The Hypochondriac's Guide to Life. and Death. (17 page)

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.

Everyone knows the classic symptoms of a heart attack: pain below the sternum in the center of the chest, sometimes radiating to the neck or jaw or down the inside surface of the left arm, often accompanied by nausea and difficulty breathing. Many people think that those symptoms pretty much sum up the worrisome type of chest pain. Ha ha. Many people are nitwits. Significant chest pains come in many subtle variations, like fine cheeses. The thing to remember about chest pains is that on the surface they may seem as different as Velveeta and Brie, yet, by and large, in the end, they all indicate that something, somewhere, has rotted.

If the pain seems like a tightness in a band across the chest, and if it gets worse with exertion, emotion, or eating, it might be angina pectoris, known as ischemic heart disease. This is caused by blocked coronary vessels that don't permit sufficient blood flow to the heart. If the pain is steady and oppressive and hurts more when you are lying down or breathing deeply, and less if you are leaning forward, it could be pericarditis. This is a potentially life-threatening inflammation of the membrane covering the heart, which can be caused by infection or tumor or even an oncoming heart attack. If the pain is deep and crushing, with nausea, weakness, and extreme shortness of breath, it could be an embolism in the pulmonary artery, or some other serious interruption of blood flow to the lungs. If the pain is sudden and nearly disabling, feeling as though your chest is being torn open from the inside, that could be a rupturing aortic aneurysm, which basically means your chest is being torn open from the inside. Usuallv, vou die.

But often, minor chest pains mean nothing. Doctors are forever trying to tell that to the hypochondriac, without much success. A case in point is the true story of Heart Attack Holmes, a man who became famous among the young residents at the George Washington University Medical Center emergency room in the late 1970s.

Mr. Holmes was a polite man who would come in practically every weekend complaining that he was having a heart attack. He described the pain with medical precision. Each time, doctors would check him out. Each time, he was perfectly healthy.

Heart Attack Holmes was a big joke among the smart young doctors at George Washington University Medical Center. Tending to him became something of a rite of passage. He was the classic hypochondriac.

One Saturday, Heart Attack Holmes came into the emergency room and said he was having a heart attack.

And he was. Dropped dead, right on the spot.

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By the way, during a hernia exam, when a doctor says, “Turn your head and cough,” did you ever wonder why you had to turn your head? Is that somehow part of the incredibly sensitive musculovisceral response that he is feeling with his educated fingers in your groin? One day I asked the doctor why you have to turn your head. He explained: “So you do not cough on
me.”

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Speaking of which, there is a medical condition called “bitrochanteric lipodystrophy” in which most of the fat in your body is concentrated in your thighs and buttocks, which get grotesquely enlarged. The downside of this condition is that you waddle like a platypus and scare the neighborhood dogs. The upside is that on Halloween you can wrap yourself in aluminum foil, stick some toilet paper in your collar, and you make a
fabulous
Hershey's® Kiss.

Are You an Alcoholic?

Nearly two-thirds
of Americans drink alcoholic beverages, and in this health-conscious age, many of them are worried that their consumption is excessive. Studies keep suggesting that excessive drinking increases the risk of several diseases, including anemia, pancreatic cancer, oral cancer, esophageal cancer, and osteoporosis. At the same time, studies keep suggesting also that moderate intake of alcohol can actually be beneficial, lowering blood pressure, reducing cholesterol levels, preventing heart disease.

It's all very confusing. How much drinking is moderate? How much is too much? What distinguishes the normal drinker from the problem drinker? Organizations like Alcoholics Anonymous have created simple diagnostic checklists to gauge whether your drinking makes you an alcoholic. Unfortunately, asking Alcoholics Anonymous if you need Alcoholics Anonymous is like asking your kid if you need a puppy. AA's tests have a very low threshold. A typical quiz from Alcoholics Anonymous asks questions like these:

1. Do you sometimes feel “tipsy” after drinking?
   

2. Have you ever inadvertently consumed more alcohol than you intended to?
   

3. Do you ever drink alone?
   

4. Do people ever criticize you for your drinking?
   

5. Have you ever woken up with a headache from excessive drinking the night before?
   

And so forth.

You take the test and are fairly proud that you have answered “no” to most of the biggies. So you sit down to grade yourself and discover that a single “yes” answer means you are in danger of becoming an alcoholic. Two “yes” answers mean you
are
an alcoholic!

The average hypochondriac will at this point be in a blind panic; he will look up the signs of alcoholism in his extensive medical library and learn that the alcoholic has “increased mean corpuscular volume, increased gamma-glutamyltransferase, increased aspartate amino transferase, and increased low-density lipoprotein cholesterol.” He will have no idea what any of these things mean, but he will worry about them obsessively. He will suspect in himself the dreaded “beer potomania,” observed in people who drink more than eight quarts of beer a day, a condition in which you have too much water in your blood and do not pee enough, which causes “water intoxication,” which can lead to confusion and lethargy and death. He will realize he has exhibited signs of neurological weaknesses typical of alcoholics, which can include twitches that are very, very shockingly like the eyelid twitches he has been increasingly noticing since the first chapter of this book. He will strongly suspect Wernicke-Korsakoff syndrome, in which alcohol poisoning leads to a lack of thiamine in the blood, causing hemorrhagic lesions in the brain, impairing the loss of the ability to encode new information or remember recent events. Ffe will not rule out Marchiafava-Bignami disease, which is an alcohol-induced decay of the corpus callosum, at the center of the brain, first detected in chronic drinkers of red wine in Italy, causing a clumsy gait, followed by stupor and seizures.

He will not go to the doctor, because all of this is way too embarrassing, but he will relentlessly monitor himself for signs of neurological deterioration. To prove to himself that he is coordinated, he will, for the first time in his life, get out on a dance floor, where he will resemble a camel attempting to goose-step. He will constantly be checking his mental acuity, going up to total strangers in the street and saying, “It is Monday, the third of March, which is, by my calculation, the sixty-second day of the year 1997 and my mother's maiden name was Frelinghuysen.” He will contrive to attend parties in which doctors will be in attendance so he can drop lines like, “So, I was just wondering whether a runny nose might indicate excessive gamma-glutamyltransferase in the blood.”

The hypochondriac will, in fact, tear himself apart, even though his drinking typically consists of a Pabst at dinner.

I contend this worry is in itself unhealthy. I contend we need to update the drinking test to weed out the healthy, normal drinker from the genuine alcoholic and to redirect the hypochondriac to more productive worries, such as whether that occasional stabbing pain up the rectum, the one that stops all conversation, might be cancer.
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Here's a new test:

ARE YOU AN ALCOHOLIC?