GIST Support Wiki

 
Living Without a Spleen

surviving splenectomy guidelines http://www.survivorshipguidelines.org/pdf/SplenicPrecautions.pdf

http://en.wikipedia.org/wiki/Asplenia

Here is a short piece on asplenia, with a few links. Note the vaccinations needed. In addition to these, my oncologist recently added Hep A. Some physicians also think Hep B is important.

Vaccinations

It is suggested that splenectomized persons receive the following vaccinations, and ideally prior to planned splenectomy surgery:

  • Pneumococcal polysaccharide vaccine (not before 2 years of age).

Children may first need one or more boosters of pneumococcal conjugate vaccine if they did not complete the full childhood series.

  • Haemophilus influenzae type b vaccine, especially if not received in

childhood. For those adults who have not been previously vaccinated, two doses given two months apart were advised in the new 2006 UK vaccination guidelines (in the UK may be given as a combined Hib/MenC vaccine).[12]

  • Meningococcal conjugate vaccine, especially if not received in

adolescence. Previously vaccinated adults require a single booster and non-immunised adults advised, in UK since 2006, to have two doses given two months apart.[12] Children too young for the conjugate vaccine should receive meningococcal polysaccharide vaccine in the interim.[7]

  • Influenza vaccine, every winter, to help prevent getting secondary

bacterial infection.



Any fever with sore throat needs prompt attention. Either ER or your physician. I now carry Augmentin, and if I get a combination of any fever with sore throat, I take a pill, call my MD, and closely monitor my temp. Once it shot from normal to 103.8 in less than an hour. That was how fast pneumonia set in for me, and I spent the night in the hospital. They wanted to keep me, but I (foolishly, I now realize) insisted on being released around 6 am.


I was told that I must be on antibiotics two weeks before, and two weeks after dental work...this includes teeth cleaning, so I would imagine that surgery demands precaution.

It's a lottery. You could be fine, or you could die. The mouth carries a lot of germs--many are the time that a spleen normally fights odd. When you cut open your mouth, you introduce these germs directly to your blood. I imagine the two weeks before is to kill possible other existing issues before risking cutting a mouth (including cleanings) and the two weeks after is to help prevent a regular bacterial infection.



The first two years after a splenectomy, you seem to be at your most vulnerable. I certainly found that to be true in my case. The first two years were rough--to the point where I thought I might die from OPSI, I had infection after infection, and spent so much time in ER that I knew all the doctors and nurses by their first names. I would show up, and be admitted immediately, hooked up to several IV's, and spend hours there, trying to convince the MDs that I did not need to be admitted. Several serious strep experiences, a couple of pneumonia bouts, a serious situation with a cat bite, a couple of critical asthma incidents--it was driving me crazy.

Now? Well, I retired last year, and am not exposed to people coming to work and me catching anything that they have by seemingly just being in the same room with them--but I also have not been seriously ill once. No trips to ER, nada.

In my research I noticed that the UK seems to be far more conservative in their care for asplenic patients. My surgeon, my GP, and my oncologist are also conservative, especially after watching me come close to dying so many times.

Current USA guidelines about antibiotics prior and post dental work are ambiguous. Some papers talk about deaths of patients, or severe near-death incidents, and say that antibiotics are needed. Other papers are (now, this year) saying that it doesn't happen that often and that other post-dental work protocol is fine, including various prescription mouth rinses, and close monitoring (by the patient!) of post surgical symptoms, with immediate trips to ER if they occur.

These symptoms are tricky though, slightly flu-like, or even common cold, malaise, fever, sniffles, achy--the kind of stuff most of us ignore, or take some aspirin, hot tea, nyquil, and go to bed with. Unfortunately, these are also the signs for overwhelming infection--and this can progress to death within a day or two, if not appropriately, and immediately treated with IV antibiotics.

I did learn that now, in surgery, they are trying to save a little of the spleen and implant it nearby, hoping that it will survive and provide the patient some protection. In addition, some bodies (lucky them!) grow new spleens.

Bottom line? I would take the antibiotics.