The Hypochondriac's Guide to Life. and Death. (20 page)

Pain in “Love” (Upper-Left Quadrant, Near the Heart)

1. Ruptured or inflamed spleen.
   Look for pallor and intense pain that worsens when the foot of the bed is elevated. Also, pain at the top of the left shoulder. The spleen usually ruptures because of physical injury, but it can become inflamed and painful for many scary reasons.
   Tumors can cause an interruption of blood flow to the spleen, causing the death of tissue. A swollen spleen can be a symptom of dozens of treacherous diseases, including leukemia, lupus erythematosus, Hodgkin's disease, polycythemia rubra vera, which attacks the bone marrow, and amyloidosis, a mysterious illness that leads to tremors, fainting spells, heart failure, and death.
   

2. Aortic aneurysm,
   a ballooning of the wall of the thoracic branch of the body's largest blood vessel. Look for accompanying lower back pain; if this aneurysm ruptures, the pain will become explosive. You are rushed to surgery. It is usually too late. Most victims die from internal hemorrhage.
   

Pain in “Hubris” (Upper-Right Quadrant)

1. Liver disease.
   Could be cancer or hepatitis, or sometimes both. With hepatitis, look for fatigue, jaundice, lack of appetite, and what medical books cheerfully call “cola-colored urine.” By the time liver cancer is diagnosed, it has often spread to or from other body systems, and in that case you are a goner.
   

2. Cholecystitis,
   an inflammation of the gallbladder. Can be caused by gallstones or infectious disease. Look for relentless pain, vomiting, fever, aching near the shoulder blade.
   

3. Leaking duodenal ulcer.
   Look for episodic gnawing pain, heartburn, belching.
   

Pain in “Impulsiveness” (Circle Below the Breastbone)

1. Perforated stomach ulcer.
   Suspect it where there is a history of long-term stomach pain characterized by a dull, burning ache two to three hours after eating. Suddenly this will yield to excruciating pain, cold sweats, gray pallor, vomiting. Untreated, it can lead to peritonitis and death.
   

2. Acute pancreatitis.
   Look for knifelike pain that seems to bore straight through to the back, and sometimes radiate to the top of the left shoulder. The central pain will later migrate south and toward the right. Sitting and leaning forward lessens the pain. Sometimes the navel dimples inward.
   

3. Pancreatic cancer.
   Look for weight loss, depression, jaundice, pain in the lower back. Pancreatic cancer has a very, very bad prognosis by the time pain has developed; it often spreads to other systems before it is diagnosed.
   

4. Stomach cancer.
   Look for a steady ache, radiating to the back.
   

5. Volvulus,
   a twisting of the intestine on itself, like a Boy Scout's half hitch. Look for pain at the lower reaches of this region, with abdominal distension, nausea, vomiting. This can also kill you if not caught in time.
   

Pain in “Bad Clams” (Lower-Left Quadrant)

1. Diverticulitis,
   an infection and inflammation of pouches in the large intestine. Look for flatulence and stomach rumbling.
   

2. Colon cancer.
   Look for severe constipation preceding the pain.
   

Pain in “Kissing a Wall Socket” (Lower-Right Quadrant)

1. Appendicitis.
   Aching pain, nausea, vomiting, extreme tenderness when one finger is pressed down on the so-called McBurney's point, which is about six inches directly to the right of the navel. Over the previous few days, the pain will have migrated down and to the right, from a few inches below the breastbone.
   

2. Regional ileitis (Crohn's disease).
   Look for severe pain following diarrhea. This is a debilitating condition of unknown
   origin that often requires surgical repair of the intestine, and sometimes a colostomy.
   

Here are answers to some commonly asked questions about the abdomen.

Can you die of stomach pain?

Yes. Anton Cermak, the mayor of Chicago, was shot to death in Miami in 1933. His assassin, Giuseppe Zangara, told police he had been crazed from the pain of an upset stomach. So, in a sense, Mayor Cermak died of stomach pain. Just not his
own
stomach pain.

I just had a large, greasy meat at Earl's House of Undercooked Poultry. I have a terrible stomachache and nausea. Might I have ptomaine poisoning?

No. There is no such thing as “ptomaine poisoning.” Ptomaines are nitrogen compounds that are released by rotting meat, and they were once thought to be poisonous. They are not; in fact, ordinary digestion produces ptomaines in the body. There is probably rotting meat in your intestines right now. I don't know how people can go about their lives knowing that inside their intestines are things that could make a vulture puke. Or what about food in the mouth? How's
this
for a foolproof diet: Every ten seconds during a meal, you are compelled to open your mouth, look in a mirror, and observe the contents before you swallow. How come no one has ever proposed
that
diet?

What is the scariest thing that abdominal pain can mean?

I am not sure I should reveal that. Hypochondriacs might get alarmed.

Oh, c'mon.

OK. Sometimes a person—usually a man in his thirties, forties, or fifties—will feel a dull ache in the “Hubris.” He will ignore it. It isn't very severe, and he is a tough guy. Soon he will find that he has a rather
nice suntan, even if he isn't out in the sun much. Still, no cause for alarm; this may actually please him. If he is a black person, his skin may lighten, turning a handsome brown-gray, like Ossie Davis. Months or even years may go by Then the man notices pain in the joints. He starts getting lethargic. Maybe his thinking gets a little confused. His heartbeat becomes irregular. He goes to a specialist. Maybe a cardiologist, for the heart symptoms. Or a rheumatologist, for the joints. Or a gastroenterologist, for the abdominal pain. Or a neurologist, for the mental confusion. Or a dermatologist, for the skin changes. Each specialist suspects and tests for some disease with which he is familiar. Nothing checks out. Months pass. Medical books liken this process to the blind men and the elephant: Everyone sees what he expects to see. No one sees the big picture.

Finally some doctor orders the right test and discovers the patient's blood has more iron in it than the
Lusitania.
The diagnosis will be hemochromatosis, a poisoning of the body by iron overload. It is inherited, but it can be in your family and you might not know it.

Untreated, hemochromatosis can affect virtually every organ in the body. Your knees freeze up with arthritis. Your hips can get deformed, so you walk like a penguin. You get so tired you fall asleep anywhere, in the middle of anything. Your testicles atrophy and you become impotent. Your body softens and loses hair, and you start to look like a woman.
4
Your heart palpitates wildly. You get easily out of breath. Your skin erupts in terrifying spidery bruises. You eventually die of liver cancer, or of painful, suppurating peritonitis, or you bleed to death from ruptured esophageal ulcers.

That's horrible!

No,
this
is horrible: Hemochromatosis is completely treatable if it is caught early enough. Every week or so you get some of your blood
drained away, and it eliminates the problem. But it is sometimes not caught early enough. Too many doctors wasting too much time.

Fortunately, in the 1980s general practitioners started wising up and catching hemochromatosis because they began ordering iron tests as part of routine blood workups. Unfortunately, in the 1990s some HMOs and other superstingy medical insurers have stopped paying for this test.

In short, look for a spike in the number of cases of runaway hemochromatosis. It will be a sharp spike. It will be made of iron.

1
This is exactly like kissing. If you keep your eyes open when kissing, it means there is something wrong with you. I learned that as a teenager, when I violated the rule and got nailed by my date. She chewed me out. Kissing with one's eyes open, she informed me, was an unmistakable sign of sexual predation; I was a rapist in training. Years passed before I realized that one can be caught at this transgression only by someone who is also kissing with her eyes open. By then my date had become a lawyer. I let it slide.

2
Another is the “pump fake” in football.

3
Not that he is infallible. Used to be, if you had a stomach ulcer, doctors disdainfully concluded you were the “ulcer type,” the sort of feeb who alphabetizes his bookcase and wears tie tacks and makes his bed with hospital corners. You were gently steered toward psychotherapy, and maybe encouraged to find a less stressful job. Now it turns out that more than half of all stomach ulcers are caused by a microbe,
H. pylori.
Your ulcer is probably no more your fault than is an earache, and just as curable. You feel pretty good about this, sort of exonerated, except you have left your job as an investment banker for a career in large-appliance repair.

4
As distinguished from an arrhenoblastoma, which is a rare ovarian tumor that turns a woman into a man. She gets a deep voice, thick facial hair, flattened breasts, and a rather unnervingly large clitoris.

Are You Too Fat? Yes. (I Mean,
Look
at You.)

Usually, medical science
is guilty of overcomplicating the simple. But sometimes it oversimplifies the complicated. A case in point is weight control. Medical books and popular health magazines inform us that if you are overweight, it is better to be an pear than an apple—that people who are large of chest and belly have greater incidence of heart disease and diabetes than people built like teardrops.

To find out whether you are apple shaped or pear shaped, take the circumference of your waist one inch above the navel and divide it by the circumference of your hips at the widest point. A normal reading is from 0.7 to 0.85. A higher figure indicates apple obesity; a lower figure indicates pear obesity.

The apple—pear distinction may be true, but it is woefully incomplete, and discriminatory against the differently bodied. What if you are neither an apple nor a pear? Here is an updated list that recognizes and celebrates diversity.