Sunday, January 08, 2006

Second Opinion

I wish this was not so complicated. The second opinion appointment went ok. Here is what the Dr. recommended:
  • Ultrasound of David's spleen. She said she felt the tip of the spleen. The spleen should not be felt. If it's palpable it could be enlarged. No problem. Non invasive.
  • Prevnar and HIB vaccinations. David has some immune deficiencies (and the test results keep getting worse) so the immunizations would protect him from pnuemococcal disease like meningitis and bacteremia, and Hepititus B. Not sure whether to do this now and would prefer to delay. Would prefer no immunizations. These disease make me sick just reading about them. After the shots they want to do an antibody test to see if he produces the antibodies against these diseases.
  • Splenectomy, in other words, remove the spleen. If he produces the antibodies against the vaccinations, supposedly, he would not need monthly IVIG injections (which are immunoglobulins obtained from many donors). The downside is that he would be on antibiotics every day for the rest of his life. The upside is that he would not have any bleeding problems. However, removal of the spleen is not 100% effective! Sometimes people still have bleeding problems (this is common with people with ITP, really).

I wish there was a black and white decision. The second opinion recommends procedures that are potentially harmful to David's immune system. He has deficiencies. I'm not sure if there is a greater risk of injury (if he keeps his spleen) vs. a risk of disease (without the spleen, saying the antibiotics don't work). My intuition is leaning towards leaving the spleen in if it's not defective.

There are more decisions to make. Thankfully, we still have time on our hands to do more research into splenectomies. We do not need to jump into an operation. Again, there is no right or wrong decision. Just trying to make the best one for our little boy.

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