and tell him what it meant. As he passed it over to me, I could see the perspiration forming on his brow. I offered him a seat and then returned to my desk, sat back in my leather chair, and slid a letter opener under the flap. I looked down at the beige paper with a neat letterhead in block letters at the top. The lab had performed a test on chromosome 19 to discover more about the apolipoprotein gene.
Let me explain what they were looking for, and what that means to someone like Joey. The protein known as apolipoprotein, or ApoE, comes in three possible varieties: 2, 3, and 4. All of them help the body deliver cholesterol and triglyceride fats to cells through the bloodstream. We inherit one copy of the gene from our mother and one copy from our father.
The ApoE2 gene is the most efficient and generally protects us from Alzheimer’s. If you have two ApoE2 genes you could probably smoke a pack of cigarettes a day, drink a quart of vodka, and skip the gym—all with relatively no ill effects, although I am not recommending you do that.
The most common gene is ApoE3, which means we have to watch our diet, exercise, and generally maintain a healthy lifestyle. ApoE4 is the least efficient in doing its job, and although not an absolute predictor of Alzheimer’s, it means we are four times more likely to get the disease if we have one copy, and ten times more likely if we inherit two copies.
Still, we don’t do this kind of testing for two reasons: First, there are some people who have one ApoE4 gene, or even two, who don’t go on to develop Alzheimer’s. Second, other than for research purposes, it makes no sense, in my opinion, to burden people with the fact that the odds are that they may succumb to the disease, when there is no cure.
Sure, there are some doctors, especially in the United States, who think a patient has a right to know everything about his body and his health. They are the same ones who order the spinal tap I mentioned before or a PET scan looking at amyloid buildup. I am not one of those, nor are most of my fellow doctors in Canada. And for that reason, I did not even mention these tests to Joey.
Joey’s eyes were glued on me, searching for any sign of reassurance. I removed my glasses and looked at the blurry form in front of me.
He said, “Well? What do you think?”
I said, “These tests serve no purpose, and it’s best just to let me pass on the results for research purposes.”
He said, “l really want to know. Let’s do this now.”
I put my glasses back on and could see his face flushed, more with fear than anger.
I glanced once more at the sheet of paper in front of me and then looked up and said, “Unfortunately, you have two copies of the ApoE4 gene.”
Florence
What If?
J oey came over today. A rare visit. He knows Bernie and I aren’t going to lend him any more money. He’s already in hock to us for over thirty thousand dollars. Bernie says to forget ever seeing any of it again, but somehow I think Joey will make it eventually. Or maybe it’s just blind hope for him.
He marched in, brushing by me like a man on a mission. I thought he would sit down when he got to the living room, but he just kept circling the furniture. I could tell this was a big one. What it was, I wasn’t sure, and something told me I didn’t want to know.
He didn’t waste any time getting to the reason for his visit. He had been to Dr. Tremblay, he explained, and the doctor had told him he had two copies of the ApoE4 gene. Even though I had no idea what he was talking about, I knew it wasn’t good. And I was right.
By the time Joey finished explaining what it meant, my body was covered in goose bumps. Joey, my only brother, might end up like Father. He tried to put up a front of bravado, but I could see the fear in his eyes. I told him I would be there for him, and his slight nod told me he knew I would be.
Then he asked about me. What if I had this ApoE4 gene, or, worse, two of them?
Let me explain what they were looking for, and what that means to someone like Joey. The protein known as apolipoprotein, or ApoE, comes in three possible varieties: 2, 3, and 4. All of them help the body deliver cholesterol and triglyceride fats to cells through the bloodstream. We inherit one copy of the gene from our mother and one copy from our father.
The ApoE2 gene is the most efficient and generally protects us from Alzheimer’s. If you have two ApoE2 genes you could probably smoke a pack of cigarettes a day, drink a quart of vodka, and skip the gym—all with relatively no ill effects, although I am not recommending you do that.
The most common gene is ApoE3, which means we have to watch our diet, exercise, and generally maintain a healthy lifestyle. ApoE4 is the least efficient in doing its job, and although not an absolute predictor of Alzheimer’s, it means we are four times more likely to get the disease if we have one copy, and ten times more likely if we inherit two copies.
Still, we don’t do this kind of testing for two reasons: First, there are some people who have one ApoE4 gene, or even two, who don’t go on to develop Alzheimer’s. Second, other than for research purposes, it makes no sense, in my opinion, to burden people with the fact that the odds are that they may succumb to the disease, when there is no cure.
Sure, there are some doctors, especially in the United States, who think a patient has a right to know everything about his body and his health. They are the same ones who order the spinal tap I mentioned before or a PET scan looking at amyloid buildup. I am not one of those, nor are most of my fellow doctors in Canada. And for that reason, I did not even mention these tests to Joey.
Joey’s eyes were glued on me, searching for any sign of reassurance. I removed my glasses and looked at the blurry form in front of me.
He said, “Well? What do you think?”
I said, “These tests serve no purpose, and it’s best just to let me pass on the results for research purposes.”
He said, “l really want to know. Let’s do this now.”
I put my glasses back on and could see his face flushed, more with fear than anger.
I glanced once more at the sheet of paper in front of me and then looked up and said, “Unfortunately, you have two copies of the ApoE4 gene.”
Florence
What If?
J oey came over today. A rare visit. He knows Bernie and I aren’t going to lend him any more money. He’s already in hock to us for over thirty thousand dollars. Bernie says to forget ever seeing any of it again, but somehow I think Joey will make it eventually. Or maybe it’s just blind hope for him.
He marched in, brushing by me like a man on a mission. I thought he would sit down when he got to the living room, but he just kept circling the furniture. I could tell this was a big one. What it was, I wasn’t sure, and something told me I didn’t want to know.
He didn’t waste any time getting to the reason for his visit. He had been to Dr. Tremblay, he explained, and the doctor had told him he had two copies of the ApoE4 gene. Even though I had no idea what he was talking about, I knew it wasn’t good. And I was right.
By the time Joey finished explaining what it meant, my body was covered in goose bumps. Joey, my only brother, might end up like Father. He tried to put up a front of bravado, but I could see the fear in his eyes. I told him I would be there for him, and his slight nod told me he knew I would be.
Then he asked about me. What if I had this ApoE4 gene, or, worse, two of them?
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