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The Hypochondriac's Guide to Life. And Death. [NOOK Book]


When every hiccup sounds like the call of doom, each stomach pang hints at incipient cancer, and a headache means it's time to firm up your last will and testament, The...
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The Hypochondriac's Guide to Life. And Death.

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When every hiccup sounds like the call of doom, each stomach pang hints at incipient cancer, and a headache means it's time to firm up your last will and testament, The Hypochondriac's Guide to Life. And Death. provides just the relief you need. Gene Weingarten has spent his whole life immersed in the eclectic details of bizarre symptoms, self-diagnosing every minor ache as a potentially deadly disease. Weingarten examines:

  • The mind of a hypochondriac
  • How your doctor can kill you
  • Ulcers and other visceral fears
  • The snaps, crackles, and pops of your body that spell disaster
  • Things that can take an eye out
  • Interpreting DocSpeak

    Blending the neurotic anxieties of Woody Allen, the folksiness of Garrison Keillor, and the absurdist vision of Dave Barry, Gene Weingarten conjures up a hilarious prescription for the hypochondriac that lurks inside all of us.
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Editorial Reviews

Alexandra Jacobs
...[W]eingarten half merrily, half anxiously dispenses with journalistic objectivity...and fleshed out concerns about his own mortaility in detail that's not for the squemish. --Entertainment Weekly
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Product Details

  • ISBN-13: 9781451603248
  • Publisher: Simon & Schuster
  • Publication date: 6/15/2010
  • Sold by: SIMON & SCHUSTER
  • Format: eBook
  • Pages: 208
  • Sales rank: 556,549
  • File size: 4 MB

Meet the Author

Gene Weingarten
Gene Weingarten is a nationally syndicated humor columnist and a Pulitzer Prize–winning staff writer for The Washington Post. He lives in Washington, DC.
Dave Barry is the author of many bestsellers including Dave Barry’s Complete Guide to Guys, Dave Barry Turns 40 and Dave Barry Is Not Making This Up. A wildly popular syndicated columnist, Barry won the 1988 Pulitzer Prize for commentary. He lives in Miami, FL.
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Read an Excerpt

Chapter One: Are You a Hypochondriac?

We must begin by abandoning antiquated, stigmatizing notions about the hypochondriac, a person who imagines himself afflicted by disease. Like alcoholism, hypochondria is not the hypochondriac's "fault," or a moral weakness, but a disease.


To hypochondriacs, I offer reassurance: We are no longer living in an era when every little symptom signaled the onset of some dreadful condition with a goofy name, like "consumption" or "whooping cough" or "St. Vitus's dance," disorders that meant you would spend the remainder of your tragically truncated life drooling out your viscera into slop buckets. Today illnesses have really hip names like "astroblastoma, " and you drool out your viscera into state-of-the-art, hypoallergenic, FDA-approved polypropylene "viscera receptacles."

Just kidding, hypochondriacs! Good Lord, get a grip. Look out the window. Do you see tumbrels in the streets? Nowadays, nearly everything is curable. Magazines are filled with ads for cancer support groups and "empowerment seminars," with pictures of survivors who are reassuring you that one can go on to have a normal, disease-free life. Typically, these people are wearing wigs that fit like yarmulkes.

Do you suffer from hypochondria? We are all susceptible to it -- it is part of our survival instinct, imprinted in our brains from infancy. We are in our crib and our diaper is wet, so we howl and thrash and whimper, and pretty soon someone comes to help us. It is our mom. She coos to us sympathetically and slathers our behind with products that make us smell like the sitting room of a nineteenth-century San Francisco bordello. An important behavioral arc has been established: Complaint brings attention; attention brings relief.

(The more loving and attentive your mom is, the more likely you are to become a hypochondriac. This is simple anthropology. Remember Binti the gorilla, the ape whose maternal instincts were so strong she rescued an injured child? It is a little-known fact that Binti's children are sniveling pantywaists. While the other young zoo gorillas are engaged in ordinary gorilla activities such as pleasuring themselves in front of kindergarten classes and consuming one another's lice, Binti's kids are off in a corner, fretfully examining their armpits for lumps.)

As he leaves infancy, of course, the developing hypochondriac must refine the nature of his tantrums. Adults cannot continue to demand attention by fussing and mewling and smearing their excreta everywhere, unless they are professional athletes. And so the hypochondriac learns the art of suffering in silencecourageous silence, deafening silence, valiant, stolid, stoic, selfless, resolute, gloomy, lip-trembling silence, until you have to strangle him to death with the drawstring of his bathrobe.

It is easy to make fun of hypochondriacs. The hypochondriac is at war with his own body. The ordinary person will notice a slight spastic tugging on his eyelid, that rhythmic twitching we all feel from time to time, and go, "Hmm."

That doesn't happen with the hypochondriac. A hypochondriac would not go "Hmm" unless you told him there was a new fatal disease whose first symptom is the inability to say "Hmm." Then he would say "Hmm" 1,723 times a day until he got laryngitis and could no longer say "Hmm," which would of course constitute proof he is dying.

No, if a hypochondriac gets an eyelid tic, his mind will instantly race through everything he knows about twitching -- health textbooks he has read and articles he has downloaded from arcane medical databases -- and he will eventually focus on the most frightening evidence he can think of, no matter how dubious its authority, such as the scene in the movie Airplane! in which Leslie Nielsen, playing a doctor, describes the symptoms of fatal food poisoning, which begins with twitching, and the pilot, played by Peter Graves, dies farting.

So the hypochondriac will know he has been poisoned. He will call the Poison Control Center.

Hypochondriac: My eyelid is twitching once every six point four seconds.

Poison Control Person: (Pause) Omigod.

Hypochondriac: OMIGOD? (Beatbeatbeatbeatbeatbeatbeat)

Poison Control Person: Quick. You need to prepare an antidote. Do you have any anchovies?

Hypochondriac: Yes!

Poison Control Person: OK, now do exactly what I say. Make a drink of mashed anchovies, root beer, and tartar-control toothpaste...

My point is that Poison Control people are shitheads. They love to have their little fun with hypochondriacs. The whole world loves to have its fun with hypochondriacs, and I am frankly tired of it.

Listen, hypochondriacs. This hook will not insult your intelligence by telling you to grow up, that it's all in your mind. It will insult your intelligence in far more sophisticated ways. This book is going to feed your disease, symptom by symptom, chapter by chapter, until -- to use complicated medical terminology -- you are so gorged on your own self-pity you puke it all out. And as everyone knows, puking it all out is a great way to purge the body of toxins. Unless it leads to a rupture of the esophagus, septicemia, peritonitis, febrile dementia, and death.

This book will also describe many rudimentary medical tests that, in the hands of the trained clinician, can be invaluable diagnostic tools. These tests are so simple that you could perform them on yourself, in the privacy of your home. Not that you should. Doctors have spent years studying the proper techniques of physical examination. No reputable writer would encourage untrained persons to engage in self-diagnosis, particularly hypochondriacs, who may be needlessly alarmed. For quick reference I will thumbnail each test with a handy icon.

  • Quick! Go to the mirror. Open your mouth. Look at your uvula, the thing that hangs down at the back like a garden slug. Is it pulsing? It shouldn't be. When your uvula throbs in time with your heartbeat it is called Mueller's sign, and it can indicate heart disease! You could die!

  • Now insert the tips of your three middle fingers into your mouth, making a vertical stack, without touching your lips or teeth. If you cannot open your mouth that wide, you might have temporomandibular joint syndrome; worse, you might have systemic sclerosis, a grotesque progressive illness in which your skin hardens and contracts and can slowly garrote the life out of you.

  • With your palm facing you, tap lightly on the very center of your wrist. You are performing the Tinel test. If you feel a radiating numbness in your hand, you might have early carpal tunnel syndrome, which can eventually turn your hands into appendages as useful and attractive as a tyrannosaurus's.

In the end this book is going to present a surefire cure for hypochondria-a dramatic, natural remedy as effective as Bactine on a boo-boo. I could disclose it here, but I won't. This is a literary technique called foreshadowing, previously employed by famous literary individuals such as William Shakespeare. In the hands of the unscrupulous, foreshadowing can be nothing more than misleading hype. The responsible writer promises no more than he can deliver. I will say only this: I am going to keep hinting at my cure for hypochondria until I finally disclose it, and you will have an orgasm.

There are other excellent books available to those persons concerned with their health. In the interests of fairness and full disclosure, I will briefly describe these volumes and list their principal advantages and disadvantages.

The first group consists of books with names like The Family Medical Guide, or The Home Medical Encyclopedia, or The Doctors' Guide to Good Health, generally published by the American Medical Association or other renowned physicians' organizations. These are helpful, responsible diagnostic books, featuring listings of symptoms in easy-to-follow flow charts, each chart terminating in a row of exclamation points urging you to see your physician without delay.

The second group are clinical texts, intended for doctors and available mostly in medical bookstores and libraries, containing lines like this, from page 458 of Current Medical Diagnosis and Treatment, 1995: "Disorders such as disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, hemolyticuremic syndrome, hypersplenism, and sepsis are easily excluded by the absence of system illness. Thus, patients with isolated thrombocytopenia with no other abnormal findings almost certainly have immune thrombocytopenia."

These books are characterized by the use of humongously scientific Latin-influenced terms such as "sternutation" and "epistaxis" and "cutis anserina" and "pyrexia" and "diaphoresis" and "singultus," which are too important and complicated to be understood by unschooled morons such as yourself.

Many of these medical books also contain pages of photographs.

So these books can be highly entertaining, though they cost much more than my book and make you vomit.

The third type consists of books arranged on endless shelves labeled "alternative medicine." These usually begin with solemn advice against succumbing to quackery, followed by a simple nine-step formula for curing lymphomas via the teachings of Mohammed Ibn Rajneesh and the use of beet suppositories.

Alternative medicine books take elaborate measures to appear serious and scientific. I am right now leafing through Alternatives in Cancer Therapy, by Ross Pelton and Lee Overholser, featuring an endorsement on the cover by Linus Pauling, the two-time Nobel laureate. Alternatives in Cancer Therapy soberly evaluates treatments that include eating mistletoe, taking enemas made from strong coffee, and drinking urine.

My book is like none of those. Unlike the family medical guides, this book will dispense no practical medical advice whatsoever. Unlike the alternative medical books, it will advance no mountebank cures. Unlike the medical texts, it will not be condescending to the reader. It will mention thrombotic thrombocytopenic purpura only for the purpose of observing that, among all diseases the author has encountered in the course of his extensive medical research requiring many, many footnotes, it has the second-funniest name.

Last, let me say that although this book will raise some legitimate concerns about health, it will not use scare tactics to inflame the public's fears in the manner that, say, untreated appendicitis can inflame the appendix until it bursts, choking the bloodstream with deadly toxins and snuffing out your life in fifteen minutes of writhing agony. We are living in an era of fabulous preventive medicine. After all, it is not every day that some guy goes to the doctor because he is peeing a lot and learns he has a prostate the size of a bagpipe, though I personally know of two people this happened to.

They did not buy this book either, and now they are dead.

Copyright © 1998 by Gene Weingarten
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Table of Contents

Introduction 15
Ch. 1 Are You a Hypochondriac? 21
Ch. 2 Relax, Hypochondria Never Killed Anyone, Oh, Wait, Yes, It Did. 31
Ch. 3 The Mind of the Hypochondriac 36
Ch. 4 How Your Doctor Can Kill You 41
Ch. 5 Man. Woman. Birth. Death. Infirmity. 47
Ch. 6 Hypochondria and Me 54
Ch. 7 Hiccups Can Mean Cancer 63
Ch. 8 Headaches: Don't Worry, They're All in Your Head 77
Ch. 9 Interpreting DocSpeak Hint: "Good" Means "Bad" 83
Ch. 10 Maybe It's Just Nerves Uh-Oh 91
Ch. 11 Infarction - Isn't That a Funny Word? Hahahahaha Thud. 102
Ch. 12 Are You an Alcoholic? 112
Ch. 13 Tumor. Rhymes with "Humor." 116
Ch. 14 Ulcers and Other Visceral Fears 124
Ch. 15 Are You Too Fat? Yes. I Mean, Look at You. 134
Ch. 16 Snap, Crackle, and Plop Minor Aches and Pains That Can Kill You 138
Ch. 17 Why You Should Not Smoke 147
Ch. 18 Pregnant? That's Wonderful! Don't Read This! 149
Ch. 19 Things That Can Take Out an Eye 158
Ch. 20 Oh, Crap Diagnosis by the Process of Elimination 170
The Final Chapter: Is Death a Laughing Matter? Of Corpse Not. 181
Bibliography 199
Index 201
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First Chapter

Chapter Seven: Hiccups Can Mean Cancer In many ways the human body is like a car. Both are complex machines. Both require regular maintenance. Both will stop working if you fill them with barbiturates and applesauce.

Having a car and having a body both require adherence to a rigid servicing schedule. Let's say you own a car and you never, ever replace the oil; and when you use jumper cables, you get them mixed up and there is a spark the size of the Crab nebula, draining all the juice out of the good battery; and once, you poured windshield wiper fluid into the power steering reservoir because they really should label these things better. My point is, if you are that much of a half-wit about your car, your car is the least of your problems, because you probably also use a hair dryer in the bathtub.

The fact is, both cars and humans are designed with idiot lights, things that alert the reasonably careful person that something serious is awry. If your car's Oil light goes on, unless you are my wife, you probably know to stop driving and see a mechanic at once. Similarly, if you experience serious chest pains, then you probably will see a doctor. The fact is, certain symptoms are by their nature scary. Lumps. High fever. Blood in the stool. Mental confusion.

This chapter is not about those common "warning signals." This chapter is about things no sane person would ever associate with serious illness, until this very moment.

Hiccups. The precise cause (or "etiology") of hiccups remains a matter of some dispute among medical scientists, who have studied the phenomenon incessantly and come away with only obvious clinical observations, such as that men hiccup, on the average, five times as frequently as women. (As far as I can see, this tends to suggest, in sophisticated medical terms, an "etiology" related to beer.) There is no reliable cure for hiccups, but there is no shortage of nostrums available, each with its adherents. The rule of thumb is that the more unpleasant the remedy, the more august is the medical authority recommending it. Grandma told you to hold your breath. Primary Care Medicine, a text for doctors, proposes inserting a catheter down your nose into your stomach. I recommend hyperventilating into a colostomy bag.

Hiccups are harmless, except when they aren't. No other commonly reported symptom has quite so many potentially dire explanations. Persistent hiccups cross into virtually every medical specialty. Neurologists know hiccups can accompany the onset of a deadly stroke or an inoperable tumor in the medulla of the brain. Cardiologists will not rule out an oncoming heart attack or an aortic aneurysm. Nephrologists will suspect kidney failure. Gastroenterologists know hiccups can indicate an "irritation" of the diaphragm or of some other organ, particularly one that touches the vagus or phrenic nerves, which control the swallowing and breathing reflexes.

On the outside of the body, an irritation is often a minor matter. On the inside, it often isn't. On the inside, it is often a tumor. Hiccups have been associated with tumors in or around the lung, in the diaphragm, the liver, the pancreas, the stomach, and even the sigmoid colon, which is down near the butt and should not, by the grace of God, have anything to do with breathing.

Insomnia. In the absence of other symptoms, excessive fatigue or excessive sleep can be an indication of many serious diseases, but insufficient sleep generally isn't. Most of the time, the insomniac knows or suspects why he can't sleep: He is worried or depressed, or he has a toothache, or asthma, or a goiter the size of a microwave oven. Insomnia seldom stands alone, but when it does, it is out there in the hellish regions of Things You Wouldn't Wish on Your Worst Enemy Even If He Ate Garbo, Your Dachshund.

The most dramatic of these is fatal familial insomnia. This is a disease caused by prions, which are proteins that act exactly like ice-nine, the instrument of the apocalypse in Kurt Vonnegut's Cat's Cradle. Ice-nine was a molecular template. If it mixed with water, it would turn the water molecules into ice-nine molecules, rock hard and useless for sustaining life. This was not good when it spread across the oceans of the world. That's how prions work. They get into your body and take other proteins and reorder their structure to resemble themselves. In fatal familial insomnia, prions take up residence in the sleep center of your brain and slowly destroy it. You start out being unable to sleep well. Then you cannot sleep at all. In desperation, you see a top neurologist like Dr. Anthony Reder of the University of Chicago.

A few years ago, a man came to see Dr. Reder. The patient was tired and grouchy -- not tired and grouchy like a bus driver at the end of his route, but tired and grouchy like the people from Invasion of the Body Snatchers immediately before the dull-eyed pods took them over. This patient looked disheveled. His hair was askew, like Beethoven's after a night of carousing. Reder had seen this before; he is a research scientist and had seen it in laboratory rats with sleep deprivation. He diagnosed fatal familial insomnia. There is no treatment. There was nothing that could be done. Within weeks, the patient was hallucinating, making up grandiose stories about himself. His appearance deteriorated. Beethoven lost a lot of his charm. He gave way to Dr. Irwin Corey. Then he died.

Laughing So Hard You Pee in Your Pants. There is actually a medical term for this. Urologists call it "giggle incontinence." It can mean nothing, or it can be a very early indication of neurologic disease, in particular multiple sclerosis.

The Sniffles. Sometimes a cold is nothing to sneeze at. It could be the first sign of Wegener's granulomatosis, a rare, fulminant, whole-system body breakdown that often starts with coughing, congestion, and blood-streaked nasal discharge. Looks just like a cold! Then, when it doesn't go away, it looks like chronic bronchitis, maybe with an ear infection. Small wonder that Wegener's granulomatosis is sometimes not properly diagnosed until it is too late to treat. By that time it has progressed to kidney failure, lung damage, and body deformities, including "saddle nose," in which the nose cartilage collapses like a rotted jack-o'-lantern.

Or your "cold" might mean you have anthrax. Anthrax is a bacillus carried by livestock; an airborne, inhaled form of it starts just like a cold. This is relatively rare, though terrorist states like Iraq are experimenting with it as a biological weapon. They are planning to use it against citizens of decadent Western regimes, in cities and towns very much like yours. A doomsday scenario? Yes. Far-fetched? Hardly. The armed services have begun a program to inoculate soldiers against airborne anthrax. When inhaled, anthrax resembles the flu for a day or two, and then you feel pretty good, as if your cold has waned. Three days pass. Then you start hacking uncontrollably, you perspire like a federal witness against the mob, and finally you turn as blue as Cookie Monster. It is nearly 100 percent fatal.

Ringing in the Ears. This is called "tinnitus." Most people experience tinnitus at one time or another, usually as a highpitched whine, but sometimes as a buzzing, whooshing, or clanging. Usually it is harmless. Sometimes the sounds can be heard by the doctor when she places a stethoscope to your ear, and this generally means it is no cause for alarm. It is when you are hearing the sounds and she is not that she begins to get concerned. Other possibilities open up, some harmless, some worrisome. It can mean Ménière's disease, a disorder of the inner ear. That would be comparatively good news; Ménière's disease is usually controllable by medication. Tinnitus can also sometimes signal multiple sclerosis, or it can accompany the first appearance of a growth on the brain stem or auditory nerve known as a "schwannoma." A schwannoma is not usually malignant, but it is not entirely harmless, either; sometimes, when it is surgically removed, facial nerves are damaged and you wind up with a perpetual snotty look on your face, like a French wine connoisseur who has been asked to evaluate Yoo-Hoo. A schwannoma also presents the practitioner with a diagnostic dilemma: How do you deliver the news to a patient that he has a tumor with a name that sounds as if you are calling him a penis-head? Come to think of it, perhaps that is why it is named a schwannoma. Maybe doctors are learning to give silly-sounding names to terrifying things to ease the tension of the diagnosis. Maybe soon they will rename a heart attack a "spankadoodle."

Cold Sores and Fever Blisters. That eruption on your lip or gums probably means a minor attack from the herpes simplex virus. No big deal. Keep it clean. Use a mouthwash. It will go away, unless it is the initial presentation of pemphigus vulgaris, a disease that is even worse than it sounds. Pemphigus begins as mouth blisters -- weeping, bleeding, painful, funky-smelling sores that spread to the skin of your scalp and elsewhere. Pemphigus can be treated and controlled but seldom is cured outright. One of the better experimental treatments involves injections of gold. It is expensive.

Pins and Needles. You say, "My foot fell asleep." Your doctor says, "You have experienced a transient episode of paresthesia." Either way, you are standing there on two feet, but one feels like a shillelagh being nibbled by carpenter ants. The usual explanation is that you sat wrong, compressing a nerve. And that's probably what happened, unless your pins and needles are the deceptively lilting overture of Guillain-Barré syndrome, a mysterious, terrifying disorder of the peripheral nerves. It starts in the foot, with sensations indistinguishable from ordinary pins and needles. Then it rapidly distinguishes itself, in the sense that a letter from the Unabomber rapidly distinguishes itself from the rest of the mail. The pins and needles will give way to profound muscle weakness. You can't lift an arm; sometimes you can't even breathe without the help of a respirator. Your brain is fine but your body is a dull lump of useless protoplasm -- sort of the opposite of Vanna White. Most people eventually recover. From then on, whenever their foot falls asleep, they do not take it lightly. They worry, waiting for the next development, on pins and needles.

Itching. Doctors call this "pruritus," which makes it sound vaguely dirty and exciting. Alas, it is just itching. When itching is localized, the diagnosis is relatively simple. Seborrhea, psoriasis, dermatitis, athlete's foot, ringworm, scabies, lice. It is when itching is generalized that all sorts of possibilities arise. If it is centered in the feet or the lower half of the body, it can be one of the first signs of Hodgkin's disease, a potentially fatal cancer of the lymphatic system. Generalized itching can signal a form of leukemia. It can be the very first symptom of lung cancer, ovarian cancer, pancreatic cancer, or prostate cancer. It is almost always the first symptom of Hanot's cirrhosis, a life-threatening liver disease of middle-aged women. And then there is mycosis fungoides, the final ring of itching hell.

Mycosis fungoides is a rare, galloping skin tumor. It starts with itching; you ignore it. Then, sometimes, years go by symptom-free. Then the itching returns with a vengeance. Then your body erupts into patchy discolorations. You resemble a dalmatian. Then the discolorations spread. You resemble a guernsey cow. Then the tumors become what the medical books describe as "tomatolike." Then things start getting really ugly...

Déjà Vu. We are all familiar with this peculiar existential phenomenon. Suddenly, irrationally, we feel we are experiencing an event, or hearing a conversation, that we have experienced before. There is another, similar condition, called "Jamais vu," in which the opposite occurs: You suddenly feel that familiar surroundings are foreign to you; you might not even recognize your spouse. Cool. Weird. Potentially deadly. Neurologists have discovered that déjà vu and jamais vu can be early signs of a tumor or hemorrhage in the temporal lobe of the cerebral cortex.

Troubled by these mental hiccups? Look for additional subtle signs of temporal lobe abnormalities. One would be seizures. If you frequently find yourself waking up on the floor at work in a pool of urine, with a gnawed pencil in your teeth, and people standing around trying to look calm, you may have a problem here.

Flushed Face. People sometimes get red in the face. This can be caused by exertion or emotion, or by profound embarrassment, such as when you are at a podium to address a national group of educators and you suddenly realize that the big exuberant German shepherd you were petting a few minutes before has nosed you in the lap so enthusiastically that you have an enormous frothy wet spot on the portion of your beige silk dress roughly corresponding to your own personal groin, not that this ever happened to anyone I know. Flushing can also be caused by drinking alcohol. Sometimes this is normal, but sometimes flushing after drinking alcohol is an early warning sign of carcinoid syndrome, in which tumors invade the lining of the stomach; this alcohol-induced facial flushing can precede the diagnosis by fifteen years! By that time, tumors have often spread to the liver or bone or another system. You have fire-hose diarrhea. Your heart walls thicken. You get short of breath. Then short of time.

Hoarseness. This is how lung cancer sometimes shows up for the first time; the tumor invades the laryngeal nerve and you suddenly sound like Vito Corleone.

Lipstick on Your Teeth. Yes, this is potentially serious. The canny internist will not discount this symptom. It suggests dry mucous membranes. If it tends to happen on one side of your mouth only, it could be due to a tumor of cranial nerve VII, which supplies the salivary glands. But the same eye would probably also be dry. If your entire mouth is dry and you are not taking any drugs that dry you out, this could be an early indication of Sjogren's syndrome, an autoimmune disease that generally affects menopausal or postmenopausal Caucasian women.

Doctors will sometimes ask a patient to eat two saltines without water; Sjogren's victims cannot do it.

Sjogren's syndrome can lead to tooth rot, sexual dysfunction, and greater susceptibility to lymphatic cancers. There are support groups for victims of Sjogren's syndrome. They are mostly women in middle age. They are very careful with their lipstick.

The Blahs. You don't feel good. You can't quite put your finger on it. You are weak and achy and maybe you have a slight sore throat or fever. Medically, this is "malaise," and it usually means a cold is coming on. Some serious ailments begin this way, too, the most terrifying of which may be Stevens-Johnson syndrome, or erythema multiforme. You start by just feeling crappy. Soon there are eruptions on the lips, the tongue, and the inside of the mouth. You blister horribly. It spreads to the genitals and, sometimes, the anus. Sometimes you go blind. Here is how bad it is: Sometimes the only place that can treat you is a hospital burn unit.

Words on the Tip of Your Tongue. It is called "partial anomia" or "tip-of-the-tongue phenomenon." You find yourself having increasing trouble retrieving the right, er, er, er...word. It could just mean benign forgetfulness: As you get older, memory and retrieval functions sometimes get a little impaired. But neurologists know partial anomia can be an early sign of several degenerative dementias. It occurs with the onset of tumors in the left hemisphere of the brain, or in metabolic disturbances typical of terminal liver disease. It can also be the very, very tip of the very, very cold iceberg known as er, er, er...Alzheimer's.

Nausea. Having nausea in the absence of vomiting is like drinking NutraSweet in the absence of Diet Coke. What's the point? Fortunately, simple lack of appetite coupled with a vague nausea that doesn't make you puke is seldom a serious symptom. Unfortunately, when it is a serious symptom, what it is a symptom of is an oncoming heart attack.

Snorting Out Food. You are dining on, say, spaghetti carbonara. Someone tells a joke, but not just any joke. It must be a joke with a certain kind of punch line: a bad-boy punch line, unexpected and a little wicked, like the one about why women don't skydive naked. Suddenly you've got pasta and bacon dribbling out of your nose. Now, maybe you are just a slob, but possibly you have a degenerative disease in the muscles served by the cranial nerves. In the early stages, these conditions can cause the sudden, startling nasal regurgitation of food or drink. The later stages make the sudden, startling nasal regurgitation of food or drink seem like the height of prandial etiquette.

Bad Breath. Medical texts first warn you, in medical-text language, that the most likely cause of bad breath is crummy dental hygiene. The catchall medical term for organisms that cause your breath to stink is "oral flora." As in, "Yo, Vinnie, stand downwind on account of your oral flora is making me want to puke up this here sausage." Once bad breath has been eliminated as a cause of bad breath, the physiology gets much more interesting, and specific. A musty, fishy odor or, alternatively, a sickeningly sweet odor could be an early sign of terminal liver failure. A light, fruity odor could mean ketoacidosis, a condition that frequently accompanies diabetes. An odor of ammonia could mean nephritic gingivitis, a mouth-and-gum disease linked to incipient kidney failure. A stench of rotting garbage could mean lung disease. A smell of sweaty feet or cheese can indicate a serious metabolic disorder. A smell of garlic may be a sign of poisoning by arsenic, selenium, tellurium, or phosphorus. However, all of these things are likely to be accompanied by other signs, such as fatigue, mouth sores, a bloody cough, jaundiced skin, or extreme thirst.

There is only one serious ailment for which bad breath alone can be the initial sign that something is wrong -- though people seldom seek help at this early stage. Who wants to arrive at the doctor complaining that you smell like a septic tank? So you wait. Eventually, you get a persistent earache. Or congestion in one nostril. That's when you discover you have a squamous cell carcinoma of the throat or sinus. The prognosis often stinks.

Yawning. One of the great mysteries of medicine is why yawns are contagious. The fact that they are is often cited as evidence that yawning itself is without clinical significance; if it can be induced by mere suggestion, how can it mean anything bad? This is good reasoning, but alas, it is wrong. Paroxysms of yawning or sighing in the absence of real fatigue can be an early sign of encephalitis, or of a tumor or hemorrhage in the central part of the brain. These things push the brain downward, making it ooze through into areas where the brain has no business being, and for some reason this process can induce yawning, sighing, and later, stupor and death. This condition is called a "central herniation," or an "uncal herniation." It is very bad. Maybe someone should write a children's book featuring a character named Uncle Herniation. He would be sort of like Sleepy the Dwarf, only he'd keep getting crushing headaches, spinal fluid would run out of his nose, and in the end he would lapse into a coma and die.

Nosebleeds. If you go to a doctor complaining of nosebleeds, he will first make vague, discreet inquiries, using big, dignified words like "extrusion," and it will slowly dawn on you that he is asking you if you pick your nose. The fact is, the capillaries in the nose are a threadwork of vessels easily damaged by, say, a pinkie. After ruling this out, and ruling out obvious other genetic causes you will probably know about -- hemophilia, for example -- the doctor will begin looking for diseases you don't know about: These include a series of things with very long names. One is an esoneuroblastoma. Another is a nasopharyngeal angiofibroma. These are nasal tumors, and they tend to debut as nosebleeds.

If these immediate causes of your nosebleed are eliminated, the doctor will consider systemic causes, diseases that affect your whole body but first show as nosebleeds. One would be an inflammation of the right side of the heart. Or the doctor might suspect Waldenström's macroglobulinemia, a blood disease that is terrifying not only because it turns you weak, pale, and blind, and then tends to kill you, but because it involves the use of an umlaut, which makes everything sound worse than it is. Try it. Settle a few umlauts atop the most benign thing you can imagine, and watch what happens: Sänta Claüs. The jolly patron of Nazi children.

But a more likely explanation for nosebleeds would be cirrhosis. You don't have to be a drunk to get cirrhosis. Liver disease can sneak up on you, and sometimes you can be near death before you notice anything is wrong. One warning signal is that the liver stops doing what it is supposed to do, including helping the body absorb vitamin K, which helps blood to clot. If there isn't enough, you bleed. It can start with the capillaries in your nose. This is the early stage. Eventually, you cough and vomit up huge gobs of cherry red, clumpy blood the consistency of rice pudding. Sometimes it will be darker and look like chicken livers or coffee grounds. This stage of your disease is called "hematemesis." People with terminal cirrhosis don't get invited to many parties.

Snoring. You snore at night and feel tired during the day. You are a man. You are middle aged. You are at least somewhat overweight. You might have obstructive sleep apnea, a serious sleep disorder in which the pharynx collapses and prevents you from breathing. This can last up to two minutes without waking you. Your heart rhythm is impaired. Your body is starved for oxygen, a condition called hypoxia. The brain hates this; it degenerates, and so do you. Your family notices changes in personality; you get cranky and irritable and, according to medical texts, you "show poor judgment at work." Untreated, this can lead to cor pulmonale, a condition that destroys the heart's right ventricle. You become impotent. You look sort of purple. The veins in your neck pop out, resembling a hangman's rope. By then, you want to die. Sometimes you do.

What can be done? First, a doctor will have to determine whether you actually have sleep apnea; some people are just fat, cranky boors with bad judgment. If the diagnosis is sleep apnea, there is an operation called uvulopalatopharyngoplasty (we'll just call it "Bob"), in which the whole back of your throat is sheared off. Usually this solves the problem. Sometimes it doesn't. You still snore and choke, only it hurts more because some idiot sheared your throat open.

Toothache. Get a bunch of dentists together in a room. Get them talking. Then get the hell out of there; there is nothing quite so stultifying as a room full of talking dentists. However, if you leave a tape recorder in the room, you can later fastforward to the good parts. If he has practiced long enough, every dentist will have a story of a patient who complained of a toothache in the lower jaw. The teeth will look fine. But the patient won't. He will have clammy skin. The dentist will send him to the emergency room. That is because an emergency room is a better place than a dentist's office to have a massive coronary.

At other times, a patient will come in complaining of pain in the molars. An X-ray will reveal an ameloblastoma, a tumor of the bone in the lower jaw, in the wisdom tooth area. This is what is known as an "insidious" tumor. It grows slowly and causes no pain until it is quite large and crowds against the root of a tooth. By that time, the only solution may be removal of all or part of the lower jaw. A prosthesis is inserted. It is usually part metal and part bone shaved from your hip. Depending on the skill of the surgeon, you might look pretty good, or you might look like Grover Cleveland. Cleveland had a jaw tumor; doctors removed a portion of the jaw and replaced it with vulcanized rubber. He was an excellent president but resembled a warthog.

Stiff Neck. "I probably just slept on it wrong." Yes, yes. Probably. In the last half century, the simple stiff neck has lost most of its cachet, due to advances in modern medicine. In the absence of other symptoms waking up with a stiff neck used to be a first sign of polio or tetanus. But these days everyone is inoculated against polio. Also tetanus. You have had a tetanus shot, and a booster in the last five years, right? Not sure? You may wish to call your doctor. Ask him. If you sound like Thurston Howell IV, you may be in trouble. Doctors call this initial stage "trismus," or lockjaw. It will be rapidly followed by a ghastly grin that makes you look like the Joker. Doctors call this "risus sardonicus." Then your body bends backward, taut, like a crossbow. Doctors call this "opisthotonos." Doctors have a term for everything. If treatment is delayed, the final symptom can be "cessation of vital signs." Doctors call this "death."

Copyright © 1998 by Gene Weingarten

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  • Anonymous

    Posted September 13, 2013


    Do not read this book especially if you are a hypochrondiatic....if anything it will make you feel worse. I do not see the point in this book unless it is to tell you about diseases and symptoms you never knew about and now if you the thought of them to make you worry. Defindently not recommended? Wish i never read it

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  • Anonymous

    Posted November 29, 2008

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    Posted July 12, 2011

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