The Hypochondriac's Guide to Life. and Death.

by Gene Weingarten

  Yes. In 1988, scientists published the results of a study called Neocortical and Hippocampal Electrical Activity Following Decapitation in Rats, in which persons in white lab coats with advanced degrees took a bunch of rats and chopped their heads off. Then they measured the severed brains for the persistence of electrical impulses suggesting consciousness. Electrical activity continued for thirteen to fourteen seconds after decapitation. This is long enough to hum the first eight bars of “La Marseillaise.”

  What’s the story with that slashing karate chop to the back of the neck that lets the hero temporarily incapacitate the villain in old TV shows like the original Mission: Impossible? And wasn’t Peter Lupus the worst actor of all time?

  The unconsciousness-inducing karate chop is a clumsy plot device to effectuate sudden, improbable escapes. It would not work in real life; neurologists say a vicious blow to the back of the neck could conceivably cause paralysis but probably not unconsciousness, unless it also killed you. Peter Lupus is the third-worst actor of all time, after Victor Mature and the guy who played the Professor on Gilligan’s Island. The worst acting performance of all time was by Shelley Duvall in The Shining.

  Is there any neurological disease that can turn you into a sex machine? How do I get it?

  Herpes simplex encephalitis is a serious infection that can attack the temporal lobes of the brain. With proper treatment you can recover, though sometimes there is irreversible damage done to the brain tissue, and permanent memory loss. One rare but possible complication from herpes simplex encephalitis is Kluver-Bucy syndrome, in which you become “hyperoral.” You try to put everything in your mouth. You show symptoms of pica, which is a desire to eat bizarre things, such as dirt or hair or cigarettes. You also have indiscriminate sexual urges. You become a voracious, sex-crazed, humping lunatic. Cats with Kluver-Bucy syndrome will rape chickens. Humans get wildly horny. They suck and lick at your face. They squeeze and probe your body. They rub their privates against you. They have no idea that there is anything wrong with this.

  Shouldn’t a book on hypochondria deal with psychiatric disorders?

  It should. Except psychiatry is in disorganized retreat these days, with mounting evidence that the hallowed tenets and principles of psychotherapy, long considered the glorious apex of modern medical achievement, are about as valid as the theory that the earth sits on a big turtle. Sigmund Freud, the brilliant brainmaster who became the model for a thousand fictional shrinks with ludicrous Teutonic accents, is now widely regarded as Daffy the Quack. People who spent twenty years weeping out their family secrets to psychotherapists are now cured by a pill. Psychotherapists are going to work for Wal-Mart, leaving behind a pile of grease-stained inkblots.

  Are Rorschach tests discredited, too?

  Not really. They remain a reasonably reliable diagnostic tool to identify delusional or pathological thinking. The key is that the blots themselves are randomly generated and therefore meaningless. The patient must supply the interpretation, drawing from within; most of us offer benign scenarios. It is here that pathologies sometimes reveal themselves. On the following page is a typical set of random Rorschach blots. Try it yourself.

  1 At one point, I was planning to identify myself on the cover of this book as “Gene Weingarten, MD,” revealing in very fine print that the “MD” meant that I lived in Maryland. I was persuaded not to do this by my publisher, who was concerned that it might be considered somewhat misleading, causing misunderstandings, legal actions by regulatory agencies, prison terms for all concerned, and so forth.

  2 Eyelid twitching: amyotrophic lateral sclerosis, which is Lou Gehrig’s disease. You waste away and then die. Also, Huntington’s chorea, in which you become irritable and obnoxious, and then you waste away and die.

  3 Heart attack. See Chapter 11, “Infarction—Isn’t That a Funny Word? Hahahahaha Thud.”

  4 Get Out of My Emergency Room.

  5 Get it?

  6 In medical school, students learn an ancient mnemonic device to remember the names of the twelve cranial nerves: “On old Olympus’s towering tops, a Finn and German viewed a hops” (olfactory, optic, oculomotor, trochlear, etc.). Because this basically makes no sense at all, in recent years smart-ass male medical students corrupted it to “Oh, oh, oh, to touch and feel a girl’s vagina and hymen!”—which, not surprisingly, has stuck. Some of these male medical students have gone on to become pillars of their communities. In general, medical books love mnemonic devices. The best one I found summarizes the causes of urinary incontinence: Dehydration, Retention, Infection, Psychologic.

  Infarction—Isn’t That a Funny Word? Hahahahaha Thud.

  She was the kind of dame who gets your attention if you are the kind of guy who doesn’t know the difference between ecru and puce, if you get my drift. She was brainy but not mouthy. She walked last but fine, like a woman who knows how a woman is supposed to walk but doesn’t give a damn. Not that she walked like a man. A goat can’t impersonate a fish.

  She took my hands in hers. Her hands felt good. Mine felt clammy, like a clam. That’s the thing about me. When I’m nervous, I can’t think of good analogies. She took the tips of my fingers in hers and pressed on them, not enough to hurt but enough to let me know she could hurt me if she wanted to. She had hurt men, you could tell.

  We were alone in a small room with a bed. I took off my tie. I took off my shirt. She reached for me. We had sex.

  OK, we didn’t have sex, because Dr. Karen Stark is a cardiologist and it would have been totally inappropriate for us to have sex in her office, plus I was wearing one of those paper gowns that expose your behind, and I am certain Dr. Stark would have been laughing too hard to properly enjoy the experience.

  I was in her Washington office to get my heart listened to. I didn’t have a heart problem, so far as I knew. In twenty years of active, aggressive hypochondria, my heart was the only organ that I never once suspected of betraying me. When I decided to get a medical exam as part of my research, I chose a cardiologist, because I felt reasonably secure. So here I was in Dr. Stark’s office, practically daring her to find something wrong.

  She put a stethoscope on my chest. She frowned. She listened again. She said: “You have an extra heart—”

  I knew it! Suddenly, all became clear: The racing pulse in times of stress! The pounding in my ears when I climbed that pyramid in Mexico! I had an extra heart! But wait. Was this good, or bad? Maybe it is like having a dual carburetor or, holy cow, a second penis. You could be a superman, the Übermensch Nietzsche dreamed of. But what if …

  “—beat.”

  “Pardon me?”

  “You have an extra heartbeat. Everyone has a few extra heartbeats.”

  “Oh. So it is no problem?”

  “Right,” she said.

  But she wasn’t really listening. Sometimes you can tell that with a woman, particularly if she has a stethoscope on your chest and she is saying “shhh.”

  “Squat down,” she commanded.

  (Oboy.)

  “You have a midsystolic click,” Dr. Stark said at last, pleased. I had asked her to find something wrong, and she did. It is called a mitral valve prolapse. Basically, the valve between my left atrium and left ventricle is a little squishy, and when it opens and contracts, part of it squeegies through the hole and makes a click, and a lot of people have it: it is sort of a benign hernia1 of the heart, and there is probably nothing to worry about, and there is certainly no reason to run home and throw open your two hundred medical books and read everything ever written about valves, including Chilton automotive manuals.

  According to The Cecil Textbook of Medicine (twentieth edition), a mitral valve prolapse is no big deal, except for the possible development of infectious endocarditis, which is basically a rampaging infection of the heart that deposits what is known, euphemistically, as “Vegetation” inside the organ and can kill you. But—and this is a big but2—“if ventricular irritability is present, the extent of the murmur of hypertrop
hic cardiomyopathy with obstruction is much louder in the post extrasystolic beat.” I have no idea what this means, but it doesn’t sound good. Fortunately, at this point my attention was distracted by a picture of a woman who has no thumb as a result of congenital heart disease. A problem with the heart can make your thumb fall off!

  I have to stop reading these books.

  A few days after my chest exam, I was leafing through a health magazine, noticing endless lists of support groups for persons with, shall we say, cutting-edge medical conditions. There were support groups for victims of anxiety disorders and eating disorders and “pet grief” and attention deficit disorders and obsessive-compulsive obsessive-compulsive obsessive-compulsive disorders, and something called “trichotillomania,” which is defined as chronic hair pulling. And there in the middle of these listings was a support group for victims of … mitral valve prolapse! So I called the phone number that was listed and I told the woman who answered that I had a mitral valve prolapse, and she said—and I am quoting here—“I’m so sorry.” I said the cardiologist told me it was nothing to worry about, and there was a full five seconds of pregnant, patronizing silence. Finally, she spoke.

  “I faint all the time,” she said.

  See, that’s the problem for hypochondriacs. Sometimes you just don’t know whom to believe—a qualified professional like Dr. Stark or some anonymous whack job on the telephone. Fortunately, at that point I had already been cured of my hypochondria in a miracle of modern science that I will disclose a few chapters from now. So I felt faint only for a few minutes, and then it passed.

  Although cardiologists have an arsenal of sophisticated tests, such as echocardiograms, many initial diagnoses are made simply by listening to your chest, taking your blood pressure, observing your breathing, evaluating your skin tone, checking whether you have any thumbs, etc. And so it is that you can sometimes play cardiologist in your own bathroom, without the formality of eight years of higher education, sucking up to professors, gobbling amphetamines like Tic Tacs, and so forth.

  * * *

  Quick! Go to a mirror. Check out your earlobe. Is it creased? There is a surprising correlation between persons with a crease going at least halfway across their earlobes diagonally and persons who have, or are likely to develop, coronary artery disease. Coronary artery disease is not good. “Coronary artery disease” has been the leading cause of death ever since it overtook “being eaten by wildebeest.” True fact: Surviving statuary of the Roman emperor Hadrian, believed to have died of heart disease, shows just such an earlobe crease.

  * * *

  The earlobe crease is a highly unsophisticated sign, though. A far more reliable indication of heart disease is “clubbing,” an abnormal enlargement of the fingertips. That is one of the reasons Dr. Stark was pressing my fingernails—she was checking out the nail bed. Of course, she knew what she was looking for, and you do not. Fortunately for you, there is a simple test for clubbing, called the Schamroth procedure.

  * * *

  Take the middle fingers of both hands and extend them, as though you were making a rude gesture toward this book. (You can stop now.) Now place the two fingers together, parallel, back to back, knuckle touching knuckle, nail touching nail, with your right hand to the left of your left hand. (You will have to cross your forearms to do this.) Inspect the small area between the nail beds. There should be a space there, roughly the shape of an elongated diamond, or a rhombus, approximately two millimeters wide at its widest point. Got it? No? If there is no space, you may have clubbing, which can indicate any number of serious cardiopulmonary diseases, including bronchiectasis (which is an often irreversible destructive disease of the bronchial walls), or endocarditis (which is a potentially fatal inflammation of the lining of the heart), or even lung cancer (which needs no introduction). It also might mean nothing is wrong with your heart: You might have liver disease, or esophageal cancer.

  Now take your pulse, at the wrist. Then count your heartbeats for the same number of seconds. Now do it again. And again. If your pulse is consistently slower than your heartbeat, this is a condition known as a “pulse deficit.” It is an indication of heart arrhythmia. Heart arrhythmia can be benign, but it can also mean heart disease, particularly in the left ventricle, which is the main pumping chamber. To be significant, a pulse deficit would have to be constant. You would have to test yourself again and again. And again. Day and night, until you were sure. Which is ridiculous. You’re probably fine. Check it again, why don’t you?

  * * *

  If you are getting confused, don’t feel bad. The heart is highly complex; there are many confusing things about it. For example, did you ever wonder why the human heart is represented this way in Valentine’s Day cards?

  The answer is that it would look ridiculous this way:

  The fact is, the human heart and lungs are nauseating-looking organs. They swell and shrink and thump and pulse. They are filigreed with angry purple blood vessels and operate beneath membranes that are about as attractive as that slimy thing that covers your dog’s open eyeball when he’s asleep. If a spaceship landed on earth and out stepped an alien that looked exactly like a human heart and lungs, the townspeople would kill it with pitchforks. But fortunately, we do not have to look at these organs. Inside our body, they work together, medically inseparable, astonishingly efficient, to keep us alive. So, breathe easier. If you can.

  * * *

  Breathe normally and count the number of in-out breaths you take in one minute. Normal respiration is 12 to 20 per minute. Now take your pulse. The ratio of respirations to heartbeats should be approximately 1 to 4. If you are breathing more rapidly than that, it can simply mean you are showing anxiety over this test. And well you might: Sustained fast breathing, known as “tachypnea,” can indicate cardiac insufficiency, emphysema, thyroid disease, metabolic disease, and sometimes tumors in the brain stem. Unusually low breathing rates, known as “bradypnea” sometimes can signal illnesses not directly related to the lungs: incipient kidney failure, strokes or tumors in the cerebrum, or even myasthenia gravis, a debilitating neuromuscular disease that can turn you into a human beanbag chair.

  Take a deep breath, and then start counting rapidly out loud. If your lungs are functioning normally, you should be able to count to 70 or so before you need to take a breath. If you don’t get near that, your lungs may be showing diminished volume, which could indicate restrictive lung disease. This would be anything that makes it hard to take deep, full breaths, including an array of lung diseases and infections ranging from pneumonia to lung cancer to kyphoscoliosis, a malformation of the spine sometimes associated with heart disease.

  Breathe normally. Time your inhalations and exhalations. In general, each exhaled breath should take about twice as long from start to finish as each inhaled breath. If it takes significantly longer, it is a sign of obstructive lung disease, which is anything that makes it hard to breathe out, such as asthma, bronchiectasis, bronchitis, or emphysema.

  Stand up. Hold both arms straight above your head, with the sides of your arms touching your ears. Remain in that position for three minutes. If you feel stuffiness, or nasal congestion, or dizziness, this is called Pemberton’s sign, and it can mean you have thyroid disease or an obstruction in the large veins leading to the heart-possibly a blood clot or tumor.

  Place your index finger next to the shinbone about halfway between the knee and the ankle. Press in for several seconds, and release. The skin should very briefly dimple inward, but return to its normal state almost immediately. A dimple that lasts more than a second or two may be a problem. This is called edema, a fluid buildup in the tissues that can signal heart or lung disorders. A dimple that lasts a minute or more may indicate impending failure of the right side of the heart.

  * * *

  If you are like most people, your principal fear is a heart attack, or an “acute myocardial infarction.” This occurs when blood flow to the heart is interrupted, and it can result in the death of
heart muscle. In recent years, the risk of heart attacks has been reduced by various medical techniques, including angioplasty, a procedure in which coronary arteries, blocked by a buildup of cholesterol from years of eating things like ham hocks and Mallomars, are snaked out with an instrument that is, basically, a $500,000 pipe cleaner. This is a somewhat controversial procedure inasmuch as it has been known to cause certain complications, such as death.

  Death does not faze cardiologists, however. Cardiologists have embraced risk taking ever since South African surgeon Christiaan Barnard first transplanted a human heart, in 1967, in an operation that brought him fame, riches, and everlasting acclaim even though the patient died blue and gasping a few days later. Cardiologists’ resultant gung ho mentality has led to many medical breakthroughs in the last thirty years, the most dramatic of which is the development of a procedure called coronary bypass, in which blood flow is diverted from a diseased coronary artery to a healthy blood vessel grafted from elsewhere in the body. Twenty years ago this was considered a dangerous surgery. But techniques rapidly improved. People began getting “double by-passes,” involving two blood vessels, and then “triple” and “quadruple” bypasses, with surgeons competing for greater numbers of bypassed vessels until they ran out of mathematical terminology and had to start making up names, like “super-squintiple” bypass.

  Doctors are still experimenting. The big news in the heart business these days is a Brazilian surgeon named Randas Batista, who is becoming the darling of the medical world. He treats people with congestive heart failure by gouging out huge hunks of their hearts, which he keeps in his office in jelly jars. He is considered a genius.