The Hypochondriac's Guide to Life. and Death. (21 page)

But by and large, proper body morphology remains a function of weight.

A few months ago, the medical establishment released a new Optimal Weight Chart, replacing the old system of height and weight with a more complex computation of body mass. This chart appears to have been drawn up by pissed-off feminists. Under these new criteria, perfectly healthy, normal men with slightly stocky bodies—say, your average major-league catcher—are computed to be overweight. Meanwhile, short women get a break. Madeleine Albright is not defined as fat even though she is built—and I do not mean this unkindly—exactly like a scoop of mashed potatoes.

I preferred the old-fashioned weight chart, and urge readers to stick with it:

To determine your bone structure, empty a twenty-four-ounce jar of Hellmann's mayonnaise and attempt to place your left hand inside. If it fits easily, you are small-boned. If it does not fit, you are large-boned. If it fits but you cannot remove your hand, you are medium-boned. To remove jar, strike crisply on the edge of a sturdy piece of furniture. If necessary, treat cuts and abrasions with a mild antiseptic to avoid clostridial myonecrosis, also known as “gas gangrene.” This is a sudden, sullen, raging infection that attacks open wounds. It causes intense pain, fever, and swelling. The skin turns white and stinks. It oozes brown liquid. If it is untreated, stupor and delirium follow, rapidly progressing to coma.

The coroner will note you were “medium-boned.”

Snap, Crackle, and Plop (Minor Aches and Pains That Can Kill You)

The other day
I was speaking to a colleague of mine, a talented and vastly accomplished professional who, in less enlightened times, might have been described as having excellent hooters. She is one of those women who make it necessary for decent men in the workplace to learn an unnatural method of communication, in which one focuses the entirety of one's apparent attention on the eyes and chin, as though the person to whom you are speaking were a severed head attached to life-sustaining devices.
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Like all old, plug-ugly guys, I was using what few meager tools I had to hold her attention—my wisdom, my urbanity, my ability to send this woman on an assignment to Paris if I chose. Things
were going swell. Then I made a monstrous error in judgment. To emphasize a point, I stood up.

At the last minute I sensed what was about to happen, but it was too late to stop.

As my behind lifted from the seat, my knee bones began popping like Rice Krispies in seltzer, like bubble wrap being stomped by an epileptic giraffe. I was halfway to my feet, committed. Suddenly aware that I needed to support my ascent with my forearm or risked collapsing back into my seat, I pushed down on the armrest of my chair, causing my elbow to lock, as it sometimes does. This required me to slowly rotate it outward, as though I were performing the disco duck at the bottom of a swimming pool. In so doing, I accidentally knocked off the bookcase and onto the floor a paperweight that is a realistic rubber replica of a prostate gland.
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Smiling gamely, I bent to retrieve it. Because I am no longer supple enough to bend from the waist, I assumed the junior high school squat-thrust position. Thus situated, I found myself at my colleagues feet, looking up. I said something I hoped was erudite. It might as well have been “ribbit.” We would never have Paris.

Medical science has a term for the popping and snapping of aging bone and cartilage. It is called “crepitus.” (“Crepitus” also happens to be the official medical term for expulsion of gas from the anus. Medical science can be cruel to the elderly.)

Orthopedics offers mostly discouraging news for the aging, but it is the one area of medicine where I did not expect to have bad news for hypochondriacs. Hypochondriacs thrive on ambiguity. In orthopedics, the problems tend to be straightforward. My friend Steve, for example, is an orthopedic surgeon whose practice is in Colorado, not far from the ski slopes. There is not a huge amount of subtlety in his line of work: People walk in with bones sticking straight out of their stomachs. Even non-ski-related
injuries tend to be easily diagnosed. Recently, a guy arrived at Steve's office with an arm problem. The arm arrived separately, in a garbage bag.

Orthopedists anticipate simple, obvious explanations, but sometimes even they are surprised. A pain in the shoulder or above the knee usually is nothing terribly serious. But every once in a while it turns out to be an osteosarcoma, which is a virulent tumor of the bone.

One of the more common complaints an orthopedist fields is lower back pain, and usually this is caused by a muscle strain or a damaged disk in the lumbar portion of the spine. This would be relatively good news. Other causes of lower back pain are tumors of the pancreas or kidney. Those would be worse news. But the worst thing, and it happens from time to time, is metastatic cancer: a malignancy that has spread from another organ, usually the lung or prostate gland or breast. Sometimes you don't know you have these other tumors until they ride the blood to the bone in your spine. The bone grows amok. It starts strangling the spinal cord. By the time you experience the first twinge in your back, it is often too late.

Occasionally, orthopedists will deal with a persistent pain in the lower back or pelvis that is not a simple strain, and not a disk problem, and not a fracture, and not a tumor. It turns out to be the first sign of Paget's disease, an infection that causes abnormal bone growth. It can be particularly evident in the head and face. Your hat size increases. Your features coarsen. You scare young children. You limp. Your bones snap like those oily wonton-soup crackers that, to my knowledge, have no official name.
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Paget's disease squeezes important nerves. It can make you deaf. It can make you dizzy. It can sometimes make you dead.

Mostly, though, orthopedic surgeons do not make complicated diagnoses. They take pride in the homely tools of their craft. They work with drills and saws and screwdrivers. They are humble carpenters who happen to own vacation chalets in Zurich.

Diagnosis of musculoskeletal problems often falls to the noble, harried general practitioner, the only doctor who typically gets to know his patient over months and years.
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This familiarity is important in diagnosing problems like arthritis or rheumatism because these conditions often develop slowly, over time, and people tend to accommodate them by slightly altering their habits. It is like having the brakes in your car slowly fail. You compensate. You start braking a little early. Then you learn to tromp down with both feet. Pretty soon you are veering into shrubbery to slow yourself, and still nothing seems awry. Eventually, you lend your car to your cousin Margaret and she drives off an escarpment.

It is that way with musculoskeletal problems. They tend to sneak up on you.

And so doctors look for subtle behavioral signs of deterioration. They listen for grunts and moans the patient may inadvertently make when performing routine physical activities. Textbooks on physical diagnosis devote pages to recognizing the warning signals in patients who are getting older and may be contracting arthritis or other connective-tissue disease. The list below is adapted from several medical-text sources. It is a scary list, not because it contains terrifying signs but because it doesn't. Everything seems so … ordinary.

After finishing this list, I spent several hours putting on sweaters, getting up from tables, tying and retying my shoes, taking off my pants, forgetting to put them on and alarming the Federal Express man, etc.

Once you know what to look for, if you are inclined toward worry, every motion you make becomes suspect. There are relatively few reliable tests that can help the diagnostician.

If your doctor suspects hip fracture or dislocation, he may ask you to take your underpants off and stand on one leg. Assuming he is not just having fun at your expense, he is checking for Trendelenburg's sign: With a healthy pelvis, the buttock above the raised leg should be held higher than the other buttock. Persons with breaks or pelvic bone disease cannot do this.