What Would Susie Say? Susie Essman's Enlarged Prostate

Susie Essman, aka Susie Greene of Larry David's HBO program, Curb Your Enthusiasm, has written a hilarious book (and yes, I actually read it) called What Would Susie Say?: Bullsh*t Wisdom About Love, Life and Comedy. For this week's CBS Doc Dot Com, I talked to Susie about some of her health issues covered in the book, including menopause, fear of germs, and hypochondria. "So far this month," she told me, "I've had Lyme disease, hysterical blindness, enlarged prostate...."

If any woman could actually have an enlarged prostate -- either her own or snatched in a fit of pique from her beleaguered television husband played by Jeff Garlin -- it would be Susie Greene. But as we discussed her real and imagined symptoms, it became clear that Susie Essman can be easily talked down from her flashes of hypochondriacal thinking. So she doesn't actually meet the official psychiatric definition of "hypochondriasis," in which a misinterpretation of symptoms leads to a preoccupation with having a serious illness that interferes with daily functions and lasts at least six months despite reassurances from a doctor. In fact, her belief that she's a hypochondriac is hypochondriacal.

True hypochondriasis can be a devastating illness but fortunately affects only about three percent of the population.

Many more of us -- just like Susie -- have occasional hypochondriacal thoughts that can be extremely challenging for doctors to address. As a physician, I do fear missing a serious illness in somebody who happens to be hypochondriacal. For me, the best approach has been to take complaints seriously, do a complete history and physical, and allow plenty of time for discussion. A patient who is convinced his day-old headache is from a brain tumor is not going to be reassured by "Oh, it's probably nothing" over the phone, especially if his friend just died of a cancer that was initially misdiagnosed. We'll both be relieved after his exam is normal and a conversation reveals he's been under extreme stress at work and, by the way, stopped drinking coffee two days ago. If symptoms persist I can always pursue further evaluation later.

Spending adequate time with patients is the best way to avoid unnecessary and expensive testing such as MRI's and CT scans, about a third of which are unnecessary.

Fortunately, my years of training and clinical experience have completely immunized me against hypochondriacal thinking. And I plan to set Susie straight about her prostate as soon as the pain from my ovarian cyst resolves.

Click here to watch Susie Essman discuss hypochondria, menopause, fear of germs, the teenage brain, intimacy in her marriage, the difference between men and women, what to look for in a man, and why she likes growing older. The clip ends with a very touching description of her grandmother Millie, who she adored.

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Comments

[lastpost]

The epitaph on a famous (hypochondriac ?) humorist’s headstone reads, “I told you I was ill”.

But aren’t some humans designed by nature to worry? If not the case, how many of us might not be here now? In the absence of another individual or object on which to focus that concern, could not that energy redirect itself inwardly? Our brains can only juggle a finite number of thoughts at any one time. When fully occupied, there is no spare capacity available for diversionary concerns.

[hershala]

Love the idea of a knowedgeable doctor who listens to the patient, takes them seriously and investigates. I went to a doctor for years, I started urinating air along with urine, asked him about it, he had never heard of such a thing. Told me that often women my age imagine symptoms, sold my business, retired and moved to another state. Guess what, my new doctor found a huge fistula the same day I first saw him. I was back visiting in Southern California ran into my doctor at the mall. I told him what happened, he apologised told me that he couldn't do anything about it because he had refered too many people to specialists and was afraid he would have been fired by the insurer if he refered anyone else and didn't have enough time to look into it himself.

I have no respect for him, his group or the insurance company.
By the time my new doctor got me into surgery I was in the early stage of kidney failure from infection. I had what was putatively good insurance. My current insurer is fine doesn't have the right to veto care and has paid what they are contracted to pay without any hassle. I want as a minimum a government option, I am fortunate to live in a state with actual insurance reform and an insurance comissioner. But in other states YIKES!! Disaster is looming just around the corner.

[katielady]

Of late, each time I have been to a doctor, the "nurse" or "assistant" who write the patient complaint or reason for visit, has written it completely wrong. Mixing the side; right or left, medications.. nuts.. I appreciate that most of the doctors I see take the time to ask and listen to the answers... listening, as I learned in Nursing School was the best skill I could acquire; second was observation of the skin and behaviour.. This requires training, time and skill sets.

[tilted windmill]

I agree. Many years ago, I told the nurse for my OB/GYN that I was taking the birth control pill, Demulen. When the doctor picked up my chart, she got a worried look on her face and asked why I was taking Demerol(a powerful pain killer).

Last year my left arm was x-rayed to diagnose a broken elbow. At the next appointment, the x-ray tech asked, "What the heck did you do now?" The doctor had requested an x-ray of my right arm. Then I gently corrected the tech when she put the R marker next to my left elbow. By the third visit, the nurse was so confused by all the Ls and Rs that she wasn't sure what to write where.

Fortunately I had the chance to talk about these mistakes and get them corrected. Heaven help us if this goes on when we are unconscious and can't ask or answer questions.

[NHGranite]

It is hard for doctors, but it is terrifying for those of us who tell doctors about symptoms they dismiss and are not treated until they damn near kill us. LISTEN TO ME

Next, let's call out all the BS about things they DO tell us are OK, which turn out to be false. Examples?

Tylenol "doc, this hurts my stomach" "no it doesn't" Turns out that was my liver that got destroyed.

"Doc, shouldn't I be on a special diet for kidney failure?" "no, not for your particular disease" oh, now you tell me you will lose accreditation unless I talk with a dietitian at your facility - even though I saw my own dietitian starting 5 years ago - how do you think I stayed off dialysis all this time?

"Doc, I got chicken pox". "Adults don't get chicken pox" "Oh my, you have chicken pox"

"Doc I am tired and my throat hurts" "It's a cold, not mono" No, it's toxoplasmosis - found before they surgically removed my swollen neck glands.

[Valerie Keefe]

I hate to be pedantic but more women have prostates than have Multiple Sclerosis. Complete Androgen Insensitivity Syndrome and Gender Dysphoria being the main causes there.

[aspiecelia]

Dr. Lapook your hypochondriac could turn out to be infected with a retrovirus after being told she was imagining her symptoms for 25 years. I have CFIDS/ME and as recently as last year had a doctor tell me the only treatment for CFS is prozac. That was just before he told me my MRI which showed several brain lesions was normal. Being a retired critical care nurse I told him he did not know what he was talking about and made an appointment with a neurologist. She ran all the normal tests for MS, but as you probably already realize she was not able to confirm the diagnosis because when CFIDS flares up it can look very similar to MS. Fortunately in CFIDS the lesions are usually lymphocytes. I am intelligent, educated and know a lot about medicine, what is and is not normal, and have been fairly miserable for 25 years. I kept going with the hope they would some day find a cure. This is probably not going to happen in my life time. I would settle at this point for doctors to be educated about CFIDS to the point of knowing it is not hypochondriasis, it is real and it is devastating.

[jan4insight]

I was diagnosed with CFIDS in 1990, after having lived with it (and all the "it's in your head" nonsense) for about 20 years (it was not even identified as a disease until 1987). The doctor who gave me this diagnosis (and I was the first patient he diagnosed with it) also gave me a great gift: He told me that medical science couldn't do anything for me.

I took his word at it, and went out on the alternative healing path. I am now a practitioner of Jin Shin Jyutsu, an energy-balance form of bodywork related to oriental medicine. I now have my life back, and I owe it largely to JSJ and other practices that I have followed over the years. But I also have to say THANK YOU to the original doc who was honest about the limits of western medicine, and therefore gave me "permission" to go find what worked for me.

[jojojo]

Speaking of Prostates...

Prostate Cancer strikes as often as Breast Cancer and kills nearly as often, but gets less than half as much research money for a cure. Even the military, which is 84% male, gives more money to breast cancer research than to prostate cancer research.

When will this blatant sexism end?

[smileatfear]

Well, 40,000 women die every year from breast cancer and about 28,000 men per year die of prostate cancer. Men get prostate cancer on average later in life than women get breast cancer. That's not to minimize the tragedy that all cancer is, but women do die younger and in greater numbers than men so that is where some of the disparity in publicity and funding comes from. And women have been willing to go public with this disease. Men, not so much with prostate cancer. When some man is willing to become the Susan G. Koman of prostate cancer than it will get more attention. How about you, jojojo? Are you willing to go public and talk about your prostate health?

[Valerie Keefe]

How about Arnold Palmer? He was very public about his prostate cancer about 10 years ago.

Also men die sooner than women in the United States by roughly 7 years. That's quite a gap.

[csavage]

The incidence of prostate cancer is higher-up to 10% of men have prostate cancer at autopsy. Of course, men tend to die of heart disease, not prostate cancer, so that autopsy report is autopsies performed on men who die of other causes. As for prostate cancer research, you are high if you don't think that's there's lots of research going on for prostate cancer. The problem is 1. PSAs aside, there is no good screening for prostate cancer and 2. there's various levels of tumor agressiveness associated with prostate cancer. Frank Zappa died of a particularly agressive tumor, there's miliions of older men who have very indolent disease. Do all warrant XRT, hormonal therapy, or a prostatectomy? Especially if they're going to die of heart disease or stroke, maybe within 5 years?
The treatment questions aren't nearly so muddled when it comes to breast cancer.
Also, FYI, testicular feminization syndrome, or androgen insensitivity syndrome, the people involved all have the anatomy of women, they just don't have a uterus. And they certainly don't have a prostate

[jojojo]

csavage wrote:

"As for prostate cancer research, you are high if you don't think that's there's lots of research going on for prostate cancer. "

Of course, I never said there wasn't research going on. Only that this research isn't getting its fair amount of funding.

It strikes more often than breast cancer, as you point out. It kills at least 70% as many (many say more than 70), as smileatfear pointed out. That it gets less than 50% as much research funding is a terrible injustice. If the numbers were reversed, and women's research was underfunded compared to men's, it would rightly be condemned as sexist. That is also the case here. Men are deemed expendable in our culture. "Women and children first", for example. That is sexist. So is the disparity in funding. There can be no reasonable dispute on that.

And now, I gotta go.

[Valerie Keefe]

One wonders though how much of a contributing factor having your immune system fight a war on two fronts might be to life-expectancy.

[contradiction]

Didn't you hear? The American Cancer Society recently indicated that screening for prostate cancer wasn't really the big of a deal because it doesn't "save enough lives" to warrant the cost of regular screening.

http://www.npr.org/templates/story/story.php?storyId=114029865

I don't think it's sexism, I think it's ignorance.

[wehrke]

I am reminded of the old tombstone that read, "See, I told you I was sick."

[LanceThruster]

I've always loved that one. I also like "Don't Touch My Stuff"

[PlaceboStudman]

Sadly, we have become a society where the only medical crisis that matters is "My" (the universal my) health crisis. Any other health crisis that gets in the way of or distracts from the focus of *my* medical crisis is, at best downplayed, if not out right ignored and disregarded as irrelevant.

We see this every single day in the Health Care debate, where Obesity and Lifestyle related illness is discussed at length, but the moment someone asks about real disease and disability, we are shut down and shouted out.

This is what happens when we prioritize by numbers, not severity

(example: MD is more severe of a disease than obesity but because more people suffer from obesity, despite it being easy to cure, and even easier to avoid all together, it gets all the attention and money)

[smileatfear]

MD is a hard one. And so is MS. And Parkinson's disease and ALS and Lupus and many other diseases that are progressive and incurable. And since those of us with those diseases are small in number we can't feed the media machine as well as "diseases" like obesity.

Money is triaged just like patients are and that makes it hard for those of us who want to live a functional life too but have to fight harder for research dollars, and pay far more for treatments, than people with preventable lifestyle diseases. I don't know what the answer is except to be constant and persistent advocates. A breakthrough in one disease often leads to an understanding and breakthrough on other similar diseases. More than a lot of people, we have to have hope.

[PlaceboStudman]

You summed it up well, "constant and persistant advocates"

We need to make sure our voices are counted amongst the calls for research and developments of treatments of every other disease.

Money needs to be redistrubuted and re-employed in cycles, from the lifestyle diseases to the congenital diseases, and back, and forth. But this will require more people to stand up to the opposition of people who, sadly, only have their own interests in mind.

It would be nice (though unrealistic) to see the American public, for example, give donations equal to 1/1000th of the grants Obama gave to the NIH

If we could get 5 million people to donate $10 or $100, it would go a long way toward helping all disease and disability

[bleek]

If doctors in the U.S. want to know a good reason why their patients are confused about health issues, they should just look in the mirror.

Doctors, and GPs in this country are so full of contradictory (or just plain false) information provided to them by the pharmaceutical companies that it's a wonder that anyone is healthy, anymore.

[csavage]

Every internist, pediatrician, and family practitioner in this country is subject to board certification and recertification. If you feel your physician is spouting off dribble from a drug rep, please report him to his specialty board.
Internal Medicine-the American Board of Internal Medicine
Family Practice-the American Academy of Family Practice
Pediatrici­ans-Americ­an Academy of Pediatrics
Specialists are certified in their specialty board and their intial training board, for example, a cardiologist is both certified by the ABIM and the American College of Cardiology.
As for drug rep dribble, I find myself spending more time correcting false information patients have gleaned from the internet, 60% of which is wrong. Please reference websites that are peer reviewed-I recommend WebMD and Mayo Clinic. I do not listen to drug reps, I find the information listed in The Medical Letter far more informative when it comes to new drugs.

[Witkacy]

I love Susie Essman - just wanted to say that.