The Hypochondriac's Guide to Life. and Death. (25 page)
Read The Hypochondriac's Guide to Life. and Death. Online
Authors: Gene Weingarten
“My advice is to stay out of bars.”
Karl got the surgery.
5
In the last few months, I have been reading extremely complicated medical books, and I must say that as a professional editor, I find them frustrating. These books were written by doctors, not writers, so they have no sense of pacing, character development, or drama. Here is a small example: Several sections on ophthalmological diseases point out that it is possible to contract gonococcal conjunctivitisâbasically, gonorrhea of the eyeâfrom contact between your eyeball and your partner's infected genitalia. That's it. That's all the detail they supply! Then they go on to something else! This would be like ending
Casablanca
before Rick tells Louis whose names to put on the letters of transit. The credits would be rolling, Ilse and the weenie Victor Laszlo would
be standing around in that phony fog, and everyone in the audience would be saying, “Huh? Wait a minute! Do some people have sex with their eyeballs?”
The single most common complaint about the eye involves “floaters,” which I dealt with briefly in
Chapter 6
. Floaters move sluggishly across your field of vision, halfheartedly trailing the play, like the fat kid in the defensive backfield. They are almost always no cause for concern, unless you suddenly notice an increase in them. A sudden increase in floaters can mean your retina is detaching, or it could be the first sign of retinitis, an early complication of AIDS.
Even though ophthalmology is one of the most sophisticated medical specialties, involving the use of high-tech futuristic equipment one would expect to find on the assembly line at Spacely Sprockets, there are a number of decidedly low-tech physical tests that can be used in basic diagnosis. To the practicing ophthalmologist, these would seem horribly primitive; asking him to perform them would be an insult, like asking the chief justice of the United States Supreme Court to represent you before Judge Judy.
Even though these tests seem to work.
Let's say you have noticed a slight deterioration in your visual acuity. If you go to an ophthalmologist, he will perform various tests on you, some of which require him to dilate your pupils so you look like Little Orphan Annie. A far simpler test exists that can quickly indicate whether your vision problem is simple or potentially more troublesome.
Take a thin piece of cardboard. Make a pinhole in it. Now look through the pinhole without glasses or corrective lenses. If your vision problem is due to simple refractive errorânearsightedness or farsightednessâyour eyesight will improve slightly when you look through the hole: You need glasses, or a change in your current prescription. This is because the pinhole blocks light waves coming in from the sides, which are the light waves that are most subject to distortion by a lens. But if your eye-sight does not get any better when you peep through the hole, this is
a sign of more serious problems, like neurological impairment or, more likely, the beginning of macular degeneration, which is a slow deterioration of the center of the retina. Eventually, to see anything at all, you will have to try to look away and catch a glimpse of it at the periphery of your vision. This is not easy. A 1977 Chevy Nova, for example, might resemble a water buffalo.
One of the initial signs of problems with your thyroid gland, or a sign of a tumor in the nasal sinuses, is a condition called proptosis, which is a bulging of the eyeballs. This happens so gradually you may not recognize it. After a while you will just seem a little startled all the time, like Loni Anderson after a recent face-lift. There is a complex device called an exophthalmometer that doctors use to measure eye bulge, but a far simpler, ancient diagnostic test seems to work quite reliably. It is called Joffroy's sign.
Tilt your head down, to look at the floor. Now, without moving your head, look up toward the ceiling. Your forehead should wrinkle. If it does not, you may have proptosis.
Have your eyes been hurting? Are they red? The good news would be conjunctivitis, which is a relatively minor infection treatable by pharmaceuticals. Worse news would be glaucoma, an increase in pressure within the eyeball that can ultimately lead to blindness. You might also have a serious condition called anterior uveitis, an inflammation of the iris and surrounding tissues. This also makes your eye hurt. If you suspect it, try this:
Close the eye that seems to be worse. Shine a flashlight into the open eye. If you feel pain
in the closed eye,
that is a positive sign for anterior uveitis. This is called the Au-Henkind test, and it is said to be nearly 100 percent reliable.
Anterior uveitis has many causes, but it can be an initial sign of awful diseases, including ankylosing spondylitis, which is, literally, a huge pain in the ass. Ankylosing spondylitis attacks in the buttocks, then spreads up the spine. It can create crippling deformities. Anterior uveitis can also signal Behcet's syndrome, which leads to fiery ulcers of the mouth and genitals, and sometimes arthritis, phlebitis, encephalitis, arterial disease, and fatal pulmonary embolisms.
That's the alarming thing about the eyes: Eyes depend on the proper functioning of a delicate lattice of capillaries, and therefore various systemic illnesses that affect the blood can show up there first. Almost every symptom can mean either a minor problem or a major problem. Isn't that exciting, hypochondriacs?
| Symptom | Most Likely Diagnosis | Most Terrifying Diagnosis |
| Red, scratchy eyes | You have conjunctivitis, a minor infection, treatable with antibiotics. | You are showing one of the first symptoms of Reiter's syndrome, a rare and mysterious condition problems and recurrent and sometimes permanent crippling arthritis. |
| Indistinct sight, particularly in the center of your field of vision | You have floaters. | You have macular degeneration. You will slowly go blind. |
| Eye discharge | You have conjunctivitis. | You have onchocerciasis, which is river blindness, caused by the bite of black flies that deposit worms in you. 6 |
| Drooping eyelid, called “ptosis” | You have a minor eyelid infection. | You have myasthenia gravis, it can turn you into flaccid goop. |
| Lump on eyelid | You have a chalazion, a papilloma, or a xanthelasma, none of which is as serious as it sounds. | You have a basal cell carcinoma or a blepharoatheroma. These are as serious as they sound. If they are caught early enough, you will survive with surgery, but your eyelid may get a little gnarly looking, like genitalia. |
| Pupils of unequal size | You have benign mydriasis, a harmless condition. | You have tabes dorsalis, usually linked to syphilis. It causes an inexorable deterioration of the spinal column. You start walking stupidly, like a drunken drum major. Then you lose control of your bladder and sexual function. |
| Double vision, with light sensitivity | You have chorioretinitis, which usually clears up. | You have botulism, which sometimes doesn't. |
| Double vision | You have a minor imbalance in the strength of the muscles around the eye. | You have an inoperable brain tumor, or a cerebral hemorrhage, or meningitis, or encephalitis, or diphtheria. |
| Cloudy vision | You have a cataract. | You have interstitial keratitis. It is a sign of many diseases, including leprosy. |
Here are some commonly asked questions about the eye:
Why do some women paint their eyelids the color of eggplants? Do they think this looks good?
This is not strictly a medical question, though the overuse of eye shadow, mascara, and other eye makeup can create corneal ulcers and exacerbate allergic reactions; this is why makeup companies must test their products by rubbing them on rabbit eyeballs until the eyeballs explode. Some men find purple eye shadow attractive. These men tend to have their first names (“Wayne”) stitched over their shirt pockets at work.
What happens to the eyes when you get to be middle aged? What is that all about?
Here is an interesting diagnostic test anyone can perform. Go to some public place, like a park or playground. Find someone who is attempting to read a book but holding it at arm's length. This person will be experimenting with different distances and squinting. He will look as though he were attempting to play a slide trombone. Then walk up to this person and say, “I bet you are exactly forty-two years old.”
7
Chances are you will be correct. This is because at almost exactly forty-two, the eye loses a certain amount of elasticity. This condition is called “presbyopia.” When my friend John Pancake was forty-eight he actually purchased
trifocals,
which leads to the obvious follow-up question:
What kind of a name is John Pancake?
This book may be tasteless, but I draw the line at making fun of someone's name. I “flatly” refuse to do so.
Remember “X-ray Specs” those $2 glasses for sale in the back of 1950s comic books that supposedly let you see through ladies' clothing? Has anyone actually invented such a product?
No one has invented such a product, nor will anyone.
Is that because no one would buy a product that would violate people's privacy in such a shameful way?
Don't be ridiculous. It won't be invented because it won't work well enough. I talked to experts in the field of sonar and infrared technology, who agreed it would be possible, and not terribly difficult, to create a visual scanner that could penetrate clothing, survey the contours of the skin below, and transmit it back to a computer, which would use an algorithm to create a realistic, skin-toned image that could be projected on a mini-computer contained within a pair of glasses. Henry E. Bass, distinguished professor of physics at Mississippi State University and director of the National Center for Physical Acoustics, estimates such a product, if it were available commercially, would cost about $1,500. No problem, for the motivated pervert. The problem is a built-in design flaw. “Pubic hair is not that much different from clothing,” Dr. Bass says. “If you are able to eliminate one, it would be hard to see the other. That's gonna be tough.”
To summarize: Fifteen hundred dollars. No pubic hair.
No X-ray Specs.
What is that pink thing in the corner of the eye? Why, in old people, does it look like worm larva?
It is called the “lachrymal caruncle.” It is one of those organs whose function is to go unnoticed for years and years until one day you really look at it, and it totally grosses you out. Another one of these is the uvula. Most people never think about the uvula, dangling in the back of the throat, bobbling back and forth unnoticed, forgotten, until some idiot makes you aware of it. Then some people become obsessed with it. They imagine they can feel it all the time, whapping against the throat, stimulating the gag function, interfering with the swallowing of food, a constant, malignant presence that CANNOT BE IGNORED AND MUST BE ELIMINATED EVEN RIGHT NOW, WITH ANYTHING YOU CAN FIND INCLUDING TOENAIL CLIPPERS OR A STAPLE REMOVER. Fortunately, this rarely occurs.