Tuesday, May 05, 2015

How Sick is Sick?

How Sick is Sick


Sick is pretty obvious some of the time.  The coughing, sneezing, miserable looking person is sick and probably very aware of it.  Other times sick is stealthy.  A friend of mine became very thirsty, day and night.  His favorite drink was Coca Cola, but he just couldn’t drink enough to quench his thirst.  A friend suggested he get his blood sugar checked.  She was a dietitian and knew the symptoms of type I diabetes.  Sure enough, my thirsty friend needed to start insulin shots right away.  

Sick can be tricky as well. Is my throat scratchy, and am I feeling tired because I’ve been socializing too much, or because I have the first symptoms of a viral infection.  Is that ache in my chest a heart attack, or is it just a bit of soreness from weightlifting earlier that week.  Worse yet, is that sharp pain in my back a pulled muscle or is it related to the misaligned vertebrae that a CAT scan reveals.  I have a tendency to hypochondria.  On the other hand, one night a few years back when my chest ached so much that I had trouble catching my breath, the doctor chastised me for waiting around until the next morning to get it checked.  I was rushed in for a CAT scan with dye injected into my heart.  That test was clear, but blood tests showed a high level of some sort of inflammation, and I had been having intense aches in my shoulders, back, and hips for weeks.  More tests and a trip to a rheumatologist gave me a diagnosis of ankylosing spondylitis: my immune system attacking my joints, also known as bamboo spine due to its unfortunate tendency to cause the vertebrae to fuse together and become brittle.    He was ready to put me on some very expensive and intense drugs to suppress my immune response (I was already taking a whopping dose of prednisone to damp down the inflammation and resultant pain).   “Wouldn’t something show on an x-ray?”, I asked.  The doctor seemed amused that I would suggest a test, but agreed to order it.  No damage at all related to ankylosing spondylitis, but badly misaligned vertebrae, as mentioned above.  Good news, that might be why my back hurts sometimes, but it’s unlikely to result in a severed spinal cord.

Kids get sick, but most of the time they think of it as a random, temporary inconvenience.  The  older I get, the more I tend to think of ailments as part of a growing collection of maladies.  Get a couple of oldsters in the right mood and they will sit and swap tales of a medical nature for hours on end.  Sick and old, seems obvious right?  But the same two oldsters may be running miles a day, swimming circles around youngsters, or biking mountain passes that might overheat the old family sedan.  

Is a kid with the flu sicker than a geezer with two joint replacements and a pacemaker?   The kid may be lying inert in bed for days and the geezer may be hiking the Pyrenees.

As hard as it is to set criteria for physical sickness, mental illness can be all the more difficult.  And the two can be confused or even entwined.  When I was severely depressed in my fifties, I lacked the energy to make it up a couple of flights of stairs without really working at it.  Physically I was a bit overweight, but otherwise as healthy as the proverbial horse.  Conversely, an engineer I worked with would sometimes feel so energized that he stayed all night long at work cranking out his usual work plus loads of patent applications.  He seemed far more healthy than me until his bipolar disorder took a swing south and landed him in a psych ward with severe depression.  Meanwhile, I was plugging along dragging my ass up and down the stairs at work, wondering what the heck was wrong with me.  Another friend realized that he was a new incarnation of the Christ.  God spoke directly to him on a very regular basis, and he was quite certain that God had revealed deep secrets to him.  He might have gone on functioning well enough except that at least one of the revelations involved a young woman who was deeply in love with my friend, according to his conversations with God.  All attempts to convince him otherwise, including a restraining order acquired by the woman, did nothing to change his mind or stop his attempts to contact the young lady.  It was pretty clear to everyone else that he was very sick, but he could not be convinced.

My bipolar coworker, my smitten friend, and I all had trouble realizing that we were sick, much less having insight into what the nature of the illness was.  These situations make me wonder about the oft quoted statistic that about one in five Americans are suffering from mental illness.  What if I were to say that one in five Americans were suffering from physical illness?  How could I have any credibility give the number of possible illnesses and the range of disability that any given illness might confer?  Of course, one might counter that we could carefully record all the diagnoses given by the various medical doctors for a given population.  But a few problems crop up.  When I was diagnosed with ankylosing spondylitis, but the diagnosis didn’t stick, how would we count that.  Not to mention that the same constellations of symptoms had also been diagnosed as pericarditis and polymyalgia rheumatica.   Would that count as three illnesses, or none since all the symptoms disappeared after a few months?  In less than a year I cycled through the emotions of thinking I had a life long progressive disease,  a serious illness that would only resolve after many months of treatment, a possible life threatening ailment, and ultimately nothing at all.  I suffered anxiety and depression as I considered the various futures posed by each diagnosis.  But I had already suffered anxiety and depression for decades at that point. Was I any worse off than when I had anguished over the various rounds of layoffs that loomed prior to me successful retirement.  And now that I was retired and stable on a regimen of medications, exercise, and relaxation methods, was I no longer sick or just in a sort of remission with side effects?

Sometimes we know we are sick, but others don’t believe us.  Other times we think we are well, but others don’t believe us.  Or we may be feeling sick and receive full support in our thoughts on the matter from friends, family, and the medical establishment.  And we could all be wrong.  

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