Pay a visit to a genetic expert and ask what the single most important piece of information is in assessing your risk for specific diseases, and what do you think they will tell you? Well surprisingly, the answer won't be one of the expensive new-age genetic tests that have come on the scene in the last few years. Rather, they will advise you to put together the most detailed family history you can muster. As an example, research published over the years at the Cleveland Clinic's Genomic Medicine Institute, headed by Dr. Charis Eng, has consistently found family history to be more valuable in predicting the risks of breast cancer, prostate cancer, and colorectal cancer than genetic testing. Some of our most common diseases, including heart disease, hypertension, strokes, inflammatory bowel diseases, and Alzheimer's, can have a strong hereditary predisposition. Dr. Eng has dubbed the often over-looked family health history as "the best kept secret in health care."
I never met my paternal grandfather, who passed away shortly before I was born. When I was growing up, my parents kept a few pictures of him in a special drawer at our house. As a young boy, one of these pictures of my grandfather always haunted me. It was a black and white photograph taken of him in the later years of his life sitting in a chair without any legs. His face was sunken and his body seemed frail, yet his eyes stared at the camera with a look of inner strength despite the limitations of a physical body that could no longer walk. There was a beam of light cast down across his face and body, giving the appearance of a man living in between light and dark, at a crossroad between life and death. My grandfather eventually died of a failing heart in his 80s.
My grandfather was a double amputee because of the effects of advanced peripheral vascular disease. From what I have been told, he smoked (a big fan of the water pipe, no less) and drank a fair amount. He lived on a different continent and in a past era, without the bells and whistles of modern medicine. Medications to thin the blood and lower cholesterol were decades away from becoming common medical treatments.
While I was away at college, my parents called me one evening to let me know that my dad was going to have surgery the next day on his leg because an artery was clogged, but that everything would be fine. My dad had a bypass graft put in his left leg to stop the pain he was getting from walking. The medical term for this is claudication. My dad never smoked, and he didn't drink. Throughout his life, he had wonderful, caring doctors; and my mom monitored his health closely. His health was carefully managed with the latest and greatest in medications for his heart and vascular system, and his primary care physician was a concierge doctor who was always a phone call away to help with all things health-related.
Despite significant cardiovascular disease, my dad was able to resume his normal activities after the presumably successful bypass surgery in his left leg. Things eventually took a turn for the worse last year when gangrene took hold of his right leg, and because of severe blockage in the blood flow to his leg he was forced to undergo an above-the-knee amputation. I remember getting hysterical calls from my relatives who had known my grandfather, frantic about the notion that my dad would be in the same tragic predicament.
About three months ago, gangrene crept into his remaining leg and he was forced to have an above-the-knee amputation of his left leg. Tragically, my dad didn't make it out of the hospital, and he passed away due to a failing heart -- in his 80s, and without his legs, much the same way his own father died half a century earlier. In those last months, my dad took on that sunken, frail appearance while keeping that steely look in his eyes, creating an eerie resemblance to the image implanted in my brain of my grandfather.
Over the years, I have preached to my patients about the importance that lifestyle and attitude have in improving how we feel. I am a firm believer in optimizing the environment we expose our bodies and our minds to in order to create the quality of life that I think my patients deserve. While I haven't changed my mind about this, I can't help but feel bowled over by the sense of finality engraved in my family's genes. Is it my chromosomes that have been directing my behavior all of these years, and have they already predetermined the time when and manner in which my end will come?
After you hit middle age, you really need to work hard at maintaining good health. Evidence strongly dictates that a key ingredient of putting together a long-term plan for aging well is to comprise a detailed family history and make sure that you and your doctor take it very seriously. For some, that may mean searching through old records like diaries, obituaries, funeral home documents, or military records. If you are adopted and cannot find information about your natural birth parents, consider hunting for information about your ethnic and racial background.
As Shakespeare wrote in his play The Tempest, "What is past is prologue." Let's not forget to remind our doctors of that.