The Hypochondriac's Guide to Life. and Death.

by Gene Weingarten

  Laughing So Hard You Pee in Your Pants. There is actually a medical term for this. Urologists call it “giggle incontinence.” It can mean nothing, or it can be a very early indication of neurologic disease, in particular multiple sclerosis.

  The Sniffles. Sometimes a cold is nothing to sneeze at. It could be the first sign of Wegener’s granulomatosis, a rare, fulminant, whole-system body breakdown that often starts with coughing, congestion, and blood-streaked nasal discharge. Looks just like a cold! Then, when it doesn’t go away, it looks like chronic bronchitis, maybe with an ear infection. Small wonder that Wegener’s granulomatosis is sometimes not properly diagnosed until it is too late to treat. By that time it has progressed to kidney failure, lung damage, and body deformities, including “saddle nose,” in which the nose cartilage collapses like a rotted jack-o’-lantern.

  Or your “cold” might mean you have anthrax. Anthrax is a bacillus carried by livestock; an airborne, inhaled form of it starts just like a cold. This is relatively rare, though terrorist states like Iraq are experimenting with it as a biological weapon. They are planning to use it against citizens of decadent Western regimes, in cities and towns very much like yours. A doomsday scenario? Yes. Far-fetched? Hardly. The armed services have begun a program to inoculate soldiers against airborne anthrax. When inhaled, anthrax resembles the flu for a day or two, and then you feel pretty good, as if your cold has waned. Three days pass. Then you start hacking uncontrollably, you perspire like a federal witness against the mob, and finally you turn as blue as Cookie Monster. It is nearly 100 percent fatal.

  Ringing in the Ears. This is called “tinnitus.” Most people experience tinnitus at one time or another, usually as a high-pitched whine, but sometimes as a buzzing, whooshing, or clanging. Usually it is harmless. Sometimes the sounds can be heard by the doctor when she places a stethoscope to your ear, and this generally means it is no cause for alarm. It is when you are hearing the sounds and she is not that she2 begins to get concerned. Other possibilities open up, some harmless, some worrisome. It can mean Ménière’s disease, a disorder of the inner ear. That would be comparatively good news; Ménière’s disease is usually controllable by medication. Tinnitus can also sometimes signal multiple sclerosis, or it can accompany the first appearance of a growth on the brain stem or auditory nerve known as a “schwannoma.” A schwannoma is not usually malignant, but it is not entirely harmless, either; sometimes, when it is surgically removed, facial nerves are damaged and you wind up with a perpetual snotty look on your face, like a French wine connoisseur who has been asked to evaluate Yoo-Hoo. A schwannoma also presents the practitioner with a diagnostic dilemma; How do you deliver the news to a patient that he has a tumor with a name that sounds as if you are calling him a penis-head? Come to think of it, perhaps that is why it is named a schwannoma. Maybe doctors are learning to give silly-sounding names to terrifying things to ease the tension of the diagnosis. Maybe soon they will rename a heart attack a “spankadoodle.”

  Cold Sores and Fever Blisters. That eruption on your lip or gums probably means a minor attack from the herpes simplex virus. No big deal. Keep it clean. Use a mouthwash. It will go away, unless it is the initial presentation of pemphigus vulgaris, a disease that is even worse than it sounds. Pemphigus begins as mouth blisters—weeping, bleeding, painful, funky-smelling sores that spread to the skin of your scalp and elsewhere. Pemphigus can be treated and controlled but seldom is cured outright. One of the better experimental treatments involves injections of gold. It is expensive.

  Pins and Needles. You say, “My foot fell asleep.” Your doctor says, “You have experienced a transient episode of paresthesia.” Either way, you are standing there on two feet, but one feels like a shillelagh being nibbled by carpenter ants. The usual explanation is that you sat wrong, compressing a nerve. And that’s probably what happened, unless your pins and needles are the deceptively lilting overture of Guillain-Barré syndrome, a mysterious, terrifying disorder of the peripheral nerves. It starts in the foot, with sensations indistinguishable from ordinary pins and needles. Then it rapidly distinguishes itself, in the sense that a letter from the Unabomber rapidly distinguishes itself from the rest of the mail. The pins and needles will give way to profound muscle weakness. You can’t lift an arm; sometimes you can’t even breathe without the help of a respirator. Your brain is fine but your body is a dull lump of useless protoplasm—sort of the opposite of Vanna White. Most people eventually recover. From then on, whenever their foot falls asleep, they do not take it lightly. They worry, waiting for the next development, on pins and needles.

  Itching. Doctors call this “pruritus,” which makes it sound vaguely dirty and exciting. Alas, it is just itching. When itching is localized, the diagnosis is relatively simple. Seborrhea, psoriasis, dermatitis, athlete’s foot, ringworm, scabies, lice.3 It is when itching is generalized that all sorts of possibilities arise. If it is centered in the feet or the lower half of the body, it can be one of the first signs of Hodgkin’s disease, a potentially fatal cancer of the lymphatic system. Generalized itching can signal a form of leukemia. It can be the very first symptom of lung cancer, ovarian cancer, pancreatic cancer, or prostate cancer. It is almost always the first symptom of Hanot’s cirrhosis, a life-threatening liver disease of middle-aged women. And then there is mycosis fungoides, the final ring of itching hell.

  Mycosis fungoides is a rare, galloping skin tumor. It starts with itching; you ignore it. Then, sometimes, years go by symptom-free. Then the itching returns with a vengeance. Then your body erupts into patchy discolorations. You resemble a dalmatian. Then the discolorations spread. You resemble a guernsey cow. Then the tumors become what the medical books describe as “tomatolike.” Then things start getting really ugly …

  Déjà Vu. We are all familiar with this peculiar existential phenomenon. Suddenly, irrationally, we feel we are experiencing an event, or hearing a conversation, that we have experienced before. There is another, similar condition, called “jamais vu,” in which the opposite occurs: You suddenly feel that familiar surroundings are foreign to you; you might not even recognize your spouse. Cool. Weird. Potentially deadly. Neurologists have discovered that déjà vu and jamais vu can be early signs of a tumor or hemorrhage in the temporal lobe of the cerebral cortex.

  Troubled by these mental hiccups? Look for additional subtle signs of temporal lobe abnormalities. One would be seizures. If you frequently find yourself waking up on the floor at work in a pool of urine, with a gnawed pencil in your teeth, and people standing around trying to look calm, you may have a problem here.4

  Flushed Face. People sometimes get red in the face. This can be caused by exertion or emotion, or by profound embarrassment, such as when you are at a podium to address a national group of educators and you suddenly realize that the big exuberant German shepherd you were petting a few minutes before has nosed you in the lap so enthusiastically that you have an enormous frothy wet spot on the portion of your beige silk dress roughly corresponding to your own personal groin, not that this ever happened to anyone I know.5 Flushing can also be caused by drinking alcohol. Sometimes this is normal, but sometimes flushing after drinking alcohol is an early warning sign of carcinoid syndrome, in which tumors invade the lining of the stomach; this alcohol-induced facial flushing can precede the diagnosis by fifteen years! By that time, tumors have often spread to the liver or bone or another system. You have fire-hose diarrhea. Your heart walls thicken. You get short of breath. Then short of time.

  Hoarseness. This is how lung cancer sometimes shows up for the first time; the tumor invades the laryngeal nerve and you suddenly sound like Vito Corleone.

  Lipstick on Your Teeth. Yes, this is potentially serious. The canny internist will not discount this symptom. It suggests dry mucous membranes. If it tends to happen on one side of your mouth only, it could be due to a tumor of cranial nerve VII, which supplies the salivary glands. But the same eye would probably also be dry. If your entire mouth is dry and you are not ta
king any drugs that dry you out, this could be an early indication of Sjogren’s syndrome, an autoimmune disease that generally affects menopausal or post-menopausal Caucasian women.

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  Doctors will sometimes ask a patient to eat two saltines without water; Sjogren’s victims cannot do it.

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  Sjogren’s syndrome can lead to tooth rot, sexual dysfunction, and greater susceptibility to lymphatic cancers. There are support groups for victims of Sjogren’s syndrome. They are mostly women in middle age. They are very careful with their lipstick.

  The Blahs. You don’t feel good. You can’t quite put your finger on it. You are weak and achy and maybe you have a slight sore throat or fever. Medically this is “malaise,” and it usually means a cold is coming on. Some serious ailments begin this way, too, the most terrifying of which may be Stevens-Johnson syndrome, or erythema multiforme. You start by just feeling crappy. Soon there are eruptions on the lips, the tongue, and the inside of the mouth. You blister horribly. It spreads to the genitals and, sometimes, the anus. Sometimes you go blind. Here is how bad it is: Sometimes the only place that can treat you is a hospital burn unit.

  Words on the Tip of Your Tongue. It is called “partial anomia” or “tip-of-the-tongue phenomenon.” You find yourself having increasing trouble retrieving the right, er, er, er … word. It could just mean benign forgetfulness: As you get older, memory and retrieval functions sometimes get a little impaired. But neurologists know partial anomia can be an early sign of several degenerative dementias. It occurs with the onset of tumors in the left hemisphere of the brain, or in metabolic disturbances typical of terminal liver disease. It can also be the very, very tip of the very, very cold iceberg known as er, er, er … Alzheimer’s.

  Nausea. Having nausea in the absence of vomiting is like drinking NutraSweet in the absence of Diet Coke. What’s the point? Fortunately, simple lack of appetite coupled with a vague nausea that doesn’t make you puke is seldom a serious symptom. Unfortunately, when it is a serious symptom, what it is a symptom of is an oncoming heart attack.

  Snorting Out Food. You are dining on, say, spaghetti carbonara. Someone tells a joke, but not just any joke. It must be a joke with a certain kind of punch line: a bad-boy punch line, unexpected and a little wicked, like the one about why women don’t skydive naked.6 Suddenly you’ve got pasta and bacon dribbling out of your nose. Now, maybe you are just a slob, but possibly you have a degenerative disease in the muscles served by the cranial nerves. In the early stages, these conditions can cause the sudden, startling nasal regurgitation of food or drink. The later stages make the sudden, startling nasal regurgitation of food or drink seem like the height of prandial etiquette.

  Bad Breath. Medical texts first warn you, in medical-text language, that the most likely cause of bad breath is crummy dental hygiene. The catchall medical term for organisms that cause your breath to stink is “oral flora.” As in, “Yo, Vinnie, stand downwind on account of your oral flora is making me want to puke up this here sausage.” Once bad breath has been eliminated as a cause of bad breath, the physiology gets much more interesting, and specific. A musty, fishy odor on alternatively, a sickeningly sweet odor could be an early sign of terminal liver failure. A light, fruity odor could mean ketoacidosis, a condition that frequently accompanies diabetes. An odor of ammonia could mean nephritic gingivitis, a mouth-and-gum disease linked to incipient kidney failure. A stench of rotting garbage could mean lung disease. A smell of sweaty feet or cheese can indicate a serious metabolic disorder. A smell of garlic may be a sign of poisoning by arsenic, selenium, tellurium, or phosphorus. However, all of these things are likely to be accompanied by other signs, such as fatigue, mouth sores, a bloody cough, jaundiced skin, or extreme thirst.

  There is only one serious ailment for which bad breath alone can be the initial sign that something is wrong—though people seldom seek help at this early stage. Who wants to arrive at the doctor complaining that you smell like a septic tank? So you wait. Eventually, you get a persistent earache. Or congestion in one nostril. That’s when you discover you have a squamous cell carcinoma of the throat or sinus. The prognosis often stinks.

  Yawning. One of the great mysteries of medicine is why yawns are contagious. The fact that they are is often cited as evidence that yawning itself is without clinical significance; if it can be induced by mere suggestion, how can it mean anything bad? This is good reasoning, but alas, it is wrong. Paroxysms of yawning or sighing in the absence of real fatigue can be an early sign of encephalitis, or of a tumor or hemorrhage in the central part of the brain. These things push the brain downward, making it ooze through into areas where the brain has no business being, and for some reason this process can induce yawning, sighing, and later, stupor and death. This condition is called a “central herniation,” or an “uncal herniation.” It is very bad. Maybe someone should write a children’s book featuring a character named Uncle Herniation. He would be sort of like Sleepy the Dwarf, only he’d keep getting crushing headaches, spinal fluid would run out of his nose, and in the end he would lapse into a coma and die.

  Nosebleeds. If you go to a doctor complaining of nosebleeds, he will first make vague, discreet inquiries, using big, dignified words like “extrusion,” and it will slowly dawn on you that he is asking you if you pick your nose. The fact is, the capillaries in the nose are a threadwork of vessels easily damaged by, say, a pinkie.7 After ruling this out, and ruling out obvious other genetic causes you will probably know about—hemophilia, for example—the doctor will begin looking for diseases you don’t know about: These include a series of things with very long names. One is an esoneuroblastoma. Another is a nasopharyngeal angiofibroma. These are nasal tumors, and they tend to debut as nosebleeds.

  If these immediate causes of your nosebleed are eliminated, the doctor will consider systemic causes, diseases that affect your whole body but first show as nosebleeds. One would be an inflammation of the right side of the heart. Or the doctor might suspect Waldenström’s macroglobulinemia, a blood disease that is terrifying not only because it turns you weak, pale, and blind, and then tends to kill you, but because it involves the use of an umlaut, which makes everything sound worse than it is. Try it. Settle a few umlauts atop the most benign thing you can imagine, and watch what happens: Sänta Claüs. The jolly patron of Nazi children.

  But a more likely explanation for nosebleeds would be cirrhosis. You don’t have to be a drunk to get cirrhosis. Liver disease can sneak up on you, and sometimes you can be near death before you notice anything is wrong. One warning signal is that the liver stops doing what it is supposed to do, including helping the body absorb vitamin K, which helps blood to clot. If there isn’t enough, you bleed. It can start with the capillaries in your nose. This is the early stage. Eventually, you cough and vomit up huge gobs of cherry red, clumpy blood the consistency of rice pudding. Sometimes it will be darker and look like chicken livers or coffee grounds. This stage of your disease is called “hematemesis.” People with terminal cirrhosis don’t get invited to many parties.

  Snoring. You snore at night and feel tired during the day. You are a man. You are middle aged. You are at least somewhat overweight. You might have obstructive sleep apnea, a serious sleep disorder in which the pharynx collapses and prevents you from breathing. This can last up to two minutes without waking you. Your heart rhythm is impaired. Your body is starved for oxygen, a condition called hypoxia. The brain hates this; it degenerates, and so do you. Your family notices changes in personality; you get cranky and irritable and, according to medical texts, you “show poor judgment at work.”8 Untreated, this can lead to cor pulmonale, a condition that destroys the heart’s right ventricle. You become impotent. You look sort of purple. The veins in your neck pop out, resembling a hangman’s rope. By then, you want to die. Sometimes you do.

  What can be done? First, a doctor will have to determine whether you actually have sleep apnea; some people are just fat, cranky boors with bad judgmen
t. If the diagnosis is sleep apnea, there is an operation called uvulopalatopharyngoplasty (we’ll just call it “Bob”), in which the whole back of your throat is sheared off. Usually this solves the problem. Sometimes it doesn’t. You still snore and choke, only it hurts more because some idiot sheared your throat open.

  Toothache. Get a bunch of dentists together in a room. Get them talking. Then get the hell out of there; there is nothing quite so stultifying as a room full of talking dentists. However, if you leave a tape recorder in the room, you can later fast-forward to the good parts. If he has practiced long enough, every dentist will have a story of a patient who complained of a toothache in the lower jaw. The teeth will look fine. But the patient won’t. He will have clammy skin. The dentist will send him to the emergency room. That is because an emergency room is a better place than a dentist’s office to have a massive coronary.

  At other times, a patient will come in complaining of pain in the molars. An X-ray will reveal an ameloblastoma, a tumor of the bone in the lower jaw, in the wisdom tooth area. This is what is known as an “insidious” tumor. It grows slowly and causes no pain until it is quite large and crowds against the root of a tooth. By that time, the only solution may be removal of all or part of the lower jaw. A prosthesis is inserted. It is usually part metal and part bone shaved from your hip. Depending on the skill of the surgeon, you might look pretty good, or you might look like Grover Cleveland. Cleveland had a jaw tumor; doctors removed a portion of the jaw and replaced it with vulcanized rubber. He was an excellent president but resembled a warthog.

  Stiff Neck. “I probably just slept on it wrong.” Yes, yes. Probably. In the last half century, the simple stiff neck has lost most of its cachet, due to advances in modern medicine. In the absence of other symptoms, waking up with a stiff neck used to be a first sign of polio or tetanus. But these days everyone is inoculated against polio. Also tetanus. You have had a tetanus shot, and a booster in the last five years, right? Not sure? You may wish to call your doctor. Ask him. If you sound like Thurston Howell IV, you may be in trouble. Doctors call this initial stage “trismus,” or lockjaw. It will be rapidly followed by a ghastly grin that makes you look like the Joker. Doctors call this “risus sardonicus.” Then your body bends backward, taut, like a crossbow. Doctors call this “opisthotonos.” Doctors have a term for everything. If treatment is delayed, the final symptom can be “cessation of vital signs.” Doctors call this “death.”