Thursday, January 13, 2011

It's all a matter of perspective...

Some calendars start on Mondays. Manic Mondays,the beginning of the work week, they start off entrenched in demands,ToDo lists and starting out 5 steps behind.

Other calendars start on Sundays, for some- a religious break- for others, sleep in late, hide-under-the-covers-and-dread-what's-coming-tomorrow followed by hours of email catch up for work. In both of these cases, the end of the week starts on Friday night, as soon as work is done. Friday night is the beginning of the big blow off, steam venting, "recovery" period that is the week-end. Run errands, run kids, catch up on house work, Honey-do lists, "all the stuff I could not get done during the week."

Lately, I have been approaching the calendar from a different perspective. I do not have weekends that last for days. Friday night is the end of my week- a true WeekEnd. Yep, a lot of times, Friday night is a blow off and vent night. But when the night is over, so is the week.

The first day of my mental week is on Saturday. This gives me two full days to spend getting prepared for all the demands that the world and my family are going to impose come Monday morning. I do not spend my Saturday and Sunday recovering from the week, or digging out from everything that got piled on me. I spend my Saturday and Sunday examining what my upcoming week requires and preparing for it.

I should be clear that, much to my children's regret, there is still a lot of house cleaning going on here on the weekends. This does not transform my life into something mystical or superior. But when I am cleaning, I am not cleaning up the messes from the previous week- I am organizing and preparing for the tasks in the week ahead. When I sit down and go over email or schedules, I am not making lists of the forgotten or missed, I am not picking up lost pieces, I am preparing for the meetings and deadlines in the coming week.

Yes, it all sounds like semantic word games. But there is a Jedi mind trick at work here. When you spend the first two days of your week with time to prepare, time to sleep in, or time to spend with family first- those Mondays start to look entirely different .

Now, if I could just get Google to offer Saturday as an option for starting my week.....

Tuesday, January 4, 2011

Nature + Nurture: Epigentics and Illness

Medical Alert PendantWe are constantly bombarded with references to growing epidemics of many types of illnesses and disorders- autism, hypothyroidism, diabetes, psoriasis, etc.. Some people argue it is a sign of the decline of our society and the overwhelming bad choices people are making. Some claim it is genetic, and the impact of modern medicine which allows "impacted" individuals to survive and pass on their genes.
The truth is that it is probably a combination of these factors, mediated by epigenetics- the impact of environment, stress and chemistry on gene expression without any change in DNA at all. This is an area only recently starting to gain the attention it deserves and we are far from real clinical, much less societal understanding.

A recent Scientific American article on the problems caused by the limitations of categorizations of the DSM manual and difficulties in tracing mental illness to its genetic roots danced around the issue of epigenetics, but handled it badly.

Consider the following excerpt:
How can these assertions be explained? In fairness to Robins and Guze, they could not have imagined the extraordinary genetic complexity that produces the risk of many common human ills, including mental disorders. What this means is that common mental disorders appear to be due to different combinations of genes in different families, acting in combination with epigenetics -- gene expression varies even if the underlying DNA sequence is the same -- and non-genetic factors.

In some families, genetic risk for mental disorders seems to be due to many, perhaps hundreds, of small variations in DNA sequence -- often single “letters” in the DNA code. Each may cause a very small increment in risk, but, in infelicitous combinations, can lead to illness. In other families, there may be background genetic risk, but the coup de grace arrives in the form of a relatively large DNA deletion, duplication, or rearrangement. Such “copy number variants” may occur de novo in apparently sporadic cases of schizophrenia or autism.

Note that although the first paragraph mentions the impact of epigenetics, the following sentences go on to talk about actual changes to the DNA. All inquiry into epigenetic controls and the impact of this on tracing genetics is avoided.

In truth, epigenetics is one of the last great mysteries in the study of illness transmission. For decades we have argued Nature versus Nurture.. debating the impact of genes over lifestyle choices in illness. But the truth is that for many illnesses (especially chronic illnesses- autoimmune diseases and mental illnesses large amongst them), the combination of genes, lifestyle and environment is the most important and hardest to categorize. Making things even more complicated, recent research is indicating that it is not just YOUR lifestyle and choices that impact you, but those of your parents and even GrandParents which can impact your health.

The good news is that there is a move to fund more research on epigenetics ( chronic illnesses are expensive, so the ROI can be argued). Just this year, the NIH issued a new series of grants to fund research into the impact of epigenetics in chronic illness. If you have one of these diseases ( as I do), will epigenetic research cure you? Unlikely. At best, we will find ways to modulate the impact of the disorder. But what it can do is break the cycle of illness being passed from generation to generation. If your children can be impacted, your grandchildren or great grandchildren might be disease free. This long term thinking is critical to breaking these cycles.