. With this action, critics say, the possible 2020 Presidential candidate has played into the concept of “racial science”–validating the alleged link between blood and race, which The New York Times calls “a bedrock principle for white supremacists and others who believe in racial hierarchies.”

That’s not, I trust, the way most of us view genetics. We may remember how we were introduced to the subject in school: with Gregor Mendel and the 29,000 pea plants he cultivated that formed the foundation of the field. But even among the experts, “we never knew how complicated heredity is,” Hercher says. Single gene inheritance, such as blood type, is fairly straightforward and rare—as are diseases attributed to a single gene, the so-called “Mendelian diseases,” which include sickle cell disease, as well as cystic fibrosis, Huntington disease, muscular dystrophy, and a few others. 

Most of genetics, Hercher stresses, is more multi-layered. Heredity, and the traits and illnesses that are in our DNA, involve the interaction of genes with both our external environment and the internal environment comprised of our hormones, metabolism, and other factors. So when we find out we have certain genes—and their variants and mutations—there’s no straight line to determining how our bodies will deal with their existence.

One important issue that stirs debates among geneticists involves ApoE4—the gene that denotes a higher risk for Alzheimer’s and carries both individual and societal implications—for care and economics—as our population ages. Approximately 25% of Caucasians carry this gene, but Hercher points out that an individual at somewhat increased risk may not develop the disease; while someone with decreased risk may still get it. 

And currently, without a cure, that raises questions. “There’s a faction in the genetics counseling community that says we have no business giving out that information,” says Hercher. Indeed, when Matt Fender initially sought guidance from his primary care doctor, Hercher reported in her Times article, the doctor responded: “What the heck do we do about it, once we know, other than create high anxiety?” However, says Hercher, “a growing faction says that whether or not to provide the information is not really our call.” In other words, it’s the patient’s decision.

So if we’re deciding to search out our ancestry–or to be tested for a possible disease– the important thing for us, the consumer/patient, is to seek education before we even consider being tested. 

How will we regard the potential results? Do we need the information to inform our choices about health decisions that must be made—before a pregnancy, for example, or to assess our odds of developing certain cancers?

On such matters, Hercher stresses, both factions in the genetics counseling community agree: if the information is to be given, good counseling should be involved to help patients think through the implications—and then to support them once they’ve decided whether or not to act on the findings.

What do you think? Have you had any experiences you’d like to share? Please enter them in the Comment box near the bottom of this post.

Annie

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