Kids, Project Baseline, Nelcy Birthday

January 30, 2019

Dear Friends, Family and Diary,

d190116_02_earlyview.jpg d190116_04_packed.jpg We packed for our first out-of-town excursion of the year with Fresno showing us a nice sunrise. The picture gives it little justice, but this may be the only sun we see all weekend, so it is worth the quick snapshot.

The drive over was completely uneventful, the best possible outcome of the boring, oft-repeated trip. The valley orchards are all bare and most fields just plowed, brown dirt. I look forward to the arrival of Spring blossoms, not too far in the future. The hills through Pacheco Pass were at their maximum green. I need to catch all the seasonal scenes in photos. Next time?

By the time we got to Gabby's in Monte Sereno, the rains had started. In the afternoon it took continuous pumping to keep the pool from overflowing. (I was told that overflowing softens the sand around the stone tiles. It seems to me the surface was soaked already, but I'm no tile stability expert.)
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Inside, it was homework time, or maybe, art project time. Gigi is always glad to provide hints and Ava enjoys creating with pens and crayons. It's a nice combination, especially on the rainy afternoon.

d190116_20_traffic.jpg d190116_22_pb-intro.jpg Our planned purpose for the trip was to attend a dinner and lecture as part of Project Baseline (PB), the health-study project Marianne and I are enrolled in. Our part is based in Palo Alto, at Stanford University, a few miles north of Sam and Ava's house. For this evening, our first hurdle was rain-affected traffic. The navigator screen was filled with warning signs and the red lines of stoppages. Some of this is normal rush hour traffic in the South Bay, but arrival of the heaviest rains of the seasons definitely didn't help.

d190116_12_homework.jpg Dinner buffet was set up outside, under the building portico. There were remarks about the chill, but also an appreciation that outdoor serving was still ok, even in the middle of the worst winter storm of the year!

Inside, the two-hundred or so program participants and guests ate and chatted about their own impression of the project. Having started in the summer of 2017, I was one of the original "subjects" and Marianne joined about a year later. Call us if you want any information.
The evening's lecture was given by Doctor Sam Gambhir, the Stanford lead researcher for Project Baseline. His hour-long presentation was fascinating, but hard to summarize for this short diary.

Dr. Sam explained how "precision medicine" has made tremendous progress on providing personalized treatments for disease, treatments such as cancer treatment based on an individual's specific genetic makeup. But Gambhir clarified that precision medicine and treatment-after-illness is not what Project Baseline is all about. The PB focus is "precision health", an understanding of an individual's condition before significant illness progression, in order to intercept that progression.

He explained the four elements of precision health. "Risk Assessment" involves understanding what disease an individual may be pre-disposed to by individual genetics or environmental experience. (In our program , we received dozens of genetic and "biome" measurements, presumably to provide needed insight into our own risk. No results to share yet. It is just research, after all.)

Given an individual assessment of risk, the next stage would be "customized monitoring". It was here that the Stanford researcher described a range of technologies under development. Currently, all PB participants wear a "Study Watch" that monitors heart rate, skin temperature, light exposure, noise exposure, activity and a once-a-day ECG (electrocardiogram).
But that is just a fraction of the monitoring being considered. Already under development and, in many cases approved for use, are "worn" devices to measure breath, tears, skin condition, heart activity,and a range of more precise activity measurements commonly found on non-medical fitness monitors such as my Fitbit or Marianne's Apple Watch.
d190116_32_wizemirror.jpg As intrusive as that sounds, Dr. Gambhir's future world goes beyond devices that require people to modify themselves with implants or specific jewelry and clothing. For example, he described customized monitoring via the European-developed Wize Mirror, a technology-filled bathroom mirror that could daily assess health indicators of visible in an individual's face.
Closer to home was one of Dr. Gambhir's own projects: The Smart Toilet. He compared this home device to the continuous monitors found on modern jet engines. Both monitor system health by looking for specific indicators in the exhaust stream. PB participants provide "exhaust" samples at annual examinations, but the toilet would transform this to a daily process. This device is just completing FDA approval and Dr. Gambhir is excited about the possibilities. I wonder.

The third stage of Precision Health would involve taking all the continuous monitoring data and building an individual's "digital twin", a computer model that could provide a look into likely health development. Again, he drew a comparison with modern jet engine monitoring that is the basis of condition-based maintenance (fix the problem before failure) versus repair-when-it-breaks maintenance. Such preemptive health intervention would be the fourth and most important stage of Precision Health.

There is no question that our PB participation provides Marianne and me insight into interesting, leading edge health technologies. Is this the future"? Who knows.


d190117_02_fixbreakfast.jpg d190117_04_samawake.jpg Thursday was a slow day, at least for Marianne and me. The little family had their normal: up early for breakfast and off to school. Gigi made palascinta, a requirement when visiting Ava and Sam. Gabby had her "green drink". Not my thing, so I went out to Starbucks for breakfast and diary writing.

d190117_10_stream.jpg d190117_12_spring.jpg It is hard to keep up exercise on these quiet travel days while, at the same time, it is more important to do so, since there is plenty of off-plan eating and drinking. My compromise was an hour-long walk through the neighborhood. The local creek had become a strong creek due to winter rains and the local bridal path was sprouting spring flowers.

In the evening, after dinner, we ended up practicing tongue-twisters, starting with the classic: "red leather, yellow leather". I don't think any of us could do that one well, but Sam invented some simpler two-word challenges. Hearty laughing all around.



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Friday started very early, especially for Ava, Sam and Gabby. They were heading to the Sierras for a ski weekend, so it was up and out by 5:30! Four hours later they were on the new snow with dad. (Gabby: Thanks for the pictures.)

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Meanwhile, Gigi and I slowly started on our much-shorter trip. Our goal was San Rafael, north of San Francisco, for a birthday celebration on Saturday. Nominally an hour-and-a-half drive, but first we needed our own breakfast.

d190118_10_germanbakery.jpg d190118_12_inside.jpg In Los Altos, we searched out "breakfast" on Yelp and ran across Esther's German Bakery". Wow, real (old) home cooking? We ordered the "Bavarian Breakfast": a pretzel, mustard, and white sausage (weisswurst). It was darn authentic, complete to the radish plate decoration! By the time we left, we had also sampled the "nut corner" (nusseke) and a puff pastry. It is a good thing we don't live close because we would visit far too frequently.

From Los Altos we drove north along El Camino Real, Skyline Drive (I-280), 19th Avenue in San Francisco, and highway 102 to the Golden Gate Bridge. For us, this was a trip over memory lane. I remembered times 50+ years ago on these same roads going into San Francisco as a teenager, often just to take pictures with my old Speed Graphic camera. That ALL-manual photography was far different from today's take-a-zillion-shots-an-hour digital process, but good training I suppose.

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For this day's pictures, we joined the tourists on the north side of the Golden Gate Bridge. We were cautious about the threats-to-tourist. (By the way, I can remember similar signs 50 years ago, so it's not that the world is getting more dangerous. It always has been tricky to be a tourist.)

Light was not good for pictures, but we had to deal with what we had, not what we wanted.

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Across-the-Bay panoramas were "required", even if they really were not going to win any photo contests on this cool, gray day. (Next month, we should get better shots. We plan a stay in a lighthouse right in San Francisco Bay!)
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Ten miles north of the Bridge, we found our San Rafael home-for-the-weekend, the Marin Lodge. It is an old "motor hotel", simple, cute, clean, and remodeled-to-be-almost-modern. Most importantly, the people were very nice and accommodating.

Our tourist goal in San Rafael was the Mission San Rafael Archangel, the 20th of the (US) California missions. The mission was established in 1817 as an extension of San Francisco's Mission Dolores but was largely abandoned 40 or 50 years later. A large mission-style parish church was constructed in 1870, but it was destroyed by arson in 1919. William Randolf Hearst funded a new church in the 1930s and in 1949 a replica of the original chapel was also constructed with Hearst money.

During our visit, a funeral was being held in the main church, but we could visit the chapel and its neighboring museum. The visit did not have the feel of history of many of our stops at other missions, but it had its own small-time charm. Worth the visit.

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d190118_62_poblano.jpg d190118_64_ropa.jpg Lunch/dinner was at LaVier, a small "Latin fusion" restaurant not far from the mission. We were there at 2:30, neither lunchtime nor dinner time, so we had the place to ourselves. Nevertheless, service was friendly, and the complete menu was offered. We settled on two "Cuban-influenced" dishes and were very impressed by the quality and imagination of each dish. Another recommendation.
I suppose I should have ended the day with some night photography of the Golden Gate Bridge, but the thought of stumbling around it the dark, just in case the clouds and fog would cooperate, wasn't attractive. So I am using the picture Marianne took of the picture above our bed in the Marin Lodge. Good enough.


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After an early diary session at Starbucks, I went back to the Lodge with "breakfast bites" and cappuccino for Marianne. After some required cleanup, we swung by a local florist to pick up a gift from Klari and were then the first guests at Il Davide, the restaurant where Nelscy's big party would be held.

d190119_06_nelscytoast.jpg d190119_08_cake.jpg d190119_10_wholecrew.jpg The party started with a champagne toast, continued with a wonderful meal, and ended with cake, as all birthday parties should. Throughout, the room was filled with happy chatter from Nelcy's kids, grandkids, and friends.

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After lunch, Marianne and I joined the family at Nelcy's house and opening of presents. We all followed house rules by walking on the carpet only with socks. Even the Labradoodle went along with the rules.

I took the opportunity to wander around the backyard garden, filled with Nelscy's own art work. Very impressive.

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The back story to Marianne and Nelcy is that they came to America at the same time, almost 68 years ago. Nelcy produced this 1951 newspaper clipping announcing the arrival of her family and Marianne's in Dallas, Texas.

Now it is Sunday. Another Starbucks diary session and cappuccino delivery and then three hours of driving home. Maybe we will stop someplace interesting.

Stay tuned.

John and Marianne