By undergoing the latest in genetic and medical testing at a cutting-edge San Diego facility, the film and television producer seeks early detection to avoid the fate of his parents and cheat death or dementia indefinitely.
I used to have perfect vision, now I pretty much wear glasses all the time. I used to have a lot of hair and now I'm losing it in the back and front. What's left on my head is getting steadily grayer, catching up with my much-more-salt-than-pepper beard. I have tendinitis in my right Achilles and my left forearm and bicep. That's it for the liability side of my health ledger. In terms of assets, I have a low resting heart rate, a low PSA (the measurement for prostate cancer risk), low blood pressure and low body fat. My daily regimen includes aggressive exercise, intermittent fasting, a vegan diet and avoidance of drugs, alcohol, sugar and anything that might hasten my descent into decrepitude and, ultimately, the terrifying abyss that seems to await us all.
At 55, my program for health maintenance was working … as far as I could tell. It was the question of what I couldn't tell — the unknown possibility of a "by the time they caught it, it was too late" condition — that brought me to this accounting of my health balance sheet at 5:35 a.m. on the 5 Freeway, driving to the high-tech health assessment company, Health Nucleus, in San Diego.
I pulled into the private parking lot in front of a modern three-story building that houses HN and its parent company, Human Longevity Inc., about 13 minutes before my scheduled 8 a.m. appointment. HN offers a state-of-the-art approach that provides a personalized, quantitative health evaluation of one's risk of cardiovascular disease, cancer, neurological disease and metabolic disfunction. HN bills itself as "the only platform in the world that combines whole genome sequencing and clinical imaging with artificial intelligence and machine learning to give you a more complete picture of health." When I told my girlfriend about what I intended to do, her response was, "What are you thinking?" in a semi-horrified tone. A majority of others to whom I told of my plans also indicated that they'd rather remain ignorant of any unseen would-be murderer hiding in their organs or genome.
While I feared something terrible might be found during this analysis of my present and future condition, I was more terrified of death, irrespective of timeline. I am holding out hope that there is some way to avoid it altogether by hanging on long enough for technology to catch up to a solution for the unpleasantness of mortality. To many, that sounds ridiculous, but I'm not alone in thinking this way. The tech billionaire class, including Larry Ellison, Peter Thiel and Jeff Bezos, has invested many millions in life extension research. Google Ventures put $1.5 billion into its startup, Calico, which develops remedies for age-related diseases. If an answer can be found to mortality, it will be accomplished through the union of technological genius and enormous amounts of cash. It is really more a matter of when than if a "God pill" will be discovered. Consequently, I have to get ahead of things by identifying any cracks in the rails that might wreck the train before it goes to the next station of science and medicine. I do not intend to go gentle into that good night.
Jena was the first person I met in the reception lobby, which was decorated with an aesthetic I'd call spa-ish: pale woods, light yellows and blues, gentle illumination. Jena had me fill out a few forms and confirmed that I had ordered the optional cardiac MRI ($800), which would bring the total bill to $6,300. (Initial visits start at $5,500 with $2,950 for each annual follow-up.) She then led me to my personal suite, which included a bathroom, coffee maker, refrigerator and snack area with water, juice, protein bars, nuts and fruit, to be consumed after my blood had been taken. There was also a phone, table, couch and 42-inch TV. Above the snacks hung boxes of small, medium and large blue latex gloves. The gloves caused me to wonder if there might be a digital prostate exam in my near future, and, if so, I hoped the examiner would be reaching for the small glove box.
Laid out on the couch was an HN logoed outfit: a V-neck shirt, drawstring pants and socks with little rubber traction nubs on the soles. Jena let me know that they were mine to keep and that she especially liked the "soft and cozy" socks. After she left, I attired myself and was joined by Cathy Vrona, R.N., who provided me with an itinerary for the morning and a questionnaire to fill out between tests, but before my meeting with Dr. Michael Doney, who would go over my history and answer any questions.
Another woman took my vitals: weight 177.6 pounds, blood pressure 118/72 and heart rate 52. I was disturbed at my weight, as it always was under 172 according to the scales at three different Los Angeles Equinox locations, but happy to be told that my blood pressure was good and even proud when she commented on how I must be athletic to have such a low resting heart rate. I almost offered that, if I take it when I just wake up, it is usually around 43, but then decided that such boastfulness would be pathetic.
I was led to another room where my blood was drawn and then returned to my suite where I met Dr. Doney, who is about my age. We went over my health history, which has been happily uneventful. He asked me about any concerns I might have and I told him that both my dead father and living mother had dementia and that I feared the genome sequencing would reveal that I would meet a similar fate. Dr. Doney explained that the genetic testing would show if I had the APOE4 gene variant, and that if I had one allele (genes have two alleles, one from the mother and the other from the father), it would mean I had a three to three and a half times greater chance of getting Alzheimer's, and that if I had two APOE4 alleles, that would increase my odds of the disease by 12 times. I presented my conjecture-slash-hope that my parents might not have Alzheimer's, but rather that their decades of reliance on anti-depressants and anti-anxiety drugs might be the cause of their condition. He agreed, saying depression itself is strongly correlated with dementia and went on to highlight that even with APOE4 E4, lifestyle would play a part of the equation and it isn't a sure thing that I'd end up a mush brain (my terminology, not his). He also said that they can usually see brain abnormalities, such as reduced hippocampus volume, in those who will have Alzheimer's, five to 10 years before cognitive difficulties arise, and this will be covered in my MRI.
In the MRI suite, I was greeted by a woman, who I guessed was in her mid-40s. She fit right in, mood-wise, with the rest of the staff: super cheerful, like the people who work at an Aman or Four Seasons Resort. She let me know that we'd be looking at one hour and 15 minutes in the machine, but I could take breaks when I wanted them. She asked what music I wanted, and I, being a middle-aged white man, chose classic rock, as I'm sure she expected.
If you haven't had an MRI before, it really isn't a big deal. You lie on your back and get slid into a giant donut that makes a lot of noise, with a TV monitor above your head, so you can watch something during the procedure. In this case, a video of tropical fish in a tank, which was distracting and pleasant to watch … for about four minutes.
As the machine started whirring and clanking, The Eagles' "Lyin' Eyes" came through the headphones. Listening to the lyrics of this ballad with more attention than I ever had before, I wondered if Henley and Frey had made up the whole story or if the lyrics emanated from real characters. The "pretty girl" is described in far greater detail than her husband, the "rich old man with hands as cold as ice," which caused me to conjecture on his backstory. Did he really love this much younger woman or was he just trying to hold on to his youth? If this was the case, as I suspected, would he also be the type who'd spend a lot of money on a high-tech health assessment that used artificial intelligence to offer a program with which he might enhance and lengthen his time left on this mortal coil? Before I could address the irony of the song, I had fallen asleep.
"Do you want to take a break?" woke me from my deep slumber. I reassured the voice that I was good, and was then told that I would need to hold my breath several times during the next part. I did this 20 times, sometimes getting a little panicky that I would not be able to make it to the point when the technician told me to exhale. It left me wondering how someone older and less fit than me would handle this activity. Later it was explained that the length of time was based on the number of heart beats they needed to count off to scan each part of my heart, so, ironically, my prized slow heartbeat was the cause of my near suffocation.
By the end of the MRI, my butt and lower back hurt and I realized that they offer breaks for good reason and that I should have afforded myself some time out of the donut.
Then came the CT scan of my arteries. The technician there, who was the most cheerful of the day, on the order of a Club Med G.O., told me that I'd have to hold my breath for these but not for nearly as long as in the MRI. Compared to the hour and a quarter spent in the donut, this was comfortable and quick. After that, I was back in my suite, had changed into my own clothes and was sitting on a couch with radiologist Dr. Nathan Hernandez to go over the MRI and CT scans.
"How often do you actually find something that is serious and in need of attention?" I asked Dr. Hernandez.
"About 15 percent of the time," he replied.
"How many of these do you do a day?"
"Usually, six to eight."
"So, once a day you have to deliver bad news?"
"About that, yes," he said, matter-of-factly.
This was the first time during the day that I actually felt a bit nervous.
On a large screen, Dr. Hernandez pulled up a profile image of my skull. For the first few seconds that he described my brain, I had trouble paying attention, as I was transfixed and alarmed by how much, without the covering of flesh and hair, I looked like an orc from The Lord of the Rings.
Coming out of my reverie, I picked up that my brain looked good. I had no white matter hyperintensites, which appear as small white spots on the MRI and could indicate cognitive disease. A person my age would normally have 10 to 15. No aneurysms. No masses. My hippocampus volume was in the 81st percentile — down to single digits would be considered normal — and that is important, as a bad reading could indicate early onset Alzheimer's.
Dr. Hernandez took me through the pictures of my insides southward to my lower organs. I wondered if he had bad news, would he have told me up front, or would he spend half an hour going through the normal stuff and then hit me with, "Now, this is interesting: You have an inoperable tumor on your liver"? I figured he wouldn't, and I was right. My arteries had zero calcifications and there was no sign of anything that looked cancerous. My prostate was slightly enlarged, but that seemed normal to him, and wasn't something to worry about since my PSA was 1.3 (above 4 being dangerous).
Five years earlier, I had been told by a doctor, an ultrasound technician, a radiologist and a urologist that I had a hernia, then that I didn't have a hernia, then that I did, then that I had two hernias. Dr. Hernandez showed me that I did not have a hernia. A massive win. After looking at my pancreas, liver, kidneys and everything else, and being shown what cancer and other diseases would look like in those organs, I was pronounced disease-free. I felt a level of relief I never imagined.
Two follow-up consultations were scheduled for the coming weeks, the first to go over lab results and further review my MRI and CT scans, the second to brief me on my genome sequencing. But at that moment, everything went as well, or better, than I had hoped.
Driving back to L.A., traffic was awful, but my mood was unusually buoyant, and that feeling continued for the next two weeks. I attributed this elation to the silencing of a subconscious din of angst playing in the background of my mind. The unknown became known, like at night when you think you hear a noise in your house and you go to see if there is an intruder and nervously turn on the lights to see that you're the only one there. It's one thing to have your blood drawn and heart EKGed in a physical every year, then being told you're "OK" — as far as they can tell. It's quite another to actually look at your own organs and see that there is nothing scary going on.
My next conversation with Dr. Doney, two weeks later, reinforced my serenity. During the call, I learned that most of what they could find out from my blood was quite good. The analysis of my visceral fat (the fat around one's middle, both the pinchable kind and that which surrounds one's organs and can only be detected by the MRI) was exceptionally low: a VAT index of 0.25, with norms ranging between 0.98 and 1.94. High visceral fat is linked to diabetes, liver disease, cancer, Alzheimer's and is the single strongest body composition risk factor for cardiac events. Dr. Doney told me to "keep doing what you're doing."
That night, I mentioned to my girlfriend, whom I'd convinced to make an HN appointment, that I have an exceptional visceral fat ratio. She said now she didn't want to go, because she was sure that her visceral fat would be higher than mine. She's very competitive.
Two and a half weeks later, I had my final consultation via video with Dr. Doney to go over my genome sequencing. I asked if we could right away get to whether or not I carried the APOE4 gene allele. Dr. Doney's calmness led me to believe that everything was as I had hoped. I was wrong. He explained that my sequencing showed that I had the homozygous APOE4 gene alleles — I had received one from my mother and one from my father — and that my chances of developing Alzheimer's disease were between 30 percent and 55 percent. I wasn't surprised, nor immediately uneasy with the news.
Dr. Doney re-explained how my genes were only one component of risk and that lifestyle factors could reduce the chances of having Alzheimer's by a third. We discussed how diet, exercise and intellectual engagement had proven to change outcomes with Alzheimer's. I knew and believed all of that. But when he said, "I don't want you to walk away from this feeling that you're on your own," my emotional state shifted. I felt a wave of gloom wash over me.
The day before I had, coincidentally, visited my mother in the dementia care facility where she lives. My mother seemed content, though she had no idea who I was nor could say anything comprehensible, but the others present did not appear at all comfortable nor happy, as best I could tell. Nobody could even ask a simple question and most had to be spoon fed by attendants and physically moved if even a slight adjustment in their position was required. I don't think any knew where they were. I didn't want to even imagine myself in a similar circumstance.
Dr. Doney went on about how I could talk to their genetics expert, then some other stuff that I don't think I fully heard, and asked if I had any questions. I composed myself and told him that I did not.
We moved on to the rest of my genome report. I had none of the 87 cancer risk genes. All of my polygenic risk factors — groups of genes that can point to an elevated possibility of getting illness, especially cancer — were within normal levels, except for thyroid cancer, which wasn't alarming, since that usually shows up in younger people and is twice as likely in women.
The hourlong review ended with being told that I'd be sent the full packet of genomic information, including many non-health related items about my genetic ancestry and a complete file of results that I could share with my physician. Dr. Doney reiterated that I could contact him at any time.
The rest of that day and much of the next, I felt anxious and unsure how having this awareness would affect me long-term. I wondered if everyone was right, that I had sought out knowledge that I would have been better off not receiving.
Thinking it through, I realized I was no different than I was prior to my trip to San Diego, other than having been roused from the fantasy that my parents had been afflicted due solely to their own choices. An unfavorable reading of two alleles is not diagnostic of disease, but rather an opportunity to make changes in one's behavior and keep aware of possible treatments that might help to avoid or moderate disease. If my genes put me at a 55 percent chance of having Alzheimer's and my behavior could lessen that by 30 percent, that indicated I have only a 38.5 percent chance of becoming demented. That my odds of maintaining my cognition appeared to be better than not seemed like a victory.
I related to my girlfriend what I’d learned about my genome. Her response was, "If anyone can beat this, you can. And, anyway, I’ll probably have Alzheimer's before you do." As I said, she’s competitive.
Eventually, I found consolation in confirmation of my overall state of good health. Had they found a mass on my liver or a large amount of calcification in my arteries, the next steps would have been frightening, painful and life-changing. The way I'd lived my life for the past three decades meant that I would not have to struggle with changes in diet, exercise and cognitive training. The only thing I was doing wrong was not getting enough sleep, and this experience prompted me to focus on my sleep hygiene, which would benefit me in more ways than one.
So, yes, I was happy I had gone to Health Nucleus and found out what I did. I would recommend it to anyone who can afford it and who wants to do everything possible to stay healthy for as long as possible. Yet, more important than the insight I gained on my health status, in fact one of the most profound pieces of wisdom that I know will help me in years to come, and that could probably help anyone, really, is … well … uh … I forgot what I was going to say.
Gavin Polone, a THR contributing editor, is a film and TV producer whose next project is Zombieland: Double Tap (Oct. 18).
A version of this story first appeared in the July 31 issue of The Hollywood Reporter magazine. To receive the magazine, click here to subscribe.