My Post Splenectomy Wellness Guide

Do you know that there are an estimated 1 million people living in the United States today that are hypo splenic (have a low functioning spleen) or are asplenic (without a functioning spleen)? I am one of those people as I had a complete splenectomy performed on February 03, 2020. This has been a difficult transition for me and as I approach the one year mark of living life without an organ while not considered essential poses some serious risks and complications in its absence. With a combination of personal research and guidance by my primary care physician and hematologist I have come up with my own particular wellness guide. Kicking off 2021, I am much more conscious of my overall health. I share my information not as a medical professional but as a patient speaking from experience. Before I talk about my approach to maintaining optimal health, I will cover the splenic basics.

What is the spleen and why is it so important?

The spleen is a small soft organ located in the upper left quadrant of the abdomen. Protected by the ribcage sitting between the 9th and 11th rib, the organ has a thin protective covering of tough connective tissue called a capsule. Although the spleen varies in size among individuals, typically it measures 3-5.5 inches long and weighs 5.3- 7.1 ounces. Generally, men have a larger spleen than women.

The primary function of the spleen is filtering blood. As blood flows into the spleen old, malfunctioned or damaged red blood cells are recognized and removed. Blood flows through a maze of many passages within the spleen. Healthy cells flow straight through and unhealthy cells are broken down by large white cells called macrophages. Once red blood cells are broken down, the spleen stores leftover components such as iron which eventually returns to the bone marrow making hemoglobin (iron containing part of the blood).

The spleen also plays a role in immune response by detecting pathogens (something that can cause disease, e.g. bacteria) and producing white blood cells called lymphocytes. These lymphocytes eat up bacteria that have a coat around them which is called encapsulated bacteria. About ¼ of lymphocytes are saved in the spleen at any one time and used to fight off bacteria which can cause conditions like pneumonia and meningitis.

As you can see the spleen which is the largest of the lymphatic system (circulation of the immune system) plays an important role in our overall health. When the spleen enlarges it cannot filter blood as efficiently as before. It may, in fact, accidentally filter out normal red blood cells and platelets (components of the blood that help stop bleeding) leaving fewer healthy blood cells in the body. Hypersplenism is the term used to describe enlargement of the spleen that leads to destruction of too many healthy red blood cells.

You may have heard of spleen injury or rupture as a result of trauma. A hard blow to the abdomen common with sports injuries, car accidents and rib fractures are a few examples leading to splenectomy or the removal of the spleen. Sometimes trauma will result in immediate rupture but it can take days even weeks for this to occur. A ruptured spleen is a life threatening emergency accompanied with internal bleeding. In addition to trauma, here are several medical conditions that attribute to Hypersplenism often resulting in either partial or total splenectomy:

• Bacterial, viral and parasitic infections- such as Syphilis, Tuberculosis, endocarditis, Mononucleosis (mono) and Malaria.

• Blood cancers- such as Hodgkin’s disease, Leukemia and Lymphoma.

• Liver diseases like Cirrhosis

• Hemolytic Anemia- a disorder where red blood cells are destroyed faster than they are made.

• Metabolic disorders- such as Gaucher’s disease and Niemann- Pick disease.

• A blood clot in a vein of either spleen or liver.

When a splenectomy is performed it is done by one of two different procedures. There is laparoscopy which involves one larger incision (about 3 inches) above the naval followed by several smaller incisions where a camera is inserted guiding the spleen to an intact safe removal. Laparotomy involves one larger incision (about 6 inches) opening up the abdomen more. This option is chosen if the surgeon feels that he/she may not be able to remove the spleen safely by the previous method. My personal procedure was called a Hand assisted laparoscopy. My surgeon marked the top of my abdomen with a small incision ready just in case conversion to laparotomy was needed to remove my spleen which had enlarged to over twice the normal human size.

It is important to note that Hypersplenism (enlarged spleen) may present itself asymptomatically. I never had any indication that there was a problem with my spleen until I began experiencing excruciating pain. Upon an MRI, doctors found a mass on my spleen which was enlarged at the time. I was told that it quite possibly could have been enlarged for a while but without any physical symptoms. My mass also could have been there growing for years. Sometimes splenic problems are discovered incidentally when looking at other issues.

What happens after a splenectomy?

After a splenectomy the liver and the lymph nodes take on many of the spleen’s important functions. Living without a spleen, however, increases the risk for certain infections especially those caused by encapsulated bacteria. There are four types of vaccinations that are required and are usually administered two weeks prior to the surgery unless the circumstances are an emergency such as with a trauma warranting surgery right away. In this case the Haemophilus B, Menningococcal, Pneumococcal and Tdap vaccines are given shortly after the splenectomy. These inoculations protect against tetanus, diphtheria, whooping cough, influenza type b, pneumonia and other serious pneumococcal diseases, and meningitis and other meningococcal disease. In addition to getting the yearly flu shot, the above vaccines must be repeated every 5 years.

In addition, post splenectomy patients need to be aware of signs of an imminent infection such as feeling unwell accompanied by a fever. In such circumstances a visit to the doctor, urgent care or emergency room should follow right away. Careful monitoring and a course of prophylactic antibiotics may be necessary. Some physicians order a low dose course of daily prophylactic antibiotics to aid in preventing infections after spleen removal, but with the rise in concern of immunity associated with long term usage poses concerns and different opinions among medical professionals. Statistics report that post splenectomy sepsis can be a lifelong risk with the first couple of years after surgery having the highest risk factor. The incidence of sepsis among post splenectomy patients is low; however, it carries a high mortality rate especially among children with hematological disorders.

My personal post splenectomy wellness guide

The above information is a brief look at the spleen and its importance. In my particular case, my issues began in the second week of January of 2020. Pain in my left side which started out as a mild intermittent annoyance, was at first self-dismissed as discomfort from working a job involving heavy physical labor. Within a week I went to the emergency room with excruciating pain and high blood pressure and was admitted upon an MRI finding of a mass and extremely blood platelet count. My hospital stay was spent undergoing a multitude of test including a bone marrow biopsy to rule out leukemia. Although I was cleared for cancer, it was decided that a splenectomy was necessary as I was severely anemic and had a mass on my spleen. The post splenectomy biopsy of the spleen revealed the mass to be a rare benign type of tumor called Littoral Cell Angioma with the cure being the spleen removal.

With the New Year and the approaching one year mark of my splenectomy I want to do everything that I can to ensure optimal health. Having an impaired immune system is especially stressful for me when I factor in the ongoing pandemic. I have isolated as much as possible aside from doctor appointments and necessary outings and fear what contracting the virus may hold for someone like me. Fortunately I have not had any type of fever or illness since my surgery and moving forward I have definitive plans to not only help keep me safe but healthy and thriving. The following are my strategies for staying healthy in 2021:

• Get vaccinated for Covid 19- At first I was a bit reluctant about being vaccinated as I tend to question and research medically related issues. In the end, however, I have decided that this will be in my best interest. In my mind I have weighed the pros and cons and the end result is simple; I am immunocompromised and at greater risk of contracting certain infections. Also becoming ill may mean longer recovery time for me than someone with a functioning spleen. I am choosing to not be risky with still too many unknowns associated with the Corona virus. In addition, I have not seen any sufficient data supporting typical outcomes for splenectomy patients contracting the virus.

• Buy a medical alert bracelet- This is something I should have done years ago since I do have allergies to two medications: erythromycin and tetracycline. I am currently searching for a medical alert bracelet that is of great quality and something that looks nice. It is extremely important to wear one just in case something happens to me one day and emergency responders find me unconscious or unable to speak. My allergic reaction to both of the previously mentioned medications is anaphylaxis (constricted airways, swollen tongue and rapid, weak pulse).

• Eat healthier - Since my surgery I have eaten smaller meals. I get full much sooner than before my spleen was removed. Despite my doctor telling me this would eventually pass, I still eat smaller meals otherwise I become bloated and am extremely uncomfortable. I have not been able to find any type of diet geared specifically towards the absence of the spleen. Instead have chosen to follow advice on a diet that is beneficial for the lymphatic system. The spleen is the largest organ of the lymphatic system (a network of tissues, organs and vessels that work together to move colorless liquid called lymph back into the circulatory system). The lymphatic system is also part of the immune system. I have chosen to focus on this area since I do not have a spleen hoping my extra care will be of long term benefit. In addition to cutting back on red meat, I eat more vegetables especially leafy greens. My meat of choice is chicken, baked, and I know that I need to include more fish specifically salmon and mackerel. I am lactose intolerant so I stick to almond milk and non-dairy options for butter, ice cream etc. I do not eat fast food and limit my sugar intake. Greasy foods tend to upset my stomach and I absolutely do not ever drink soda! I have to measure my portions at meals ensuring that I not only avoid overeating but I always tend to leave just a little bit of room in my stomach. This beats the alternative feeling which is bloated and sometimes a little on the painful side. Here are 3 other suggestions recommended for a lymphatic health:

1. Avoid exposure to toxic chemicals found in things like pesticides and cleaning chemicals. These things can build up in your system and make it harder for your body to filter waste.

2. Drink plenty of water to ensure that lymph ( clear fluid containing white blood cells) can easily move throughout the body

3. Proper exercise in addition to healthy diet

• Deep tissue massage- I was told to not lift much after my splenectomy to avoid getting a hernia but I was not given any information whatsoever about adhesions. An adhesion is a band of scar tissue that joins two internal body organs or tissues to other internal surfaces which are not normally connected. Adhesions are very common after abdominal surgeries, radiation and infection and occur as the body attempts to heal itself. They can appear as thin sheets of tissue similar to plastic wrap or as thick fibrous bands.

A diagnostic laparoscopy is the only accurate way to confirm adhesions and if found will be released during the same procedure. The down side to this is the risk of adhesions reoccurring as abdominal surgery poses a 93% chance of adhesions in the first place. I did research on this topic shortly after release from the hospital and came across deep tissue massage as a recommendation in both preventing the onset of adhesions and as a method of managing ones that are already present. I began lightly massaging my abdomen shortly after my bandages were taken off which was two weeks post splenectomy. I have built up pressure over time and I use cold pressed coconut oil which also has aided in scar healing. Deep tissue massage breaks down collagen fibers and adhesions which can restrict movement and increase pain resulting in an increase in stress.

Despite my efforts I do suspect a minimal amount of adhesion growth. This is something I will follow up with my primary care provider about at my one year checkup as I have had some symptoms. I will continue deep tissue massage with determination, however, as I do find it comforting and receive adequate alleviation from my minor symptoms. Typical symptoms of adhesions or what is commonly referred to as Adhesion- Related Disorder (ARD) are chronic pain, pain with movement; walking, sitting, lying on side, pain and difficulty with bowel movement, urinary bladder dysfunction, and emotional disorders such as depression, thoughts of suicide and feelings of hopelessness. Unfortunately sometimes the symptoms of ARD are confused with other medical conditions such as chronic fatigue, irritable bowel and endometriosis to name a few.

• Lymphatic yoga- I have enjoyed yoga for years. I find it to be beneficial emotionally as well as physically. Poses like supported pelvic tilt, cobra pose and abdominal twist (a variation of the half lord of the fishes) all are particularly beneficial in stretching abdominal adhesions. Recently I have been reading up on Lymphatic yoga and in 2021 this specific style is a big” to do” in my personal wellness guide. Lymphatic yoga includes supported and inverted poses that increase the flow of lymph (clear watery fluid that moves through the body picking up bacteria and viruses filtering them out via the lymph nodes). Unlike blood that moves as a result of the heart pumping, lymph moves by muscular contractions. The lymph is affected by gravity so anytime your head is below your heart in poses like downward facing dog for example, lymph moves into your respiratory organs where germs often enter the body. Returning to the upright position prompts gravity draining the lymph, sending it through the lymph nodes for cleansing. A support or yoga block is recommended while holding poses which allows the neck, throat and tongue to fully relax encouraging the lymph to flow freely through the nose and the throat.

It is important to keep in mind that yoga poses or asana are just a small aspect of the full spiritual practice. Breathing, in fact, is the key component and breath awareness is called pranayama. The deep intentional breathing which accompanies the poses or asana removes energetic blockages serving to purify the body. This in turn increases prana or the vital life force energy that is flowing through our bodies. Indeed, prana is the most important physical part of yoga. Only deep breathing with the full body opens energy channels increasing prana. Shallow, short chest breathes trigger the body’s stress response and deplete energy which is important to always remember.

You can practice as many poses as you like but if you avoid the deep breathing technique the body will not receive the benefit of the practice. Breathing is what causes the movement relaxing the body. Trying to shape your body into different poses when stiff will only cause injury. Breathing in yoga stimulates a transformation in the mind and the body cleansing and purifying them so the true essence can shine forth. Circulation improves, the nervous system calms, hormonal balance improves and organs are regenerated.

As I reflect on 2020 and all of its challenges I can say that I now have a greater appreciation for life. I feel extremely fortunate that my splenic problems were attributed to a benign tumor instead of the feared cancer diagnosis. Healing has been a timely process unlike the 4 to 8 weeks recovery time noted in many medical journals. I certainly do not debunk medical professionals but feel that those numbers are greatly generalized. I also feel it to be a bit misleading especially when factoring in the importance of deep tissue healing within the abdomen. Personally, I did not begin to feel like a whole person again until 6 months post splenectomy.

Moving forward in 2021, I will continue to work closely with my doctors and incorporate the guidelines in my practical wellness guide. Last year was a transitory year filled with many roadblocks and gradual healing but this year is the year that I regain and maintain my maximum strength. I certainly have endured a test of my patience many times along the road to recovery but I have learned so much about the human body and its intricacies along the way. For me, slow and steady wins the race and this year I will regain my momentum all while remaining proactive and safe.

Thank you for taking the time to read my story. I am always looking for updated information regarding post splenectomy health. If you have information to share or perhaps a personal story, you can find me on F.B as Marilyn Glover or Instagram; GMarilyn29. Take care!!