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  • Karl Thunemann

A Co-Morbidity Slog

I began to feel a bit snarky about all my comorbidities. I was making a mountain out of a mole hill. Ah, let sleeping dogs lie. Where is the pudding? (As in the proof …) And other bromides. But my unconscious had other ideas.

In the preceding epistle, “My Co-Morbidity Waltz,” I concluded that my list of 14 C-M’s was incomplete: Certainly, other entities would come forth. And a couple of days later, I awoke to awareness of three more. How could I have forgotten?

One was the most recently diagnosed: Barrett’s esophagus, generally considered to be a consequence of acid reflux, carrying a small risk of developing cancer. My primary doc referred me to a G-I surgeon for an endoscopy and colonoscopy.  I thought these tests were no longer used with patients of my advanced age, and now I face a future—however foreshortened—of endless follow-ups! Is Barrett’s considered a co-morbidity? I find no mention in my web searches, but it must be!

I wondered—have I inflated the effect of my comorbidities? Or does their sheer number give them the weight of an iceberg—mostly underwater—bearing down on me?

Here's another, diagnosed almost two decades ago by my sainted first physiatrist, now retired. He said my spine was riddled with arthritis. And I am here to tell you, it must be present in my feet, knees, hips, and hands, though not yet confirmed by x-rays. Feeling is believing! And yet none of my present doctors (a list not quite as lengthy as that of my perceived comorbidities, thank God) is treating arthritis, as far as I can tell.

But here the internet provides more information. First I found a helpful article on the website of the Arthritis Foundation—which, unfortunately, I have been unable to re-discover. And second, I refer to my new favorite website, It speaks directly to comorbidity. *

So, you ask, wherein lies the snarky quality you offered above as a teaser? It lies in the third comorbidity that checked in that morning: tinnitus. When I shared this condition with one of my confidantes, we turned snarky, laughing in derision at the idea this disruption should be treated with any respect whatsoever. It’s nothing but a constant clattering in the ears. And—did I say “constant”? —well, I’m not aware of it all the time. This morning I scarcely heard it at all until I started composing this paragraph. But because it so often shows up unexpectedly I am forced to believe that the ringing is constant, even if my awareness is not. Even so, it seemed like a minor irritant, at least until I discovered the American Tinnitus Association. (Really, I thought at first. Somebody is making this up.) The ATA site rings with analysis of tinnitus and comorbidity. Some C-M’s are primary. Some are outriders. There’s so much we do not know about this topic.

I came to a full stop. I had lost my inner snark. I left this epistle alone for days and days. I wondered—have I inflated the effect of my comorbidities? Or does their sheer number give them the weight of an iceberg—mostly underwater—bearing down on me? I suppose some meditative path will emerge. I must be patient. In the meantime, I ponder my swelling comorbidity chorus:

Cerebral palsy--- voice offstage says Why not call it hemiplegia?  It’s weighted in an official comorbidity protocol.  Speaker: Shush, we’re doing a reading here!  … Sleep apnea. Myopia. A history of falling. Macular degeneration. The dread Brothers S: sciatica, stenosis, scoliosis, and a sedentary life, all afflicting the spine.  Mild cognitive impairment. (Oh, mild indeed like the cheroots of a misspent youth!) Post Traumatic Stress Syndrome. Anxiety. And how could we overlook hypertension? Or persistent skin cancers? (I am a California boy, I am!) And now coming forthcoming: Barrett’s esophagus, arthritis, and tinnitus. †  

While I am waiting, I will treat myself with apple cider vinegar, and maybe gingko biloba. It’s said they can help with tinnitus. And may I find a wise path that enables me to acknowledge my comorbidities without becoming in thrall to them.

*  Researchers are increasingly concerned about the rise in comorbidity among people with arthritis. As the U.S. population ages, they are looking at ways to mitigate the effects of treating multiple chronic conditions. Treatments for multiple conditions can include conflicting medical advice, increased cost, and duplicative tests or adverse medication effects. The medical community is recognizing this, and many doctors are working on a more patient-centered approach.  “Overview of Comorbidity and Arthritis,” from

†   Here I take a pause. How can I have omitted vascular disease? Well, it is not a separate entity. Mild Cognitive Impairment is effectively its agent.


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