Preface

Untitled Document

Long Life: Prolonging The Productive, Fulfilling Lives of Women: A Survival Strategy

The Central Message of the Book : it is actually rapidly becoming possible, at the level of the human cell, to prolong life.

The message is a leap beyond the usual strategies for living healthfully, although nutrition, exercise, and disease prevention are covered in detail as well.

Immortality of the living human cell is within our grasp. Genes in the cell control cell aging. There are genes that cause cell death: they are known as self-destruct genes. These genes can be turned off.

Beyond that, various inherited genes predispose each woman to certain life threatening diseases. Genetic manipulation is being developed to negate the effects of these predisposing genes. Some diseases are already being treated this way.

Genes exist in the chromosomes each of us inherits. The end of each chromosome is called a telomere, which is made up of DNA. The telomere prevents mutations (abnormal recombinations of the chromosomes) from happening.

The telomere is maintained and repaired by an enzyme called telomerase. If telomerase is activated, a cell may be induced to become immortal.

If telomerase is inhibited, cells die. This has great implications in cancer treatment: cancer cells multiply in a bizarre fashion indefinitely. Cancer cells eventually take over the host body and kill it. Specifically making the cancer cell die, without damaging the woman, is the goal of all cancer treatment.

Every organ and tissue in the human body is made up of specialized cells. Specialized cells arise from the stem cells found in the early developing baby (the embryo) in the uterus. It is now possible to grow new specialized organ and muscle cells from stem cells.

Stem cells are present in the Amniotic Fluid, which is the liquid surrounding and bathing the developing baby in the uterus. These stem cells from the the amniotic fluid can be removed without harm to the baby, and very recently have been shown to be capable of developing into specialized cells.

When a baby is born, a blood sample can be saved and stored indefinitely from the umbilical cord that attached the fetus to the afterbirth, or placenta. If this child unfortunately happens to get leukemia in later life, she can get a curative stem cell transplant of her very own cells – a perfect cell match. The stem cells will evolve into new, healthy, blood cells, and the affected woman is cured.

The entire field of organ transplantation: the replacement of hopelessly diseased organs by healthy ones –will be revolutionized by the availability of new organs that will not be rejected by the body of the woman needing the transplant.

Survival Strategy :

It is finally possible to prolong healthful, useful, enjoyable life beyond the biblical threescore and ten: seventy years. In order to achieve this, a woman needs a survival strategy.

Some components of this strategy can be achieved by the woman herself, while others involve understanding and being active in issues that impact her whole nation and society.

A woman can logically expect to survive healthfully to an advanced age only within a stable, advanced, educated society in which random and directed violence is guarded against and largely eliminated. General measures of public health, including the presence of a safe and assured water and food supply, and protection from disease agents by vaccination and other means, must be in place. The environment should be free of debilitating levels of noxious agents.

The woman herself should not use substances that can irreversibly harm her. The classic example is cigarette smoking: this one habit, once marketed to woman as somehow ‘equalizing’ them (“You’ve come a long way, baby”) has taken lung cancer, which currently in the vast majority of cases is caused by the carcinogens in cigarette smoke – from being a minor factor in women’s lives, to being the single greatest cause of cancer deaths in women in our society today.

It is necessary for a woman to intelligently differentiate between generally accepted maxims (eat three meals a day and ‘snacks’) easy fixes (many diets and ‘diet’ drugs), and what really, by good evidence, works to maintain a healthful existence. To achieve this, it is even necessary to re-explore and possibly challenge old concepts: who says three meals a day are necessary, or even healthful for many women? Exercise is good, but long term high impact exercise can be harmful, as a lot of aging athletes can attest.

The concept of preventative medicine has largely turned out to be pie in the sky, and a convenient way for politicians and insurers trying to scrimp on health care, to divert public attention from the real issues of identifying and properly treating disease. With some great exceptions, such as prenatal care, to protect women from developing complications of pregnancy, and the newly attained ability to immunize women against some subtypes of the human papilloma virus (HPV) that causes cancer of the cervix, there is really no such thing as ‘preventative’ medicine.

Healthful living can delay the onset of some of the most important disease conditions that are prevalent as women get older, including arteriosclerotic heart and cardiovascular disease, and diabetes.

When people think and talk of ‘preventative’ medicine, what they are really talking about is the very early diagnosis of disease states. It is then possible to eradicate the disease, or bring it under control, while this is still possible and even easy. In other words, what is being ‘prevented’ is often the complications and gravity of the disease, and consequent extensive treatment, and not the disease itself.

This is even true in the hallmark and most successful of all ‘preventative’ medicine programs: the development and almost universal deployment in our society of quality prenatal care for the expectant mother. Incipient disease states in both the mother and her developing child can be diagnosed at earlier and earlier times, allowing for proper treatment to be instituted, before permanent damage is caused. Some conditions of pregnancy can actually be prevented from occurring, by proper care (some of the hypertensive disorders of pregnancy).

There is great resistance to the very early diagnosis of disease in our advanced society, because of the costs involved, and because of the potential for harmful intervention in situations where a disease process is not even yet evident by symptoms and signs. These concerns have to be addressed on a disease by disease basis, but as a general principle, intervening in a disease process early is usually beneficial, and costs per person come down as diagnostic techniques are universally applied: the old mass production approach. The classic example is the Papanicolaou smear. There was great resistance to the adoption of this technique when it was first used for the early diagnosis of cancer of the cervix more than half a century ago. It is now considered perfectly acceptable to absorb the cost of regularly testing every sexually active adult woman by the ‘Pap’ smear: but DNA probe screening (from the same cervical mucus) for the actual sexually transmitted causative virus of cervical cancer (HPV), which is a far more specific and advanced test, is meeting the same objections today that the ‘Pap’ smear met half a century ago: it costs too much, not necessary for many women, and leads to overtreatment.

A survival strategy implies that, once a disease condition is found, and found early, that the woman be knowledgeable about her treatment options.

Generally speaking the treatment selected should be evidence based . Ideally, medicine today utilizes treatments that are proven to be beneficial. For most diseases in most women, evidence based medicine works: it is logical to use the treatment that has been shown to work.

However, by definition, medicine would never advance if no treatment could be utilized unless it already had been proven to work.

There is an explosion of information, new scientific data, and new instrumentation in both diagnosis and treatment, including robotics and beyond, in medicine today. Controlled studies on selected patients are used to find out which methods and modalities work.

It is often a different matter to find out which modalities are clearly superior: often an evolving technology will not show its superiority in an early stage of development.

A classic example is laparoscopy, or minimally invasive surgery, which has become one of the hallmarks of modern gynecologic surgery. When it was first introduced some forty years ago, it was derided as ‘peeking through a keyhole’, and competent gynecologic surgeons contended that they could make adequate diagnoses by simple pelvic examination, without resorting to surgery, and that optimal treatment involved bigger incisions for an adequate look and access to the reproductive organs. As the instrumentation became increasingly superior, and as gynecologic surgeons became increasingly adept, laparoscopy became the preferred way to approach many gynecologic conditions, to the point where the old issues were no longer even debated. In fact, laparoscopy has spread way beyond gynecology, and is a preferred method for many procedures in other surgical fields.

If a woman is successful in her survival strategy, she will not succumb to communicable diseases, whether spread through the food chain, water supply, droplet infection (for respiratory diseases), or sexual transmission (for example Human Immunodeficiency Virus: HIV; Human Papilloma Virus: HPV).

She will know her genetic background and her susceptibility to various inherited states (for example, the presence or absence BRCA genes for breast and ovarian cancer). She will be vigilant and be checked for the early onset of such a disease. She will tend to be slim, but not too thin, and have an adequate intake of known nutrients, including protein and calcium.

She will exercise regularly, but will avoid excessive high impact workouts. She will refrain from substance abuse, the use of illicit drugs, smoking, and excessive alcohol. She will drive carefully and within the speed limit, wearing a seat belt. When pregnant, she will seek competent prenatal care early and regularly, and will deliver where evidence shows she is most safe, and where her baby will have the best chance not only for survival, but for survival in optimal mental and physical condition.

When a disease state inevitably enters her life (hopefully in much later life), she will quickly seek expert help, make herself knowledgeable about possible alternative treatment regimens, and in most cases go with evidence-based treatment, but not close her eyes to scientifically valid emerging techniques that may be applicable.

She will remember to always keep her mind inquiring and her body active. If she does all these things, and her parents were long lived, she just might be the first person to reach, with intact faculties, that theoretical age: one hundred and thirty five, which is not quite double the classical threescore and ten.

The Eventful Journey to Healthful Advanced Age: Hurdles to get by :

There are significant life events – hurdles – that must be overcome on a woman’s way to an advanced healthy age

Genetic Makeup

It is possible to know your genetic susceptibility to various important disease states, and to be vigilant throughout life for early signs of appearance of these diseases.

It is even becoming possible to actually alter the genetic makeup, so that disease states can be avoided all together.

Being Born

The passage through the birth canal was, in times past, likened to a ‘perilous journey’. Even in our enlightened obstetric age, the intrauterine environment of the developing fetus, and the labor and delivery process, are significant factors leading to the birth of a woman in optimal physical and mental condition.

Childhood Diseases

Many of the scourges of times past, such as poliomyelitis and other communicable diseases, have now been eliminated by the widespread use of appropriate vaccinations, and careful attention to public health. However, there are still significant communicable diseases present in the world, such as tuberculosis. New communicable diseases actually arise: for example SARS (Severe Acute Respiratory Syndrome).

Accidents

Teenagers and young (and even older) adults often put themselves in harm’s way, without adequate protection. Depression and suicide are often neglected pitfalls for young women: the signs should be looked for, and treatment instituted.

Sexually Transmitted Diseases

The most significant of the sexually transmitted diseases today, from the viewpoint of difficulty in treatment and the shortening of lifespan, is AIDS – Acquired Immunodeficiency Syndrome – which opens a woman to a panoply of life threatening infections.

Pregnancy

Although in our modern society, maternal and fetal mortality have been vastly reduced, and most mothers-to-be are at low risk for obstetric complications, debilitating disease, injury, and even death in childbirth still occur. Women who delay childbearing are in a higher risk category for complications of pregnancy, both to themselves and their growing fetuses.

Diseases of Aging

As a woman gets older, she becomes increasingly prone to developing arteriosclerotic heart and vascular disease, hypertension, stroke, diabetes, arthritis and other illnesses that tend to be chronic, and that can be life threatening. Cancer becomes more prevalent. A healthful life style and attention to genetic makeup, along with early diagnosis and treatment are all important in the management of such conditions. It is now possible to turn previously fatal diseases into manageable, chronic states.

Age Seventy

Statistically, if a woman arrives at age 70 mentally and physically fit, relatively unscathed by the passage of time and life events, she has a substantial further life expectancy. She should have multiple opportunities and goals. She can expect to remain active and fit.

Age One Hundred

There are substantial numbers of women in our society now reaching that age. It is no longer considered to be an almost unattainable milestone. Theoretically, a woman should be able to live to approximately the age of one hundred and thirty five, although that age has not yet been attained.

( Next: See Immortality: The Sequel )

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