The Vast Unknown
“We are made of starstuff.”
- Carl Sagan, astronomer, scientist (1934–1996)
There is much we don’t know.
About 70% of our planet is covered with water, and we have only begun to understand what lies beneath the surface. New species are discovered every so often. Denizens of the deep continue to astonish with their variety, hue, appearance, and ability to function and thrive under circumstances of utter darkness and tremendous pressure.
In addition to inner space, outer space beckons. Its allure is strong. Some want to believe we are not alone. We have sent spacecraft to other planets at considerable expense and investment. Mars may have been inhabitable at one time. The rovers that yet roam are impressive in their ingenuity of design and function.
Before that, the SETI (Search for ExtraTerrestrial Intelligence) program was launched. We have heard nothing conclusive from other worlds, but, as Carl Sagan, one of SETI’s founders, observed, “Absence of proof is not proof of absence.” The odds of other intelligent (perhaps more intelligent) life somewhere in the vast universe, not necessarily in our solar system or even our galaxy, are more than remote.
But one of the frontiers that continues to hold fascination and secrets is something closer to home: the human body.
Almost two decades ago I was sitting at my office desk, staring at the PC monitor. I happened to close one eye at a time, gazing with first one and then the other. To my dismay, I discovered that, with one eye, lines of print were fairly straight (as I perceived them with binocular vision), but, with the other, they were crooked as a snake-oil salesman.
That was my introduction to macular degeneration. There is no known effective treatment for the dry form of AMD (age-related macular degeneration).
Recently, I was informed by a retinal specialist that my AMD had progressed, and has transformed into the wet form, for which injections may be beneficial, or I’ve developed central serous retinopathy (CSR). He asked if I take steroids.
As a matter of fact, I do. I’ve been using a steroid nasal spray for a long time. It seems to help my allergic rhinitis. No one warned that it might be causative in CSR. I agreed to stop Flonase.
That same day, I also saw a glaucoma specialist. Tests showed that it, too, had progressed (along with macular degeneration, it’s one of the two leading causes of blindness in this country). My interest in guide dogs has definitely heightened.
Several years ago I developed a strange discoloration on one side of my face. It was asymptomatic, but unsightly. After seeing more than one dermatologist and undergoing more than one skin biopsy, I was informed I had an unfamiliar affliction: erythema dyschromicum perstans. Anything with a name like that sounded serious. The good news was that my disorder had a name. The bad news? The treatment that was most effective was potentially lethal.
I elected not to risk death over a matter of cosmesis, and decided to try more benign preparations. Nothing I used seemed to affect the discoloration.
Then, as mysteriously as it had appeared, it disappeared.
A couple years ago I was sitting in my home office when I suddenly felt faint and mildly nauseous (recalling how James Comey described the way he felt when he contemplated the possibility his actions as then FBI director may have affected the outcome of the 2016 Presidential election).
Thinking I might be having a vasovagal reaction, I checked my pulse. It was irregular. This was something new.
I crawled to my bedroom and, sitting on the carpeted floor, cogitated what to do. I live alone.
I could call my daughter, who lives in an adjacent town. But what would she do? Probably call an ambulance. Then what?
I decided to crawl into bed and hope for the best.
Fortunately, the feeling of faintness abated with time.
A few days later, I had an EKG and wore a 24 Holter monitor. Other than an occasional PAC (premature atrial contraction), it was normal.
More recently, I took a friend, who’s slightly my senior, to a medical facility for something similar, although more serious. She had fallen, lost consciousness, and hit her head. It wasn’t clear as to the sequence of events.
Her workup revealed nothing. Unfortunately, no cause was discovered. Fortunately, she has not had recurrence.
Almost a decade ago sciatica visited, and stayed. Lumbar MRI scan showed abnormalities which explained the sciatica. After a variety of conservative measures, none of which lessened symptoms, I underwent surgery a couple years ago.
Although my MRI scan is worse than preoperatively, I seem about 10% improved.
Some time ago, I developed peripheral neuropathy. There are close to 100 causes of the condition. Fortunately, algorithms can narrow matters.
The two most common causes in this country are alcoholism and diabetes.
After a reasonable workup, which revealed nothing definitive, the neurologist suggested I try alpha lipoic acid on an empiric basis.
This I did, with perhaps salutary results.
I have osteoarthritis of the hands. I mind the deformity less than the periodic pain, which I endure.
Recently I developed a mucous cyst on one finger. I aspirated it with a small caliber needle and got a gelatinous substance typical of the condition, which is associated with osteoarthritis and communicates with a joint by a stalk. No one seems to know why these occur.
I write not to elicit sympathy, but, rather, to perhaps enlighten regarding the multitude of medical conditions about which little is really known.
The correlation between symptoms and findings on lumbar MRI scan (considered the single most definitive imaging study for evaluation of sciatica) is poor. Sciatica sometimes improves on its own without specific treatment.
I still am unsure as to the cause of my friend’s loss of consciousness. It could have been any number of things.
PACs and their cousin, PVCs (premature ventricular contractions) are not well understood, but, in general, they’re often benign.
No one ever explained why I developed erythema dyschromicum perstans. Fortunately for me, the perstans part was not long-lived.
My glaucoma is open angle type. Up until very recently, my intraocular pressure readings were normal. It and macular degeneration are poorly understood. I remain cautiously optimistic, hoping for slow progression or more definitive treatment than now extant. Meanwhile, I keep an eye out (no pun intended) for guide puppies, which may become grown before I need one.
These examples are merely from my own archives.
We don’t have good understanding of a host of other conditions, including rheumatoid arthritis (RA), autoimmune disease (of which RA may be one), fibromyalgia; certain neurologic conditions (multiple sclerosis, amyotrophic lateral sclerosis, trigeminal neuralgia); multiple myeloma, many other malignancies; some cardiopulmonary conditions, including asthma and cardiomyopathy; allergies, including those to various food, such as peanuts or gluten; gastrointestinal disorders, such as malabsorption, Crohn’s disease and ulcerative colitis; psoriasis and other skin conditions. The list seems endless.
Why do some (but not all) smokers develop cancer? Some participants in riotous living do not seem to reap what they sow, at least in this life. When I read obituaries, I sometimes wonder if it’s true only the good die young.
I interned at a large county hospital, where, for a time, I cared for patients on a TB ward. My TB skin test has remained negative. Some other healthcare workers became positive. Why?
For many afflictions (and those mentioned are only of the corpus; it doesn’t include the numerous mental ones, including schizophrenia), healthcare professionals do the best they can, but they see through a glass darkly.
That glass may or may not be someday clearer.
Like some other things in life, medicine changes.
Decades ago, when I was in medical training, it was thought that bacteria could not survive the highly acidic environment of the stomach. We now know, however, that most peptic ulcers are associated with a bacterium, Helicobacter pylori.
A bland diet with little roughage was once recommended for patients with diverticulitis, inflammation of diverticula, little outpouchings of the colon. Now a diet with roughage is recommended as beneficial in treatment.
And as regards inflammation, that of the arteries may play a role in the development of atherosclerosis. We knew nothing of this half a century ago.
The cure for the common cold continues to elude. Ben Franklin, long ago, opined something to this effect: “If a cold be treated, it will last a fortnight. Left alone, it will be gone in a couple weeks.”
This remains true today.
Will a cure for cancer be discovered in our lifetime? Perhaps. But perhaps not.
We may someday know more — much more. Some mysteries may forever remain that, however.
Many afflictions are treated empirically, because we don’t know the whys or wherefores. When a cell mutates, and things go awry. When termites in the quiet night begin to gnaw. When a syndrome becomes a disease, and when the cause of an idiopathic disorder becomes known.
If you have been or are plagued with health problems, know that help may be on the way. We look forward to a better time and a better place.
If you have made it to your stage of life without much going wrong, pause a moment. Count your blessings. Bend a knee. Give thanks.