MIND & BODY: Worried Sick

Sure, elective CT scans can save lives. But what can the latest medical trend do for a hard case of hypochondria?

A couple of years ago, during my first annual physical in about a decade, my doctor said she heard a slight arrhythmia in my heart. Nothing to worry about, she assured me. In fact, if anything, the arrhythmia was a sign of good health. Most people get by with a simple ba-dump, ba-dump. Not me. I have a little extra cardiac activity. Ba-da-dump, ba-da-dump. My heart is like the rimshot to a punch line.

And the joke got even funnier recently when I went for an office consult. I asked my doctor about my arrhythmia and she listened to my heart again. But she couldn’t hear it. The arrhythmia, that is. She said my heart sounded perfectly normal. Now, a rational person might mutter, “Hmpf,” and get on with the rest of his life. A cynic might think a doctor with two diagnoses of the same patient isn’t trying hard enough. A hypochondriac might be convinced that he with the erratic heartbeat is about to die.

My doctor, Amy Anderson, is excellent. I’m not normal, but I’m not your typical hypochondriac, either. When I cough, I don’t think I have bronchitis. Sore throats are but a nuisance, not strep. I can have a headache and not jump to the conclusion that I have encephalitis.

On the contrary, when I’m seemingly healthy, that’s when I feel like something is terribly, drastically, imminently wrong. In Westerns, the gunslingers note when it’s quiet—too quiet. Similarly, I’ve been healthy—too healthy. I can remember just enough of seventh grade Life Science to know that the inner workings of the human specimen are a Rube Goldberg system of organs, veins, neurons, pulleys, rubber bands, and tape. I refuse to believe that it all comes together to keep me upright without a hitch.

So what’s a young, asymptomatic man supposed to do when he’s the only one convinced he’s sick? Get a full-body CT scan.

Until recently, CT scans were slow, daunting, claustrophobic procedures that were purely diagnostic. The tests were too inconvenient and expensive to be done for any other reason. But advancements in technology have led to faster machines that can take more pictures in less time with better results. Nowadays, for about a thousand bucks, you can get a CT scan whenever you want one, rather than waiting for whenever you need one. You don’t even have to go to a hospital—and in some cases you don’t even need a doctor.

Just as people have taken stronger interest in their personal finances, the medically curious are taking more control of their health. As HMOs become more bureaucratic and less helpful, people are dipping into their own wallets for, they hope, a clean bill of health. Facilities offering full-body scans are popping up all over the country—to the delight of some doctors and the chagrin of others.

“It’s a waste of money and a bad idea,” Robert Smith, Ph.D., told American Medical News last year. He’s the director of the American Cancer Society’s screening program. Similarly, the American College of Radiology has said, “There is no evidence that total-body CT screening is cost-effective or is effective in prolonging life.” Even the FDA has expressed concerns, specifically about the promises that proprietors of such places are making in advertisements.

When mammograms first came on the medical scene, they were subject to the same criticisms: unnecessary, unreliable, and uncalled-for. Mammography has proven to be beneficial, and CT scans may follow suit. Supporters of screening scans point out that the tests are affordable and safe. Plus, the technology is highly advanced but still relatively young. CT scans will only get better.

The CAT scan, as it was known before it dropped the “axial” in “computerized axial tomography,” is as old as I am. In 1972, a Brit named Sir Godfrey Hounsfield (he was knighted for his medical contribution) devised a way to shoot hundreds of narrow X-rays through the body, which could then be plugged into a computer to create a cross-section image of a person’s interior workings. The first CT scans took several hours to get enough data for a single slice and several days to make anything of it. Scanners these days can image a slice every half-second, and results are ready within minutes.

The flip side of all of this great technology is that we’re finding things sooner than we ever have, which isn’t necessarily a good thing. On the mental side, someone who walks on the tight rope of sound health is doing just fine until he looks down. Physically, early detection can lead to more harm than help.

“Sometimes, it gives you information that’s just not worth it,” says my doctor before the scan. “It could find a lump in the pancreas. Then you go to great lengths to find out that it’s benign, but you’ve ended up creating problems chasing it.”

She goes on to tell me all the things the scan is good for detecting: calcium in the vessels of the heart, masses in the lungs, problems in the kidney, carcinomas in the abdomen. I nod as she goes through the list. These are new things for me to worry about. These are new maladies I undoubtedly have. For this story and, more importantly, for my sanity, Dr. Anderson arranged for me to have a preventive CT scan within days of my office consult. “I’m a hypochondriac, too,” she tells me.

Conveniently, my doctor’s office has a CT scan machine, an almost-top-of-the-line GE LightSpeed Plus, in the basement of its building. If you don’t happen to be a patient at MedProvider near Baylor, you’re not out of luck. More and more medical facilities are offering screening scans. Some places, like ViaScan in Las Colinas, Vital Imaging in Plano, and hundred of others across the country, are specializing in them. Their machines, they’ll tell you, are actually EBT scanners, using electron beams and providing better glimpses of one’s coronary arteries. Basically, though, they both do pretty much the same job, like VHS and Beta.

Because the procedure involves radiation—very little, a receptionist will add—state laws require a doctor’s prescription for a scan. If you can’t get your practitioner to sign off on it, many places have doctors on staff to write a prescription for you for a very low additional cost. Since mine was in-house, it wasn’t a problem.

No, the only problem I had was of my own making: I showed up. By the time scan day came, I didn’t want to go through with it, and my misgivings only grew worse as I sat in the waiting room. Anxiety about the test and, more to the point, the results, mixed with guilt about taking it in the first place. Other patients were waiting for diagnostic tests that they needed; I was there flaunting my supposed good health.

A nurse escorted me back to the scan room where Steve the Technologist guided me through the process of my EKG-gated multi-detector CT scan. I climbed onto a table and, beneath the offered sheet, took my pants down to about mid-thigh so my buckle and zipper wouldn’t show up in the scan. He told me to put my hands above my head, and then he left the room, assuring me he would be in voice contact.

The table moved in and out of the donut-shaped machine a few times like an extremely slow piston (fans of the double entendre, please note: as Freud once said, sometimes a cigar is just a cigar). Over an intercom, Steve instructed me to relax, but the louder, more authoritative directives came from a disembodied, recorded voice that told me when to breathe and when to hold it. My breath, that is. “Take a breath and hold it,” the voice said. The voice did not say for how long. The voice had no idea what kind of anxiety that can cause in an already anxious person. After about two or three breath holds and four or five minutes, the test was done.

As Steve the Technologist introduced me to Samuel the Radiologist, I couldn’t take my eyes off the computer screen. That was me there, and I knew it wasn’t good. The screen was black except for an off-center gray splotch. It looked like nothing I remembered from seventh grade Life Science.

“What’s that?” I asked in my bravest voice.

“That’s your heart,” the radiologist said.

He went on to give me a tour of my innards with the enthusiasm of a kid playing I Spy, pointing out my liver, stomach, intestine, spleen, aorta. The computer software allowed him to go frame by frame through all 129 “cuts” that the CT scan took or scroll through my innards like a flip book. The science of virtually spelunking through a human body was remarkable enough, let alone the fact that it was my body.

I finally asked him the question I had hoped I wouldn’t have to ask: “Am I healthy?”

“Oh, absolutely,” he said and went right on with the tour.

Sure enough, the report I got in the mail confirmed his diagnosis. I got a coronary artery calcium score of zero, which places me in the 10th percentile of men aged 21-30, meaning 90 percent of other guys my age would have a higher score. The official clinical recommendation on the report says: “Reassure patient.”

A normal person wouldn’t even need reassurance and could go on living the life of, well, a normal person. A cynic would wonder why a score of zero doesn’t place him in the top one percentile. A hypochondriac, though, panics about what the CT scan must have missed.