Hey, those innoculations aren't the end of the story. I was involved with a patient who went swimming in a waterfall pool in Hawaii and came down with leptospirosis. He didn't mention to his primary care provider that he'd had a splenectomy (and the provider documented other surgical history, so not sure why he omitted that, probably just forgot).
His 9 friends didn't get sick. But they had spleens. He ended up intubated in the ICU and became sufficiently well known in certain circles that I have had conversations with doctors involved in his care on both coasts. Which means he was a terribly interesting patient.
You never, ever want to be an interesting patient...
Leptospirosis is seriously nasty. I know kayakers who've had doctors not take their risk level seriously ("Hi doc, I was kayaking in this nasty canal and now I have flu like symptoms, please check for leptospirosis", "Nah, leptospirosis is rare and the test are expensive"). An extended stay in ICU resulted for a couple of them.
...I have to ask (of course, you don't need to answer): how did you tear your spleen in half? After all, most organs go on the inside, and are fairly well protected...
Unfortunately I have no cool story to tell. Most people who lose a spleen are in a motorbike or car accident.
Me? I fell onto the wooden edging of a playground with just the right angle, and just the right force to rupture it. Somehow, it was cleanly torn in half.
Oh well --- you can't win 'em all, I suppose. For certain very specialist meanings of the word 'win'?
When I was about six or seven I fell over in the playground, sliding on ice, and managed to hit the side of my right wrist against the edge of a concrete slab, and gave myself a greenstick fracture. Despite complaining that it hurt, the teachers at the school didn't think there was anything wrong with me, and it was only after school that my father felt my wrist and decided there was a notch there, and I went to the hospital.
That wasn't the most annoying bit. The most annoying bit was that, while spending the day at school writing with a broken arm, all the teachers commented on how much my handwriting had improved.
My teachers weren't sure how to treat me on return: I was still re-learning walking, after being bed-ridden for 5 weeks. So some kind of let me get away with anything, and the others expected me to try harder to catch up.
But again: The school didn't think there was anything wrong with me at first, probably just winded. Then I started puking blood everywhere. Great way to get people to actually listen to a kid.
Also, what is it with not trusting kids with pain? I developed pains in my leg in Year 9. More than a decade later, and my specialists think that was the first symptom of either MS or one of the fibro family.
I know lots of kids complain about minor aches and pains... But give it a bit of attention would you?
The spleen is a solid organ. Imagine squeezing a solid ball made of foam or gelatin. It will tear as you squeeze it, as it can't flatten out like a hollow sphere could (i.e. your stomach, intestines, etc).
You have a number of solid organs, but the spleen and the liver are the most commonly injured, due to their positions on opposite sides of your abdomen.
Splenic ruptures are fairly common with serious abdominal trauma. There is even a grading system...
How common without serious abdominal trauma? I didn't bruise, tear any muscles or crack any ribs or anything of the like. That kind of stat might give me something to brag about, not like a crappy immune system is something to be proud of.
The grading system is kinda cool. Unfortunately I can't use behind my current WiFi away from home. Maybe you can tell me how I did: The spleen was horizontally rupture into two pieces.
It's not that uncommon to have little to no bruising. One of the more common signs is actually pain in the left shoulder[1]
As far as the grading of your spleen... It depends on whether the major vessels leading into the spleen were torn or not, but it certainly sounds like you had a grade 4 or 5 tear (on a scale of 1 to 5).
Two quarts is getting very close to irreversible shock territory, so nice job not dying.
EDIT: Upon rereading... If you were in primary school, then two quarts would represent a very large fraction of your total blood volume (like, anywhere from 70 to 120%). You'd be very firmly in 'dead' territory at that point (assuming they weren't simultaneously putting more in)
Shame that the article doesn't mention how we know so much about long term survival rates of people with no spleen. IIRC During the Second World War (aka WWII) large numbers of injured soldiers had their spleens removed in passing, this gave a large population to follow
I know that we have embryonic stem cells (controversial) and adult stem cells that can be harvested from skin tissue (not controversial, possibly difficult/expensive?). I'm not particularly well versed in this field, but it could possibly be more expedient than other methods of getting adult stem cells. It could also be even more difficult/expensive, and that's assuming that they're pluripotent and not spleen-specific in the first place, though.
Nothing was mentioned about multiple spleens at birth (Polysplenia). Yes, some people are born with multiple spleens. In such case, it has nothing to do with injury and there doesn't seem to be enough knowledge on why this occurs.
Multiple spleens often result in mis-diagnosis (during radiology) leading to wrong treatment. When you know you have accessory spleens, it is always good to give them a heads up.
Oh hey, this is me! I had two accessory spleens. But the bad news is that ALL of them absolutely had to come out -- the accessories were discovered during a medically necessary splenectomy.
As the article says, the spleen filters your red blood cells and platelets. Think of it like a swimming pool filter for your blood stream. It knows which cells to break down because they're misshapen, spherical, instead of the "donut without a hole" shape. RBC's live about three months before degrading like that.
There's just one problem: what happens if your red blood cells are ALL funny-shaped, even the young healthy ones? Why then, your spleen valiantly tries to catch 'em all, like Pokémon, and you end up breaking down your own blood supply, auto-hemolytic anemia.
Welcome to hereditary spherocytosis, which is what I have. Despite its name, it was not hereditary in my case; about 25% of cases are de novo mutations. Incidence is about 1 in 6500, though some milder cases go undetected.
So, after a childhood of jaundice at birth, inexplicable anemia, paleness, and just being really really tired all the time, finally at age six did my pediatrician notice that my spleen was massively enlarged (due to working overtime) and two years later I had to have it out, along with the two accessories they discovered on the operating table. This was the late 1980's so I juuust missed the beginning of the era of laparoscopic surgery, so I have a heck of an abdominal scar.
Poor little spleen, it was only trying to do its job. The fault lay with my blood, not with it.
Meanwhile, I'm immune-compromised for life and have to stay on top of all kinds of vaccines. Note to other spleenless wonders posting here: there's a brand new Meningitis Type B vaccine that just came out in late 2014; get on that. Also Prevnar, Pneumovax, annual flu shots and all the other fun stuff.
The spleen was the one working overtime, since it would normally be filtering a fraction of his blood that was problematic, but instead 100% of his blood 'needed' to be filtered.
30 comments
[ 3.0 ms ] story [ 82.9 ms ] threadSubsequent testing over the next five years showed it, sadly, failed to become active.
For people like me, getting your inoculations is imperative. Annual gp visits help keep it in check.
As for the rest, depending on herd immunity is the answer.
His 9 friends didn't get sick. But they had spleens. He ended up intubated in the ICU and became sufficiently well known in certain circles that I have had conversations with doctors involved in his care on both coasts. Which means he was a terribly interesting patient.
You never, ever want to be an interesting patient...
It's always one of the first things I bring up with a doctor, relevant or not, because without a spleen, my immunity is compromised.
As my GP said, "This stops most people from getting whooping cough, it'll stop you dying from it."
Me? I fell onto the wooden edging of a playground with just the right angle, and just the right force to rupture it. Somehow, it was cleanly torn in half.
When I was about six or seven I fell over in the playground, sliding on ice, and managed to hit the side of my right wrist against the edge of a concrete slab, and gave myself a greenstick fracture. Despite complaining that it hurt, the teachers at the school didn't think there was anything wrong with me, and it was only after school that my father felt my wrist and decided there was a notch there, and I went to the hospital.
That wasn't the most annoying bit. The most annoying bit was that, while spending the day at school writing with a broken arm, all the teachers commented on how much my handwriting had improved.
My teachers weren't sure how to treat me on return: I was still re-learning walking, after being bed-ridden for 5 weeks. So some kind of let me get away with anything, and the others expected me to try harder to catch up.
But again: The school didn't think there was anything wrong with me at first, probably just winded. Then I started puking blood everywhere. Great way to get people to actually listen to a kid.
Also, what is it with not trusting kids with pain? I developed pains in my leg in Year 9. More than a decade later, and my specialists think that was the first symptom of either MS or one of the fibro family.
I know lots of kids complain about minor aches and pains... But give it a bit of attention would you?
You have a number of solid organs, but the spleen and the liver are the most commonly injured, due to their positions on opposite sides of your abdomen.
Splenic ruptures are fairly common with serious abdominal trauma. There is even a grading system...
http://www.aast.org/Library/TraumaTools/InjuryScoringScales....
The grading system is kinda cool. Unfortunately I can't use behind my current WiFi away from home. Maybe you can tell me how I did: The spleen was horizontally rupture into two pieces.
As far as the grading of your spleen... It depends on whether the major vessels leading into the spleen were torn or not, but it certainly sounds like you had a grade 4 or 5 tear (on a scale of 1 to 5).
[1]: https://en.wikipedia.org/wiki/Kehr's_sign
4 or 5 sounds about right, I lost something around 2 quarts of blood, though that may have more been due to inaction.
All I remember from the ultrasound was thinking the red was really pretty, and then vomiting.
Thanks for sharing your knowledge, it's fascinating stuff.
EDIT: Upon rereading... If you were in primary school, then two quarts would represent a very large fraction of your total blood volume (like, anywhere from 70 to 120%). You'd be very firmly in 'dead' territory at that point (assuming they weren't simultaneously putting more in)
I call myself "splenically superior" and argue that it obviously explains my mean personality. :-)
I humbly submit that I deserved downvotes. It is better to disincentive us hopeless clowns on HN, even when we manage to be funny.
Edit: That was quick. :-)
For those who might not recognize it, this derives from a hilarious (and, atypically, authenticated) witticism of Churchill's: http://www.newsweek.com/boneless-wonder-176272.
Had my kids been in Parliament in 1931 they would have said "burn".
Multiple spleens often result in mis-diagnosis (during radiology) leading to wrong treatment. When you know you have accessory spleens, it is always good to give them a heads up.
As the article says, the spleen filters your red blood cells and platelets. Think of it like a swimming pool filter for your blood stream. It knows which cells to break down because they're misshapen, spherical, instead of the "donut without a hole" shape. RBC's live about three months before degrading like that.
There's just one problem: what happens if your red blood cells are ALL funny-shaped, even the young healthy ones? Why then, your spleen valiantly tries to catch 'em all, like Pokémon, and you end up breaking down your own blood supply, auto-hemolytic anemia.
Welcome to hereditary spherocytosis, which is what I have. Despite its name, it was not hereditary in my case; about 25% of cases are de novo mutations. Incidence is about 1 in 6500, though some milder cases go undetected.
So, after a childhood of jaundice at birth, inexplicable anemia, paleness, and just being really really tired all the time, finally at age six did my pediatrician notice that my spleen was massively enlarged (due to working overtime) and two years later I had to have it out, along with the two accessories they discovered on the operating table. This was the late 1980's so I juuust missed the beginning of the era of laparoscopic surgery, so I have a heck of an abdominal scar.
Poor little spleen, it was only trying to do its job. The fault lay with my blood, not with it.
Meanwhile, I'm immune-compromised for life and have to stay on top of all kinds of vaccines. Note to other spleenless wonders posting here: there's a brand new Meningitis Type B vaccine that just came out in late 2014; get on that. Also Prevnar, Pneumovax, annual flu shots and all the other fun stuff.
Who was working overtime here? Six year old you or the pediatrician? Neither makes sense to me.