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Old Spleens Suck (2021)

197 points| benkuhn | 3 years ago |sarahconstantin.substack.com

84 comments

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aklemm|3 years ago

As an adolescent around 1990, I burst my spleen in the final minutes of a school ski trip. Nearly bled to death as the school staff transported me home and left me in my living room to be found later by my parents nearly unconscious.

Anyway, I got to the emergency room that evening and there was much debate whether to remove my spleen. They decided not to and instead kept me hospitalized for 10 days and then out of school for 3 more weeks after that waiting for it to heal on its own.

GenerocUsername|3 years ago

Hi! Nice to meet you! Similar story! I was on a university research trip in the Philippians when my spleen spontaneously ruptured. It took 4 days to get home and by the time I got back to States for diagnosis half my blood was in my belly area... I rejected surgery since it had been days since initial event and healed on my own...

jessriedel|3 years ago

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gonehome|3 years ago

There’s another interesting spleen fact that I remember reading: people who survive flight ejections and hitting water at high speed tend to have had their spleens removed.

Probably because otherwise the impact causes a rupture and you bleed out too quickly to survive.

theobeers|3 years ago

This does come up in the story of Cliff Judkins, a Marine Corps pilot who, in 1963, survived a fall of 15,000 feet into the Pacific Ocean. He had had his spleen removed a few years earlier, and a doctor told him that was probably a factor in his not being killed by the impact. Judkins' account is worth a read:

https://uss-la-ca135.org/60/1960Judkins-Knott.html

krisoft|3 years ago

What do you mean by “flight ejections”? Are we talking about ejection seat activations in military aircraft?

This factoid sounds very suspect. Doesn’t most people who need to activate an ejection seat survive spleen or no spleen? Deaths may occur of course, an ejection is not without risks, but if everyone or nearly everyone with a spleen dies then my understanding of the risk associated with an ejection is seriously miscalibrated.

Also the group of “active military pilots who had their spleen removed” must be a small group, likewise “military pilot who needed to activate an ejection seat” is a small group (but probably a bigger one than the spleenless group). So one would expect that there is almost nobody in the intersection of these two rarefied sets.

Obviously this is all very handwavy reasoning, so who knows. But if you have a source that would be highly appreciated.

pavlov|3 years ago

I honestly expected this article to be about the other meaning of spleen, a melancholy or depressive longing (as in Baudelaire’s “Le spleen de Paris”). Something about looking forward, giving up old spleens, etc.

Instead it’s genuinely interesting information about how an organ changes over time.

flobosg|3 years ago

> the other meaning of spleen

TIL; and of course it is derived from Hippocrates’ theory of humors…it all makes sense in retrospect!

dm319|3 years ago

The premise of this article is based on a single study in 1969 on mice. I agree with the general premise that the immune system ages and becomes less effective as we get older, but will need more convincing that removing the spleen will make you live longer.

pacaro|3 years ago

IIRC a lot of our data about human splenectomy comes from World War II, where it was performed often enough that some long term followups were possible with sufficiently large n

rhn_mk1|3 years ago

umbers.

gcanyon|3 years ago

I've been without a spleen for longer than I had one. I wonder if -- if any of this translates to humans -- spleens are beneficial to the young but a risk to the old, meaning that since I survived my youth without, it's all good going forward; or if young spleens give long-lasting benefits, meaning that the best course is to have the spleen into old age, but then jettison it later in life (than I did).

mescaline|3 years ago

Did you get vaccines to compensate? I've been told there are three that I need, but not sure when or if I need boosters.

clarkevans|3 years ago

Is there a good introductory book on understanding inflammation and autoimmune diseases?

aborowie|3 years ago

A gorgeously illustrated deep dive into the immune system that will forever change how you think about your body, from the creator of the popular science YouTube channel Kurzgesagt—In a Nutshell

Immune: A Journey into the Mysterious System That Keeps You Alive

by Philipp Dettmer

mescaline|3 years ago

I'm getting my spleen removed on the 11th of April. I'll let y'all know how it going in a few years. I'd do anything to fight back these wrinkles.

manmal|3 years ago

I wonder if senolytics like Fisetin or Quercetin could help reduce those problematic cells.

Asparagirl|3 years ago

Huh. Well, this is interesting. As someone who’s been sans spleen since age eight, all I ever heard or read about was my risk for minor bacterial infections to potentially turn into overwhelming sepsis. I was put on penicillin VK 250 mg twice a day prophylactically from the time of my splenectomy until age seventeen, when I transferred to an adult primary care physician instead of my pediatrician. I have to get the pneumovax (which protects against multiple strains of bacterial pneumonia) every five years. And I’m still constantly figuring out if I’m truly up-to-date on all my other vaccines, because some of them (like the new multiple flavors of meningitis vaccines) didn’t exist when I was younger. In short, I’ve also associated my lack-of-spleen with hypervigilance about health, and not as a potential benefit as this article posits.

Also, splenectomy led to some fun times during the pandemic because it was and is somewhat unclear whether being permanently immune-compromised due to a splenectomy applied really only to bacteria and sepsis risk, or possibly to virii like coronovairus too, since antibodies and the things that help you “clear” an infection (including a viral infection?) are also produced in your spleen. In the UK, having had a splenectomy was explicitly listed as a condition for what they called “shielding” during the worst of the pandemic, but in the US it was not considered to be a condition named for early access to a full third dose (rather than a booster) of the vaccine.

Other side effects, not mentioned in this article:

- I now have enormous tonsils, to the point where my uvula hangs at a 45 degree angle, probably because the tonsils are making up for the spleen loss, since they serve a somewhat similar function.

- As another commenter here notes, we basically only have long-term data on splenectomized people’s outcomes because of WWII. The small risk of quick sepsis is always going to be there, and did impact their lifespan. But we don’t have enough recent data, in an age of more available antibiotics, to say if there are other potential problems to look for.

- As for histamine/allergy or autoimmune issues being lessened in mice without spleens —- well, I have the same annoying allergies as everyone else in my family, take Claritin daily, and developed auto-immune antibodies due to celiac and then got the oft-associated thyroid problems. So, a sample size of one here, but a splenectomy didn’t seem to be protective against either of those immune-related outcomes here.

All that being said, I don’t miss having a spleen. It was breaking down my entire (congenitally somewhat mishapen) red blood cell supply as a kid, like a swimming pool filter run amuck, leading to anemia and exhaustion and pallor. And while removing it did not make my blood cells gain a normal shape and size, it completely changed my quality of life.

gcanyon|3 years ago

Mine was removed in my twenties. I got the recommendation for pneumovax, and the warning about sudden overwhelming infection, but other than that, nothing too serious.

davidkuhta|3 years ago

Some insights into a rationale ex-spleen nation of the future. Thanks for sharing.

ryeights|3 years ago

I think it is obvious at this point that the human body is designed to self-destruct, causing death at old age, once a certain biological threshold is reached. Resistance to this idea comes not from a rational perspective, but a semi-religious belief that your own body would not betray you.

Tenoke|3 years ago

It's odd to claim that's obvious when there are alternative explanations - the body is simply not all that optimized for old age because it isn't as much of a priority for passing genes and if such a complex system isn't optimized for it things are bound to give out.

resoluteteeth|3 years ago

The programmed aging theory may be "obvious" but there is not really evidence to support it as of the present.

If true, it would likely be very easy to stop aging (there would likely be some mechanism in cells causing aging that could simply be switched off), but this has not been borne out by research so far, and this is despite the fact that much anti-aging researching assumes it to be true.

The preponderance of the evidence currently seems to support the theory that aging is caused by damage building up over a lifetime.

m463|3 years ago

I've wondered what kinds of things we're doing both good and bad to our bodies.

For example, with modern society food availability is high. For example we could eat kale every day. Starving is optional. yet I've read that fasting is the way to metabolize senescent cells, but maybe nobody does it anymore.

twobitshifter|3 years ago

I wouldn’t say self destruct, your body and your child’s body and your grandchild’s body are all a continuation of the same organism. Selection favors clearing out the old dead mutated cells and that is just extending to bodies as well. If we conceptualize ourselves as separate from our descendents, we think we’re dying, but if we procreate our cell line lives on, which is the only outcome which matters to evolution.

outworlder|3 years ago

There's little incentive for the repair processes to be perfect. There would actually be zero incentive after we reproduce - and some species are exactly like that. The moment you reproduce, you die.

Humans, being a social species, might have pushed evolution towards trying to repair a bit more than it should. Older humans can still contribute - sometimes a lot - to the group. Older males can still reproduce in many cases.

antattack|3 years ago

Evolution's natural selection looses it's power after ones child reached maturity. It's now up to our frontal lobe to keep on improving our bodies.

With that said, it's possible that long life might have negative effect on resource availability which might affect procreation and child rearing, and might find shorter life-span more advantageous to survival of species.

Rury|3 years ago

>belief that your own body would not betray you

I think this is a fair point. We're multicellular life forms. We're not 1 living thing, but rather a collection of many living things working together. It could be that some of those living things start to betray each other (for personal gain) which aids in our demise. Just as individual humans can do the same to each other, leading to society's demise. But I'm not sure that means we were designed to self-destruct.

cheschire|3 years ago

Why is that “obvious” and why is the “other” side the religious one and not your “design” assertion?

I’m not an expert on such subjects but it seems more closely related to the concepts of evolution to say natural selection does not show preference for abnormally long lived individuals because it is unknown or unimportant at time of procreation which traits lead towards lifetime longevity beyond short term hunter gatherer traits.

gscott|3 years ago

I plan to go to China every 15 years and get all new organs. As long as I don't accidentally turn on Tesla Auto-Pilot I should live a long time.

threatripper|3 years ago

> body is designed to self-destruct

This way of thinking is dangerous. This is like saying that there is "planned obsolescence" when in reality products are designed to last a certain period. They are not designed to fail after that period but they are also not designed to last longer than that period. The end result is similar but the intention is totally different.

strictfp|3 years ago

It's hard to survive in the presence of a constant onslaught of forces trying to break you down. Plus we have another way of surviving: multiplying. And multiplying gives us mutations as well, i.e better fitness. So why should our organism optimize for longlivety?