Thursday, July 31, 2014

Don't die.

I haven't aged into the colonoscopy demo yet, but it'll be here soon enough. As it is, a few years back I reached that age where your annual physical involves the doctor putting things into places from which things usually only come out.

And the time for my physical came again, so I girded my loins and clenched my duodenum and off I went.


At my advanced age and hard-won wisdom I know how to deal with unpleasant things---you lie and say you had a work emergency and promise to reschedule.

But that wasn't what I did, not this time. I've written about my friend who died suddenly late last year, no warning, natural causes. I was thinking of him as the day of my physical approached. I don't think he was good about preventive care. I suspect his death could have been prevented, or at least postponed.

So I went.

The doc was happy enough with my health, at least pending the results of the blood and urine test. I guess I won't die of natural causes right away. Although I've done a lot of work with medical copy and I know all kinds of things can sneak up on you and kill you while you feel perfectly fine. Of course, the problem with working on medical copy is that you come down with everything you study.

No one put it finer than Jerome K. Jerome in his classic Three Men in a Boat, describing the condition my wife and I have come to know as Real Housemaid's Knee:
It is a most extraordinary thing, but I never read a patent medicine advertisement without being impelled to the conclusion that I am suffering from the particular disease therein dealt with in its most virulent form.  The diagnosis seems in every case to correspond exactly with all the sensations that I have ever felt.
I remember going to the British Museum one day to read up the treatment for some slight ailment of which I had a touch—hay fever, I fancy it was.  I got down the book, and read all I came to read; and then, in an unthinking moment, I idly turned the leaves, and began to indolently study diseases, generally.  I forget which was the first distemper I plunged into—some fearful, devastating scourge, I know—and, before I had glanced half down the list of “premonitory symptoms,” it was borne in upon me that I had fairly got it. 
I sat for awhile, frozen with horror; and then, in the listlessness of despair, I again turned over the pages.  I came to typhoid fever—read the symptoms—discovered that I had typhoid fever, must have had it for months without knowing it—wondered what else I had got; turned up St. Vitus’s Dance—found, as I expected, that I had that too,—began to get interested in my case, and determined to sift it to the bottom, and so started alphabetically—read up ague, and learnt that I was sickening for it, and that the acute stage would commence in about another fortnight.  Bright’s disease, I was relieved to find, I had only in a modified form, and, so far as that was concerned, I might live for years.  Cholera I had, with severe complications; and diphtheria I seemed to have been born with.  I plodded conscientiously through the twenty-six letters, and the only malady I could conclude I had not got was housemaid’s knee.
I felt rather hurt about this at first; it seemed somehow to be a sort of slight. Why hadn’t I got housemaid’s knee?  Why this invidious reservation?  After a while, however, less grasping feelings prevailed.  I reflected that I had every other known malady in the pharmacology, and I grew less selfish, and determined to do without housemaid’s knee.  Gout, in its most malignant stage, it would appear, had seized me without my being aware of it; and zymosis I had evidently been suffering with from boyhood.  There were no more diseases after zymosis, so I concluded there was nothing else the matter with me. 
I sat and pondered.  I thought what an interesting case I must be from a medical point of view, what an acquisition I should be to a class!  Students would have no need to “walk the hospitals,” if they had me.  I was a hospital in myself.  All they need do would be to walk round me, and, after that, take their diploma.
Then I wondered how long I had to live.  I tried to examine myself.  I felt my pulse.  I could not at first feel any pulse at all.  Then, all of a sudden, it seemed to start off.  I pulled out my watch and timed it.  I made it a hundred and forty-seven to the minute.  I tried to feel my heart.  I could not feel my heart.  It had stopped beating.  I have since been induced to come to the opinion that it must have been there all the time, and must have been beating, but I cannot account for it.  I patted myself all over my front, from what I call my waist up to my head, and I went a bit round each side, and a little way up the back.  But I could not feel or hear anything.  I tried to look at my tongue.  I stuck it out as far as ever it would go, and I shut one eye, and tried to examine it with the other.  I could only see the tip, and the only thing that I could gain from that was to feel more certain than before that I had scarlet fever.
 I had walked into that reading-room a happy, healthy man.  I crawled out a decrepit wreck. 
WebMD has a brilliant niche, convincing the healthy they have tumors.

At least you can get your annual physical, which provides some level of comfort despite its huge level of discomfort while it endures. But so many people would rather follow my own instinct and bail on it.

One of the great myths of modern policy is that preventive care saves everybody money. As one doctor put it in the Wall Street Journal some years ago:
Prevention is a good thing to do, but why equate it with saving money when it won’t? Think about this: discovering high cholesterol in a person who is feeling well, is really just discovering a risk factor and not a disease; it predicts that you have a greater chance of having a heart attack than someone with a normal cholesterol. Now you can reduce the probability of a heart attack by swallowing a statin, and it will make good sense for you personally, especially if you have other risk factors (male sex, smoking etc.). But if you are treating a population, keep in mind that you may have to treat several hundred people to prevent one heart attack. Using a statin costs about $150,000 for every year of life it saves in men, and even more in women (since their heart-attack risk is lower)—I don’t see the savings there.
The problem comes in turning medicine into a policy rather than a personal responsibility. I want you to go get yourself checked out not because I think it will save me tax dollars, but because it will save you money and may save you from an early death.

You are obviously a reader with discerning taste, being on this blog, and we need more of you around. Take care of yourself and enjoy your life. And don't check every little symptom on WebMD; that housemaid's knee is not a malignant knee tumor, trust me.
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