My hypochrondriasis is incredibly prescient

Hey, remember when I told everybody that an insulinoma would explain my Insta-Bitch? Well, all that self-awareness made me actually pay attention to insulinoma as a disease, even though it is very rare. It paid off, though, because it was the answer on my exam last week! The question was a case presentation of a woman brought in by her friend, because the woman had been eating tons and gaining weight suddenly, acting generally irritated and anxious, and had a headache lasting weeks. I was reading it and not understanding what the question was trying to hint at, and thought, “Huh, that sounds like me when I’m hungry…. OH HEYYYY, insulinoma is an answer choice!” Very exciting. Good job, unfounded paranoia!

For the record, though, I did not see an insulinoma while on my Internal Medicine rotation. So really, the exam was not representative of my actual Internal Medicine rotation at a certain Big City Hospital. Had the test been truly representative, the patient in the question would have been a 50-something-year-old male, probably homeless, with hypertension or high cholesterol or poorly-controlled diabetes (or all three), current or former smoker/drinker, coming in for shortness of breath or chest pain after drinking all weekend/doing cocaine/losing his medications (all things that happened). It’s like a really tedious and frustrating game of Mad Libs.

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Self-diagnosis

Wow, I thought the paranoid self-diagnosing would stop after Boards, but that turned out to be false. I’m just using different books, now.

Things I’ve diagnosed myself with, using Step Up to Medicine
From the week of August 3, 2008.

Diffuse Esophageal Spasm
What: Uncoordinated spontaneous contraction of the esophagus, preventing or causing painful swallowing of food.
Why I totally had it: Sometimes when I swallow, food feels like it’s getting stuck, and then I get chest pain between the clavicle down to the sternum.
But actually: I really need to chew my food more thoroughly, and not inhale my food all at once.

CHOOSE!

My roommate Aubrey and I enjoy (“enjoy”) picking diseases we’d suffer from, if we had to. We also like to list diseases we’d rather die from than get treatment for (usually because the treatments are awful), and diseases we’d never ever want to get.

This is a variation on the old game of “Gun To Your Head” or “CHOOSE!,” which is Grace’s succinct summary of the rules.

So, if I had to have a worm infection, I’d pick Taenia saginata, the beef tapeworm.

Why? It causes loss of appetite or an early feeling of fullness — hello, weight loss! It sucks out nutrients, so you have to eat more just to stay nourished. It stays only in the GI tract, and does not invade other tissues the way Taenia solium, the pork tapeworm, does (this is called cysticercosis). The pork tapeworm can invade your brain and cause seizures, and eventually kills.

The beef tapeworm is like a real version of the Food Wormhole or Hollow Leg we have so fondly wished for when faced with a mountain of delicious food and limited gastric capacity. The beef tapeworm is the organic, all-natural answer to Alli or laxatives or whatever gross things people medicate themselves with to lose weight.

And finally, you can’t get the beef tapeworm unless you eat beef, so this means an exponential increase in steaks and burgers for dinner!

More Self-Diagnosis

Things I’ve diagnosed myself with, using Robbins & Cotran: Pathologic Basis of Disease, 7th ed.
From the week of April 27, 2008.

Iron deficiency anemia
What: Lack of iron, causing lowered levels of hemoglobin.
Why I totally had it: Had a spoon-like dip in my thumb’s fingernail (koilonychia) — a sign of iron deficiency.
But actually it was: A little dip in my thumb’s fingernail that I’ve had since forever.

Hashimoto’s thyroiditis
What: Underactive thyroid, caused by autoimmune destruction of thyroid.
Why I totally had it: Weight gain, fatigue, memory loss, intolerance to cold temperatures.
But actually it was: Poor eating habits (potato chips and Diet Coke are not real dinner), sleep deprivation, and New York’s shitty “springtime” weather.

Self-Diagnosis Roundup

Things I’ve diagnosed myself with, using Robbins & Cotran: Pathologic Basis of Disease, 7th ed.
From the week of April 13, 2008.

Insulinoma
What: Neuroendocrine tumor of the beta cells in the pancreas, secreting excessive amounts of insulin.
Why I totally had it: Lethargy, forgetfulness, and irritability (aka Insta-Bitch).
But actually it was: Sleep-deprivation and being hungry at the same time.

Diabetes mellitus, type 2
What: Insulin-resistant diabetes, resulting in hyperglycemia (high blood glucose).
Why I totally had it: Lethargy, increased thirst, increased urination, 2 of 5 risk factors for metabolic syndrome.
But actually it was: Warmer weather and drinking more water.

Throat cancer
What: CANCER of my THROAT!! Squamous cell cancer of the soft palate or tonsils. Or, squamous cell cancer of the esophagus.
Why I totally had it: Painful and difficulty swallowing, red and suspiciously vascularized (lots of tiny blood vessels) uvula.
But actually it was: A sore throat.