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Is it a manifestation, or a symptom?

These are two terms that get bandied about quite often, and I might add incorrectly for the most part. I even recently received an email telling me that according to dictionary.com, they are synonymous.

Well contrary to popular belief, not everything you read on the internet is true, especially when it comes to health care [and health care reform I would add]. Manifestations and symptoms, although related, are not the same thing.

Symptoms are something that alert you to a problem, i.e. night sweats, bleeding that won't stop, fatigue, bone fractures [in the case of Multiple Myeloma], and manifestations enable the doctor to reach a proper diagnosis. Even more simply put, manifestations can be measured, symptoms cannot.

For example,

Increased bone fractures are a symptom of Multiple Myeloma, resulting from decreased bone density, which is confirmed through additional blood tests looking for abnormal amounts of plasma cells, and certain particular antibodies of Multiple Myeloma.

Low platelets are a manifestation of many diseases, which can result in symptoms, such as internal bleeding from minor bumps, or bleeding from cuts that won't stop.

Low neutrophil counts are another manifestation, causing increased infections (a symptom) because of the body's lack of neutrophils to fight off the infections.

High lymphocytes, as in my case, are an indication of a lymphoproliferative disease, which can result in fatigue, night sweats, weight loss and other symptoms.

So why do I bring this up, you might ask yourself? I don't know for sure, except to say I think it's important to distinguish between the two. [Plus it's a rainy weekend, and I don't have much else to do.]

Just being diagnosed with a terminal illness, doesn't mean you're on your death bed, and it doesn't even mean treatment is immediately warranted. And despite being ingrained in our minds the earlier you can diagnose cancer and treat it, the better off you will be, that isn't always the case. There really is some truth to the statement,
sometimes the cure can be worse than the disease

In my case, I was diagnosed with Mantle Cell Lymphoma (MCL) in March of 2002. My MCL has manifested itself in many ways, high lymphocyte count, low hemoglobin, particular antibodies (CD markers), and several chromosomal aberations. But with the exception of an enlarged spleen [which I'm not sure is actually not a manifestation] I have no symptoms, and I feel mostly fine.

Had I been treated, when first diagnosed, I may have achieved a 5 year (or even longer) remission, but would I have been better off in the long run? What is the likelihood of a cure? What would have been the resultant side effects of the chemo? Would future treatment options be limited?

Those are important questions to ask, and while I'm never going to know for sure, somehow I doubt I'd be better off today had I started treatment early.

There have been many lessons I've learned in my almost 8 years since diagnosis, but two have stuck with me the longest. The first being,
No one cares more about you than you do

and the second was from a hematologist in the UK, who said:
You treat the patient, not the disease

Just a little something to think about in the coming year!

Comments

Becky said…
Good, positive advise.
Gerry said…
Back to your riding Manifestation or a symptom ?
The rain sucks, my son's family is here to enjoy the sun that doesn't exist in Ney Jersey. Go figure?
Gerry said…
By the way I went for immediate chemo, that was 11 years back! Sure hope it continues to work....
Marc said…
Well tell your son's family to go home.

And I didn't say immediate treatment wasn't justified in every case, just in some cases, and besides you were probably exhibiting symptoms.

You just have to remember, we have a perverse system of medical care in the US. Doctors don't get paid nearly as much if they don't treat you. So the incentive is to always treat, especially if you have good insurance.

Just had to get that political rant in. :)
Alan Posner said…
I've never heard the term "manifestations" used in medicine. We used the term "signs" instead. i.e. signs and symptoms. (Signs is synonymous with your use of "manifestations".)

I would agree there is no benefit to early chemo for diseases which can't be "cured" with chemo. However there are hematological diseases that can be cured, and early treatment is of benefit.
Marc said…
That could be. I've just always used the term manifestation (I'm not a doctor) to differentiate from symptoms, which it seems most people don't clearly understand.

It is good to know I'm not too far off the mark.

Thanks!

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