135 ms·

Old Spleens Suck (2021)

197 points by benkuhn 4y ago

Asparagirl 4y 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 4y 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.
gonehome 4y 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.
- krisoft 4y 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.
  - sokoloff 4y ago
    The risk of injury in ejection is quite a bit higher than most people expect (typically over 25% towards 50% for older tech ejection seats). It’s still a way better scenario than riding it in. It is not uncommon for an ejection to end a pilot’s tactical jet flying days for medical reasons.
    - AvocadoPanic 4y ago
      Doesn't everyone remember what happened to Goose?
    - krisoft 4y ago
      > The risk of injury in ejection is quite a bit higher than most people expect I agree with you on that. But the question here is risk of death, not risk of injury. I don’t have reliable statistics but found this[1] article which says about ejections: “If you look at statistics around the world, the survival rate is greater than 92 per cent.” 1: https://amp.smh.com.au/education/how-dangerous-is-it-to-eject-from-a-fighter-jet-20120730-239mp.html https://amp.smh.com.au/education/how-dangerous-is-it-to-ejec...
pavlov 4y 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 4y ago
  > the other meaning of spleen TIL; and of course it is derived from Hippocrates’ theory of humors…it all makes sense in retrospect!
ryeights 4y 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.
- strictfp 4y 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?
- resoluteteeth 4y 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.
  - ryeights 4y ago
    I don’t think it is at all necessarily true that there would be one mechanism for programmed aging that could be disabled by modern medicine. Rather, evolutionary pressures might cause many mechanisms to develop simultaneously to prevent aging of individuals too far beyond the point of reproductive viability. If aging is caused by built-up damage, how would babies ever come to exist and live normal lifespans? The cell lines that produce new human embryos are millions of years old, yet each newly born human doesn’t face the problems of old age until they are 40+ years old.
    - harshreality 4y ago
      There's a strong filtering process. You're ignoring all the people, fetuses, embryos, and gametes that never pass on their genes. When genomic damage gets too significant, and damage occurs to critical genes, individuals do not survive to reproductive age, fetuses are miscarried and aren't born, or embryonic development breaks and it might not even be known that fertilization occurred. Aren't there also mechanisms that reduce accumulation of genetic damage in gametes compared to the rest of the body? That helps too.
clarkevans 4y ago
Is there a good introductory book on understanding inflammation and autoimmune diseases?
- aborowie 4y 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
  - thunderbong 4y ago
    YouTube link to introduction of the book - https://www.youtube.com/watch?v=lXfEK8G8CUI https://www.youtube.com/watch?v=lXfEK8G8CUI
  - gpvos 4y ago
    I came here specifically to recommend that book. It helped me understand a few more words in this article.
pacaro 4y 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 4y ago
  umbers.
  - _Microft 4y ago
    That was more than likely not a typo. n is used like this in some fields: https://en.wikipedia.org/wiki/N#Other_uses https://en.wikipedia.org/wiki/N#Other_uses
    - HPsquared 4y ago
      Specifically in statistics, lowercase n refers to sample size.
aklemm 4y 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.
- jessriedel 4y ago
  - aklemm 4y ago
    Just a tangential anecdote offered on a fine Friday night. I’ll be sure to check the rules of this subreddit more closely in the future.
    - hungryforcodes 4y ago
      I enjoyed it.
      - cwwc 4y ago
        Concurred.
    - workaccount21 4y ago
      cool story bro, unironically.
    - jessriedel 4y ago
      I mean, hardly anyone disputes the usefulness of moderation. I think these sorts of anecdotes lower the quality of the discussion, and HNers should take that into consideration.
  - melissalobos 4y ago
davidkuhta 4y ago
Some insights into a rationale ex-spleen nation of the future. Thanks for sharing.
steve76 4y ago
gcanyon 4y 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 4y 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.
  - gscott 4y ago
    pneumovax every 5 years
  - gcanyon 4y ago
    pneumovax, and I got the booster for covid about as soon as it was available. I'll get double-boosted in another month or two.
    - Asparagirl 4y ago
      Hi, fellow spleenless person. Make sure to look into the meningitis vaccines, too; there are multiple types of those now, and some only came in the market within the past few years. Also, if you give birth, your doctor may want to put you on prophylactic antibiotics while in labor or shortly thereafter.
mescaline 4y 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.
temptemptemp111 4y ago
manmal 4y ago
I wonder if senolytics like Fisetin or Quercetin could help reduce those problematic cells.
dm319 4y 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.

197 points by benkuhn 4y 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 4y 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.

gonehome 4y 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.

krisoft 4y 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.
- sokoloff 4y ago
  The risk of injury in ejection is quite a bit higher than most people expect (typically over 25% towards 50% for older tech ejection seats). It’s still a way better scenario than riding it in. It is not uncommon for an ejection to end a pilot’s tactical jet flying days for medical reasons.
  - AvocadoPanic 4y ago
    Doesn't everyone remember what happened to Goose?
  - krisoft 4y ago
    > The risk of injury in ejection is quite a bit higher than most people expect I agree with you on that. But the question here is risk of death, not risk of injury. I don’t have reliable statistics but found this[1] article which says about ejections: “If you look at statistics around the world, the survival rate is greater than 92 per cent.” 1: https://amp.smh.com.au/education/how-dangerous-is-it-to-eject-from-a-fighter-jet-20120730-239mp.html https://amp.smh.com.au/education/how-dangerous-is-it-to-ejec...

pavlov 4y 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 4y ago
> the other meaning of spleen TIL; and of course it is derived from Hippocrates’ theory of humors…it all makes sense in retrospect!

ryeights 4y 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.

strictfp 4y 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?
resoluteteeth 4y 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.
- ryeights 4y ago
  I don’t think it is at all necessarily true that there would be one mechanism for programmed aging that could be disabled by modern medicine. Rather, evolutionary pressures might cause many mechanisms to develop simultaneously to prevent aging of individuals too far beyond the point of reproductive viability. If aging is caused by built-up damage, how would babies ever come to exist and live normal lifespans? The cell lines that produce new human embryos are millions of years old, yet each newly born human doesn’t face the problems of old age until they are 40+ years old.
  - harshreality 4y ago
    There's a strong filtering process. You're ignoring all the people, fetuses, embryos, and gametes that never pass on their genes. When genomic damage gets too significant, and damage occurs to critical genes, individuals do not survive to reproductive age, fetuses are miscarried and aren't born, or embryonic development breaks and it might not even be known that fertilization occurred. Aren't there also mechanisms that reduce accumulation of genetic damage in gametes compared to the rest of the body? That helps too.

clarkevans 4y ago

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

aborowie 4y 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
- thunderbong 4y ago
  YouTube link to introduction of the book - https://www.youtube.com/watch?v=lXfEK8G8CUI https://www.youtube.com/watch?v=lXfEK8G8CUI
- gpvos 4y ago
  I came here specifically to recommend that book. It helped me understand a few more words in this article.

pacaro 4y 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 4y ago
umbers.
- _Microft 4y ago
  That was more than likely not a typo. n is used like this in some fields: https://en.wikipedia.org/wiki/N#Other_uses https://en.wikipedia.org/wiki/N#Other_uses
  - HPsquared 4y ago
    Specifically in statistics, lowercase n refers to sample size.

aklemm 4y 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.

jessriedel 4y ago
- aklemm 4y ago
  Just a tangential anecdote offered on a fine Friday night. I’ll be sure to check the rules of this subreddit more closely in the future.
  - hungryforcodes 4y ago
    I enjoyed it.
    - cwwc 4y ago
      Concurred.
  - workaccount21 4y ago
    cool story bro, unironically.
  - jessriedel 4y ago
    I mean, hardly anyone disputes the usefulness of moderation. I think these sorts of anecdotes lower the quality of the discussion, and HNers should take that into consideration.
- melissalobos 4y ago

davidkuhta 4y ago

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

steve76 4y ago

gcanyon 4y 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 4y 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.
- gscott 4y ago
  pneumovax every 5 years
- gcanyon 4y ago
  pneumovax, and I got the booster for covid about as soon as it was available. I'll get double-boosted in another month or two.
  - Asparagirl 4y ago
    Hi, fellow spleenless person. Make sure to look into the meningitis vaccines, too; there are multiple types of those now, and some only came in the market within the past few years. Also, if you give birth, your doctor may want to put you on prophylactic antibiotics while in labor or shortly thereafter.

mescaline 4y 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.

temptemptemp111 4y ago

manmal 4y ago

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

dm319 4y 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.