The Hypochondriac's Guide to Life. and Death. (22 page)

But mostly, diagnosis of musculoskeletal problems is hit-and-miss. Blood tests are not definitive, even for arthritis or lupus erythematosus. It is precisely this subtle nature of musculoskeletal disorders that makes them particularly tempting for the hypochondriac. Diagnosis depends on a highly subjective accounting of what hurts. In short, this is the area in which hypochondriacs can be at their most creative.

Every era contains some musculoskeletal ailment that is characterized by diffuse pain, fatigue, and irritability in the absence of any clear diagnostic evidence of disease. Medical science has always given important-sounding names to these conditions. In the 1800s, patients were diagnosed with “neurasthenia.” In the early 1900s, this was upgraded to “neuromyasthenia.” In the 1930s there was “myalgic encephalomyelitis.” Now all of these illnesses are recognized as quaint artifacts from an unsophisticated past. What silly, gullible bozos we were! Now people get “fibromyalgia.”

Fibromyalgia is a trendy disease. It is growing exponentially. Fifteen years ago, it did not exist. In 1990, there were nine hundred thousand reported cases. In 1995, there were 2 million. In many ways, fibromyalgia, like AIDS, is a modern-day pandemic. Perhaps it would be instructive to compare the two ailments.

AIDS.
Strikes young, vigorous people in the prime of their lives, sapping them of energy, making them helpless in the face of opportunistic infections, leading to painful skin lesions, malignant sarcomas, neurological impairment, dementia, and death.

Fibromyalgia.
Makes you feel icky-doody.

The Fibromyalgia sufferer reports tender, achy muscles and joints. He says he has trouble sleeping. His muscles feel stiff. He is tired. He is irascible. He is depressed. He is nervous. He tends to have other vague anxiety-driven disorders, like “irritable bowel syndrome” and “chronic fatigue syndrome” Fibromyalgia doesn't get worse; it just hangs around, like a dingleberry. Also, for some blamed reason it doesn't show up on any chemical tests.

Now, it this sounds like the sufferer of fibromyalgia is a big ol' sissy, that just shows how insensitive you are. If fibromyalgia weren't a real disorder, would doctors be accepting millions of dollars in fees to treat it?

Recently I attended a meeting in Rockville, Maryland, of a support group for persons with fibromyalgia and chronic fatigue syndrome. Rather, I
attempted
to attend the meeting. There were about a dozen people sitting around in chairs, looking tragic. When I said I was writing a book, I was escorted out by a man named Aaron who looked as though he might be a funeral director or possibly a professional airline-crash grief counselor. He informed me that the group was very sensitive about negative publicity; they were afraid they would be portrayed as lazy, whining lunatics. Shocked and insulted, I solemnly assured him that I was a scientist engaged in an objective pursuit of the truth, but he didn't fall for it.

Reputable medical texts tread very, very gingerly around fibromyalgia. Some discount it altogether. Some take it seriously but note delicately that the recommended treatment includes “reassurance” and “frank discussion” and “sympathetic support.” The books do give criteria for diagnosing fibromyalgia, identifying eighteen pressure points on the body that show tenderness when pressed with a finger. Supposedly, you cannot diagnose fibromyalgia unless the patient reports pain in eleven of the eighteen points.

Interestingly, not many medical texts give a diagram of these supposed pressure points, and when they describe them they do so in highly technical language (“the left and right lateral epicondyle, the supraspinatus above the scapular line …”). I suspect
this is deliberate. Doctors know where these points are. If the hypochondriacal patient knew also, he would feel pain wherever he was supposed to.

This leads me to an interesting ethical dilemma. I know precisely where the eighteen diagnostic pressure points are. This book is supposed to be a handbook for hypochondriacs; they are my audience. They have paid for this book. I owe them something. Yet, shall I give them information that might exacerbate their affliction? Dare I tell them where they are supposed to feel pain?

After careful consideration, begun in the previous paragraph, I have reached a decision.

Here are the pressure points, explained in simple terms:

One immediately inside the point of each shoulder blade, about an inch to the left and right of the spine

Two at the precise points where the schoolyard bully used to pinch you at the top of the back of your neck

One at the very top and center of each shoulder

One beside each elbow on the outside of the body as the arm hangs at your side

One at the outside top of each buttock

One at the center of the abdomen, approximately two inches directly above the navel

One to the side of each knee on the inside portion of the leg

Two at the base of the neck just below and to the left and right of the larynx

Two immediately below and to the left and right of the indentation at the top of the sternum

One beneath the chin, directly under the center of the tongue

There. Now you have it.

Except, there are two pressure points I have not given you. And I made up two that do not exist. If you feel pain there, it will instantly alert any doctor that you are a loon.

Good luck.

1
This method of communication was first developed by men in the 1970s, when women began breast-feeding as a political act, florping out their personal apparatuses in the middle of restaurants, management training seminars, etc. Fortunately, this practice is on the decline. Now, when women wish to make male coworkers uncomfortable, they weep: copious, rolling torrents of lachrymation, loosed at ludicrously inopportune moments, such as during performance evaluations. Unlike the Breast Florp, the Sudden Weep is not easily countered by a man. There are several strategies, none of them foolproof. You have to do something dramatic to recapture the moment. Some men will wildly applaud. I start speaking in German.

2
Don't ask.

3
How about “General Tso's osteosarcoma”?

4
Among doctors, there is a distinct hierarchy in medical specialties. If medical specialties were animals, orthopedic surgeons would be ocelots or jaguars—sleek, elegant animals that might be the pets of international drug dealers. Gastroenterologists would be plow horses, wearing doofy straw hats. Pediatricians are big, friendly, drooly dogs. General practitioners are chiggers.

Why You Should Not Smoke

Medical studies
have proven statistically that smoking is linked to lung cancer, oral cancer, bladder cancer, osteoporosis, myocardial infarction, pancreatic cancer, strokes, bronchitis, esophageal cancer, high blood pressure, and for all we know, those chin moles with a single, revolting hair. And yet many hypochondriacs—more aware than most people about medical risks—continue to smoke. Why?

Possibly
because
the evidence is statistical. Ever since Ross Perot took to the airwaves with flip charts the size of queen-size mattresses, mathematically proving that NAFTA would turn us into a nation of earthworm ranchers, prostitutes, and freelance garbagemen, we have learned to mistrust statistics. We know they can be manipulated. We want facts, not figures.

Scientists haven't learned this lesson yet. They scorn so-called anecdotal evidence—individual case studies that may prove their point—because anecdotal evidence is considered unscientific, prone to being emotionalized. So they continue to publish studies that read like this—“The incidence of malignant pulmonary neoplasms, endobronchial lesions and bronchopulmonary sequestrations showed a median increase of forty-six percent in patients who have exhibited sustained alveolar exposure to products
containing nicotinated byproducts”—as opposed to this unscientific, purely anecdotal report published on May 22, 1997, and reprinted here as a public service:

GAINESVILLE, Fla. (AP)—A throat cancer patient died after setting himself on fire trying to light a cigar. He was unable to yell for help because his illness had cost him his vocal cords.

“I don't ever want to witness anything like I witnessed this morning/' said Katie Brown, sister of Abraham Mosley. ‘That will stay with me the rest of my life. He was a walking torch when I woke up.”

Mosley, 64, was taken to a hospital Tuesday after the fire but died a short time later.

Confined to a hospital bed in his kitchen, he apparently ignited strips of paper on a stove burner trying to light a cigar because his cancer left him unable to manipulate matches or a lighter. The flaming paper ignited gauze bandages that were around his neck. The fire then spread to his pajamas.

The silent seconds until the smoke alarm sounded may have cost Mosley his life, although officials said he did not have long to live because of his cancer, which was smoking-related.

Pregnant? That's
Wonderful!
Don't Read This!

Pregnancy is a mystical,
highly complicated physiological state in which the female body responds to timeless genetic imperatives by adapting itself to the arduous, totally natural though repulsive task at hand.