Sunday, June 22, 2014

The Evolutionary basis for beauty

I have been enjoying thinking about the notion of “beauty” and its evolutionary origins. The specific question is what evolutionary pressure would favour people (or other animals, of course) who could appreciate beauty?

I am not an evolutionary biologist and this area is far from my areas of expertise. Therefore, all of what follows is just non-expert ruminations on the subject.

Some have suggested that being able to appreciate beauty is an argument against evolution and in favour of divine creation. While I don’t think the solution to the question is to invoke a magical and untestable response, the question remains intriguing.

The most obvious starting point connects beauty in relation to other humans. That is easily tied to mate selection and reproduction and can be associated with what may benefit species survival. There is nothing that particularly ties this to humans since we see evidence throughout the animal world of male and female displays of “beauty” features such as impressive antlers, powerful muscles, and pretty feathers. It may be that the real origin of both beauty and ugliness resides with mate selection, but why would the notion of either extend beyond?

Why would humans appreciate the beauty of a sunset or the tranquility of a northern lake or the beauty of the rugged granite coast of the eastern seaboard (Maine through Newfoundland)?

I think it is probably fruitful to start with the other side of this question: what is the evolutionary benefit of recognizing ugliness? This is easier to put into a survival benefit context. The landscapes that are ugly are, for the most part, inhospitable for us – the wastelands of volcanoes or swamp areas harbouring insect and vertebrate dangers. These areas suggest “stay away”. In a modern context these would be toxic-extruding containers in a landfill, chemical waste ponds associated with the Alberta Tar Sands development, etc. The ugly animals are frequently those we really should not touch such as scorpions, spiders, scorpion fish, wolf fish and rats.

Possibly beauty is simply the antithetical response to ugly. The menacing sky of an approaching tornado is frightening and, in contrast, the placid sunset is soothing and attractive. The rat is offset by the kitten. Humans have abstracted and extended beauty and ugliness so that we no longer restrict our perception to what I suggest may be the more limited basis of their origins. We can see beauty in paintings. We can even see beauty where the general view is of ugliness. Here I am specifically thinking that the scuba diver sees the scorpion fish’s beauty in its adaptation and camouflage after recognizing the “do not touch” message. The barren ruggedness of a lava field can be appreciated when home is elsewhere.

We have certainly been able to extend both poles. The beauty and elegance of a mathematical proof is only available once fairly extensive background mathematical experience is established. The same is true when we marvel at the beauty of a fine dovetail joint in woodworking, the full appreciation of which requires the understanding of the challenges associated with making dovetail joints. This is probably uniquely human.

Still unaddressed is Bach. How does music fit into the evolutionary framework? There are many examples in music from classical, folk, jazz, blues, etc. that are overpowering with their beauty. It seems unsatisfactory to suggest that the beauty of Bach is merely the contrast and compliment of the shrill sounds of a devastating storm.

It also strikes me that human characteristics are rarely entirely restricted to humans. Evolutionary biology has provided a huge amount of evidence that we share much with the rest of life on the planet. The differences in our DNA and the DNA of apes is remarkably small. Even with some other animals, the similarities are as fascinating as the differences. We know that marine mammals, such as dolphins and whales, and land animals, such as elephants, dogs and cats, have a sense of self and other (one of the strong reasons for not confining these animals in cages).

It follows therefore that we may not be the only animals who are able to appreciate beauty. What sort of continuum is this? A lush acacia tree may be an obvious suggestion of something beautiful to an elephant, but does the elephant also recognize the beauty of the sunset silhouetting those lush acacia trees? This is clearly something very difficult to ascertain, but I think it is within the realm of the probable. When, as a scuba diver, I look at a reef in the Caribbean and see its spectacular beauty, do the dolphins also see the beauty of the reef? Again, I see no reason to suppose that they are not capable of their own appreciation of beauty. Many of us have watched dogs and cats respond to music and although this may not always be a reaction reflecting an appreciation of beauty, on other occasions it is. The appreciation of music is not restricted to humans and this therefore suggests there is something about music that is linked to the evolution of life.

There is a fine line between anthropomorphising the experience of non-human animals and recognizing the continuity of the expression of life on the planet. While not diminishing the accomplishments belonging only to humans, it is important to recognize that we are not as unique as we previously assumed.

Friday, May 30, 2014

Partial nephrectomy - the story

I have experienced digestive and lower intestinal discomfort for a long time. Periodically, I get concerned that something major is amiss rather than just having a temperamental gut. Thus my GP and I thought it prudent to have a CAT scan just to be sure everything was what it should be inside.

The CAT scan took place April 1st (2014), a Tuesday. On Thursday I received a call from my GP telling me that the scan showed a 3 cm cyst in my left kidney and that he wanted to have an ultrasound done to determine whether it was fluid filled (benign) or solid (tumour). The ultrasound took place on Monday April 7. On Tuesday, at a pre-scheduled appointment with him, he had the results and the ultrasound evidence was that I was dealing with a tumour in my left kidney. He immediately arranged for an appointment with a urologist the following day.

The meeting with the urologist was direct and it was clear I really had two choices: full kidney removal or remove the tumour and save as much of the kidney as possible. He recommended, an I concurred, that some kidney function is better than none, even though the right kidney was there in either case. That settled, the first day available for the surgery was Tuesday May 20, just over a week ago.

I had a pre-admission appointment at the hospital on April 14th. While discussing the process with the anesthesiologist, I was offered and chose to have epidural pain management. This involves the insertion of a tube into the spinal column and the administration of pain medication specifically targeting my mid-section. The two key benefits of this technology are more effective pain management and avoiding the mental impact of narcotic pain management, such as morphine.

In the interim, we went to Akumal, Mexico as previously planned and were able to enjoy the warmth and water and the underwater pictures from that trip are available here. We returned to Nova Scotia on May 3rd.

Donna drove me to the hospital at 6:00 AM Tuesday May 20 where I was admitted and "fitted out" in preparation for surgery. After what seemed like extensive waiting, I was finally ushered into the operating room. The epidural tube was then inserted. While not a "comfortable" procedure, the pain of inserting the tube was quite minimal. I was sitting up and covered in warmed blankets. It felt very nice.

Once the epidural was in place, I lay down on the OR bed, on my back. The last thing I remember is an "oxygen" mask being placed over my mouth and nose. I did not count backward from 100 or 10 (or 1). I regained consciousness in the recovery room about 3 1/2 hours later.

After about an hour in the recovery room, I was transferred to the Intermediate Care ward. All surgery patients with epidural inserts spend some time in Intermediate Care. I was connected to an electronic vital signs monitor, as is everyone else in Intermediate Care. At this point I had 5-6 wires connected to me (I never did actually count), an IV drip providing both hydration and some other stuff, a catheter (which was very thankfully inserted while I was unconscious), a surgical site fluid drain consisting of a tube into the area around the kidney and a plastic bulb that collected excess fluid from inside, an oxygen tube in my nostrils and draped around my ears, and the epidural.

One of the key advantages to Intermediate Care is there are two nurses assigned specifically to this unit of 4 patients. This is a very busy room. It seemed like someone was always receiving attention for something, either the patient needing assistance or the nurses needing to check on a patient. I stayed in Intermediate Care until Friday, roughly mid-day, at which point I was transferred to a semi-private room on the surgical ward.

On Wednesday, I had my first "walk" which was no more than about 15 m (32 ft.) round trip and it was very slow. Not only was my body refusing to move in more than very small increments, I was towing or pushing a pole containing my IV and epidural medication. The next day I made a loop of the nurse's station, about double the distance.

The surgeon/urologist visited at least once a day. He indicated the surgery was a success. He had removed the tumour and was able to keep 50-75% of the kidney.

On Thursday afternoon, the epidural was removed and pain management was through morphine injection. While I was happy to have one less tube connected to me, morphine is not quite as an effective pain management system. With the epidural, pain, even immediately following the operation, was always at 3 or below and averaged between 1 & 2 on a scale of 0-10. The morphine was able to control pain at about 1 step higher - not bad, but not as good as the epidural.

I think it was on Thursday that I noticed a great deal of pain in my right hip. (Although this may have been on Wednesday - while the epidural left me more mentally aware, I was still doing little more than sleeping. I couldn't manage to read more than three pages at a time before deciding it was time for another nap. As a result, some of the timing and sequence of events remain somewhat fuzzy.) Both nurses and doctors explained that this was caused during surgery. While unconscious, I was twisted onto my right side so that the surgeon could have the best access to the left kidney. The patient couldn't complain about the uncomfortable position, being unconscious, so the strain put on the right hip by twisting it around is simply part of the operational procedures.

The pain in my right hip was debilitating. I couldn't shift the position of my right leg without intense pain. This meant the walking I was supposed to do was difficult. I was told that this would go away once I got home and was able to walk about more.

On Friday the remaining tubes were removed, I was disconnected from the vital signs monitor and moved to a semi-private room in the early afternoon. I was also shifted from the morphine injection to morphine pills, primarily because pills are much more manageable at home than injections.

Later, another patient arrived who was waiting for appendectomy surgery, hoping it would be that evening. Since this was an emergency admission, he was waiting for an opening in the surgical schedule. At some time in the evening, he was taken off to have his surgery and returned to the room in the very late hours of Friday or the early hours of Saturday morning.

On Saturday, the urologist informed me that he had received the biopsy report on the tumour. He was a bit surprise that it had come back so soon, but was generally pleased with the report. The tumour was definitely cancerous, but the report also indicated he had successfully removed it completely and there were no signs of the cancer in any of the lymph nodes, indicating that it had not spread. The cancer was also identified as the most common form of kidney cancer. I think that means primarily that we know how the cancer develops and what the future likely entails, which in this case I think means things will be OK.

Later that afternoon, my roommate was sent home. Very late on Saturday night, another patient arrived. He was dealing with a blood clot of some sort and unlike my first roommate, was not communicative.

I left the hospital at about 10:30 AM Sunday morning, along with discharge instructions and a prescription for morphine, and arrived home at 11:00 AM. Getting in and out of the car was challenging and every little bump seemed to reverberate through my incision, my right leg and my back. The five steps from the driveway to the door were slow and challenging. Fortunately, Donna and Ian were there to assist. They had assembled a bed on the main floor thus eliminating any need to go upstairs. Donna got the prescription filled and got a walker.

It's now 8 days after the surgery and my right hip is almost completely pain-free. I can get up and down out of chairs and from the toilet without further difficulty. I have been taking less and less morphine and haven't had any since Monday night at around 11:00 PM. Tomorrow I see my GP to have the staples removed from the incision.

I'm quite pleased with the progress of the whole thing and feel things are getting better every day. I'm still looking at a lengthy recovery period of about another five weeks before returning to life as normal and I still feel the need for naps. There is still some pain, but it's manageable.

This report wouldn't be complete without comments concerning the health care system. I was exceptionally pleased with the speed with which the problem was addressed. Once the potential tumour was spotted, it was just over a week until the ambiguity of the observation was eliminated and I had the surgery scheduled, which was just under six weeks from my first appointment with the urologist. The surgery itself was the surgery that provided the best long term benefit to me, not the least costly to the system or the easiest for the surgeon. (That would have been a full nephrectomy done through laparoscopic surgery, but would have left me with no left kidney.) The epidural pain management is also clearly a superior technology. Finally the nursing care I received was excellent. While in the semi-private room on the surgical floor, it was evident the nurses were going flat-out. Despite that, I was always given the attention I needed, even when what I needed was just more water. The Canadian health care system is not perfect and we have to figure out how to more effectively fund it. (However, we should be spending more on nurses.) Despite those concerns, it is a superb system that meets the needs of those of us who require its services, regardless of ability to pay.

Thursday, May 29, 2014

Staples Removed - thrid stage complete

The third stage of this saga is now complete. The first stage was the discovery of the tumour, the second the surgery and the third the immediate post-operative recovery stage.

The staples were removed this morning from the incision. there were 14 of the things. These are heavy-duty bits of wire that really are staples. Fortunately, there was not much discomfort involved - I told my doctor that I was a real wimp as far as pain goes and he just laughed. I imagine these things would have really hurt going in - fortunately I was unconscious with the anesthetic at the time.

It also seems I am incredibly fortunate. The serendipitous discovery of the tumour meant that it was removed before it expanded out of the kidney. Once that happens, the outcome is much less positive. I also learned the type of cancer is clear cell renal carcinoma. In Canada, 6,000 people will be diagnosed with kidney cancer this year and over 1,700 will die from it. Roughly 1 in 57 Canadians will be diagnosed with kidney cancer sometime in their lives and 1 in 141 Canadians will die from kidney cancer. Those are fairly sobering statistics.

Donna is again participating in the Canadian Cancer Society Relay For Life event, this time in Hants West. I encourage everyone to support the various fights against cancer. There are very few of us who will not be affected by one of the variants of this disease as it attacks us or our loved ones.