Our parents’ children

My balikbayan sister visited last January and told me she was thinking of selling her house and retiring to a two-level condo.

“But isn’t that impractical for the elderly, having to climb up and down stairs?” I asked.

“Not with parents like ours,” she replied, pointing out how our parents, in their 90s, are still able to walk around—with difficulty, yes, but still able.

As life expectancies lengthen, we’re going to hear more of this kind of conversation, where “kids” like ourselves, now senior citizens, talk about our parents in their 80s and 90s.

For decades now, physicians have been asking new patients for their family histories, to help assess their health vulnerabilities. Cardiovascular diseases, diabetes, and certain forms of cancers are now known to have strong genetic components, and physicians want to get as much information as possible for the patients’ records. In more recent years, specific tests have become available to assess for particular genes that predispose a person to some diseases—for example, breast cancer.

But even without fancy tests, you can do your own genetic screening simply by observing diseases and causes of death among consanguineous relatives, meaning those who are related to you by blood. That can include parents, grandparents, uncles and aunts, and, as I will explain later, even our own children.

A slight detour is in order here. When I lecture to health professionals and health science students, I always warn them about the problems of determining “true” blood relatives because of widespread tampering of birth records.  There is, for example, “simulated births” where people register a child as their offspring, even if that is not the case. This happens sometimes to avoid the stigma around adoption.  You have all kinds of strange situations here—for example, a couple trying to avoid the stigma around adoption.

Or there may be parents whose young unmarried daughter gets pregnant, and, again to avoid stigma, they register the grandchild as their child. Yes, you could make a movie out of it: “Anak ko, apo ko.”

But at least in this latter case, there’s a real genetic relationship. With adopted children, the registered parents might not be remotely related, biologically, to the child.

Mirrors

Let’s get back now to cases where there is a real genetic relationship. Our parents are, of course, the best ones to observe; they are mirrors to ourselves now, and the future. You can and should observe your parents and construct a family history.

Start with life expectancies: How old are they now, or if they are deceased, what was their age when they died? Factor our accidents and infectious diseases: My paternal grandfather died of pneumonia in his 40s, but his children, including my father, all have or had very long lives. If my grandfather hadn’t gotten pneumonia, he would probably have reached a ripe old age as well.  My paternal grandmother lived to be 97, so you can see that we have a “bank” of good genes.

Now, simply having a particular genetic disease or ailment in the family tree does not mean you’re sure to get it. But knowing you have the risk means you can adjust your lifestyle to lower that risk.

Generally, surveys conducted in developed countries as well as some developing ones like the Philippines show that the elderly today are healthier than their counterparts 20 or 30 years ago, mainly because of advances in both curative and preventive medicine. Our knowledge about healthy lifestyles is fairly recent, but is making significant differences in the way we age, and prevent particular diseases. It’s important as well to recognize many of the preventive measures because conditions like cancer and cardiovascular diseases are quite generic: a good diet and lots of exercise, for example.

Other people can be quite drastic with their efforts to prevent a particular disease. What actress Angelina Jolie did last year, a “preventive mastectomy (breast removal)” when a genetic test showed she had the gene for breast cancer, was very controversial.

With other conditions, like Alzheimer’s, the research is still not clear on what can be done for prevention. People will say, “Ah, just keep your mind active. You’re a professor, anyway, so you won’t get it.”

Unfortunately, it isn’t that simple, but again, just knowing a parent has it does mean you might be better prepared when the time comes, for example, in recognizing early signs and symptoms.  There are now tests for early detection of Alzheimer’s—this does not involve the genes but what are called biomarkers of changes in the brain—but there are both financial ($3,000 a test) and ethical considerations around testing.

Do look at the positive aspects as well (as my sister and I have been doing), such as what I described as “longevity genes.” But there’s more to life than numbers. We need to be aware, too, of the quality of life. Thus, seeing how physically healthy my parents are adds to the optimism, balancing out the pessimism that comes with the presence of Alzheimer’s.

Our children’s parents

Recognizing that we are our parents’ children helps keep us healthier, but there’s another fascinating twist to our genetics: recognizing that we are our children’s parents. Many developmental conditions—autism, attention deficit hyperactivity disorder (ADHD), Asperger’s syndrome (the inability to recognize other people’s emotions)—were “discovered” only in the last 50 years or so.

Which means that older people may have had these conditions without knowing it… until their children were diagnosed. I’ve had friends who tell me that growing up, they were labeled as “sobrang malikot” (too rowdy) or “bobo” (stupid) in school, sometimes even being expelled for it, when in fact it was a developmental condition that could have been treated through counseling and medicines. And then they became parents and when their children started having problems in school, and then being diagnosed, say with ADHD, they began to realize, Oh, my, he probably got it from me.

As our understanding of genetics expands, we will be able to use our family histories not just to understand our own health vulnerabilities, but also to be kinder and more tolerant of others, entire families even, who seem “unhealthy” or “strange.”

* * *

E-mail: mtan@inquirer.com.ph