Medical Advice-- Bike crash-- Ruptured Spleen

Triathlon Forum
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For the past ten months I have been working, living, and training in Santiago, Chile. I am 23 year old male. About 1 month ago, I was riding my mountain bike and got run off the road by a car, causing me to crash which ultrasound revealed a severely ruptured spleen.

I had an open spleenectomy performed about 6 hours after the crash and my spleen was removed because they said it was broken in half (irreperable they said). I was internally stiched back up. Then about 12 hours after my surgery, a CT scan revealed a mistake had been made in my surgery (possibly a blood vessel was knicked) and I had continued to internally bleed over night while sleeping. I was rushed back into surgery, opened again on the same incision, and the problem was fixed. Afterwards, for poorly understood reasons, I suffered for another 7 days of pretty serious fevers (which the surgeon believes was a possible infection of my lung, which they said was punctured in the accident). I lost a great deal of blood in the second surgery, and had to have 9 transfusions in the days following–my hematocrit that week was 23% (Normally for me ~45).

10 days after the first surgery (Nov 10) I returned home to my apartment in Santiago and was able to walk about 8 blocks. 17 days after the surgery (Nov 27) and recieving all immunizations I came back to the U.S., at which point able to walk about half a mile.

The reason for this posting is to solicit medical advice or ask anyone who has had a spleen removed how their recovery proceeded (especially open spleenectomy pacients). Besides the terrible 7 inch scar accross my abdomen that I am trying to heal (currently using silicion strips), my mobility has still been limited still almost 1 month post-op. I still can’t sleep on my stomach, but am finally starting to feel like I am gaining some of my ab strength back (I can sit up in bed now easily, I can flex my abs a little). I can walk pretty normally, although I realize my body is still likely healing greatly internally although the scar is completely closed.

I am going absolutely crazy at home not being able exercise at all but am assuring myself doing nothing is the right thing to be doing now and anything else will just set me back more. I’ve been taking great care (sleep, diet, supplements) of myself but want to know realistically how long I will have to live this isolated sickly lifestyle. To be honest I still feel tired and lazy often, with little desire to be around many other people.

Would physical therapy be a good thing to consider at some point? If so, when? What should I focus on? Is there anything else I can be doing to help facilitate the recovery process (e.g., do you think there is any real funcional benefit to walking everyday for internal healing?). The scar itself feels terrible, when I walk I feel as though i’ve literally been sewn back together and every step pulls at the skin from both sides…its really unpleasent and I couldn’t imagine running, swimming, etc at this point.

Thank you all for taking the time to read this, I realize it was lengthy, and thanks in advance for your advice and support.

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I had my spleen removed about 15 years ago for a much different reason however. I assume it was “open” as I also have a nine inch scar on my midline. It took me a long, long time to heal up all the way. I am not an exercise physiologist by any means, but I imagine that due to the fact that most exercises engage your core to some degree, it would be taxing on the site to do most anything. I know I felt like I could split open at nearly any point in time, although that’s probably a bit over dramatic.

In my opinion, you need to focus on healing, period. You just underwent a MAJOR surgury, and it is going to take a while to heal fully. If you rush the process, you may do further damage, which could ultimately prolong your recovery. But on the other side of that coin, you may not do any damage at all. The question is, do you really want to take that gamble?

You will have a lot of time to train and compete once this has healed up sufficiently. Spend the time now allowing that to happen.

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Why not ask, I don’t know, a medical professional for their advice? YOu know someone who has seen your chart, tests, and knows your case in and out? I know, novel idea and all…

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I don’t think you’re experiencing anything that is out of the ordinary following major abdominal surgery. It’s rather common for people to be out of work from jobs that are not physically taxing for 6 weeks after abdominal surgery, so obviously training will be delayed longer than that. As far as feeling like you were literally sewn back together; well, you were. It really sounds like you’re progressing physically as well as can be expected.

The mental aspect is always tough in these situations. You’re young, healthy, and active and then you’re suddenly laid up. Stir crazy, cabin fever, whatever you want to call it, is often as hard to deal with as the physical healing, if not harder. I had shoulder surgery several years ago and was far less limited than you are and I hated being stuck inside, not being able do the normal stuff. You asked if walking is good for healing and the answer is yes. It will do a world of good for your legs, engaging your core, and getting you off the couch. You’ve noted a couple of milestones in how far you’ve been able to walk as time progresses, keep track of this-not so much for goal setting, but so your brain can see that you really are improving.

I don’t know how follow up care is coordinated with your international travel, but talk to your doctor. He’ll be able to guide you as far as when you can expect to ramp things up again, if phys. therapy is indicated, etc.

Take care of yourself and good luck. You’ve been through a lot, but I’m sure you’ll be back at it like nothing ever happened by spring.

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The reason for this posting is to solicit medical advice . . .

There is your problem.

Looking for insight from people who have had a similar experience is one thing, but seeking medical advice on an anonymous forum is a terrible idea. No one here has seen your medical records. No one here knows enough to give you ANY medical advice (other than, perhaps, to go see a doctor).

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Thanks Raul, yeah, when thought about it like that I definitely don’t want to take that gamble, even if training sooner would temporarily give me more peace of mind.

Besides recovery, can you tell me how your experience has been living without your spleen? To be honest I didn’t understand splenic function well before this accident happened to me and I have tried to read up quite a bit on google scholar, etc, and several of the articles have really intimidated me. In the first several years after your operation did you struggle from more sickness? Have you noticed any noticable differences in your immune function or how you have to treat illness when you think you may be getting sick? Anything else I should know? I just got the neumoccocal, meningitis, h1n1, and influenza vaccines.

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Take it easy okay. As I mentioned, I just returned from another country recently and of course the first thing I did was try and make a follow-up appointment with a local surgeon to ask these types of questions. They gave me an appointment a few weeks from now. Besides that, in my experience (which i’m sure is not all that dissimilar from many other triathletes who have gotten surgery), many surgeons who are non-athletes can be very unknowledgable about giving realistic advice to athletes. They often give wide margains for recovery ‘eg, you should feel better in 3-6 months’. As you and I know there are several sports medicine docs who troll this forum, i’d personally prefer to hear their opinions to give me an idea how the next year of my life will be. Wouldn’t you?

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Follow up with a general surgeon or a trauma surgeon. Your lungs/chest need f/u as well as your spleen/abd. You need to check that you were given all req. immunizations. Try to get/bring you chart from Chile (Op report, D/C summary…) to your appt.

To answer your question - I’d imagine you’d want to rest for at least 6 months. You’ll need a good amount of time to heal -plus get your hematocrit back up. Transfused rbc’s don’t last very well. I would not do anything more than an easy short walk until specifically cleared by a surgeon.

Dave

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I cannot offer any advice, but I wish you speedy healing.

(((hugs))))

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Wow - what a story. You are actually pretty lucky to be alive!

As was mentioned, there is absolutely no way any medical “advice” should be dispensed via any forum, medical or otherwise, with your situation. Being only 23 with lots of S/B/R ahead of you, take it easy, heal up, and consult with a general/trauma surgeon regarding your progress and long term plans - you are only 1 month post-op, nothing in the big picture.

Good luck!

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To anser your last question, “No, I wouldn’t seek the advice of a sports med doctor at all in this case”.

Sports medicine doc should say “Well my area of expertise has nothing to do with ruptured spleens, emergency abdominal surgery, or punctured lungs, so you are in the wrong place. I can not answer any of your questions as they fall WAY outside my area”.

You are seeking advice from the wrong people - you want the advice of a specialist in trauma or a general surgeon who does trauma (as happens where I live).

They give wide margins for recover as there are wide margins for recovery! People on this site overplay the “doctors don’t know how to treat athletes” - it may be true to an extent as doctors are good at what they do. Many doctors don’t see compulsive triathletes who over-train and get injured (like me:)) but sports med docs definitely never treat your type of injuries…it would be like saying “I had a stroke or heart attack but I want to see a sports med doctor (vs. neuro/cardiology) as I’m an athlete and cardiologists and neurologists don’t know how to treat athletes”. You had life-threatening injuries - your ONLY concern should be healing from them for the time being. I can’t imagine a sports med doc has anything to offer you (unless you also have some ortho issues).

Dave

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enduroevo, i feel your pain. my spleenectomy was 21 years ago this Christmas eve. visiting the family for Christmas dinner and some guy lost control of his car. in a blinding snow storm he drove off the rode and took me out at full speed.
i don’t remember doing anything special for recovery. i walked a lot. i remember my friends having a great time trying to make me laugh because they knew it was excruciatingly painful to laugh for the first few weeks.
but, have faith. you will get better. i didn’t take up triathlon until 10 years later but I’ve done 9 IMs since then, so i expect there is no reason you should not anticipate a full recovery for endurance sports.
good luck

13

When I was 16 I was in a car accident. When my parents arrived at the hospital, they were told I had a ruptured spleen and a broken back, and might not make it out of surgery. After they split me open they realized my spleen was fine, as was my back. This was in the late '70’s before they had all this fancy imaging equipment. So I have that same scar right down my middle.

I was sidelined for a little while. Even though they had not removed my spleen, they had done all the surgery to do so. At first my belly button was missing, but it reappeared when they took the stitches out. As a stupid kid, I started doing stuff too soon. My scar is much more pronounced than it would have been had I taken it easy. I don’t believe I can ever get that nice flat stomach because of the surgery- if false it makes for a great excuse! You know how you used to be able to touch your stomach and feel the center? I no longer have that feeling. It feels wither slightly to the left or slightly to the right. If I try to find the center, it makes me nuts- like Monk not being able to touch a parking meter.

Take it easy! You have the rest of your life ahead of you. Heal well. Do not push it. Your body had been through a tremendous injury and shock. Just relax and heal. Next years tri season does not matter, the rest of your life does. Read, get a musical instrument (not the drums), or find a hobby to occupy your mind. But just let your body heal.