Can spleen rupture without trauma?
DEAR DR. ROACH: My husband was admitted to the hospital with a ruptured spleen that bled into his belly. His surgeon repaired it with a coil. He was not in an accident and had no injuries or any bruising anywhere on his body. His doctor had never seen this; he says a ruptured spleen usually is sustained from some sort of accident. My husband is almost 59, and in good health otherwise. How could this happen, and could this happen again? -- J.C.
ANSWER: The spleen removes defective red blood cells from the circulation, and it also destroys bacteria and infected cells. In fact, it is in many ways like a big lymph node, responding to infections by activating and enlarging.
Although a ruptured spleen is well-described in the literature, I’ve never seen a case like your husband’s either. The last ruptured spleen I saw was a college football player who was simultaneously hit by two opposing players, one on either side, both much larger than he was.
Most people with spleen rupture had an enlarged spleen to begin with, from cancer such as leukemia or lymphoma, infection such as EBV (the virus that causes mononucleosis), inflammatory conditions such as pancreatitis or mechanical causes such as pregnancy. A few cases are related to medications, and a few have no identifiable cause for rupture.
As far as risk of it happening again, there you have me. I found one paper that says the prognosis is “excellent.” I would have to refer you back to his surgeon. People who have had their spleens removed are at risk for certain infections, and should have a vaccine for pneumococcus, a major cause of pneumonia. The vaccine is normally given at age 65. Your husband should speak with his doctor about getting it now (since I don’t know if his spleen is now considered normal).
DEAR DR. ROACH: I read in your column that for vaginal atrophy (dryness/itching) you suggest that a woman use topical cream instead of estrogen cream. I am 59 years old, and have been using Premarin cream externally for a month with noticeable results. I use a dab every other day. Should I continue to use it even when I don’t have symptoms, or only as needed? If you think non-hormonal cream would be better, could you suggest one? I have tried one, but it didn’t seem to be effective. -- A.A.
ANSWER: I’m sorry I wasn’t clear. “Topical” in this case meant a vaginal estrogen cream, as opposed to estrogen taken by mouth. I would continue using it, since it has been effective. Most women use it twice a week after initial treatment.
Non-estrogen creams are fine for many women, but estrogen creams like Premarin usually are more effective.
Dryness and itching may be caused by recurring vaginal infections, which are often troubling to women. The booklet explains them and their treatment. Readers can order a copy by writing: Dr. Roach -- No. 1203W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med. cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.
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