Most of us have heard the expression, “Silence is golden.”  The poet Thomas Carlyle, observed, “Silence is the element in which great things fashion themselves together; that at length they may emerge, full-formed… Silence is golden.”  But when it comes to our health, if those “great things fashion(ing) themselves” in silence to later “emerge, full-formed” are diseases, then silence isn’t so golden at all.  Why?  Because silent (asymptomatic) disease processes allow bad maladies to quietly sneak up on us without much warning.

            Let’s be more specific.  About two thirds of all deaths in the U.S. are attributed to just five causes: heart disease, cancer, chronic respiratory disease, accidents, and stroke. Most of these are the end result of silent processes that we don’t recognize until it’s too late.  The number one cause of death, heart disease, involves atherosclerosis, where plaque blocks the arteries that supply the heart.  When complete blockage of one of these occurs a heart attack often results.  That same process of atherosclerosis and artery blockage, when it involves arteries up in the brain, causes most strokes (the #5 cause of death) as well.  But until a heart attack or stroke hits, the process of blocking arteries is often silent, producing few or no symptoms.

            To go back a step further in the process, the factors that produce atherosclerosis, such as high blood pressure, elevated cholesterol, artery inflammation, and even early diabetes, also may bring little or no symptoms.  In fact, I occasionally wish some of these factors were routinely painful so that folks would be more motivated to treat them aggressively.

            What about cancer, the #2 cause of death?  Many types of cancer can grow for quite some time before any symptoms occur.  So screening tests, such as the wildly popular colonoscopy or mammograms or Pap smears are ways to discover cancers and pre-cancers while they are still curable.

            Even chronic lung disease (COPD, etc.), which is the #3 cause of death, can be mostly silent for a long time.  Because God builds a lot of reserve into lungs, folks can lose a substantial amount of lung function before they actually notice shortness of breath.  That’s where a simple in-office pulmonary function test can give a heads up before someone gets to a critical stage.  Sometimes that kind of information can help discover and define an otherwise stealthy process that, usually with the help of cigarette smoking, is slowly robbing breath from a person.

            I love it when my patients are aggressive with prevention; I would so much rather them be aggressive with preventing heart disease than with having to be aggressive in getting bypass surgery after a blockage finally shows itself with crushing chest pain. I’d rather they were aggressive in stroke prevention rather than having to be aggressive with rehab to try to be able to walk or speak again after a stroke.

            So what we’re saying is, so much of health is (often with the help of a trusted physician) discovering and controlling the silent processes that are going on inside us in order to prevent the big disasters.  If we wait until we can feel a problem, we’ve often waited too long.  So if it’s been a while, get a check-up that looks for and identifies these silent processes, because when it comes to our long term health, silence isn’t always golden.

Andrew Smith, MD is board-certified in Family Medicine and manages the Maryville office of Trinity Medical Associates located at 1503 East Lamar Alexander Parkway, Maryville.  He is accepting new patients with most commercial insurances and participates in Trinity’s Direct Primary Care program for patients who are without insurance, who belong to a cost sharing program, or who are Medicare beneficiaries.   Contact him at 982-0835