Benign or Not?
Suffering in silence seems like an endless journey exacerbated by misinformation, misdiagnosis, and misrepresentation of symptoms and signs. Patients are made to feel as if they are living in an alternate reality, in the terrible upside down.
Sickle cell anemia wreaks havoc on the lives of hundreds of thousands of Americans, and countless numbers worldwide. Yet, its sneaky cousin, sickle cell trait, gets very little press. Anyone with Sickle cell anemia has no less than 2 other family members that have Sickle Cell trait. That means millions worldwide have inherited this mutation with the potential to deform and distort the very cells responsible for the most essential life element, oxygen.
The math really is quite simple. If the red blood cells do not carry out their oxygen-carrying capacity to the optimal extent demanded in any given circumstance, the deleterious effects can strike literally anywhere in the body. Honestly, what part of your body does not need oxygen? where are you devoid of blood vessels? Exactly... nowhere. This precious biological commodity is in short supply for the ones whose blood refuses to make its delivery.
So, what many physicians have traditionally been taught does not really add up when we ponder the pathology. Sickle cell is not just sickle cell anemia but exists on a spectrum informed by the genetic, epigenetic, and environmental milieu experienced by each individual patient who bears its mark. Homozygous genetic abnormalities almost always prove more intense in phenotypic representations. Yet we cannot fall into the fallacy that heterozygous genetic alterations have no symptoms. Or, shall we venture to say, we cannot presume the phenotypic expression of said phenomena would be ..... RARE.
Narratives developed in response to deeper cultural and political climates should not get to inform medical truth so pervasively but this is the sad reality of our era. Fortunately, some advances in the perception of various ethnicities have lessened the significance of concerns that admitting to the health complications of sickle hemoglobinopathies will lead to unfair financial disadvantages. Truthfully any illness can have this unfortunate consequence. However the consequences of pretense have been equally disadvantageous, and in some cases fatal. The deaths of what appeared to be young healthy athletes and military recruits beg the question: where are our priorities? is it worth dying for a million dollar NFL contract or veteran benefits? What bizarre times...
Instead, it is past time to consider each patient, and his history, studies, signs and symptoms on their own merits. It is time to do good old fashion medicine, and actually listen to the echoes of suffering so that it will no longer be silent. When a tree falls in the forest, there is ALWAYS someone around to hear it if we will just open the ears of our hearts.
