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Friday, April 25, 2008

Goiters For Dummies

I’ve been living with this goiter for a couple of months now, and I’ve finally figured out what’s got me annoyed about it – I mean, apart from the $9,842 in medical bills it has taken to diagnose something that doctors during the Victorian Age could have spotted from across the street. But I’ve figured out that the real trouble with being diagnosed with a weird, 19th century, tintype ailment is that there’s no sexy, big-budget commercial hawking the latest miracle drug to treat it.

Fade up on middle aged man standing in a field of wheat, staring off into the horizon, with a look like when David Caruso whips off his sunglasses on CSI. “I should have seen it coming,” he says in a whispery voice-over, as ominous minor chords play on a distant piano.

“I had all the risks,” he says, as we see him pushing aside a salt shaker and just grinding pepper onto his eggs.

“Not enough iodized salt in my diet…” Cut to him chasing a young girl through the woods, “Married to my first cousin… It was only a matter of time.”

Then the tender, caring, and thoroughly unctuous big-budget, vaguely familiar, has-been TV star announcer, takes over.

“Ask your doctor if Goiter-Be-Gone is right for you.”

“Goiter” is one of those words like “bustle” or “crankstarter” that 21st century Americans just don’t hear anymore. They haunt the silvery black and white images of another world, a world we know because of men like James Agee, photographers and historians of the 1930's who trekked, like Lewis and Clark, into the Smoky Mountains, crossing into the Mississippi bayous, conquering Cape Fear and the Great Dismal Swamp. They set out to record a way of life that was quickly dying, mostly with the noble goal of sopping up WPA federal grant money.

It was a world in which the vast majority of diseases, ailments and lumpy growths that took people down were preventable, without the need of a miracle injection or an exciting new treatment. Our parents had the answer for preventing all of them. All you had to do was eat right. (Of course, it also helped to get your sewage a little farther from your drinking water.) Now that modern science and the National Enquirer have discovered all of the bad foods to avoid and the good ones to gobble down as though they have been watered by Ponce de Leon’s famous fountain, we are all supposed to live forever. It must frustrate health food enthusiasts, joggers, and the perennially healthy when they wind up in the hospital anyway, dying of absolutely nothing.

Naturally, when I discovered my own infirmity was the humble goiter – shaped like the state of Florida, and about the size of my nephew’s favorite stuffed rabbit – I did what every modern child of this futuristic age does. I scared the crap out of myself by looking it up on the internet. With the morbid curiosity that propels people to rubberneck car crashes or go see Oliver Stone movies, I began to look into the genetic history of the goiter, and found some fascinating and bizarre twists and turns. Or at least fascinating and bizarre if you’re trying to avoid running the snow-blower after a freak snowstorm in March.

When Americans hear terminology about “racial imperatives”, eugenics, and “genetic inferiority,” they tend to creep out and think of Nazi Germany, and rightly so. Most aren’t aware of the fact that genetic progress, as well as social and educational progress, was part of the terminology of U.S. idealists of the late 1920's and the 1930's who wanted to make mankind’s lot better, generally by recommending the locking up or sterilizing of the NOKD’s (“Not Our Kind, Darling”). These sleek, well-heeled men and women, educated in the best Ivy League schools of the East, crept into the dark backwaters of America as though they were on safari in Equatorial Guinea, and were shocked by what they found – whole valleys and counties filled with people who looked like the kid in Deliverance who gets into a banjo pickin’ contest with Ronny Cox.

These country folks were enduring lack of education, poor diets, and, let’s face it, a lot of what was called consanguinity (defined in the new England Journal of Medicine as “a girl who can’t run faster than her brothers and cousins.”) Consanguinity, or the nuptial commingling of people who are related to one another, isn’t a very good idea. In the Puritanical land of New England, it was sharply discouraged, but in the sparsely populated rural backcountry, it went on with little objection. Nowadays, of course, with the advent of noted and respected research organizations like People Magazine, we can clearly see, for instance, in the ruling Windsor family of Great Britain just what happens to people who routinely marry their cousins. Prince Charles got those jug ears from a gene pool the size of a Holiday Inn Express hot tub.

And so, the U.S. Health Department rolled up its sleeves and set out to conquer ignorance, lack of hygiene, preventable diseases of dietary deficiency, and consanguinity, as well as other causes of birth defects. You don’t hear as much about this anymore, even though programs like the March of Dimes for healthy babies, grew out of it, effectively putting centuries of circus sideshows out of business. Be fair - when was the last time you saw a pinhead (outside of Tod Browning’s 1932 picture Freaks)?

Diseases of dietary deficiency, so rarely seen today, were a house of horrors in their own time. Pellagra was caused principally by a lack of niacin and other vitamins, as well as a diet way too high in corn and potatoes and way too low in meat. British seamen were called “limeys” because, starting in the late 17th century, they drank lime, lemon or orange juice each day to ward off scurvy, a disease my mother used to threaten me with when I refused to eat grapefruit with my chocolate milk. No sooner did I dump the milk and switch to grapefruit, she’d drag out rickets, as a threat for not drinking the moo juice.

So the battle was called in the early half of the 20th century to try to remake Man in the image of Science, by the creepy methodology of selective breeding. Ideas about improving Man’s genetics crossed the Atlantic back and forth like wildfire. But as the 1930's came to a close, Nazi Germany and America diverged on this eugenics issue - Americans backed off the idea that genetic tinkering was all it was cracked up to be, especially when the local health authorities wanted to lock up their favorite mad aunt. The Nazis, on the other hand, got over their squeamishness without quite the same pangs of self-reflection, and set about removing as many NOKD’s as they could build camps and ovens for.

Genetics are back today, and they’re hotter than ever. Since the completion of the Human Genome Project, charting the entirety of man’s DNA, huge leaps forward have been made in predicting the genetic likelihood of certain diseases in a patient, by virtue of which cousin your great-great-great granddaddy nailed behind the waddle hut, or which side of the forest he wandered out of. There’s no denying that had I been a descendant of the “people of the lowlands,” where salt and fish were plentiful, I probably wouldn’t be in this fix. But clearly my family grew out of the tough and wiry “mountain people” (meaning a bunch of lederhosen- wearing hill jacks out of Estonia who could take out a mastodon with just three guys, but whose diet was not high in the foods of the tidewater folks). Well, at least I don’t have webbed toes. But there’s no denying the creepy possibility of some future squint-eyed insurance adjuster demanding a copy of your genetic code to see whether you are a good health risk or a medical liability.

If I have to deal with this lump every day, I demand some self-important attention. So I’ve decided that what goiters need is better PR. I’ve got one, so it’s clearly not just a washed-up, has-been, yesterday kind of affliction. It’s a hip-hop-happenin’, sub-sternal lump of the 21st century! It needs the Goiter Channel. It needs a special colored lapel ribbon to unite sufferers, supporters and sympathetic Hollywood actors who can become goiter experts merely by playing goiter sufferers in movies. It needs Congressional hearings. It needs a whole line of fashion wear (Dame Fashion says drape your goiter this season in swaths of madras!).

And, of course, there’s the obligatory list of famous goiteratti, those legions of noble notables from the ranks of celebrity who led happy, normal, multi-million dollar lives while bravely facing their goiters in the mirror every day and still managing to go on: Frank Sinatra, Rod Stewart, Kim Il Sung, George H.W. and Barbara Bush, Muhammed Ali, Joe Piscopo, Michelangelo. (I’m guessing this is the only time Joe Piscopo and Michelangelo have ever been mentioned in the same sentence.) In fact, Michelangelo actually wrote a poem about his goiter, which developed while painting the Sistine Chapel:

I’ve grown a goiter by dwelling in this den-
As cats from stagnant streams in Lombardy,
Or in what other land they hap to be-
Which drives the belly close beneath the chin:
My beard turns up to heaven; my nape falls in,
Fixed on my spine: my breastbone visibly
Grows like a harp: a rich embroidery
Bedews my face from brushdrops thick and thin.

If he could paint that ceiling with a goiter and still go on, I know I’ll make it too. Take it from me and Joe Piscopo.

My surgery is Tuesday.


  1. No no no. You've got the drug names all wrong. You want Goiterid XR, Goitera ([read in a soft, urgent voice]: stop taking Goitera if you grow hair on your palms and howl at the moon. Patients taking Goitera may grow extra genitals. If this happens, see your doctor). And of course the old standby, Goivexa.

    Ain't pharma branding wunnerful?

  2. Chris, good luck with your surgery, I see now that you have a mirthful gift for the ironic. It is a hoot to follow the meanderings.

  3. Chris,

    Take care of yourself. Let me know if I can help in any way. Toni and I will be thinking of you and Alice!


  4. The branding should include a few more side effects as well... in the same soft, urgent voice, but read a bit faster...

    "Common side effects include: abdominal pain, abnormal heartbeat, incontinence, agitation, allergic reaction, arthritis, back pain, blurred vision, bronchitis, convulsions, chest pain, acute auditory hallucinations, erectile dysfunction, constipation, diarrhea, difficulty breathing, dipsomania, dizziness, flu symptoms, fluid retention, flatulence, headache, hyperventilation, indigestion, infertility, inflammation of sinus and nasal passages, insomnia, joint pain, lethargy, leprosy, muscle aching or weakness, night sweats, nausea, night terrors, rash, scabies, stomach pain, temporary blindness, urinary tract infection, vomiting, weakness, and rectal bleeding."

  5. Surgery? For a GOITER?

    Isn't modern medicine wonderful. Sigh.

    Goiter is caused by iodine deficiency. Our modern life has many iodine antagonists: bromines (in bread and Mtn. Dew) and chlorine and fluoride and percholorate to name a few.

    Lugol's solution would have cured it.

    See Dr. Brownstein's book on iodine and the website Iodineforhealth.com

  6. Well, yes, thanks for the advertisement. Lugol's solution might have cured it if it hadn't grown to the size of a large house cat behind my ribcage, mashing against my heart and lungs so I couldn't breathe properly. There was no external sign of the thing-it sent a thin tendril down the side of my esophagus until it found more spacious accommodations and expanded into a complete subdivision with improvements already in.


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