how fruitful is splenectomy at 65 yea... - ITP Support Assoc...
how fruitful is splenectomy at 65 years of age..my dad has been itp patient from 8 years
I would say your dad needs to have the indium labelled platelet test before embarking on such a drastic procedure. You may know platelets are killed in either your spleen or liver and I am sure NickyD will agree. Nicky had her spleen removed and she still has ITP and needs to take antibiotics forever. By having the above test it will show where the platelets are being destroyed - if it is the spleen then a splenectomy can be considered.
Mags
thanks Mag...i am not sure if this test happens here in India...as in these 8 years of ITP the doctor has never asked us to get it done...i will find out.....My dad has already tried wysolone,depsone,danazol and revolade...latest being Danozol...nothing has made his platelet level to rise above 20,000...bruising has increased.... He is a diabetic and all these medicines have severe effect on his sugar levels...dont know what to do next
There are increases in reports that in the elderly splenectomy is less successful and as Mags4743 said antibiotics would be required for life (in the UK daily). There are other treatments available,either used singly or in combination.I am older than your father and take the immunosupressant mycopdenolate morfetil, MMF,which is working well. Other immunosupresants ,such as azathioprine (Imuran) are available.They have a downside such as an increase in getting infections or a small risk of skin cancer so care is needed. The side effects should always be evaluated,but the treatment can always be stopped. In contrast once thee spleen is removed it cannot be replaced..
Good luck, Derek
What a coincidence!! I too am diabetic and the medication I took increased my blood sugar levels. Recently I had a liver function test and I was found to have a fatty liver. Long story but I was given metformin for diabetes and my liver function is now normal and my platelets did increase to 63 - not wonderful I know, but better than they have been. It may be that your dad has problems with his liver and maybe the platelets are being destroyed there. None of the medications worked for me and I have a theory! I SHOULD ADD THAT I HAVE NO MEDICAL EXPERIENCE WHATSOEVER BUT I think that these medications work on the people whose platelets are killed in their spleen i.e suppress their immune system, but I think if platelets are not killed in the spleen , they don't work. Perhaps you should ask your father to have a liver function test - it is only a blood test - to see if that reveals anything. Is your dad on insulin or tablets?
Regards
Mags
he is on Insulin and he got the liver function test done 2 days back and everything is within normal range,,,mags what are you taking along with metformin for increasing the platelet count?
My metformin is for diabetes not ITP. I do not take any medication at all now for ITP. I am one of the lucky ones I don't bleed or bruise so I feel better without the medication and it doesn't make any difference when I take it. Without medication my platelets are currently 63 but do vary from time to time.
I do hope you and your father are able to sort his medication out.
Best regards
Mags
Immunosuppressants such as MMF are used extensively to prevent rejection of organ transplants such as liver,heart and kidneys. They act by inhibiting the production of the B and B cell lymphocytes which are implicated in antibodies involved in tissue rejection. In ITP they act on the production of the rogue antibodies involved in platelet distruction. Unfortunately it is like the cracking a hazelnut with a sledgehammer approach.As mags says if you have a platelet count which is safe then go with the no treatment approach.I only wish I could. What platelet count does your father have and if is above 30 ,and there are no bleeding or tiredness symptoms, is it stable?What other treatments has your father been given?
Derek
Hi dhwani. I agree with Mags and Derek. I have had a count of around 10 for 20 years, take no medication unless I need to have the count raised for surgical reasons. I am lucky, whilst I bruise occassionally, I have only had one bleed. I travel extensively, but I have modified my life style to exclude dangerous sports. ( I wish I should be so lucky being 68 dangerous sports finished many years ago!!!!!)
I have not had my spleen removed, I refused as this is major surgery and the after affects and no gaurantee of success influenced my decision.
If you can find somewhere in India for the Indium test, that is a good point to start from. On a final note, I started to eat porridge a couple of years ago to reduce my cholesterol as I had tried statins which made me feel aweful. My cholesterol has reduced but equally my platelet count has increased. Coincidence? I do not know but if it is working, go with it. My count last time on my yearly visit was 37.
If your Dad does not bleed and does not partake of dangerous persuits, he can live with a count of 20 as many others do, but only do this with the approval of your doctor. Good luck and I hope this has been helpful.
thanks Sailor.... my dad's doctor is keen on spleen removal though i am not and my dad has not had any bleeding instances just bruises on his body. he also gets some ruptures in the eye usually which show as red clots for long time. he is 65, so now he has cataract in both his eyes and that is affecting his vision....till last year wyslone was working perfectly for him...but now that is not helping and neither is any other medicine...i understand from what u tell me and the others that it is ok to have low platelet count if you are not bleeding.....he is complaining of increased fatigue though.....whether i should hold back from spleen removal and have him try a combination of wysolone and danazol or go ahead with what the doctor is saying is a very big question in front of me
Just a thought but Doctors always tend to suggest the now old splenectomy approach early on in the treatment process. But now in several countries an infusion of Rituximab (Rituxan in the US) is suggested early on . Rituximab is a monoclonal antibibody acting on B cell lymphocytes.It can work well and give good remission periods.it does have its down side of side effects early on in the treatment for some patients and is not a cure, but then neither is a splenectomy. Some ITP patients on this site have had this drug and can tell you more about it. See the video about it on the Association's home page. Hope that is a useful piece of information for you for your father's decision. For many of us there are no easy options for ITP treatment...except to have an emergency plan of action if necessary .It probably will not have to be implemented (my plan has never been used), but carrying a card stating you have ITP and do not administer aspirin or any blood thinner is useful.
Derek
this is really helpful...thanks alot Derek
Hi dhwani
If you can to anything to avoid having the splenectomy - then that it the better course of action. I have to take penicillin twice a day for the rest of my life and am more prone to picking up infection. I did not know about the indium test and would have taken it prior to having the surgery. NickyD
NickyD I finally found a sensible doctor who agrees with whatever you and others are saying. his name is Dr.sunil J parekh and he practises in Mumbai... if anyone has ITP in India they should consult him as he is a haemotologist who has expertise in ITP cases. he agreed that the ITP pateint above the age of 60 should not get splenectomy and that if my dad has not had any bleeding episodes and only has bruising then he should not take any steroids or medicines. pretty much like derek. I cant thank you guys enough for being a great support during this time.
My Brother age 63 recently got his Liver transplanted with an ITP Liver and now his platelet counter are hovering between 15000 - 17000. I would request you to help me with Dr Sunil J Parekh contact number in Mumbai. I am here in new Delhi and will leave back to my country (Pakistan) shortly. Would to have the situation discussed with Dr. Sunil. Thanks.
Zahid H Khan.
dynasel@gmail.com
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