December 9, 2021

RIP Anastasia cat

It’s not been a good day. I had an unsolvable problem at work with one of my long term house call patients. I pride myself at coming up with creative solutions to complex medico-social issues but this one stumps me. We had final dress/preview of The Reindeer Monologues and I went up about two thirds of the way through my piece. I was able to cover it and get back on track but it’s still a frightening thing to draw a blank and have no one else on stage able to help you. And then, when I got home, I found Anastasia, one of my two cats, had died sometime today. She was somewhere around sixteen and had had a good long healthy life, but she was friendly and one more link to my old life with Tommy is gone. I still have her brother, Oliver with me but he’s a stinker and nowhere near as friendly and charming as his sister was, although in recent months he has taken to sleeping on the bed with me. This is all well and good until he decides to start yowling around 3 AM for some peculiar feline reason. He gets a pillow thrown at him when he does that. Maybe he’ll learn.

I’m glad I decided to challenge myself with The Reindeer Monologues. It’s not been the easiest thing to learn or keep straight and the mental exercise and focus necessary to hold the stage and the audience is very good for my brain and one of the few things I can do to build new neural connections and stave off dementia a little while longer. We’re pretty sure my mother’s dementia was genetic which means I have a 50% chance of having inherited it. Fortunately, mental exercise can help mitigate things so I plan on keeping up with the stage work as long as I can do it safely as the skills necessary to succeed are the skills that can create new brain pathways around blocks.

We’ve learned a few things from the Sisters of St. Scholastica. They’re an order of cloistered nuns from the upper Midwest who have greatly improved our understanding of dementia in old age. The problem with understanding disease processes in the elderly is often sorting out what is caused by disease and what is caused by many years of disparate life experiences. This is especially true of the dementing illnesses of aging. How do you know what is disease and what is due to decades of bad choices and bad habits? In order to control for the latter, you have to have a population of individuals who have had similar lifestyle choices and exposures throughout their lives. Enter the nuns. Cloistered nuns are one population of which this is true. They live in the same buildings, have the same schedules, eat the same food etc. The Sisters of Scholastica are an order dedicated to learning and research so when they were approached by dementia researchers some decades ago, they agreed to be guinea pigs. As these women have aged and died, some have become demented in old age and some have not and, as their intellect in life has been chronicles and their brains have been studied post mortem, a few things have been learned.

First, when researchers went back and looked at essays these women wrote many decades ago on entering the novitiate, they realized that they could predict the chance of manifesting dementia based on the complexity of language and syntax they used as young women. The more nuanced and complicated their writing, the less likely dementia would manifest itself prior to death. What does this mean? Does this mean that dementia is a life long process that we can detect even in healthy young adults if we could only find the right tools? Or does this mean that we simply aren’t all created equal and that some of us are given more complex brains and that these are somehow dementia protective? I would favor the latter, especially as autopsy studies of some of the brains showed that they were riddled with the pathologic changes of Alzheimer’s that did not fit with the clinical status of the individual at the time of death. Some women were able to stave off the signs and symptoms of dementia and reorder and remodel their brains to get around the blocks caused by decay. How were they able to do that? It’s not entirely clear but the thought is that some women were able to mobilize their brains later in life through new learning to keep things in shape. And I suppose nine page twelve and a half minute monologues qualify as that.

The Sisters of St Scholastica dedicated their lives and deaths to learning and the greater good. I think we could all take a lesson from that, especially as I continue to see significant breakdowns in the social order fueled by political hyperpartisanship at the expense of science, health, education, and other common goods. Viral pandemics are a common enemy and scourge on all of us and we should be united in the very necessary job of bringing the current one under control. It ain’t happening at any level. We have one piece of relatively good news with the rise of omicron (God, that sounds like a not particularly good Marvel film) in that the clinical disease it causes appears to be less virulent than Delta. Delta continues to remain the major strain infecting the US and causing the current surges in Northern states. Omicron is here but there are still very few cases reported through testing and it remains to be seen if it can outcompete Delta with its increased transmissibility given the various factors of behavior, climate, and genetics that exist within the US.

The local Alabama Covid numbers have started to tick up a bit in the last few weeks but remain relatively low. We’re about 10% higher than two weeks ago which isn’t much. However, we’re not quite at the point where we’ll see the effects of Thanksgiving travel and gatherings on case rates. That’s another week or so out so it may start to go up quickly over the next few days. Elsewhere in the country, especially in the Upper Midwest and New England, the numbers are surging forward to the point that health systems are buckling again. I’m still suspicious climate is playing a role here and, if that is so, as we start to get colder in the Deep South, our numbers may start increasing again. I still wear my mask indoors at the store or in other larger gatherings. I’m not at the theater as it’s a small cast and we’re all vaccinated so I’m putting some faith in Thespis. An interesting study came out earlier this week suggesting that the coronavirus has a prediliction for fatty tissue and infects fat cells and immune cells that reside in fatty tissue more completely than other parts of the body and that this is why we have seen much more serious cases of Covid in obese people. It’s not the comorbidities of obesity such as diabetes that are raising risk but the actual fatty tissue itself that’s the problem. I’d like to see more on that before I’ll fully believe it but it’s an interesting idea. Whether you’re BMI is higher than you would like or not, get your vaccines and your booster. There’s good evidence that boosted individuals do well with breakthrough omicron infections.

I’m trying to make any sense at all out of national partisan politics these days. We have a congress that appears unable to even begin to do the people’s business, a major political party that has pushed out all moderating forces (nearly 50% of the Republican members of congress who were there in 2017 have either quit, not been reelected or announced their retirements with this next cycle), a justice department that projects an aura of blithe indifference to crimes when committed by the wealthy and well connected, and a supreme court that seems anxious to throw out the whole concept of stare decisis in order to enshrine the priorities of movement conservatism in constitutional law. Maybe the apparatus is totally rotten and needs to collapse. I was hoping I might be able to get away with a life of apres moi le deluge, but I seem to have been cursed with living in interesting times along with the rest of us. I’ve tried to leave most politics out of my remarks on Covid over the last couple of years but I can’t help but think maybe it’s time to wade back into those waters. Or maybe I should have a hot toddy and toddle off to bed.

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