The Hypochondriac's Guide to Life. and Death. (27 page)

My point is, you might wish to keep an eye on your stools.

Whether we admit it or not, we all sneak a peek into the toilet bowl, at least briefly. It is human nature. The hypochondriac will linger a bit. The human body does not offer too many opportunities for people to examine their biological exudates; a hypochondriac would pass up this chance about as often as a paleontologist would walk past a fibula sticking out of a creek bed.

I asked Dr. Orkin for his advice on what to look for in stools, and he said: “Blood.” Then he added, “Also, little squirming things.”
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Other signs are subtler:

Pencil-Thin Stools.
A bad sign if they persist over time. If they are unaccompanied by other symptoms, this suggests a narrowing of the intestine, possibly caused by cancer of the rectum or sigmoid colon.

Black Stools.
If they are the color and consistency of tar and smell kind of metallic, this can mean bleeding in the upper gastrointestinal tract. Suspect stomach cancer, duodenal ulcers, inflammatory bowel disease, or embolisms or thromboses in the blood vessels of the gut.

White Stools.
Often described as being the color of aluminum, persistent pale stools suggest your body is not secreting bile, which gives poop its brown color. You want white stools to be accompanied by pain, because that would
probably mean you have gallstones causing an obstruction of the common bile duct; that is treatable by simple surgery. Persistent white stools without pain can mean pancreatic or duodenal cancer, or cancer of the bile ducts.

Maroon Stools.
Particularly if they are of pasty consistency, maroon stools suggest bleeding in the lower intestinal tract, possibly caused by colon cancer or diverticulosis. Diverticulosis can sometimes require a colostomy or, in serious cases, removal of the entire large intestine.

Sinkers Becoming Floaters.
Yes, there is medical significance to this preschool obsession. If your stools used to sink and now tend to float, it could be a problem. Stool that floats has more fat in it than stool that does not float. Something is causing malabsorption of fat. If you are in pain, it could be an obstructed bile duct or pancreatitis. Without pain, suspect early pancreatic cancer or a diffuse lymphoma of the small intestine.

Gargantuan Stools.
This can be one sign of megacolon, in which the large intestine swells up like the
Graf Zeppelin.
The rectum becomes a stern sentry; nothing passes without a struggle. Constipation can be profound, the stools large and hard. Megacolon with constipation tends to indicate a neurological disorder or possibly Chagas's disease, caused by infection by a protozoan. Chagas's disease can eventually cause a total body breakdown, affecting the heart and brain. A final symptom, as listed dispassionately in medical texts after “fever” and “myocarditis” and “ischemic chest pain,” is “sudden unexpected death.”

No chapter on pooping would be complete without a passage on the passage of gas, and no chapter on the passage of gas would be complete without an interview with Dr. Michael D. Levitt. Dr. Levitt is chief of research at the Veterans Affairs Medical Center in Minneapolis and professor of medicine at the University of Minnesota, and he is the world's leading expert on the subject of farting. I got him on the phone. The very first thing Dr. Levitt told me is that he is famous, and so I worried that he would be a little stuffy, especially when he began listing his credentials.

“I took a fellowship in gastroenterology with Dr. Franz J. Ingelfinger, which is a good name for a gastroenterologist, if you see what I mean. We called him ‘the Finger.' He was famous. I realized no one was studying intestinal gas, so you didn't have to do anything particularly good to get published.”

I stopped worrying about Dr. Levitt being stuffy.

In a long and distinguished career, Dr. Levitt has published dozens of articles on intestinal gas, including “Floating Stools: Flatus vs. Fat,” and what some might consider his masterwork, “Studies of a Flatulent Patient,” which chronicles the gas output of one twenty-eight-year-old man who averaged 34 flatulations a day, plus or minus 7, with a standard deviation of 1.
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A gas chromatograph was used to do detailed chemical analyses. This article was published in the prestigious
New England Journal of Medicine
and includes many footnotes and citations of the work of distinguished doctors, including Michael D. Levitt and Hippocrates.

Dr. Levitt was the first person to figure out a foolproof way to measure the chemical content of intestinal gas: “This is how I got famous,” was how he put it. He figured out that since gas is absorbed by the large intestine, and the blood goes into the patient's lungs, “if you sample someone's breath, you can analyze the gases in his intestine.”

In other words, we breathe what we fart?

“Well, yes.”

Wow.

Dr. Levitt is also the inventor of the Mylar pantaloons, which are baggy, airtight pants that may be worn for purposes of analyzing flatulence. They were sewn by Dr. Levitt's wife, Shirley, who is the Betsy Ross of intestinal gas research. Dr. Levitt's Mylar pantaloons were used to spectacular success in one test of a commercial product, a fart-absorbing seat cushion. Dr. Levitt's tests proved conclusively that this product worked as advertised.

What is the medical significance of all this?

Passage of gas, Dr. Levitt said mournfully, “is virtually never indicative of serious disease.”

So, farting isn't important?

“Right. I am constantly trying to find out why it is important.”

But why does he spend so much time studying the field?

“it's a good question. Maybe on my deathbed I will wish I had studied cancer.”

The interview was going handsomely, I thought, but something was bothering me. This book is ostensibly about hypochondria, and hypochondria thrives on the fear of serious disease. If farting does not suggest serious disease, why should any of this be of interest to the hypochondriac?

Dr. Levitt tried to help. He said he has conducted studies suggesting that lactose intolerance is a lot of hooey, that people who have been diagnosed as lactose intolerant might well be hypochondriacs.

Big deal.

I could tell Dr. Levitt was holding back, so I said nothing. It's a trick journalists use. Bob Woodward and I are particularly good at it. Sometimes if you just dummy up, your source will get uncomfortable and start babbling to fill in the silence. Sometimes, if he's got a secret, he coughs it up.

Two seconds passed. Four.

“Right now,” Dr. Levitt finally said, “the love of my life is sulfur gases produced in the colon.” Sulfur gases are what make farts smell bad. “I am in love with the idea that overproduction of gases causes problems.”

Problems? What problems?

“It's still theoretical,” he cautioned.

Noted.

“Well, ulcerative colitis.” Ulcerative colitis is an awful illness that burns and scars your intestines. It holds you hostage to its pain. It can make you a lifelong invalid. Dr. Levitt said that when you analyze the rectal output of people with ulcerative colitis, you find excessive hydrogen sulfide gas, “enough to kill twenty-five mice!”

And?

Hydrogen sulfide is a toxin, he said. Toxins cause disease. His voice got a little theatrical. What if, he said, the hydrogen sulfide is not a
byproduct
of ulcerative colitis? What if it
causes
ulcerative colitis?

Is that possible?

“I am working on it.”

But wait. Gas is absorbed into the blood from the intestines. He, Michael D. Levitt, established that many years ago, with the famous breath-fart experiment. Might it be possible that hydrogen sulfide is reabsorbed into the body and causes other diseases?

“It is possible,” Dr. Levitt said. “People don't like it when I speculate on that, but I speculate on that.”

The phone line crackled. Was it a bad connection, or the electricity of the moment? “Once they are in the blood, gases go to the liver, and then to the lungs, where they are cleared,” Dr. Levitt said. Theoretically, he said, they could cause disease to either organ.

What sort of diseases?

Anything, he said, that attacks the liver or the lung.

B-but that could be …

“Exactly.”

Farts might cause cancer.

1
The editors at big, gray newspapers like
The New York Times
try mightily to maintain a sense of decorum and stiff formality, even at the risk of sounding hopelessly fuddy-duddy, such as by referring to Snoop Doggy Dogg as “Mr. Dogg.”

2
The story quotes a doctor who specializes in this problem. His name is Dr. Ikeshita.

3
The sounds of babbling brooks, chirping larks, etc. Wouldn't it be great if every fifteen minutes or so the Sound Princess emitted an EXTREMELY LOUD fart?

4
The World Almanac
provides a terrific antidote to sugary we-are-the-world fantasies. We are not the world. The world is dorky. In Equatorial Guinea, the two main ethnic groups are the “Fangs” and the “Bubi.” The leader of Gabon is “President Bongo.” The entire economy of Djibouti is listed as “salt.”

5
Am I the only one who has noticed that the British novelist John Mortimer, known for his urbanity, created a detective whose name, basically, is Rump Hole?

6
I recently learned there is an actual answer to this: Toilet paper squares are small not because anyone is expected to use just one but because some people use two, and some use three, and this is the only way of accommodating both types of clientele. Seriously. Entire scientific studies have been done on this by the toilet paper industry.

7
There is something about this story that propels normal, decent people into uncharacteristic excesses of sophomoric humor. When I showed it to my friend Pat, who is a Sunday school teacher, the mother of two young children, and an authority on the proper use of the English language, she said, and I quote: “Kind of gives new meaning to the term ‘shitting a brick.'”

8
Note to deodorant manufacturers:
Consider handgrip.

9
Giving rise, presumably, to the term “boner.”

10
This is not a recent development. In a pioneering 1934 thesis, famed British colorectal surgeon J. P. Lockhart-Mummery dryly pointed out that any object that can be inserted in the rectum has, at some time, been removed. Lockhart-Mummery dealt delicately with the subject. Autoeroticism was not mentioned; he accepted the patients' explanations for their predicament, including attempted relief from itching and accidents of a most unfortunate nature (“I was gardening naked when …”).

11
Want to play a great trick on a hypochondriac? Get a couple of night crawlers and put them in the toilet tank before he goes into the bathroom. The last thing he will see after flushing are two enormous worms swirling down the drain.

12
A normal output is 10 farts a day, with a standard deviation of 5, Dr. Levitt says. “So up to twenty a day can be considered normal.” The known medical record is 155 farts in a day.

Is Death a Laughing Matter? Of Corpse Not.

T
he meaning of life is that it ends.

You know those signs that say, “Bridge Freezes Before Roadway”? Did you ever wonder what that meant? I found out one day in 1979, when I was driving over a bridge in Lansing, Michigan, in a light drizzle just as the temperature dropped from thirty-three degrees to thirty-two. Instantly, my car was a hockey puck. It spun out and bumped to rest against the guardrail. There was zero traction. Tires wailing, I could not free myself.

I sat there, feeling stupid, when suddenly I saw over my shoulder a City of Lansing truck coming in my direction on the bridge, spreading sand. Good, I thought. Then I realized that the truck, about the size of a big-city garbage truck, was
also
a hockey puck. Shit, I thought. I could see the driver's face. His mouth was agape and his eyeballs were boinging out like golf balls on Slinkys. He was moving about forty miles an hour, barreling right at me. My car was a 1978 Dodge Colt, which is approximately the size of a Saint Bernard.