The Hypochondriac's Guide to Life. and Death. (16 page)

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.