The Hypochondriac's Guide to Life. and Death.

by Gene Weingarten

  “Decompensated” Docked Decked. It means the failure of a system—whatever ails you has reached the point that the organ in question is no longer able to maintain basic body functioning. If you have compensated liver disease, your liver is functioning well enough to sustain life. If you have decompensated liver disease, it is not.

  “Discomfort” Discomfort, as from an itch Pain, as from insertion of a penis catheter

  An “embarrassment” A faux pas

  A sudden, dramatic problem caused by an interruption to circulation or a drop in blood pressure, occasionally produced by bad diagnostic technique. Feeling for a pulse on the carotid artery on both sides of the neck at the same time, for example, can sometimes cause unconsciousness, as if the patient were being hanged. (See “syncope” below.)

  A “dissection” Something bad that happens to a frog Something bad that happens to you. It’s a spontaneous ripping and rending of tissue, as though it is being unzipped by God. When it happens to your aorta, you often die.

  An “event” A party No party. A bad thing. A thrombotic event, for example, is a stroke.

  “latrogenic” A play by Aristophanes Describes an illness or injury caused by medical treatment or diagnostic procedures. For example, sometimes a spark caused by a colonoscope will accidentally ignite intestinal gas, causing an explosion in the body. It can be fatal. And disgusting.

  “Idiopathic” Duh Duh. When doctors diagnose an illness as idiopathic, it means they have no idea what is causing it.

  An “insult” Injured feelings Injured flesh, often grave damage. In the autopsy report, for example, JFK’s head wound was described as an “insult.”

  “Palliative treatment” Some sort of treatment No treatment. Doctors have given up on a cure. At best, they will do something final and dramatic, like amputating a gangrenous limb or creating a permanent colostomy. Usually, though, palliative treatment means doping you up until you die.

  “Precocious” Mozart Mozart did not have huge hairy genitals at the age of four, so far as we know. Medically, a precocious development occurs unnaturally early, and is usually a very bad sign. Precocious puberty, for example, occurs in pineal hyperplasia syndrome, or tumors of the hypothalamus. Kids get adult-looking genitals at age four. No, it is not cool.

  “Progressive” Modern, forward-thinking, socially conscious Deadly. A “progressive” disease is one that is progressing, inexorably, despite treatment. Multiple sclerosis is often described as “progressive.”

  “Resection” Restore, put back, fix Cut away. Amputate.

  “Tamponade” Women’s personal hygiene procedure Restrictive pressure on the heart, causing reduced blood flow to the body, breathlessness, and sometimes syncope.

  “Syncope” Thelonious Monk Thelonious Monk OD’s. Syncope is fainting, unconsciousness.

  “Prodrome” A dirt-floored stadium in some toilet of a town, outfitted for tractor pulls and demolition derbies The early stage of a disease. It is often deceptively mild. Prodromal symptoms are sometimes described as “premonitory.”

  “Premonitory” You may already be a winner! You lose. If a symptom is premonitory, it seems trivial, but isn’t. You know: Hiccups. Cancer.

  A “bad result” A bad result A very bad result. This is universal DocSpeak for “death.”

  Maybe It’s Just Nerves (Uh-Oh)

  On virtually every level, I am unqualified to write a medical book,1 but if simple incompetence prevented people from getting publishing contracts, John Grisham would be pushing a broom at Jiffy Lube. My ignorance is particularly overwhelming on the subject of the brain and the nervous system.

  Fortunately, I had an ace in the hole: Dr. James Prokop, an eminent neurosurgeon I knew in Greenwich, Connecticut. I was counting on Dr. Prokop because of his humor and graciousness, because of his encyclopedic knowledge of his field, and because he was my wife’s uncle. I was going to supply Dr. Prokop with various minor symptoms, such as eyelid twitching, and he was going to tell me how these symptoms could signify frightening neurological deterioration.2 Privately, we would chortle over how alarmist we were being, how the human body is not so delicate a machine that sudden death awaits us all, any minute, without warning. Then, three days before I was to talk with Dr. Prokop, he suddenly died.3

  So I am feeling a little shaky right now, trying to write about neurology. Fortunately, neurology offers the ignoramus a toe-hold, since much of it can be reduced to terrifying case studies and simple diagnostic exams that scare the bejesus out of you.

  * * *

  Reach into your pocket or purse. Feel for a quarter. Don’t take it out, just explore its surfaces with your fingertips. Can you tell which side is heads and which is tails? You should be able to. This is called “stereognosis” and it is a basic test of the functioning of the parietal lobes of the brain. Failure to distinguish heads from tails can sometimes herald the presence of a parietal lobe tumor or an oncoming stroke.

  * * *

  Fear of strokes and brain tumors is what most frequently brings hypochondriacs to neurologists’ offices. Hypochondriacs know that strokes and tumors can cause unusual symptoms, that virtually any blip or jiggle of sensation, any failure of memory, can sometimes signal something dire. My friend James Lileks, a writer who is a ferocious hypochondriac, once read that hallucinating the smell of a burnt match can mean an impending stroke. He began noticing this smell all the time, and suffering paralyzing panic attacks. It did not occur to James that the reason he was smelling burnt matches all the time was that he was lighting matches all the time. Me is a cigarette smoker. This is how hypochondriacs think.

  I have news for hypochondriacs. It is much worse than they think. Incipient strokes or tumors can create astonishing havoc in the pathways of perception, in ways hypochondriacs never would suspect, until this very moment. Yes, tumors or strokes can lead to so-called uncinate fits, which cause hallucinations of smell, but the smells are not limited to burnt phosphorus; people detect the odor of garbage, lemons, banana oil, wet asphalt, acrid fumes, dirty diapers. In general, perception can be wickedly distorted: A stroke victim once woke up screaming because he saw a human arm in his bed, right next to him. In fact, there was an arm. It was his own. He did not recognize it.

  A stroke or tumor in the visual processing center of the brain can announce itself in something called the Alice in Wonderland syndrome, in which the victim sees an object and then hallucinates the same object repeatedly. Dr. Hal Blumenfeld, a neurologist I know in New Haven, Connecticut, had a patient who was looking at a potted plant in her home. A few minutes later, it reappeared. It was growing out of an omelet.

  A stroke or tumor in certain areas of the cerebral cortex can make you feel as though you have been transported to a parallel universe peopled by evil impostors. This phenomenon is called “reduplicative paramnesia.” You will be talking to someone who looks exactly like your brother Vincent, and sounds exactly like your brother Vincent, and still seems to have that scar from the day you launched a pushpin at him with a soupspoon, but he can’t fool you. You are onto his little game.

  A stroke or tumor in the brain’s temporal lobe can result in a condition known as “jargon aphasia.” The person with this condition understands what you are saying and speaks fluently in his ordinary voice, and he knows exactly what he wants to say, but the words come out all wrong. He becomes Norm Crosby, that annoying comedian who says things like “Greetings and salivations, I was expectorating you to come.” No one understands the person with jargon aphasia. He is trapped in a Tower of Babel nightmare. Sometimes he commits suicide.

  Parietal lobe tumors can cause a bewildering sense of spatial disorientation. You might get lost between your mailbox and your house. Or you might have difficulty putting on a shirt because you keep trying to fit your head through the armhole.

  But the niftiest symptom of a stroke or brain tumor is a rare disorder called Lhermitte’s peduncular hallucinosis; this was disclosed to me by Dr. Anthony Reder of the University of Chicago
. Dr. Reder solemnly assured me he was not inventing this just so he could share a giggle with his graduate students by getting a preposterous fiction printed in an actual book; I assured him I did not for one minute suspect that a man of his stature and integrity would engage in such infantile behavior. Then I spent the next day searching doubtfully through neurology texts until, to my astonishment, I found it. In Lhermitte’s peduncular hallucinosis, a strangling of the oxygen supply to the base of the brain causes people to see cartoonish little characters in the room, about three feet tall, often dressed in what appear to be military-type uniforms, gaily colored in pastels. They are friendly critters, completely unthreatening, and they generally go away when the cause of the oxygen deprivation is relieved, whether by drugs, surgery, or death.

  Hypochondriacs do not know of these things, by and large. The symptoms of strokes and tumors that they fear are far more common: paralysis on one side of the body, muscle weakness, inability to talk. Sometimes they fear these things so desperately that they develop the symptoms, a form of hysteria. Emergency room doctors in particular are adept at weeding out the nuts, or “gomers,”4 from the real disease victims: When a patient says he can’t talk, doctors will sometimes ask him to whisper. Usually, he can. If you can whisper, then there is nothing wrong with the speech center in your brain. When a patient claims complete paralysis in an arm or appears to be unconscious, doctors will sometimes lay him on a bed, hold his hand above his face, and let go. If a patient is faking or imagining paralysis, he generally won’t let his hand bash his face; it will fall to the side.

  Dr. Mark Smith, director of the Washington Hospital Center emergency room in Washington, D.C., once confronted a patient who complained of paralysis on the right side of his body. Indeed, the right side appeared to be flaccid, but Smith was suspicious. So he asked the person to make a series of voluntary motions with the right side of his body. Nothing. Finally, Dr. Smith asked him to turn his head to the left and right. He could turn it to the left, but not to the right. Bingo. Turning to the right is accomplished by a muscle on the left side of the neck, and vice versa.

  Tumors and strokes. Strokes and tumors. The basic, boring repertoire of the hypochondriac. And then suddenly, a few years ago, some neurologists found themselves facing a new complaint. The disease was actually an old one, identified in 1920. But no one had heard about it until cows in England started behaving in an uncivil manner, which greatly distressed the Brits, who wear formal attire to cockfights. This was, of course, the debut of “mad cow disease.” If you eat the meat of an infected animal, it can cause a fatal nerve disorder known as Creutzfeldt-Jakob disease. By all rights none of this should have caused much consternation in the United States because

  These were British cows.

  No one outside England seemed to be sick.

  Globally, Creutzfeldt-Jakob disease is a one-in-a-million occurrence, mostly seen in tissue-transplant patients, so rare that as an epidemic it had previously been sighted only in the 1950s in the eastern highlands of Papua New Guinea, in the form of a fatal illness called kuru. Kuru was eradicated when the residents of the eastern highlands of Papua New Guinea were persuaded to stop eating one another.

  Unfortunately, this triad was not enough to allay the fears of American hypochondriacs, because the symptoms of Creutzfeldt-Jakob disease are dismayingly familiar. The disease causes you to get nervous and twitchy and tired, and leads to a “spongiform brain,” in which your brain tissue literally gets soft and squishy and your ability to think and remember deteriorates rapidly. Who among us has not from time to time, particularly on Sunday mornings, suspected himself of having a spongiform brain?

  The Internet filled up with terrified postings from hypochondriacs, including one highly literate woman who said her life had become a hellish cycle of unfounded medical fears: “When I forget a name or a telephone number, I feel that panicked realization that my brain is already sponging up and will soon have the consistency of a Nerf ball.”

  It is not that hypochondriacs want to be sick, but the fact is there are certain diseases that are irresistible to them, diseases that mimic the sorts of symptoms caused by the stresses of modern life and the ravages of age. This gives them something to help explain why they are so damned tired and achy all the time and why things seem to slip from their minds. They want an explanation other than that they are getting old and forgetful and their bodies are inexorably breaking down and life from that point on will be a graceless descent into senescence and groaning decrepitude. They want to blame it on a bug. The degree of tear and excitement exhibited by hypochondriacs is proportional to the severity of the disease they suspect, and in the case of mad cow disease, an inevitably fatal condition, the steaks were high.5

  In time, the furor waned. And then, bang, it was back. In September 1997, University of Kentucky scientists reported five cases of Creutzfeldt-Jakob disease linked to the consumption of scrambled eggs with squirrel brains, which apparently is something of a delicacy among gap-toothed hillbillies in bib overalls who live in towns with names like West Horse Jowl, Kentucky. This brought the hypochondriacs out again.

  This is, of course, ridiculous. Normal people don’t eat squirrel brains. Normal people are much more likely to get bitten by a tick and get Lyme disease, which causes you to feel tired and achy and forgetful. Hypochondriacs love Lyme disease; internists probably diagnose one or two cases of Lyme disease a year, but they deal with dozens of people who think they have it and seem mildly disappointed to learn they do not.

  Lyme disease causes peripheral neuropathies, which are debilitating disorders affecting muscles and the nerves that control them. Eventually, peripheral neuropathies can make the skin feel as though you are wearing stockings and gloves all the time. Earlier, it is subtler. It can be detected by a basic diagnostic procedure called “two-point-discrimination tests.”

  * * *

  Get two pins, and a ruler with millimeter markings. Touch the skin in various parts of the body with the two pins held apart at varying distances to see how close together the points must be before you feel the stimulus as a single point, not two. Different parts of the body should have different degrees of sensitivity, and, no, the fingertips are only the second most sensitive organ. First are the lips and tongue, a rather nice piece of work by the Almighty, who, after all, puts great emphasis on the perpetuation of the species, if you get my meaning. In general, the lips and the tongue should be able to discriminate between points that are 1 millimeter apart. Next, the fingertips: 2 to 8 millimeters. The toes: 3 to 8 millimeters. The palm of the hand: 8 to 12. The chest and forearms: 40. The back: 40 to 70. The upper arms and thighs: 75. Keep experimenting with distances. In these normal ranges, if you consistently feel two pinpricks as one, you might have peripheral neuropathy. Not a good thing to have. This could be evidence not only of Lyme disease but of any number of other serious conditions, including diabetes, AIDS, and poisoning by arsenic or cyanide. Impaired two-point discrimination can also signal damage to the spinal cord typical of multiple sclerosis.

  Still unsure? Take off your shoes and socks. Have someone take a small bluntly pointed object, like a swizzle stick, and scrape it lightly down the sole of your foot, from the heel to the base of the little toe, and then across to the ball of the foot. Your toes should clench, which is called the plantar reflex. If they don’t, it could indicate peripheral neuropathies. Sometimes you get an opposite reaction, in which the toes extend upward and the big toe fans out. This is called a positive Babinski sign, and it is often bad news. It suggests some disease or breakdown in the motor pathways of the central nervous system.

  Other simple tests can detect basic neurological problems:

  Lie on your back. Take the heel of one foot and place it on the opposite knee. Run the heel down the center of the leg, staying on the shinbone. This is called the heel-shin test, and it is a surprisingly sensitive way to detect early disease of the cerebellum, the portion of the brain that controls equilibrium and volunta
ry muscular activity. Your heel should be able to stay to the middle of the leg without deviating to the sides or showing hesitant, herky-jerky motion. Cerebellar disease eventually may result in an unsteady gait and, ultimately, inability to walk. Among the conditions that sometimes can be diagnosed with this test is … Creutzfeldt-Jakob disease!

  Sit on the edge of a bed or table that lets your legs swing free. Have a friend take a small hammer and tap you lightly but sharply on the knee, about a half inch below the lower edge of the kneecap. This is, of course, the famous patellar reflex. Most people think that if there is a muscle reaction, it is good. That is not necessarily so. Your foot should swing forward, but just a little. A very strong reaction—say, if you kick your friend’s teeth in—is not good; it suggests some lesion in the brain or spinal cord. No reaction at all suggests that you are a professional ballet dancer who goes on pointe, or that you have peripheral neuropathies, or, most likely, that you did the test wrong. And an opposite reaction—the foot swings backward—is symptomatic of a tumor or other injury to the lumbar portion of the spinal cord.

  One last test. This will seem familiar. Go to a mirror, put a Popsicle stick in your mouth, press down on your tongue, and say “ahh.” You probably thought doctors did this to inspect your tonsils. Sometimes they are checking for the proper operation of your cranial nerves.6 Your uvula is supposed to rise a little, and vibrate, but remain in the center of the throat. If it moves to one side or the other, it suggests a disorder involving the vagus or glossopharyngeal nerves. This can indicate a brain tumor or a stroke.

  * * *

  And now, some important commonly asked scientific questions about the brain and central nervous system.

  During the Reign of Terror, when someone was guillotined and his head plopped off into a wicker basket, and some French revolutionary, drunk on power and revenge, held the head up by the hair in front of a ravening crowd of semiliterate blood-thirsty keening yeehaws with bad teeth, might there have been a few horrifying seconds when the head was still conscious and saw this happen?