Summer is just around the corner (FINALLY!), and we can all look forward to spending more time outside- on the beach, going for a walk or a hike, or just lounging around in our own back yard. As wonderful as that may sound, what you may NOT know is that being outside poses a potential risk for Hodgkin's survivors who don't have a spleen, or who have had an irradiated spleen- I'm talking about the dreaded tick. And no, not the kind of tick that causes Lyme disease, but the deer ticks that transmits "Babesia," or "piroplasm," which is a parasite similar to malaria and infects the red blood cell system. As with other diseases that cause infection and force our already compromised bodies to put up a good fight, Hodgkin's survivors who are lacking a functioning spleen may not have the ability to rise to the occasion.
It is imperative that Hodgkin's survivors who don't have spleens take immediate action when faced with infections...
particularly those infections caused by "encapsulated bacteria," or bacteria that have an extra coat of protection, making it much more difficult for our immune system to fight them off. People who are lacking a spleen are essentially defenseless when it comes to battling infections caused by encapsulated bacterias. In addition to Babesia, other examples include "Streptococcus pneumoniae," " Haemophilus influenzae", and "Neisseria meningitidis".
Symptoms of Babesiosis include high fever and chills, as well as fatigue, shortness of breath, headache, chest pain, sweats, and muscle ache. Streptococcus pneumoniae and Haemophilus influenza are both common causes of upper respiratory infections. Their symptoms are actually similar to Babesiosis and may also include a cough and altered mental status/confusion. Neisseria meningititis symptoms include all of the above as well as a stiff neck, nausea and vomiting.
In all of these cases, people who are lacking splenetic function are at great risk in that infection from encapsulated bacteria can lead to sepsis, which can be fatal.
There is no way to be sure that a high fever is a result of these kinds of infections without a blood culture, and, unfortunately, the results of blood cultures can take anywhere from a few hours to a few days. For Hodgkin's survivors without spleens, time is of the essence.
It is widely recommend that asplenic patients seek immediate attention if they have any of the symptoms described above. DO NOT WAIT. Tell your health care provider that you don't have a spleen. Give them a complete list of your symptoms. Insist on having a blood culture performed AND that you receive a strong antibiotic while waiting for results.
GET VACCINATED! Vaccines can dramatically reduce your chance of infection. It is recommended that survivors without splenetic function receive the pneumococcal, meningococcal, and HIB (Hameophilus influenzae type B) vaccines. It is also commonly recommended that we receive an annual flu shot as well. Talk to your physician about a vaccine schedule- which ones, how often, etc.
As for Babesia, prevention is similar to the recommendations for Lyme disease- avoid wooded, brushy areas as well as overgrown grasses, dunes, etc. Walk on well-worn paths. Cover exposed skin with long pants, socks, and a long sleeved shirt. Do a "tick check" when you are back indoors- a head to toe thorough look- and on your pets too!
Lastly, remember that not all health care providers are used to seeing people without spleens. Removing the spleen during the staging process for Hodgkin's is no longer routine. Like everything else, you may have to be proactive about this piece of your medical history. You can wear a medical ID bracelet that states that you are asplenic. You can also carry a medical ID card that lists your previous surgeries, treatment, prescriptions, etc. And, you can do both- just to be on the safe side.
Not having a spleen may be the most significant consequence of earlier diagnosis and treatment for Hodgkin's, and yet it is often overlooked, as it is the "absence" of something as opposed to something "new" - like cardiac disease or secondary cancers. It is relatively silent. But it could be relatively deadly.