Hypochondria and Diagnosis in the Age of Google

© 2011 Keith McWalter

One night last summer as I lay in bed, I felt something move in my chest just behind the base of the sternum.  That was it, just a movement, not a “flip-flop,” not even a “flutter,” as the doctors I would later visit liked to call it.  A settling or a shifting or maybe a twitch (as I shall call it), though that is the wrong word for the slight, slippery subsidence I thought I was feeling.  I turned over and went to sleep with my usual quick ease.

Over the next few days and nights I felt the twitch several more times, most often while prone and about to go to sleep, but sometimes while sitting upright at my desk or walking to the mailbox or running my customary two miles every other day.  Increased activity did not seem to correlate with the twitch; being prone, however, did, and also brought on a mild but uncomfortable heartburn.  I had had acid reflux in summers past, usually after eating ‘way too many heirloom tomatoes, and usually popped an antacid or two to make it go away.  I thought the twitch might be related to acid reflux, perhaps some sort of esophageal spasm.  But it was new, and strange, and as a fit, bodily-aware, medically well-read male in late middle age (or so I liked to think of myself), a bit worrisome.  I resolved to see a doctor about it.

My wife and I had recently moved from San Francisco to a small college town in Ohio, and most of our medical roots and support systems were out west.  One of the few surprises about moving to Ohio, where I had gone to college and returned frequently to visit family over the years, was the relative paucity of doctors there and the difficulty of getting to see them.  It slowly dawned on us that in the San Francisco Bay Area we had been living in a medically-saturated environment, with more specialists, clinics, medical “concierge” boutiques, and hospitals than you could count, all competing for clients.  Not so in the wilds of mid-Ohio.  Call after call was met with “he/she isn’t accepting any new patients right now.”  Patience is right.

I phoned the office of our internist in California, who had cared for both my and my wife and with whom I was on a first-name basis (Eric), and in a few hours he called back.  I described my symptoms and he agreed that it sounded a lot more like acid reflux than angina, and suggested that I take a proton pump inhibitor (a classification that struck me as more appropriate to nuclear physics than medicine) to see if this would “tamp it down.”

Like any other information-hungry person in the modern era, I turned to Google.  I went to the Mayo Clinic’s website and looked up “angina” and “esophageal spasms” as well as “myocardial infarction” and the symptom “heart flutter” (having decided that “twitch” was insufficiently clinical).  My symptoms didn’t match up with what I read, but I kept on reading, following links to diseases farther and farther afield.  Soon I felt downright feeble. I looked up how to pronounce omeprazole, the proton-manipulator (accent on the first syllable, long “o”), and its litany of possible side-effects, which as a lawyer I tend to view as mere litigation-inhibitors rather than actual information.  I walked over to the pharmacy in our little town and took the first dose that evening.

Eric and I had agreed that it would be good to see a local doctor in any event. Through friends, I finally found an internist willing to see me at an outpatient clinic in New Albany, a suburb just east of Columbus.  As the clinic turned out to be not at all near the road named in its address, I arrived ten minutes late.  The obese, unhealthy-looking receptionist looked me up and down, looked at her schedule sheet, and told me with no small hint of triumph that due to my tardiness the doctor couldn’t possibly see me now.  Having driven half an hour across the cornfields to get there, and in no minor dudgeon myself, I responded in my most ominous lawyerly tones that if that were the case it would be most unfortunate.  At this she roused herself and shambled off to confirm the impossibility of seeing the physician I had come to see.

A different receptionist of far cheerier mien eventually returned to tell me that, while the doctor I’d had an appointment with was indeed unavailable (I suspected a pressing tee time), another one (perhaps a non-golfer) could see me in twenty minutes.  She assured me with a big smile that he was just as good as the first one.  I told her that, as I’d never laid eyes on either one of them, I was in no position to judge, and would be happy to see Doctor Number Two.  At this point (though I didn’t tell her this) all I wanted was someone with a brain armed with a stethoscope who could hear more about what was going on in my chest than I could feel with my fingers.  I’d even downloaded a heart monitor to my iPhone (there is indeed an app for that), but felt too ridiculous pressing the butt end of the phone to my ribcage to get a reading.

A middle-aged nurse of nearly narcoleptic reserve took my blood pressure, and it was high.  “One sixty over eighty-five,” she muttered.  This too was news to me.  She applied a half-dozen sensors to my torso and took a resting electrocardiogram, which lasted about sixty seconds, then left without another word.  Doctor Number Two soon appeared. He was an amiable man not much younger than me, tall and lanky with a Ronald Reagan hair tint, in a polo shirt and no lab coat (maybe he had been on the golf course).  He appeared to listen intently to my account of the twitch, but on parroting it back to me converted it into “chest pain,” and was quickly running down his diagnostic decision tree in the direction of angina.  I told him that I rather suspected acid reflux, as I’d had it before and my symptoms seemed more pronounced when I was prone.  “Half the men who are having heart attacks think they have heartburn,” he said.  “Here I am,” I replied.

I told him that my internist out west had tentatively prescribed omeprazole.  His eyebrows went up, but I couldn’t tell if this was because it had been prescribed or because I could pronounce it. He listened to my chest and back with his stethoscope, hence fulfilling my main goal for the visit. He said my EKG had been unremarkable. He asked whether I’d experienced any shortness of breath (no) or pain in the jaw or extremities (no – I knew all these heart attack symptoms from Google), and said that he wanted to put me on a beta-blocker to bring down my high blood pressure and “protect the heart” until more tests could be run.  I thought it interesting that I would now be on both a “blocker” and an “inhibitor” (medicine was so defensive), but said nothing.  He said he would arrange an appointment for a cardiac stress test with a nearby cardiologist as soon as possible (which turned out to be four days later).  He loaded me up with free samples of the beta-blocker and instructed me to take one a day until we got to the bottom of things.

I thanked him and drove home, feeling somewhat relieved.  As a regular runner, I was sure I would ace the stress test.  My EKG had been normal.  My high blood pressure could be at least partly accounted for by the frustration of trying to find the clinic and my unpleasant encounter with the obese receptionist.  We were going to confuse things a bit by combining the omeprazole with the beta-blocker (if I had relief, who would know which had worked?), but it seemed unlikely that the beta-blocker would affect the heartburn, so if that went away I would credit the omeprazole and the case for a gastric-only source of my problems would be strengthened.  Or so went my lawyer’s logic.

To be continued…..

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