The Hypochondriac's Guide to Life. and Death. (14 page)

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,”
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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

1. These were British cows.
   

2. No one outside England seemed to be sick.
   

3. 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.
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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 voluntary 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.
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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.