Vlog the Inhaler, or The Occasional Video Blog Musings of Jim Thornton

Regular vlog readers may recall that I have long made a distinction between two forms of hypochondria:

• the delusional form, wherein a sufferer imagines he or she has a serious illness, becomes obsessed with it, and eventually cannot be dissuaded out of this belief despite all medical evidence to the contrary

• the non-delusional form, which is identical to the above with but one subtle distinction, i.e., that the sufferer knows full well his or her beliefs are irrational but nevertheless still can't shake their obsessive hold

The Masters swimming world, I have learned, has no shortage of both forms of this disorder. For purposes of lively debate, let me just throw out Leslie "the Fortress" Livingston and Paul "the Hulk" Wolfe as prototypical exemplars of Type 1, and myself as a text book example of Type 2.

Note: if either Leslie or Paul happen to read the above paragraph and take even minor offense at my suggestion, I think we can all agree that this proves, beyond doubt, the validity of my diagnosis.

Call their rancor a positive Thornton Sign.

We armchair clinicians have long understood that delusional hypochondriacs always express a positive Thornton Sign when confronted with an accurate diagnosis of their disorder. The condition is, alas, ego alien, and sufferers will do anything in their powers to spit the hook, so to speak.

Non-delusional hypochondriacs, on the other hand, just as invariably express a negative Thornton sign. To us, hypochondria is hardly alien to our sense of self; it is, alas, all too ego syn-tonic. Thus we will not debate our diagnosis but rather acknowledge it via a kind of hopeless existential shrug with which both Sartre and Kafka were so intimately familiar.

The following passage by Mr. Kafka, I think, perfectly captures the mindset of those of us in the non-delusional hypochondriacal world.

It was very early in the morning, the streets clean and deserted, I was on my way to the station. As I compared the tower clock with my watch I realized it was much later than I had thought and that I had to hurry; the shock of this discovery made me feel uncertain of the way, I wasn't very well acquainted with the town as yet; fortunately, there was a policeman at hand, I ran to him and breathlessly asked him the way. He smiled and said: "You asking me the way?" "Yes," I said, "since I can't find it myself." "Give it up! Give it up!" said he, and turned with a sudden jerk, like someone who wants to be alone with his laughter.

My non-delusional hypochondriacal twin brother, John, is good friends with the non-delusional hypochondriacal screen writer Jon Cohen (Jon's most famous screenplay was Minority Report). Jon, who could be our triplet psychiatrically speaking, coined a term for episodes of our form of the disease: nutties.

I am slowly being sucked into a nutty right now, and I thought it might prove enlightening to those who have never suffered one to see the sequence--and perhaps reassuring to fellow travelers that you are not entirely alone in the murky world where "give it up! give it up!" is the best advice you will ever get.

Step 1. An actual symptom appears somewhere on your body or within your mood. In this case, the actual symptom was the first tiny mottled skin lesion in, well, you know very well where the tiny mottled skin lesion was.

Step 2. Attempt at John Wayning the thing away. Ignore, deny, and assume that the body is resilient, such buboes are temporary, the best cure for any medical problem is to ignore it.

Step 3. Persistence of symptom, with or without worsening, though worsening does tend to get ones attention.

Step 4. Attempts at self cure via over the counter products.

Step 5. Asking friends about it; trying to corner a doctor on your swimming team into looking at the lesion and offering free medical advice.

Step 6. Short-lived last attempt regression to Step 2.

Step 7. Internet research

Step 8. Go to a doctor and take his or her recommendation, expecting fairly quick improvement

Step 9. When improvement fails to occur within 17 minutes, more Internet research.

Step 10. Constant monitoring.

Step 11. Attempts to clarify your thoughts on the nature of the buboe and its possible causes by writing these thoughts down.

Step 12. Recruiting new technologies, like a Logitech QuikCapture webcam and blog capabilities, to contribute your thoughts to the Internet

Step 13. Accidentally discover new possibilities for the buboe's cause, possibilities that actually have some plausible connection to your own case, such as a side effect to a drug you have taken for other reasons. Case-in-point:

FDA issues warning for Provigil

(Reuters) UPDATED 2007-10-24
Provigil, a medication used to treat excessive sleepiness, may cause serious skin rashes and suicidal thoughts, according to a warning from the Food and Drug Administration. Rare incidents of life-threatening skin rashes and psychiatric symptoms in patients with a history of depression and mania have been reported with Provigil use. Patients with narcolepsy or obstructive sleep apnea who take the drug to help stay awake should stop taking the medication if they develop such reactions.

Step 14. Follow up the new suspect with additional Internet research:

Stevens-Johnson syndrome and toxic epidermal necrolysis are two forms of the same life-threatening skin disease that cause rash, skin peeling, and sores on the mucous membranes.

• Stevens-Johnson syndrome and toxic epidermal necrolysis usually are caused by drugs or a bacterial infection.
• Typical symptoms for both diseases include fever, body aches, a flat red rash, blisters that break out on the mucous membranes, and small areas of peeling skin (Stevens-Johnson syndrome) or large areas of peeling skin (toxic epidermal necrolysis).
• Affected people are hospitalized in a burn unit, given fluids and sometimes corticosteroids and antibiotics and all suspected drugs are stopped.

In Stevens-Johnson syndrome, a person has blistering of mucous membranes, typically in the mouth, eyes, and vagina, and patchy areas of rash. In toxic epidermal necrolysis, there is a similar blistering of mucous membranes, but in addition the entire top layer of the skin (the epidermis) peels off in sheets from large areas of the body. Both disorders can be life threatening.

Step 15. Clammy dread begins to seep into ones pores, and the mind becomes increasingly hi-jacked with thoughts of ones dermis beginning to peel off in sheets, which leads to more frantic internet searches for photographs documenting this outcome

Step 16. The word nonsense! echoes through the back eddies of the non-delusional hypochondriac's mind, often in close tandem with such worries are madness!

From these early stages 1-16, of course, the nutty only begins to gain strength like a ligature being twisted with the help of an inserted stick to provide leverage and torque.

How quickly the narrowing spiral tightens!

Alas, it is only starting. And as much as we know what we must do, we cannot yet do it. We have not become sufficiently exhausted. The prospect of our flesh tearing off our bodies -- such worries are madness! --still seems a fate to be avoided. We remain too energetic to view flaying as salvation.

Much further in the future still is the only mindset that ever ends one nutty and inaugurates the interlude of peace before the next one starts:

"Give it up! Give it up!" said he, and turned with a sudden jerk, like someone who wants to be alone with his laughter.

Pictorial groin update later today, after tennis.