Ruptured spleen normally due to trauma

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DEAR DR. ROACH: Very recently, 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 kind of 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.

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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 whether his spleen is now considered normal).

DEAR DR. ROACH: I’m confused about the medical rule not to drink any alcohol while on antibiotics. After doing Internet research on reputable sites, I found, to my surprise, that the overwhelming medical opinion is that moderate alcohol use does not render most antibiotics ineffective. I do understand that alcohol should not be used with specific antibiotics, e.g. Flagyl, because of adverse physical reactions. I read that the warning not to mix alcohol with antibiotics stems from doctors fearing patients taking antibiotics to cure STDs would have lowered inhibitions and engage in unprotected sex. Could you please set the record straight for the public on this subject? K.L.

ANSWER: I never learned the rule that alcohol shouldn’t be taken while on antibiotics, with the exception of metronidazole (Flagyl), the combination of which causes extremely unpleasant nausea and vomiting, headache, shortness of breath and other symptoms. This reaction can happen to a lesser extent with sulfamethoxazole (a component of Bactrim or Septra) as well as other, less commonly used antibiotics such as tinidazole and some cephalosporins. The antituberculosis drug isoniazid can cause liver damage in combination with excess alcohol.

In general, if you are sick enough to need antibiotics, it is prudent to avoid alcohol, and certainly to avoid excess alcohol. But alcohol does not render antibiotics ineffective. Preventing STDs is much better than treating them, since not all can be cured. Part of being sexually responsible is making good decisions. You are correct that people are more likely to make unwise decisions with even moderate amounts of alcohol. That’s true with or without antibiotics.

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 or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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