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Medical Histories and Family Trees

By Rebeldad Brian Reid

A couple of years ago, I was jogging with my father when our conversation turned to how lucky we seemed to be, genetically. That's not to say there was no reason to be concerned: I shared my grandfather's red hair, fair skin and propensity for skin cancer and there is a clear genetic link to Alzheimer's disease, which claimed my grandmother memory and, eventually, her life. But both of them lived well into their 80s and remained healthy and active through their eighth decade .

"Well," I said. "At least there's no other heart disease or cancer risk hanging out there."

"Actually," my dad answered. "My father did have prostate cancer, about 10 years ago. But it was no big deal."

We ran on. I was a little speechless. No one had ever told me before. I'm sure I was away from home at the time. I'm sure it was handled, as was family tradition, with stoic calm. And I'm sure the outcome was positive. Caught early, prostate cancer is not a dread diagnosis.

It's the rare parent who can't claim that there is not some worrisome genetic risk factor in the family tree. Some of us may have been touched, personally or through a family member, breast cancer or mental illness or high cholesterol or any one of hundreds of other conditions.

At some point, we need to share those details with our kids so that they can make good medical decisions, but it isn't easy to pinpoint the right time to talk about that history. Sometimes, the answer is clear: Alcoholism, for instance, should be broached before a child begins to think about drinking. Sometimes, the answer is forced upon us: At some point, kids will ask what really happened to Uncle Frank or Cousin Larry. And sometimes, there's no harm in delaying: I'm still years away from having to worry about my prostate health.

I'm curious if any of you have dealt with this, and when you thought it best to start talking about some of those more difficult family histories.

Brian Reid writes about parenting and work-family balance. You can read his blog at rebeldad.com.

By Brian Reid |  July 2, 2009; 7:00 AM ET  | Category:  Health
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Comments


This needs to be approached carefully.

I believe the best thing you can do is tell your children, and then attend to your own health maintenance. If you get caught by something and die young it colors their lives forever.

I know women who want to have both breasts removed because their mother's died of breast cancer. It doesn't matter that their own breast are clear. They can't stand the suspense. I think this is a little extreme.

Everyone has risk. Would you mutilate yourself to avoid it? The best thing you can do for your children is be sensible about your own health and educate them to care for themselves. After that it's a random walk.

Posted by: RedBird27 | July 2, 2009 7:34 AM | Report abuse

My FIL died from prostate cancer, which was not caught early. About 10 additional family members (young and old) have died of cancer, diabetes and a host of other illnesses in the past 5 years and it has had an effect on my older daughter, so yes, you do have to be careful. We got the "Are you going to get cancer?" question early on and you can't promise that you won't.

Basically we tell our kids that we take care of ourselves, exercise, eat right, don't smoke. We don't list all the genetic problems from both sides of the family, but as they come up we handle them one by one. My kids will have a much firmer grasp of their families medical histories as they get older than I or my husband did, since I think it is easier to talk about these days.

Posted by: cheekymonkey | July 2, 2009 8:18 AM | Report abuse

I am adopted so I don't spend a lot of time worrying about this. But my husband wasn't adopted and I don't think he knows much about his families medical history. Everyone in his family seemed to die of old age. :)

Posted by: foamgnome | July 2, 2009 9:54 AM | Report abuse

This is an interesting issue for me and my kids. While I know a fair bit about my own family's medical history, my ex was adopted and does not.
My ex developed late-onset schizophrenia several years ago (now successfully controlled with medication but the paranoia meant it took years before he'd admit there was a problem. He sought treatment for "anxiety" and a smart psychiatrist figured out what was really going on and got him on the right meds). Being the ex-wife gave me exactly zero credibility in trying to get him some help incidentally.
Schizophrenia does tend to reappear in families but the "late-onset" may be a different category. Most cases develop in teens or young adults. So it'd help a lot to know if schizophrenia had appeared somewhere else in his family tree!
All I can do is hope for the best for my kids and keep my eyes open I guess.

Posted by: annenh | July 2, 2009 11:09 AM | Report abuse

Like Brian, we seem pretty lucky (on my side). My mom had cancer young (50s), but my grandmother (her mom) just turned 99. And all her sisters (and her mom) lived to the 80s. The men, however, well, they seemed to all die young. There's one male in my generation, and we're all watching him, cause all the males on that side died quite young. We'll see how it goes.

Anyway, I think you talk as things come up. My kids know my mom's not here, there's no need to discuss cancer yet with them. They're kinda young. We don't talk about how their grandfather had prostate cancer or grandma had heart problems, but we did visit her in the hospital and so they knew she was sick.

I think you discuss things, tho (and the whole prostate thing, well, get it checked, regardless of history, because from what I understand, for all males if you live long enough, well, you will get prostate cancer). My family had a history of not discussing things, keeping things hush hush. And it is NOT a good idea. Of course, you discuss things as they are age appropriate, but there's no need to not say anything, and not be truthful.

Posted by: atlmom1234 | July 2, 2009 11:31 AM | Report abuse

I knew from the get-go that my grandmother had had breast cancer, because she left her prosthetic in plain view. And her arthritis made it tough for her to clasp her bra, so she always needed help with it. My own very pale skin and tendency to sunburn naturally led me to take very good care of my skin and avoid the sun, though no one in my family has had skin cancer. I started using self-tanner in high school and haven't had an intentional suntan since. My one challenge now is finding a sunscreen that will last through a marathon without re-application!

Aside from skin and breast cancer (which every woman and some men have to think about at least a little), we got lucky. All of my grandparents except one (who smoked himself to death before I was born) are still around and reasonably healthy--and my paternal grandmother is well into her 90s. Her mother lived into her 100s, and was clear-minded up until her last moment.

My father's family is Amerindian, and healthy and tough. My mother's family is European, and as mutt dogs tend to inherit the best of their ancestral breeds, so do mutt people. I may not have inherited thick, lustrous hair or a perfect figure, and I wish my nose were a little bit smaller, but genetically, I've known for a long time that I should count my blessings. Here's hoping the same will be true of my kids, if I have them.

Posted by: Monagatuna | July 2, 2009 11:49 AM | Report abuse

Colon cancer is the big one for one side of my family. So far, I haven't had any polyps (which tend to start in the 30s for those who get the cancer), so I may not have received that gene.

A fairly benign condition I've discovered on the other side of the family is color-blindness. My son has a mild version (can't distinguish light greens and oranges). There have been very few males on that side for several generations, but my mother remembered that her uncle is color-blind. So we've had a few generations of female carriers without any expression.

Posted by: mouse4 | July 2, 2009 12:21 PM | Report abuse

Women in my family, both sides, live very long lives. But there's a fair amount of mental illness in Mom's family, and she's bi-polar. There also seems to be a high number of autism spectrum disorders the men in her family, so it's obvious where the genetic components of older son's autism came from.

On my father's side, almost all the men got cancer of one kind or another in their 50's or early 60's. And it seems they weren't getting regular screenings because pretty much all of them were untreatable, and were dead within a year or so of diagnosis. Dad's still healthy and cruising along happily at 76. His older brother never got cancer, either, though he smoked for almost 50 years. He died of multiple massive heart attacks when he was 70.

For my sons, the biggest risk is going to be crippling arthritis. All the women in my direct line have it in our hips for our whole lives, and develop it in our hands as we age. DH is starting to have it in his hands. His sister is on some pretty scary meds for her hands, and their mother had it too. The solution, of course, is to keep moving the joints - not too agressively - and replace failing hips or knees when we get into our 70's or 80's. Great-grandmother never had the option of hip replacement and spent the last ten years of her life sitting in a chair because she couldn't move anymore. She lived to 90.

I think it's really helpful to know as much as possible about family history, because there's a lot that can be done to prevent or postpone most hereditary illnesses. Healthy diet, exercise, etc. I'm pretty motivated because I *don't* want cancer. Watching older relatives failing due to untreatable cancers - *NOT* something I want to experience myself - it's got to be the worst way to die!

So the boys get a good example and are getting good habits established now, and we do talk to them about how their ancestors have had problems, and why we need to exercise, and eat all the veggies, and limit "bad" / junk foods. DH is a good cook, so the kids have always enjoyed well-prepaired, balanced meals, and they actually *like* most vegetables. Growing some of our own has also been a good way to get them interested in eating them.

Posted by: SueMc | July 2, 2009 12:21 PM | Report abuse

I know women who want to have both breasts removed because their mother's died of breast cancer. It doesn't matter that their own breast are clear. They can't stand the suspense. I think this is a little extreme.

Everyone has risk. Would you mutilate yourself to avoid it? The best thing you can do for your children is be sensible about your own health and educate them to care for themselves. After that it's a random walk.

Posted by: RedBird27 | July 2, 2009 7:34 AM | Report abuse

My mother has ovarian cancer (stage III), and has the BRCA-1 gene, so my likelihood of having the gene is pretty high which puts me at huge risk for both breast and ovarian cancer. My husband and I have watched my mother in law over these past two years struggle with and die from stage IV ovarian cancer.

Am I thinking of having a complete hysterectomy now that we've had our child?? you bet!!! If you've never been through the chemotherapy route and the pain it can cause, you can't make judgements on people "mutilating" themselves to lower their risk!!

And yes our son will know about the genetic risks in his family when he is older. It's not right to keep it a secret from him.

Posted by: annwhite1 | July 2, 2009 12:43 PM | Report abuse

annwhite- it's tough, I know. I lost my mom to ovarian cancer (stage 3b) in January. It was a very difficult last month for her- her doctor suggested a "chemo break" (the idiot!), since she jad been on chemo for 2.5 yrs, and it was just downhill from there. Luckily for my sister and I, she was negative for the BRAC mutation. The scary thing is, even with a total hysterectomy, you can still get what is considered ovarian cancer, if it develops in the area around the intestines, since those tissue types are closely related.

But I have one big recommendation- don't just talk with your kids about family medical histories, write it down in detail and make copies! My mom would tell me little information items in passing, which then got forgotten or mixed up. I have lost so much of my mother's side medical history because we didn't write down the stuff she knew about her parents. Hopefully I can pry info on my mom, dad and his parents out of my dad, at least.

Posted by: DrCath | July 2, 2009 1:03 PM | Report abuse

My family was pretty open about physical problems, so I have a good idea what illnesses might lurk in my genes. What they weren't open about was mental problems. I have strong suspicions about one of my grandmothers. But my parents came out of an era when no one talked about mental illness, and now everyone in that generation is gone. At least we're all more aware today, and more willing to get help for someone rather than feeling we have to cover it up, but it would be really helpful if we knew what to watch out for.

Posted by: PLozar | July 2, 2009 1:55 PM | Report abuse

Genetic links to schizophrenia and bi-polar were in the news this week. Here's one article about it. http://www.independent.co.uk/news/science/unlocked-the-secrets-of-schizophrenia-1727987.html

There are a lot of markers in my family: diabetes, depression, breast tumors; but the one that worries me the most is the schizophrenia, which my mom has and is all around her mom's family. I'm very scared about it for any kids I have. It's very scary to have something so awful hang over you, and have you question everything.

All that said, I'm glad people are mostly open about the diseases we carry in my family. I'd rather know what is in my lineage than not. And my family did it well: I never worried about getting schizophrenia until I was old enough to handle the possibility. As a kid, I just knew my mom had it, they didn't talk about genetics. Being careful is certainly the key here.

Posted by: r3hsad | July 2, 2009 2:02 PM | Report abuse

ann and dr: my mom passed away from ovarian cancer about 12 years ago. She had been diagnosed, surgery, then had a round of chemo, it came back, she had more chemo, then she passed. It was definitely tough. My heart goes out to the two of you.

Posted by: atlmom1234 | July 2, 2009 3:07 PM | Report abuse

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