Stephen G. Bloom

I momentarily imagine the voice on the other end responding, “Poor baby, come in immediately. Back pain is simply horrible. We can give you drugs, shots, lotions, anything to make that terrible ouch go away.”

Instead, this is what I get: “Have you lost control of your bowels?” from a woman who sounds like the thin-lipped Frau Farbissina, the evil henchwoman in the Austin Powers movies.

Come again?

“Have you lost control of your bowels?”

Despite the agony in my back, I keep repeating to myself, “Remember this, because no one will ever believe you.”

“No,” I answer, getting Frau’s drift about how far the needle must go on the Pain-O-Meter to merit an appointment. “But if losing control of my bowels is what it takes to see a doctor, I will climb on your desk, squat over your appointment book, and let loose.”

Click. I imagine Frau’s lips turning upward to form a satisfied smile.

My next call is to a physician friend, suitably sympathetic, who calls in a scrip for Tylenol 3 to the local Walgreen’s, although I’m uncertain how I will get there to pick it up.

“Bed rest, that’s what you need,” my friend prescribes. “Lie flat on your back for the next week. Don’t move.”

That’s what I do, and sure enough, the pain disappears.

- – - – - – - – - – - – - – - – - – - – -

Flash forward four years. At 5 a.m. one Tuesday last April, I awaken and my lower right leg has gone totally numb.

“God, could this be a stroke?” I ask myself, my heart racing like I have won the trifecta. From knee to big toe, you could stick in long, sharp needles and I wouldn’t feel a thing.

I tap my wife on the shoulder. She is snoring lightly.

“Am I speaking clearly? Is my speech garbled?”

“Go back to sleep,” she says, hugging her buckwheat hull pillow.

“Kaan yu oonderstund da wurds I um saaaayig?”

“Go back to sleep,” the wife advises again, this time more sternly.

So, I’m not having a stroke. But my right leg and foot are still numb, and the moment the clock radio goes from 7:59 to 8:00, I call my internist over at the University of Iowa Hospitals and Clinics, rated by U.S. News & World Report as the nation’s sixth best medical center for primary care.

“He’s out till tomorrow,” secretary Denise says. “But he’ll call in for messages, and I’ll ask him to call you.”

“But this is an emergency, Denise!”

“He’s booked until next Wednesday, his clinic day. That’s the day he’s reserved to see patients.”

Where does the hospital get these people? The reject pile of token-takers at the New York City Transit Authority? The motto seems to be, “How can’t we help you?”

“You can always go to the emergency room,” Denise offers cheerfully before hanging up.

Like an idiot, I actually think the doctor will call back, so I sit — actually lie — on the floor by the phone, all the while the pain still radiating from my lower back, shooting down my right leg like I stuck my big toe into a 220-volt electrical socket. The doctor does not call.

I call Denise at 8 the next morning. “Oh, he’s in clinic,” she says as though I should know better. “But I left a message with him, and he should return your call.”

Another day goes by. The doctor does not call. The pain gets worse.

I call Denise. “Doctor is still in clinic,” she tells me as though that explains everything.

If they treat me like this, and I’m a tenured professor at this hallowed institute, how do they treat a pig farmer from Sioux City? Then again, I wonder, how would they treat a University of Iowa tight end with back problems, starting in this Saturday’s game against second-ranked Penn State?

Used to be your doctor would see you the same day. That was his responsibility, his oath to serve you, the patient. He (and it almost always was a he) was your private personnel manager. You had a relationship with him.

Next time you’re at the movies, try shouting, “Is there a doctor in the house?” and see if anyone but a pervert comes to offer you mouth-to-mouth resuscitation. These days it takes papal intervention to set up an appointment with your physician six weeks in advance.

I am desperate. I want to know what’s happening to the trusty body that has given me prime service for 47 years. For Christ’s sake, I can hardly walk, and my own physician is too busy to see me.

I turn testy. “If the doctor is in the clinic, could you give me his pager number?” I ask Denise in a tone she is unaccustomed to hearing.

I page the doctor, and seconds later, hallelujah, praise the Lord, he calls back.

I am in agonizing pain, but I need to talk like I’m in agonizing pain, which I do. “The pain is ex-cru-ci-ating,” I tell the doctor, pulling out the word like Atlantic City taffy.

“How fast can you get over here?”

“Any time,” I answer breathlessly. Do with me what you will, but do it now.

“I could see you — but only if you can get here in the next 15 minutes.”

“OK,” I answer, thinking I’ve scored an audience with John-Paul himself.

I tear over to the hospital complex and whip into a parking spot; all the while my right leg feels like a fully operational cattle prod. I go through the rat’s maze of the hospital complex and find the internal medicine clinic. After I wait 10 minutes, a nurse checks me in. First she weighs me (180 lbs.) and then takes my blood pressure (143/83).

“Is your blood pressure always this high? This is something you might want to talk to Doctor about.”

I guess we call him Doctor.

I demure from saying, “Your blood pressure would be high if a couple of days ago you thought you were having a stroke, and now you feel pain that possibly rivals childbirth, and you’ve called the doctor three times and each time you’ve been lied to, and now, miracle of miracles, the Holy Shaman deigns to see you.”

Doctor comes into the examination room. He lifts my leg. I respond accordingly, which is to scream, and he says: “These things usually go away. Rest, and if it doesn’t get any better in a week, call me. We could give you an MRI and an X-ray, but all that would do is cost you and your insurance company $1,500. And whatever you do, don’t see a chiropractor.”

I don’t want to see a chiropractor. I want to spend the $1,500, but am not given a choice. Within 10 minutes, Doctor is out the door, and I am alone again with my pain — and a prescription for Darvocet.

Exactly seven days later, the agony hasn’t gone away, so I call Doctor, and it’s back in the ring again with Denise.

“Doctor can’t see you today.”

“But he told me that if in a week I didn’t improve, I was to call and he would see me.”

“Doctor is on rounds today. He can’t possibly see you.”

“But I’m still in ex-cru-ci-ating pain.”

Silence.

This has gone too far. Fortunately, I’m a packrat; I find the crumpled piece of paper with Doctor’s pager number on it, and call him, punching in my telephone number.

Doctor calls back, sounding annoyed. I go into my song but not the dance, and Doctor tells me he’ll call one of his friends at orthopaedics, but gives me precise instructions.

“Wait five minutes. Then call this number. If the line is busy at first, call back. They will answer.” It sounds like Doctor is setting up an undercover drug buy.

I wait the prescribed time, call orthopaedics, and finally no Denise. A dulcet-toned woman who sounds like Jaclyn Smith in the 1985 made-for-TV movie “Florence Nightingale” tells me to get over right away. She thinks she may be able to squeeze me in.

I race over to the hospital, park, pull my peg leg out, hobble through the maze to orthopaedics, only to meet the Jaclyn Smith clerk, who summarily waves me toward a waiting room. All seats are taken, which is just as well, because sitting is too painful, so I stand.

Twenty-five minutes later, another clerk shows me to an examination room. It is now 10:15 a.m., and the pain is shooting from hip to toe. My leg feels floppy, like an electric eel about to impress the kids at the Shedd Aquarium. This isn’t altogether bad: I want to be experiencing intense pain when the Holy Shaman arrives so that he can properly diagnose me. The worst thing would be to tell him that the pain comes and goes, and it just went.

So I sit down; this increases the pain. I’m in this tiny room, writhing in agony, waiting more than an hour, flipping through old issues of Field and Stream, when a guy in a white coat who looks about 12 years old comes in.

Ah, the medical student, aka the warm-up act.

He pushes and pulls my legs and seems nice enough, jotting notes on my chart. The warm-up act informs me that the Holy Shaman will “be with you shortly.”

“Shortly” turns out to be 70 minutes. Back to the Field and Streams. Gore-Tex waders are in, by the way, but expensive.

Finally, the H.S. comes in, and introduces himself as “Dr. Found.” I’m tempted to ask if he got lost, but I demure. He is the doctor, after all. Found manipulates my limbs, writes something down, pulls at my big toe, then says, “Let’s schedule an MRI, X-rays, and a test to see how the nerves in your leg conduct electricity.”

At X-ray, I wait 15 minutes before they take their photographs, and after that, I’m afraid I’ll be late for the MRI, so I tell the X-ray people that I want to take my X-ray films with me. The secretary looks at me like I’ve lost my marbles, but after 30 minutes, hands over the X-ray.

I find MRI. I slide inside the MRI tube, which makes me feel like I’m in a straitjacket, but I handle it by repeating a mantra I learned in transcendental meditation class in 1972. When I slide out, the technician tells me that the MRI people won’t have time to read the MRI because it’s too late in the day, but he promises to keep my X-rays and MRI together for the Holy Shaman’s mystical circle-reading tomorrow. By 3 tomorrow, X-ray and MRI will be in my file at orthopaedics. “Guaranteed,” the technician says with a smile.

Friday, I get the conductivity test, called an electromyogram or EMG. Another warm-up act, about 14 but not wearing an identification tag or white coat, comes into the examination room.

“Who are you?” I ask. “And how do I know you’re a doctor?”

“You’ll have to trust me,” he says, looking like Frau Farbissina’s colleague, Mustafa, without the fez.

“What are you going to do?”

Mustafa disappears without answering. He returns with a thick maroon medical textbook. This is not reassuring.

Mustafa starts poking my back with electrical probes, which make my legs jump when he turns the dial on high. “Yeow!” I scream. He is not impressed.

Mustafa leaves, and this time returns with a guy shuffling in Haflinger clogs, who starts pushing the needle into my lower back, each time saying “Aha!” whenever I yell “Yeow!” After 15 minutes of making my limbs twitch, Mustafa tells me, “Wait there,” pointing to another room.

After 20 minutes of nursing my burns, I tiptoe into the office area, where Mustafa and Clogman are huddled around a computer. Mustafa looks menacingly at me and points me back to the waiting room. “Sit there,” he commands as I slink back to the Naugahyde couch.

I make my way to ortho, and ask about my MRI and X-ray. The Jaclyn Smith clerk smiles warmly, but says my MRI and X-ray are nowhere to be found. “We’ve checked with X-ray and MRI and they say we have them.” She shakes her head, tossing her springy hair. “We could always put a trace on them, but that’s likely to take a couple of weeks.” She smiles.

Within the recesses of my brain I hear the voice of Mrs. Torresee, my fourth-grade elementary school teacher, saying, “Act mature. They might not remember you, but they’ll remember your manners.”

Out the window with Mrs. Torresee. These are desperate times. I place my palms on Jackie’s desk, lean forward as far as my back allows, and say to Jackie in a low but steady voice, “I want you to listen to me very carefully. I want you to get up slowly from behind your desk. You’re going with me to MRI.

“That’s right,” I say. “I mean what I’m saying. Get up, now!”

Jackie is not alarmed. She deals with back-pain lunatics every day. “Sir,” she says calmly, as though she’s the one on Darvocet. “I can’t leave my post at ortho and go with you. You can understand that.” Jackie’s eyes squint, showing emotion. She tilts her head and frowns, her pink lips producing a slight pout.

Smooth. Very smooth. If only Jaclyn Smith could act this well.

“Please,” I say. “I have been in ex-cru-ci-ating pain for three weeks. Can’t you please, please help me?” Tears miraculously well up in my eyes.

Mao said all it takes is one person to start a revolution. Before my eyes, Jackie transforms herself into Tania, the hospital guerrilla.

She looks me in the eye, nods her head, and rises from behind her desk. Together, as comrades, we troop down the long coordinator to MRI.

Standing in tandem in front of the MRI desk, I say defiantly to the clerk, “Ten minutes ago, I was told that ortho had my MRI. Ortho doesn’t have them.”

“You must be mistaken, sir,” the clerk informs. “Ortho does have your MRI.”

At which point, I lay down my royal flush.

“Well, this is ortho,” I say pointing to Tania, “and ortho doesn’t have my MRI.”

Tania smiles smugly. “He’s right. You never sent it to us.”

A stalemate of sorts for a minute or two. The clerk’s eyebrows go haywire. She starts to say something, then looks to her right and left. The other clerks have retreated, abandoning her. This could be a postal situation.

The clerk disappears and ducks behind the Great Oz’s curtain, into the Holy Shaman’s offices. In five minutes, she returns with a large envelope, and ignominiously hands over my MRI.

I look at Tania, wanting to give her a high-five, but instead we smile at each other dreamily like in a Correctol TV commercial.

As we’re walking back to ortho, the thrill of victory coursing through my veins, I ask Tania when Dr. Found will be able to look at my newly discovered MRI.

Poof! All traces of Tania are now gone. “Oh, he can’t possibly review them today. His wife just got a new job and he’s home looking after the children.”

“Could he perhaps look at them Monday?” I venture timidly.

“I wouldn’t count on it. He’s very busy, especially since his wife got the new job.”

Over the weekend, while I’m waiting for Dr. Found’s wife to adjust to her new proletariat life, the back pain gets so bad I think that maybe a chiropractor wouldn’t be such a bad idea. Could I possibly be in worse pain? But the thought of someone manipulating my back makes me wince. Instead, I dose up on the Darvocet. When I’m not on my back, I pace around the house stiffly, as though I have a pole stuck up my butt, making my posture resemble Al Gore’s. To bide my time, I read a book my wife buys, “The Mind-Body Connection,” by Dr. John Sarno, a runaway bestseller that says my back problem is in my head.

At 8 Monday morning, Dr. Found does call with the results of the MRI. It shows a “significant” herniated disk between my fourth and fifth vertebrae. He suggests I get an epidural cortisone shot. He says he can get me into the steroid people at 3. “If that doesn’t work, we may be thinking of surgery down the road.”

Waiting for 3 is like waiting for the Venus space shuttle to launch. The pain has come back with a vengeance. Sitting is impossible. The only thing that doesn’t hurt is lying flat on the floor, which I do as I count down to 3.

At the appointed hour, I queue up behind another aching back. When it’s my turn, the receptionist is busy talking on the phone. Jackie is nowhere to be found. The check-in lady continues yakking as though I am invisible. The shooting pain has me going through the roof, so I lean against her desk, but this time, I am in no mood to play the hostage game.

Instead, I lie down on the floor in front of her desk.

“Please help me,” I mumble from the textured maroon carpet.

But the check-in lady continues gabbing on the phone.

Could this be Frau Farbissina, the woman who four years ago asked if I had lost control of my bowels? Again, I say to myself, “Remember this, because no one will ever believe it.”

After a minute or two, while I’m collapsed on the floor, Frau — still on the phone — gets up from her ergonomic chair and peers down her half-glasses at me. She puts the caller on hold and dials the PA system: “Nurse: Stat to front desk.” Then she goes back to her phone call, for all I know talking about last night’s episode of “ER.”

A nurse shows up, bless her heart, and wheels me on a gurney to a sterile-looking cave where a doctor who goes by the name Tartar sticks a needle in the base of my spine, injecting a steroid into the fluid surrounding my spine.

In another five days, I have another injection. That seems to do the trick.

- – - – - – - – - – - – - – - – - – - – -

Five months later, I am following the recommendations of my physician friend. I have given up golf. No raking leaves this fall, and come winter, forget shoveling snow. Too much cross-body movement. I try giving up making the bed, taking out the garbage and emptying the laundry hamper, but so far, the wife has not bought these precautionary measures.

About 43,000 patients a year have the stamina and perseverance to get an appointment at the world-famous ortho clinic, which makes it among the top 10 busiest academic orthopedic centers in the United States. Back pain is the leading cause of disability for people between the ages of 19 and 45, and eight out of every 10 Americans have severe back pain at least once during their lives.

But what good is a back doctor if you have to lose control of your bowels before he or she will see you? And if you just have ex-cru-ciating pain, then the next available appointment isn’t for another five weeks.

I guess it comes as no surprise that today when I call to see how long the wait is for a new appointment, I get a busy signal, and when I finally get through, the clinic is so busy that I have to leave my name and number on an answering machine, and six hours later, no one bothers to call back.

If Frau and her troops haven’t already put me on some internal hit list, then I’m sure my name will be on one soon. I can hardly wait for the next time my back goes out.

April’s drug-induced frigidity is causing her enough anxiety to consider taking an additional drug to relax her. “I’m afraid my partner will ask me to go off the Zoloft, but I feel too good on it. I’m starting to think I’m going to have to fake it, and I don’t want to do that, but I don’t really know what else to do.”

April is not alone. The antidepressant she is taking is an SSRI (selective serotonin reuptake inhibitor) and, like other drugs in the same family (Prozac, Paxil, Luvox, Effexor and Celexa), they clobber sex drive in up to 80 percent of those who take them. But SSRIs are so awesomely effective that, for most people who take them, the pleasures of sex take a back seat to a sense of calm and serenity that the drugs create.

SSRIs are the current drugs of choice for treating depression, and the most popular still is Prozac. At $2.6 billion, Prozac, which costs about $90 a month, has the third-best annual sales of any pharmaceutical sold in the United States, according to market research firm IMS Health.

Such drugs may be great for prisoners, priests and recovering nymphomaniacs. But what about the rest of us?

Claire, a 46-year-old writer from Detroit, is a case in point. Before Claire got married 20 years ago, she prided herself on her libertine ways. At any given moment, Claire would have three or four lovers stashed away. Sex was Claire’s middle name.

Because of health-related problems and difficulties at her job, Claire started taking Paxil four years ago. “I was totally stressed out. I was in tears every day. Everything seemed too much to handle. No small thing was too small to set me off. I felt I was in a tornado continually sucking me down. If I snagged my sweater on barbed wire, I’d be unable to get free. I’d stay snared for days or weeks. Paxil was terrific. But no one warned me about the side effects — although, really, it didn’t matter because suddenly there was peace, some days I wasn’t in tears. And soon, I never felt the need to cry.”

The cost: Claire’s libido — which had been such a central part of her life — diminished and then dried up. She and her husband, with whom she was still deeply in love, ceased to have sex with any regularity. They had become their parents; sex was reserved for special occasions, like their anniversary night.

Still, Claire was feeling so great on the antidepressant that in the summer of 1998, she thought she could go it alone (“A little voice inside me said I didn’t need to rely on a drug any longer …”), so she started cutting back on the Paxil and within weeks her libido kicked back in. This was the old Claire.

Alas, by late winter, Claire was back to weeping every day, not sleeping, not eating. “My sex drive may have come back, but in that condition I wasn’t interested. I didn’t want to go on Paxil again. It had caused me to have night sweats and my heart would race. So, when I returned to my psychiatrist, he suggested Celexa, but warned me about the sexual side effects.”

“‘Start me on whatever is going to work the fastest,’ I told him, and my husband (who was in the waiting room) agreed.”

Unlike Paxil, Celexa didn’t cause the weird side effects in Claire. Her outlook on life became rosy again. But, again, the drug did a number on Claire’s libido — and still does. “It’s not as though I don’t want to cuddle or kiss. It’s just that my genitalia isn’t aroused, but with the drug, nothing is easily aroused. We probably have sex once or twice a week. But I don’t initiate it. I initiate it intellectually and psychologically, but for me it always can wait. I love my husband and I want to connect, but it always can wait till tomorrow.”

To jump-start their sex life, Claire and her husband started using a vibrator, and now routinely rely on it whenever they get intimate. “It was taking a long, long time, and I would get frustrated. So this [the vibrator] seems to work. It’s very participatory on the part of my husband, and it’s made my orgasms very intense. I used to define myself by my sexuality, and I don’t any more. Nowadays, all my orgasms are vibrator-orgasms,” Claire says in a wistful tone.

Still, she says that going off Celexa would be too much of a gamble. “Now, when I snag myself, I can untangle myself quickly and move on.”

Another friend of mine, Holly, a self-described divorced Atlanta housewife with two teenage children, started taking Prozac in 1989 when her gynecologist prescribed it for anxiety. “I had two small children at the time, was working full time, and I had just too much to juggle. I noticed a slow but very dramatic change in everything once I was on the Prozac. In one sense, nothing changes, but your reaction to everything changes. I could be stopped in traffic, late to pick up my kids from day care, and in the past, that would cause me a lot of stress, but with the Prozac, I’d just accept the reality and was much, much calmer. You roll with everything. You observe things differently. I’d have a peaceful response to things that in the past would cause me to freak.”

But as with Claire, the drug nailed her sex life. “I remember initially on Prozac I had little interest in sex. It really was a nasty side effect. But it was a trade-off: Everything functioned so much more smoothly that I never got too concerned about what it was doing to my sex drive.”

With Holly — who is 48, works out with a personal trainer every week and is engaged to remarry in the fall — her libido gradually returned after about a year on the drug. Psychiatrists say some people neutralize the effect the drug has on their sex drive, but it can take months, sometimes years.

Holly noticed something else about the Prozac, something commonly known as “Prozac poop-out.” The longer she took the drug, the less effective it seemed to become. In 1992, her gynecologist switched her to Paxil, but that seemed to deaden her much more than the Prozac did — and not just her sex drive. “My emotions, reactions, feelings were numbed with the Paxil. Again, though, my sex drive came back but it took time, maybe a year.”

Finally, two years ago, Holly went to a psychiatrist who prescribed Celexa. “For the first three weeks, I felt euphoric, almost giddy. Then I came down a little, but I don’t feel deadened. I have back my emotions. It still has an negative effect on my sex drive, but at least it’s the least of the three drugs.”

Everywhere I turned, I heard the same story. The drugs were great, so great that they were worth giving up great sex for. Cassie, a pixieish, freckle-faced, 33-year-old Web site developer from San Francisco, told me that a crushing, traumatic divorce two years ago sent her crashing into a downward spiral, and Prozac was the only way out. She credits Prozac with saving her life. For the first year on the drug, her sex drive was minimal, but “who wants to have sex when you’re trying to climb back to being yourself again?” In the last year, she said, her body seems to have compensated for the Prozac and her libido appears to be coming back, although she can’t say for sure because she’s not currently in a relationship.

When I canvassed my male friends on antidepressants about their sex lives, I got a different story. Either these guys are super studs and nothing can deaden their firm, erect ardor — or maybe it was an Arnold Schwarzenegger macho-guy thing.

Greg, a 48-year-old television producer (and marathon runner) in Los Angeles, went on Prozac for depression in 1990, but developed chronic insomnia (a common side effect), so he switched to Zoloft a year later. Greg says he doesn’t really know whether the SSRI has done anything to his sex drive. Now married and the father of a 2-year-old daughter, he says his interest in sex hasn’t dampened, but his frequency is off from what it used to be. “I’m not prowling around as I did when I was 29.” Still, Greg says he has no problem getting and keeping an erection, masturbating and fantasizing. That also might have something to do with his wife’s travel schedule: She’s away on business for up to two weeks at a time.

Another friend, Todd, a 41-year-old Manhattan media executive who is a drop-dead double for actor/playwright Sam Shepard, underwent a debilitating bout of depression while living overseas two years ago, so bad that he thought he’d have to be hospitalized. His psychiatrist prescribed Effexor, which gradually seemed to lift the dark clouds. Todd isn’t sure about what sexual side effects the drug had on him. “I was so depressed, I didn’t want to have sex. And with the Effexor, my mood got better, the depression eased, so I think, in that way, the drug probably helped me sexually.” Todd weaned himself off the drug and now takes no antidepressants, and says he hasn’t had a relapse.

It seems that in the trade-off between feeling blissed out and having orgasms, blissed out wins big. It used to be that anyone in the make-love-not-war generation would regale total strangers with the intimate details of their sex life — blow jobs in movie theaters; mile-high-club trysts; threesomes in the backyard swimming pool. No one talked about money, except for how poor you were. Sex in all its multipositional glory was eminently worthy of conversation.

Welcome to the New Millennium, where the dot-com generation happily chats about IPOs, their nifty Palm VII handhelds and their accessory-dripping Lincoln Navigator SUVs. RAM size is what’s important. Bandwidth is one’s calling card. But mention orgasms, and the lattes go cold.

I’m not making light of depression. Surveys variously indicate that as many as 1 out of 3 women and 1 out of 8 men will, sometime during their lives, be classified as clinically depressed. And the World Health Organization says that by 2020, depression will top the list of health-related maladies in the developed world, and that severe depression will be the second-greatest cause of disability. It is a real disease; a crushing feeling that the world is closing in on you, that a thick black curtain is crashing down on your life.

Considering the enormous popularity of antidepressant drugs like Prozac, Paxil and Zoloft, and the drug culture that spawned them and now adores them, it makes sense that modern-day pharmacology has perfected such an effective and profitable pharmaceutical, which can pinpoint with awesome accuracy the neurotransmitters and receptor sites that cause depression.

The world’s first SSRI, Prozac, was launched in 1986 in Belgium, and approved a year later for use in the United States. Since then, about 17 million Americans have taken the cream-and-lettuce-colored capsule. Prozac is the most widely prescribed antidepressant in the world.

Since its introduction, other drugs with similar properties have come down the pike: The most-widely known include Paxil, Zoloft, Luvox, Effexor and Celexa. Each is slightly different in its formulation and, therefore, affects users differently. Effexor, for instance, is not a straight SSRI; it blocks reuptake of not just serotonin, but also norepinephrine and dopamine.

A very short chemistry lesson on how SSRIs work and why they can massacre your sex drive: Higher levels of serotonin in the brain generally lead to enhanced moods. Prozac and its family of drugs increase the level of serotonin by preventing its uptake in receptor nerve cells, thereby assisting brain cells to communicate better with one another. For reasons not completely understood, the rush of serotonin causes in many people an effect that restores confidence, eases anxiety and improves self-esteem. The downside is that while the serotonin is doing all this great stuff, another chemical in the brain, dopamine — known to increase sexual desire — is suppressed.

Alas, the proposition was too good to be true. There is no free lunch. No rights to morning reveries of fellatio or sweet-dream send-offs of cunnilingus and a (legally) drug-induced feeling that makes you happy. If you want to be chemically induced confident and serene (or, at least, no longer depressed), you may have to kiss off such sexual luxuries once thought to be absolute generational rights.

As far as physicians (and anyone who’s ever had sex before) can determine, there are four kinds of sexual dysfunction when it comes to SSRIs: loss of sexual desire, difficulty getting aroused (in men, erectile flaccidity; in women, lack of lubrication and similar lack of engorgement), duration of time from arousal to orgasm, and intensity and length of orgasm. Both women and men report about the same incidence of dysfunction when they take SSRIs.

But the incidence of dysfunction while on SSRIs probably is even greater than reported. The underlying problem is that physicians and patients often are too uptight to talk about the sexual side effects of antidepressants. Some patients are too embarrassed to fess up. Many are so happy that they’re not depressed any longer that the dip in their sex lives becomes secondary to their spectacularly upturned mood. It’s a price, but one that most SSRI-users happily pay.

Leave it to the world of fluorescent-tanned scientists to study just why SSRIs dampen sexual ardor. Three physicians at the University of Gvteborg in Sweden (J. Matuszcyk Vega, K. Larsson and E. Eriksson) injected a male rat with fluoxetine (the chemical compound of Prozac), and the poor little guy couldn’t ejaculate when he frequented a female rat nearby.

Fellows at the Department of Psychiatry and Neurosexology concocted another pioneering study at the Hague’s Leyenburg Hospital. While having sex with their partners, volunteers equipped with stopwatches timed how long it took them to ejaculate while on SSRIs. The doctors concluded that the men’s ejaculations were dramatically slowed, and in some cases, stopped by the SSRIs. Off the SSRIs, the men performed splendidly. I wonder where the men put the watch while they were pumping away.

It thus should come as no surprise that Prozac and other antidepressants of their ilk are extraordinarily effective when it comes to curing one sexual malady: premature ejaculation. The guy who used to come in five seconds before taking SSRIs can now last a manly 20 minutes.

For those on SSRIs, don’t despair. There are a host of legal drugs and herbs that may help restore your libido and return your orgasms to 21-gun salutes. But as in prescribing SSRIs, it’s a hit-and-miss proposition. Some drugs and herbs work to bring back libido; others fail with flagging colors.

Before you mainline yet another dose of a potent herb or drug (which, too, may carry side effects), most psychiatrists suggest one of the following strategies to help stoke your libido. Don’t try the following at home, kids, until you discuss it with your physician.

Plan a drug-free holiday. For example, go off your SSRI Thursday through Sunday and then attempt sex (even wild sex!) Sunday night. This may work with Paxil, Zoloft, Celexa or Effexor, but it won’t if you’re taking Prozac, which stays in your system for a longer time than the other drugs. Drug half-life is the time it takes for the pharmaceutical to decrease by half of its original dose in your blood stream. Prozac’s half-life is about a week; Paxil’s and Zoloft take about a day. The drug-free holiday strategy is a gamble. Many users don’t want to risk being off their SSRI, even for a day.

Lower your dosage. The standard daily dose of Prozac, for instance, is 20 mgs. Reduce it to 10 mgs., by either getting a new prescription or (the less expensive way) by taking a 20-mg. capsule once every other day. This works especially well with Prozac, precisely because its half-life is so long; results with other SSRIs may be mixed.

Switch antidepressants. Wellbutrin, Remeron, Effexor, Luvox, Celexa, Serzone and Desyrel may be less likely to destroy libido but, for many, aren’t as effective in combating depression as Prozac, Paxil or Zoloft. (Interestingly, the smoking-cessation drug, Zyban, is the exact same formula as Wellbutrin in a smaller dose.)

Wait. Give your body time to compensate for the rush of serotonin that bathes the delicate receptor tissues of the brain. Some or most of your sex drive may eventually return. Some people, like Holly, develop tolerance to the sexual side effects and eventually bounce back.

If you are able to maintain your composure and return to your sexual equilibrium after trying the above, read no further. If not, some additional gambits: The drug yohimbine has shown to reverse the sexual side effects of SSRIs, says M.J. Gitlin, a psychiatrist at UCLA. Yohimbe, an African bark, is available over the counter; your physician will have to write a script for yohimbine, a pharmaceutical agent. It is a non-hormonal drug, in pill form, designed to decrease the outflow of blood from the penile tissue. Yohimbe chewing gum is available in some health food stores. One patient reported to his physician that he chewed 10 to 15 pieces immediately before he “had an incredible sexual time with his girlfriend.”

Some physicians suggest taking a half-tab to one tab (5.4 mg. each) of the pill an hour or so before the “event.” Beware, though, yohimbine can produce insomnia, already a side effect for many people on SSRIs.

The herb ginkgo biloba may also work. Alan Jay Cohen, a psychiatrist at the University of California at San Francisco, did a study on ginkgo-tree leaf extracts in which he reported that 86 percent of patients who took two 60-120-mg. capsules twice a day reported substantial improvement in their sexual function, with no side effects. Cohen says that ginkgo biloba restored the blood flow to the genitalia often blocked by the serotonin-enhancing drugs. In the business, ginkgo biloba is called a vasodilating agent. The popular prescription drug, Viagra, does much of the same.

The key issue is that the SSRI-related drop in libido is related to dopamine down-regulation. Some shrinks suggest Ritalin (methylphenidate) as an antidote for sexual dysfunction. Methylphenidate and Symmetrel (amantadine) trigger dopamine. Others prescribe Periactin (cyproheptadine) to be taken several hours before sex. Another option is Buspar (buspirone), administered concurrently with the SSRI, to get sexual responsiveness back.

Clearly, what worries some physicians and positively terrifies Eli Lilly and Company, the maker of Prozac, is that such onerous side effects will cause people to abandon the drug. In 1998, Lilly spent more than $95 million on promoting Prozac, which put the drug on a list of the 10 most-promoted pharmaceuticals in the U.S., and made it the list’s only antidepressant.

Lilly ostensibly wants to make a last-ditch try to hook as many new customers on Prozac as possible. Lilly’s Prozac patents expire in 2004, when drugmakers will be able to formulate a generic version at prices 60 percent to 80 percent less than what Prozac goes for now. Lilly, though, has something else up its lab-coat sleeve. It plans to license a variant of Prozac, called R-fluoxetine, and that patent doesn’t expire until 2015. Lilly is touting R-fluoxetine, saying it has fewer severe impotence side effects and won’t keep people up nights.

When I asked Lilly flack Blair Austin about worries that Prozac takers’ loss of sexual interest will cut into the company’s business, this is what I got: “It is difficult to determine the level of impact by SSRIs on sexual function and interest. Some patients do experience problems with sexual functioning during treatment with SSRIs; others have shown improvement during SSRI therapy.” So much for going out on a limb.

If all else fails, here’s another idea: Three psychiatrists wrote in the Journal of Clinical Psychiatry that granisetron (a sexual stimulant in rats) works great in men and women, if taken one hour before sex. But the drug, available as Kytril (and labeled for chemotherapy-related nausea control), costs $50 a pill. That means it would have to be a very hot date.

My first real encounter with girls was during the summer of ’64, which my family spent in Miami Beach. We drove our beige 1959 Chevrolet station wagon with the fins past Pedro’s South of the Border, past the “IMPEACH EARL WARREN” signs, past the Georgia fireworks stands and onto Miami Beach in all its orgasmic splendor.

We drove on the Arthur Godfrey Causeway, along neon Collins Avenue, our eyes bugging out as we passed palace after palace: the Sans Souci, the Versailles, the Fontainebleau, the Eden Roc, the Seville, the Deauville. We avoided the haute chateaux and opted for the Roney Plaza, a worn-out stucco place on the beach that used to be the grande dame in the 1930s. My father got a deal because the Roney was about to be torn down and turned into condominiums. Besides, who left the summer heat of Hartford, Conn., for the 100 percent humidity of Miami in August?

We drove up the Roney’s half-circle driveway and under the breezeway, unloaded our unmatched luggage and walked into the lobby with white and gold provincial furniture everywhere — gilded mirrors, puffed-cushioned sofas and sectionals, drop-leaf tea tables. The royal blue velvet appliqui wallpaper would have been too opulent for Marie Antoinette, but Miami Beach tourists loved it.

My mother stuck out her hand and introduced herself to the social director, Lillian Ross, a ditsy divorcie from Great Neck, N.Y., who looked like Carmen Miranda without the fruit. All Miami Beach hotels had social directors, syrupy matchmakers in Capri pants and see-through high heels whose job it was to ensure that the guests had a grand time. Lillian was the one who organized Mr. and Mrs. Biederman’s slide show of their trip to Majorca, the Sunday afternoon volleyball games, the luaus (no pork), bingo, canasta and mahjong and the excursions to Hialeah.

“We have a lovely group of families this season,” Lillian cooed as she poofed up her beehive and reached out to shake the old man’s hand.

A little guy wearing khaki shorts and an orange T-shirt that read “I’ve been to Parrot Jungle!” suddenly materialized from nowhere.

“Arnie here is from White Plains,” Lillian said proudly, pulling a runty kid toward her. “Arnie’s parents are spending the whole summer with us at the Roney.”

“Gimme five, pal!” Arnie said, sliding his right palm waist-high to me.

The two of us immediately went to the pool to survey the girl situation. Arnie pulled out a black comb and slipped it through his amber waves. Arnie could comb his hair, whereas mine was so curly I could barely get a steel-bristle brush through it.

What impressed me most about Arnie was what he told me within 15 minutes of meeting him.

He had touched a girl’s breast! Actual skin to skin, not any through-the-sweater feel.

Holy smokes!

My only experience with sex had been at a hot and heavy spin-the-bottle session on a sultry June evening when six boys and girls gathered on Carol Klinghoffer’s veranda. Carol pulled out a six-and-a-half-ounce Pepsi bottle, and when my turn came up, the bottle spun to Karen Resnick, a pretty girl with a mouth that to this day reminds me of Jean Seberg’s. Puckering my lips, I leaned across the circle of wide-eyed kids, tenderly brushed aside strands of Karen’s blond hair and planted my trembling lips on her rosy right cheek. It was wonderful.

At the Roney that summer, my sister, Penny, four years older than I, was already planning her own series of sexual exploits. Penny’s plan was to pick up guys who drove Corvette Stingrays up and down Collins Avenue. She quickly teamed up with a girl named Bobbie from Brookline, Mass. The two would idly stroll up and down Collins and tell boys they were college students staying at the Fontainebleau, studying art history.

As for me, I spent every day with Arnie, who took up residence poolside on a chaise lounge. The only things missing were a cigarette holder dangling from his mouth, a martini by his side and a racing form from Hialeah. In the afternoon, we bodysurfed in the Atlantic before baking on the sand listening to “Telstar” on my transistor radio, furiously strumming on imaginary electric guitars.

Midway through the summer, we were following our daily routine when two girls we had never seen before placed their Coppertone beach towels 15 feet away from us on the sand. Arnie poked me in the ribs.

“Ac-tion,” he whispered, raising both eyebrows.

The girls pretended to ignore us, setting up for the day: transistor radio, Johnson’s baby oil, cardboard metallic sun reflectors. Arnie swaggered over to the bustier of the two, the one with Jean Shrimpton legs. She had on an olive-green bikini bottom and avocado shapes to cover her melon-size breasts, which were spilling out all over the beach.

“Let me assist you,” Arnie purred.

She handed him the baby oil and Arnie started rubbing this total stranger’s back!

“You girls new on the beach?” Arnie asked, deftly slipping his hand under the bikini strap.

“We’re at the hotel for two weeks,” the chesty girl volunteered. “We just got here this morning from New Jersey.”

Jersey girls!

They had a reputation for two things: complaining and giving it away. One Jersey girl every Connecticut boy knew about had taken on four boys at the same time. Another Garden State lass had entertained every player on a high school football team in the back seat of her father’s Corvair. The players waited on line at the open car door.

And here before my eyes were two live saucy Jersey dishes in the flesh!

Arnie motioned me to join him. “This is my good friend, Steve. He’s from Connecticut.” Arnie could just as well have said I was from Outer Mongolia. The girls looked bored, but that meant everything was going fine.

“Hi,” I said with a nod.

Meanwhile, Arnie had reached a critical juncture. He had finished slathering the built girl’s back. Would he go for the other girl? No way.

“Fair maiden,” he ventured where few had gone before. “May I assist the sun gods by applying some oil to your lovely back?”

The other Jersey girl said nothing. She shook her mane of tawny hair, turned over on her flat stomach and gave Arnie her lithe back. As he started rubbing the small of her back, I heard an almost imperceptible sigh ooze from her mouth. It seemed as though her body quivered as Arnie started massaging her Clorox skin, inches from the split orbs of her firm buns.

Zowie!

I flashed on the Trojan I had stolen from my father’s dresser drawer, now stored in a secret recess of my wallet, patiently awaiting service.

Then it dawned on me. The wallet was back at the hotel! After carrying around that cockamamie thing for a whole year, I was caught unprepared. Jersey girls don’t materialize every day. They can be loose as a goose one day and tight as a drum the next. You never know.

Arnie set down the bottle of baby oil. “Steve here is a wonderful swimmer, aren’t you, pal?”

I had a rough time doing the dead man’s float. I looked out at the blue expanse, and said stoically, “I do five miles a day when the surf’s down. Sometimes 10. The lifeguards here depend on me.”

“You don’t have a swimmer’s body,” said the busty girl.

“Looks are deceiving,” I replied, nodding my head, then winking.

And she bought it! The girl with the avocados looked at me with a wicked smile, exactly how Jersey girls were supposed to smile.

Thus began two remarkable weeks. Joan (the one with breasts) became Arnie’s girl. Audrey (the one with the back) was mine.

After our waiter, Oscar, cleared away the dinner plates every night in the Roney’s main dining room, the old man and my mother played bingo in the upstairs game room. Lillian Ross called out the numbers. Penny and Bobbie painted makeup on their faces and strutted Collins. Arnie and Joan hung out at the pool. Audrey and I walked the beach. My M.O. was to drape my right hand over Audrey’s shoulder. This was serious business. Slowly and surely, like a crab moving in the night, my hand would creep down under her arm, through her sleeveless blouse, and touch the stiff fabric of her brassiere.

Actually, I was more like a barracuda on a feeding frenzy. I crooked my arm and twisted my hand into the hole of her blouse. Then I slipped my hand under her bra and tentatively touched with the tips of my fingers whatever was there. It was great while it lasted, which was never more than a second or two. Audrey was an expert at wiggling her right shoulder, which sent my hand scurrying back to her shoulder. The portions were small, but that hardly made a difference. Once landed, for however brief a moment, I had the same singular sensation Neil Armstrong experienced four years later when he walked on the moon. “Apollo to Earth! Apollo to Earth! We have made contact!”

Sometimes Audrey and I ambled down to Wolfies, where we scarfed egg creams and coconut-creme pies. In and out of the grungy grease pit, Audrey seemed unaware of my roving claw. Not once did she glance at my bathing suit, which looked like a tent from an erection so potent I could spin a set of chip-proof plates on it. We were raising our cholesterol and glucose levels, but doing nothing to lower our pants. Through it all, Audrey chattered away.

Forget about talking, I had trouble breathing. Audrey talked incessantly about everything under the Miami moon. Our nightly discussions involved philosophical tracts about how her sister had ruined at least six of Audrey’s A-line skirts, why her sister’s feet smelled like rotting cheese (she ran around in Keds all day) and when her sister was going to get her own bathroom (never). How could she possibly think that crap interested me? I didn’t care about Audrey’s sister. I didn’t care about Audrey’s clothes. I cared about what was under them. I wanted some deep love talk, about the waves, the silky sand, the moon dipping low, you and me forever baby. I think Audrey must have talked to me in the same way she talked to her girlfriends. Maybe the same way she would someday talk to her hairdresser, her shrink or her drippy husband.

A couple of days after my exploits with Audrey began, my mother started up. “Harold, talk to him! Talk to him! You better tell him about the facts of life before it’s too late!”

The old man didn’t want any part of it. He was a meat-and-potatoes guy. Discussing sex, discussing anything, was out of the question.

“Go on, Ruth, he’s only 13!” the old man shouted, scrunching his nose and shooing off my mother with his hand as if clearing the air after a fart.

The old man buried his nose in the business pages of the Miami Herald, following his three stocks. Up one-eighth one day, down a quarter the next. It was fractions to me.

“Steve’s a jerk, anyway,” chimed in Penny. “Why does he have to know the facts of life? Who’d want to go out with him?”

My mother eventually bludgeoned the old man into telling me the facts of life. It was something he did not take to lightly. If he was uncomfortable talking about hygiene — like shaking off a soft penis after taking a whiz — he wasn’t going to have an easy time explaining how to stick a hard one into a woman’s jewel box. The reasons for my father’s reticence eluded me. I couldn’t figure out why. This was the same guy who stashed a jumbo box of unlubricated Trojans in his dresser drawer.

One afternoon near the end of my halcyon days in Miami Beach, the rain was coming down in sheets. Thunder ripped like a cattle whip. Lightning illuminated the beach as though an atomic bomb had exploded. The sudden inclement weather wiped out any possibility that Arnie and I had for bodysurfing or feeling up Audrey and Joan.

Arnie went to visit his aunt in North Miami Beach. She was knitting him a sweater and she needed to trace his shoulders. Penny and my mother went shopping along Lincoln Road. Audrey and Joan said they were spending the day with their grandmothers on Treasure Island.

After the old man finished his Spanish omelet, I knew I was in for it when he put his hand on my shoulder. The old man rarely touched me.

“Steve, whaddaya say we shoot the breeze?”

Where’d he pick that up?

The old man was silent in the elevator going up to the room, except for a couple of burps, the combustible byproducts of 17 straight days of Spanish omelets. He took out two Tums and shuffled uncomfortably from zori to zori.

In the room, the old man laid out the agenda. “Steve, your mother wants me to give you some pointers about girls.”

Penny was busy shopping for brassieres. Arnie was getting a cable-knit sweater sized for him. The girls were slurping chicken soup, maybe scouting plastic surgeons for designer nose jobs. I was learning about sex.

“Yeah, yeah, yeah, Dad. I got a pretty good idea about all that stuff. Guys I know talk about positions and French kissing all the time.” About the only thing I really knew was Bruce Fishman’s admonition: “You can’t do anything with a girl until her nipples are as hard as bullets.”

But the old man was not to be sidetracked even by a recitation of the Kama Sutra. He had a job to do. He droned on and on about the penis and the vagina, about prophylactics (so that was what Trojans were called), about unwanted babies coming into the world.

“Yeah, yeah, Dad. I know all this stuff.”

No matter. Before my eyes, the old man had transformed himself into Alfred C. Kinsey.

“You need a prophylactic, Steve? You need protection? You come to me.”

Imagine, the old man, the grumpy guy who lived for his three crummy stocks and hawked rubber-soled bluchers to cops and Miss America pumps to schoolteachers, offering me rubbers!

Once he started he couldn’t be stopped.

“I’ve seen a lot of guys like you who get a girl in trouble, and then they have to marry her,” the old man said, hanging his head like a long-eared, sad-eyed hush puppy. “All cudda been avoided. I dunno why they don’t use protection, a prophylactic. They’re too cheap, too afraid to go to the druggist, caught up in the moment? Beats me.”

I was numb. The old man could have dragged me over hot coals and I wouldn’t have felt a thing. Using a multisyllabic word like prophylactic was completely weird and uncharacteristic. It was like LBJ talking in Boston lockjaw. This was a historic occasion, the closest I was ever going to get to Yalta or Potsdam. The old man and I talking about cocks, cunts, babes and babies.

What I couldn’t get through my mind was sex and my parents. Did they actually do it?

“And one last thing, Steve,” he said, pointing a gnarled finger at my nose. “There’s nothing wrong with sex-u-al intercourse. If you love the girl. It can be a beau-ti-ful thing between a man and a woman — when it’s the right thing to do. At the right time and at the right place, when you’re older.”

When the old man had finished, we descended in the elevator silent, each of us ragged and spent. We both could have used a cigarette.

For better or worse, probably better, Audrey left four days later, before I could try out any of my father’s advice.

But the night before she and her family flew back to Jersey, Audrey for the first time allowed me to cup in my right hand her tiny breast. For as long as I wanted. Hours, it seemed. She didn’t talk about her sister, clothes, the classes she was planning on taking next year. We necked for two hours on the Roney veranda. Lillian Ross walked by and smiled, content in knowing that another summer had come and gone, and boys like me were still crazy about girls like Audrey.

Heated by my father’s sex talk, I tried to slip my fingers into the nether regions under her shift with spaghetti straps, but that was off limits. In her mind, I think Audrey felt she had already gone all the way. From an encounter on the beach to a prolonged sweaty clench, it was heady enough stuff for Audrey, even though she was from Jersey.

The farthest south I got that night was to brush my hand against Audrey’s pint-size derrière. And you know what? There were no soft, subtle furrows of flesh as I had dreamed. Instead I got something that felt like a ham wrapped in plastic. Alas, little Audrey was wearing a girdle!

Hell, I wasn’t angry. I was ecstatic. Arnie had promised me the moon, my father had suggested stars. In two weeks, my complexion had turned peaches and cream.

As for Arnie, he left the Roney a day after Joan and Audrey. In the lobby, Arnie’s father was hunched over the counter at the checkout window, sweating the bill. Arnie glided an Ace comb through his hair as he took one last glance at the glittering ocean.

Then Arnie took out his index finger from the pocket of his khaki shorts, ran it under his nose and inhaled deeply. He smiled like a demon.

“Joan, what a sweet maiden,” Arnie said in a soft voice.

No way!

It may or may not have been true. It didn’t make any difference. Arnie could blow smoke rings and order double martinis neat. He was God.

Arnie’s father was tying suitcases onto the roof rack of their two-tone Fairlane coupe.

“Chop, chop!” Arnie’s father shouted as he revved up the Ford. “We gotta make Jacksonville by dark.”

In fact, Levitt’s career could only happen in America. “In other countries, no way would a scientist study farts. But for reasons I can’t completely figure out, farting is considered wrong in America and people are worried about it. Farts have been good to me. I’ve done very well, thank you.”

Levitt works with four assistants out of a small laboratory on the third floor of the V.A. hospital, about a mile west of the Mississippi River. Every day he receives at least one long-distance phone consultation from a worried farter, almost always a man whose wife has prompted her husband to find out why he cuts the cheese so often.

Levitt’s job doesn’t end when he leaves the hospital at night, either. “Every cocktail party I go to, I always get at least one wife who comes up to me and complains about her husband’s farts.”

To clear the air (there will be no more puns in this story), Levitt says that his research has shown that on average the normal number of flatulatic occurrences a day is 10. There are scores more, but they are all internal explosions and since this gas technically never leaves the body, it can’t really be considered flatulence.

Levitt notes that if you have on average more than 22 separate flatulent occurrences a day, then you may want to consider several things: what you eat, how fast you eat it and how much air you swallow when you eat or drink.

In his 40-year career, Levitt has seen only two patients (both men) who farted upward of 140 times a day, but these extraordinary cases were lactose-intolerant individuals and, once dairy products were cut out of their diets, they returned to the normal range of acceptability. “These two were the biggest farters of my career. One of them complained that his sex life had been ruined by his chronic farting,” Levitt says.

There are four possible reasons why some people fart more than others: They eat a lot of carbohydrates; they swallow air when they eat; the bacteria in their intestines are more efficient in turning carbohydrates into gas; or, conversely, the bacteria in their intestines don’t consume carbohydrates efficiently, and therefore produce gas.

Levitt says an average male fart is made up of about 110 milliliters of gas (almost half a cup), with 80 milliliters for a woman’s (a third of a cup). That adds up to a lot of gas — 38 ounces during a single day for men, 27 ounces for women. Although some women claim they never fart, Levitt says that’s not true. They just fart less because they are smaller.

Gassy food is gassy food for everyone, says Levitt, with a crucial caveat. Some people are able to absorb and tolerate the gas they produce better than others. The single most gas-producing food for most everyone, Levitt says, is — no surprise — baked beans. The musical fruit is made up entirely of simple carbohydrates, which are not absorbed in the intestines. Once inside the intestines, the sludge that was once beans is broken down by bacteria and enzymes, and then ferments. In that process, the thick, gooey substance can produce potent gases that have nowhere to go but down — and out, thank goodness.

Out is important. While Levitt says he has never treated someone who held a fart in too long, there are dangerous side effects (including dizziness and headaches). Your colon becomes bloated, and theoretically, the methane and other lethal gases could add enough toxins to your blood to poison you. Levitt does not recommend holding in farts.

Besides beans, vegetables (especially broccoli, brussels sprouts, cabbage and cauliflower) are also gas producers, as are grains and fiber. (Pumpernickel, the dark-grain bread, means “goblin that breaks wind” in Old German.) In fact, some of the healthiest foods, touted as anodynes for cancer and heart disease, are the foods that produce the most gas.

But what if you don’t eat lots of veggies and carbs and you still exceed 10 explosions a day on the fart-o-meter scale that Levitt says is normal? There could be several reasons:

Drinking too many carbonated beverages. The fizz in most carbonated beverages comes from carbon dioxide, which is dissipated by the time it reaches your intestines. But many soft drinks contain fructose, a sugar the intestines have a difficult time absorbing, thereby causing flatus, the medical term for farts (which comes from the Latin meaning “the act of blowing”).

Drinking through a straw. If you sip air when you swallow, then the air has to come out some way, often through your butt.

Eating too fast, and eating too much fast food. Chew your food slowly. The act of eating quickly tends to induce the diner to take in air, thereby bloating the colon, as well as turning the air inside deadly.

Chewing gum. When you chew gum, you swallow air, and that means more of the above.

Not enough exercise. Exercising helps the body absorb gases in the colon, thereby dissipating them by the time they reach your anus. If you happen to fart while you are exercising, particularly in a health club, it’s usually not so bad because most people wear headsets and listen to music, which tends to obscure the sound. As for smell, workout places often are venues of assorted bodily odors, so run-of-the-mill farts often go undetected, particularly if you don’t look suspicious.

Speaking of silent but deadly, Levitt doubts their existence. “Noisy farts can smell just as bad as silent ones,” he says. “That’s another myth that needs to be put to rest.”

Whether silent or musical, all farts are made up of a variety of gases. The majority are made up of nitrogen, oxygen, carbon dioxide, hydrogen and methane — all odorless. As anyone who has been to summer camp knows, methane, even in small amounts, can torch a match. The higher density of methane, the greater the bluish-green flames. The hydrogen in farts can cause a loud popping sound when ignited. Fart smells come in when sulfur gets stirred into the gaseous mix. Hydrogen causes the fart to waft quickly upward.

So, now that we know what’s in them, how do we make them go away? Levitt says that over-the-counter items like Bean-O and Gas-Ex rarely work. Bean-O does, though, have a 24-hour toll-free hot line, (800) 257-8650 (no, it doesn’t spell out F-A-R-T), and has a nifty collection of promotional materials, including a fanny pack and yellow windbreaker (get it?). Antacids work on some people, but Levitt stresses that for the best results, users should take no more than four tablespoons or tablets a day.

For odor, about the only thing that Levitt says works is a fart cushion made of charcoal, called the Tooter Trapper, invented by a man whose co-workers complained of his farts so much that they demanded he be moved out of the office pool into a separate room with a door. The air filter, which you sit on, does a good job of eliminating fart odors but, of course, treats only the results, not the symptoms, of the noxious-smelling gas.

Forget Glade or Airwick, or even matches, to eradicate fart smells. The thing that works best is opening a window. Lighting a match may camouflage the smell but will not dispel it, says Levitt.

And as for masking the sound, Levitt says that depending on the anatomical peculiarities of a person’s anus, sounds can vary when gas is squeezed through such a tight opening. The larger the volume of gas expelled and the greater the pressure exerted, generally the greater the noise, although Levitt says that standing usually tends to minimize the sound over sitting, which can amplify the toot.

Besides food, antibiotics occasionally cause some people to fart more, Levitt says, because the medications can disrupt the natural flora of the colon, thereby making it more difficult to break down certain foods, and thus leading to more flatus.

Americans are probably the most supercilious about farts. Other cultures are less squeamish about them. The British explorer and linguist Sir Richard Francis Burton, who first translated the “Kama Sutra” in 1883, contends in one of his many books that a tribe of Arabian Bedouins created a language of arcane codes and warnings through a series of intricately nuanced farts.

Farting came out of the closet in the United States in the breakthrough 1974 film “Blazing Saddles,” in which Mel Brooks plays Gov. Le Petomane, who serves up baked beans around the campfire one night and hears the results from a bivouac of cowboys. Actually, Brooks’ character was named after Joseph Pujol, known as Le Petroman (which translates to the “Fartiste”), who in 1892 debuted at the Moulin Rouge in Paris with a show that featured Pujol paying a flute, smoking a cigarette, blowing out candles, even singing La Marseillaise from anus air. Pujol extinguished candles from 2 feet away and became famous for his imitations of thunder, cannons and 2 yards of calico fabric being ripped. Pujol opened his own theater (the Pompadour), in which he starred for two decades before dying in 1945.

Levitt says Pujol probably was able to aspirate through his anus, that is, suck air in through his butt, and with that air performed his assortment of tricks. So it really wasn’t Pujol’s farts that amazed his audiences, but merely air that traveled a wee distance, instead of the longer, more arduous trip from mouth to colon to buttocks.

Farts, of course, predate Pujol. The Aristophanes play “The Clouds” contains a reference to farts. In Dante’s “Divine Comedy,” flatulent demons in the eighth ring of Hell make “trumpets of their asses.” Hieronymus Bosch’s “The Garden of Earthly Delights” shows a young woman with red roses shooting out from her derrihre. And in 1776, Benjamin Franklin published a book of bawdy essays called “Fart Proudly.”

Franklin wasn’t the only one who knew that farts are funny. For a host of complex cultural reasons, farts render 10-year-old boys silly, not to mention more than a few grown men who still get amused for some reason by anal gas. It’s a strange thing, though, farts. Take, for example, the expression “old fart.” It’s a term of insult when spoken in the third person, but one of pride when spoken about oneself.

And for those of you who must have an Internet fart connection, there are plenty of places. My personal favorite is farts.com, which offers an audio sampling of scores of farts, and allows viewers to rate the flatulence on several criteria, including verisimilitude, pitch, duration and volume.

“May we help you?” he asked suspiciously.

“We,” I quickly surmised, was the Almighty Spa God looking down at our poor lot: the sandals, Gap-issue shorts and tie-dyed T-shirts, our blanched skin that had never enjoyed a thermal mineral kur mud bath, Vichy shower body polish, Yon-Ka eye treatment, deep pore cleansing facial or algae body masque.

We bid mother-in-law and the rest of our middle-class life goodbye for the next four days as we sped across Miami’s blue waters to William and Rosamund Vanderbilt’s Xanadu island, built in the 1920s, accessible only by Fisher Island ferry, yacht, seaplane or helicopter.

Today, Oprah Winfrey, Boris Becker, Mel Brooks and “Cagney and Lacey” star Sharon Gless own terra cotta-roofed condominiums on the island, a palm-covered spit seven minutes from Miami Beach’s MacArthur Causeway. Frequent guests include Demi Moore, Meg Ryan, Arnold Schwarzenegger, Jack Nicholson, Paul Newman and Sharon Stone. No-view studio apartments start at $550,000, while split-level panoramic villas go for $6 million.

Peacocks roam everywhere on the thatched patch of land, and an aviary boasts a collection of South American toucans and cockatiels. The mile-long beach was constructed with white sand imported from the Bahamas and is raked each morning at sunrise. But the centerpiece of the island is the pretentiously named Spa Internazionale, located in Vanderbilt’s old 22,000-square-foot seaplane hangar, where an army of white-uniformed, strong-fingered masseuses awaits. To spa freaks hell-bent on relaxation at any cost, these gurus of kneaded flesh are to luffas what Michael Jordan (who has stayed on the island) is to basketballs.

As soon as our ferry pulled in to dock at the 216-acre island, another security agent armed with a clipboard and walkie-talkie drove us silently in a hunter-green golf cart to the refurbished Vanderbilt mansion, so that we could sign away our life savings.

In the back seat of the E-Z-Go mini-limo, my wife pulled out a mirror from her handbag, pursed her lips like a pouting Madonna and outlined them with Yves St. Laurent No. 5 liner. I worked on my pesky eyebrows.

We must have passed F.I. clearance because once at the reception desk, the two trilingual clerks were all smiles and whispers. “Champagne?” one clerk asked. “Why not,” my wife said, not accustomed to free liquor except at weddings.

Of course, nothing is free at Fisher Island, but so that you never have to touch money during your recuperative visit, guests are issued gold-lettered Fisher Island charge cards. With champagne flutes in hand, we were introduced to Tico, a handsome Chilean who chauffeured our personal E-Z-Go to our refurbished cottage, Villa No. 1102, built to accommodate Willie and Rosamund’s guests 50 years ago.

This was no Motel 6: floors of Italian tiles covered with Persian rugs, French doors, private patio with hot tub, two-room bathroom suite. On a mahogany table, a basket of perfectly ripened Anjou pears and imported cheese awaited next to a cut-crystal vase of roses, tiger lilies and hyacinths.

Hanging inside the closet — none of those tacky hotel hangers you can’t remove — were two rain ponchos and terry cloth robes, which didn’t come with advisos about what would happen if you swiped them. No Gideon’s Bibles in these bedside tables. Next to the sofa was a decanter filled with sherry.

Tico stood at the door, smiling serenely like a tanned version of Clarence in “It’s a Wonderful Life.” Before backpedaling, he dangled keys to our E-Z-Go — the preferred means of transportation on Fisher Island. What where we, a couple of hayseeds from Iowa, doing at a ritzy place like this?

Truth be told, we were there to celebrate. We had just come back from four long days at Disney World with our 6-year-old son. We needed to recuperate from the masses of humanity standing in line sweating like pigs in 100-degree heat behind signs that cheerfully announced: “Two-hour wait from this point.”

There was another reason for our own largesse. I had just been granted tenure as a professor of journalism, and after chasing fires and politicians for 20 years, and for the last four years attending faculty meetings at which the main topic of discussion was whether to install a lock on the unisex bathroom door, what was wrong with a blast of hedonistic excess?

Iowa is a wonderful place for a writer for one reason: There is nothing to distract you. Corn and plenty of it, plus a population of five pigs for every Iowan. Alas, Iowa is not where Wolfgang Puck plans to open his next restaurant. In a recent poll by the local newspaper, the Red Lobster was voted best seafood restaurant, followed by Long John Silver’s.

As we were to discover over the next four days, Fisher Island is for life’s seminal celebrations — 50th birthdays, making partner, fourth-marriage honeymoons or trading in your cheapskate husband for a sugar daddy. Fisher Island’s brochure bills itself as a resort that is “absolutely the best of the best.”

Our previous benchmark for ultra luxury had been Little Dix Bay in the British Virgin Islands. One afternoon there, while lazing on rafts 30 yards from shore, we suddenly had a hankering for a cold and refreshing beverage, preferably with a double shot of alcohol in it. I motioned with the index finger of my right hand toward my mouth. Without a second’s delay, a pith-helmeted man in Bermuda shorts waded out to us, took our order and, within minutes, returned with two frosty daiquiris on a silver platter.

No way Fisher Island could rival that, I thought, although by the end of our stay, the experience had been close. Of course, such ridiculous service costs plenty. Three-night spa packages at Fisher Island go for $3,380 per couple; seven-day prices fetch $6,900 for two.

But that’s during high season. From May 1 to October 31, the four-day, bare-bones Romance Package for two costs a mere $990, exclusive of meals and spa treatments. The stripped-down version costs more than the Holiday Inn Express, to be sure, but at Fisher Island you get more — some of it tangible, some not.

What Fisher Island is selling, in addition to impeccable service, dining and accommodations, is security and proximity. No paparazzi here. We were about as close to paparazzi as anyone gets on Fisher Island, and all we had was a Canon Sure-Shot. Hermetically sealed and deafeningly quiet, Fisher Island is less than 15 minutes from the high-pitched frenzy of Miami’s trendy South Beach, where tourists flock for photos in front of Gianni Versace’s mansion, yet it might as well be a thousand miles away.

Built in 1905, when a passageway was dredged from the Atlantic Ocean to Biscayne Bay, Fisher Island is named after Miami Beach land baron Carl Fisher, who bought the key in 1919 from Dana Dorsey, a black millionaire whose failed dream had been to turn the isle into a resort for wealthy black tourists. Fisher grew tired of the island and in 1925 traded it for Vanderbilt’s 250-foot yacht, the Eagle. The trade wasn’t as bad as $24 worth of trinkets, but it’s one reason why you’ve heard of Vanderbilt and not Fisher.

Vanderbilt sunk millions into the island, building a nine-hole golf course, azure-tile pool, grass tennis courts and a stone mansion with seven fireplaces and a library with walls that came from an estate once owned by Napoleon. After Vanderbilt’s death in 1944, the island bounced between land barons, and in the early 1960s, an investment group headed by Bebe Rebozo (and including Richard Nixon) bought the island. In 1979, the island changed hands again, this time to a holding company, which built expensive condos, expensive restaurants and a brand new expensive golf course. In 1991, Spa Internazionale opened for business, specializing in, as the brochure promises, “customized body treatments.”
We might be hayseeds, but we were hayseeds with a mission. As soon as Tico left our cottage, I called the sybaritic spa and made reservations for a thermal mineral mud kur. Maybe it was my living in Iowa with so many pigs, but there has always been something appealing about slathering my torso in mud.

Before embarking on such a task, though, I wanted to be in the right frame of mind. We chilled on the white-sand beach, lay out under a canvas cabana and — following directions in our Fisher Island guidebook — hoisted the cabana’s green flag up its mini mast to signal we wanted a drink. No waiter clad in Bermuda shorts and pith helmet appeared, but it still worked just fine. Within minutes a cabana boy was at my elbow, taking our margarita orders.

That night, we dined in one of the island’s five restaurants, the Cafe Porto Cervo, an elegant place with a patio overlooking 200-foot-long yachts. We feasted on sumptuous portions of shrimp and scallops grilled in garlic — not quite Red Lobster, but I got used to it. On our left were two divorcies with designer noses who spoke with thick Miami accents and wore Rolex watches heavy enough to require forklifts. On our right was a Middle Eastern family of 22. Our waiter, from Paris, recommended the tiramisu. When he returned and saw our plate scraped empty, he asked with a discreet smile, “Something wrong with your dessert, sir?”

On our way back to our cottage, we drove the E-Z-Go through the island’s residential neighborhoods, where the Fisher’s 500 year-round families from 39 nations live. I hoped to get a glimpse of Mel Brooks and his wife, Mrs. Robinson (aka Anne Bancroft), or of Oprah and Stedman walking hand in hand, but I came up empty — just an army of kids on new Rollerblades and a motorized skateboard. It all was so surrealistically pleasant; the few women we saw — their perfectly pedicured feet squeezed into high-heeled, come-hither slippers — were all manicured and bronzed, chic and very thin. All excess weight had been either sucked out by machine or sweated off by the butt-blaster and spin classes offered daily at the Spa Internazionale. The men looked like aging bad-guy extras from “Miami Vice”; now in their 50s, they still had pony tails, but their once-hirsute pates were bald and their one-time washboard abs today had more flab than ripple. Their tans, though, remained remarkable.

Primed for the mud experience of my life, I showed up promptly for my appointment the next day. Masseur Eduardo painted my body with hot, black Hungarian mud. Back home, we try not to track mud into our house. In fact, most Iowa houses have a room off the kitchen, called the Mud Room, designed as a place where you can kick off your muddy boots before entering the living quarters. But here, you pay $125 so that a stranger can slather gooey dirt over your body.

But frankly, Eduardo — a nice Brazilian guy who is the trainer for the U.S. Olympic Rowing team — was too stingy with the black gold. I knew the stuff was expensive, coming all the way from Hungary, but I still expected to get dipped from head to toe and then soak in the stuff. Instead Eduardo dabbed a little here and there as though he was touching up a pretty good paint job. For all I could tell, the touted mud could have come from a backyard in Hialeah. With lights dimmed and taped moans from cetaceans piped into my room, I lay for 15 minutes, then Eduardo wrapped me in white sheets that must be very messy to wash. Next, Eduardo led me to a long, narrow tub with bubbling water that the brochure promised was “laden with thermal mineral crystals derived from the world famous Sarvar Spring in Hungary.”

To tell the truth, I get more pleasure from our own bathtub in Iowa overlooking the cornfields. The last step was for Eduardo to rub cream into the skin around my knees, elbows, wrists and ankles, which felt oily and smelled like something out of a Victoria’s Secret catalog.

The next day’s herbal wrap turned out to be more to my liking. Billed as incorporating “the ancient Egyptian custom of wrapping the body and the Far Eastern practice of using herbs to relax, detoxify and remove the body of excess fluids,” this treatment had me feeling akin to a moth in a steaming hot cocoon. Eduardo used piping hot linen sheets that smelled like cranberries and chamomile, followed with a brief finger-point massage. When he had finished pummeling my body, expiated of toxins, I felt like a wet noodle.

Actually, what I enjoyed most about the spa was an outdoor “Roman Waterfall” Jacuzzi. This is the drill: You stand in a large, semi-circular shower area complete with statues and columns and allow the rapidly cascading water from above to pummel your neck and shoulders. It was a deep, almost rough, massage (punishment for excess pleasure?). The sound of the rushing water blocked out all other noises. Forget Rome. It felt like I was body surfing Iguacu Falls.

After more afternoons of hoisting our green flag on the side of our beach-front cabana, more lonely jaunts in the E-Z-Go, hours doing the back stroke in the waveless ocean water, we were ready to return to Iowa to watch the corn grow. We paid our bill: The whole shebang — the body treatments, restaurants, the beach daiquiris, the 18-percent gratuities, the tax added in — came to $1,835 for two.

I’m still not sure whether it was worth it. We certainly were relaxed, ready to face the rigors of the world again. In fact, we were looking forward to talking with someone who wasn’t an obsequious servant. For four days, there had been polite nods and smiles, but nothing more. “Quiet, hushed elegance” is how the brochures describe the sensation. At times, though, it was eerie, like Stepford gone south for the summer. The blond topless woman with the too-perfect twin orbs floating in the calm water, the two French men wearing Bally loafers and chain-smoking Gitanes at the Tiki Bar, the honeymooners from Caracas with too much sunscreen on their noses — no one talked to anyone else. But after all, that’s why they had come to Fisher Island.

Of course, who stays in Miami during the summer? The wealthy Americans, Brazilians, Venezuelans, French, Germans, Italians and, recently, Russians who own residences on the island don’t hang out in August. If you’ve got enough money to own an apartment on Fisher Island or stay as a guest, you’ve probably got enough to be somewhere besides under the blazing Florida sun in 100-percent humidity. The whole island seemed like a neutron bomb had been detonated. But while the summer cuts down the number of people on the island, it doesn’t change the year-round mood of the place.

To most residents, the island is bliss, a nouveau Malibu without the gawkers or the mud slides. “It is like Los Angeles used to be when it was a pueblo and we were kids,” Sharon Gless’ husband, TV producer Barney Rosenzweig, wrote in a recent issue of the island’s magazine, FI. “It is about maqana, and deep breathing without having to think about it. It is about healing, about feeling warm and loose and free and sexy.”

Whatever. On the way back to raucous civilization on the ferry, which operates every 15 minutes 24 hours a day, there was the usual assortment of expensive wheels with dark windows. As each drove onto the dock, an attendant stood poised with a water hose. A flick of the windshield wipers signaled the attendant to spray the car. No conversation necessary.

To flick meant you wanted the attendant to rinse away any salt that might have accumulated on the windshield during the seven-minute ferry ride. At Fisher Island, they think of everything.