Some people with polysplenia have poor spleen function
Dear Dr. Roach: I read your recent article about spleens. Our daughter, who is 54 years old, recently had an MRI or CT scan due to another issue and the doctors were baffled as to what they saw. It turns out that she has “polysplenia.” We were all shocked, especially since those who are born with polysplenia mostly only live until the age of five.
In your article, you stated the spleen “acts as a kind of master node where the cells of the immune system interact with each other, improving the body’s ability to fight off infection.”
Since she has several small spleens, does she still have a compromised immune system? Are there precautions that she needs to take?
She has always been pretty active. She fell a few years back and broke five ribs and punctured her lung. She recovered fairly well from that. However, when she attempted to break up a fight with her dog and another, she was bitten — it took a lot of care for her and she still has problems with her hand. Please let us know what she needs to do to stay healthy.
E.R. Polysplenia, having multiple small spleens, is an unusual condition. It can happen by itself or in combination with other developmental abnormalities.
One common associated condition is situs inversus, where all the organs are on the opposite side: the heart is on the right, the liver on the left, and so on. It is in combination of some of the other conditions where the life expectancy is so drastically reduced — your daughter clearly does not have one of those conditions.
Some people with multiple spleens paradoxically have poor spleen function and should follow the same precautions as people who have no spleen because of a medical condition or trauma, including having additional immunizations and a low threshold to be seen by their doctor with new onset of fever. A medical alert bracelet or wallet card is a wise precaution.
People with no spleens are at risk for certain infections, hence the need for additional immunizations and sometimes treatment with antibiotics to prevent infections. One dangerous infection for people without spleens is Capnocytophaga canimorsis, a problematic result of dog bites. People with no spleens who are bitten by a dog need immediate medical attention, as sepsis, a life-threatening complication of severe infection, can result.
Dear Dr. Roach: I have had Type 2 diabetes for about three years. I take glipizide. In January, I got COVID. Since then, my blood sugars have risen sharply. My doctor doesn’t know if this is due to COVID. What’s your take? Do I need more than one medicine to control my sugar?
J.K.F. There are many reports of diabetes worsening (or starting) after COVID infection. This can come down to several possible reasons, including being an effect of the inflammatory response on the insulin-producing cells in the pancreas.
There are other possibilities. Many people have gained some weight during the pandemic, and that usually causes blood sugar to go up. The medication you are on, glipizide, works by increasing insulin production by the pancreas, but in many people, it stops working after a few years. It is seldom the first choice of treatment for Type 2 diabetes.
Other treatments, such as metformin, do a better job protecting the heart, eyes, kidneys, and nerves from damage from diabetes. Many people need more than one medication in addition to diet and exercise.