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Family Physician
Family Physician, Doctor
Category: Medical
Satisfied Customers: 2592
Experience:  Emergency Medicine and Family Practice for over 26 years
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Had fusion of L1-S1. Developed serum over lumbar area. It is

Customer Question

Had fusion of L1-S1. Developed serum over lumbar area. It is painful and leaves me unable to sleep on my back as that increases inflation and enlarging of serum. Had severe case of mononucleosis in college which kept me hospitalized for 12 weeks and took over a year to recover. RBCs ran a little high 48 to 54 and platelets have continually fallen to less than 100. No etoh in 16 months. Had only used wine 1-2 glasses 4 to5 nights a week, usually if I was preparing the dinner meal. I'm not 65, have asthma (premie baby 3 lbs 4oz in 1949). Splenectomy puts me at greater risk for infection but platelets less than 100 could result in DIC if I was injured in a fall or auto accident. Have not tried large dose steroids yet. All vaccinations are current. Get annual flu shot and pneumonia booster. ??recommendations??
Submitted: 4 months ago.
Category: Medical
Expert:  Neuro Doctor replied 4 months ago.

Hi, I am an American Board Certified Neurologist and I am very glad to help you with your health concerns.

First I will ask few questions so that I can gather additional information related to your health concerns.

1) What treatments were already tried for the management of Seroma (Serum collection after surgery)?

2) What treatments you have already tried for the pain management?

3) Have you been investigated to find out what is causing the low platelet count and high RBC count?

Best regards,

Neuro Doctor

Customer: replied 4 months ago.
Answer 1. None. Platelet count has been below 100. Usually around 80. Neurosurgery does not want to touch me with such a low count. No drainage or opening area to get it to draw and scar down.Answer 2. Pain management has gone from various NSAIDs with little relief. Vioxx caused right bundle branch block. Next used were tricyclics, quadracyclics, and neuroleptics. After two to four weeks use developed multiple side effects to point it was easier to live with pain rather than side effects. Norco 10mg qid which I took only one-half tab HS as needed for pain so I could l sleep. After 8 years I developed macropapular rash with intense itching all over. Was last ride on Tramadol 50mg HS and pen. After less than two weeks developed macropapular rash with intense itching. Adjuncts such as Benadryl 50-100 mg provided little relief.Currently on Melatonin 6 mg 30 minutes before HS and Valium 2.5 to 5 mg HS. Helps but still cannot sleep on my back as it puts more pressure on lumbar seroma causing pain and numbness to toes.4. Answer: Father had polycythemia. Mine was due to dehydration due to working as surgical assistant and not getting sufficient time between cases to hydrate well and empty my bladder. RBS run around 42 now. Platelets appear due to spleen. Have nodule in liver with accompanying cirrhosis. Liver mildly to moderately enlarged, but that was 15 months ago. CT, MRI, MRI w/ contrast, and ultrasound all performed and reviewed by liver specialist as well as liver cancer specialist and radiologist. All said no signs of CA (but that still puts me at 5% chance of developing CA for next 5 plus years). There are no signs of shunting between liver and spleen. Had stopped ETOH two months prior exams and have not had any ETOH or longing for it in past 15 months.In literature review and Harrison's it appears I may have few options: a. high dose steroid, b. partial splenectomy (doubtful as to effectiveness), c. full splenectomy which would cure plated destructions, but leaves me more susceptible to infections, esp meningitis or other viral as well as bacterial infections.So do I have any other options that you or other specialist may have hidden away. I need to approach my VA MD to have CT or MRI before next appt. He tends to meet, then get labs or rad info, which seems to me a waist of an appointment w/o info in hand.I also am a PharmD, completed med school courses and clinics with sophomore and senior boards with 94 percentile. Did not take state boards for license in TX. Had just lost a child at approximately term +/- a week with fetal demised due to strangulation followed by losing a patient due to 1st year resident failing to contact me (2nd yr) and unable to contact senior resident or staff as they were working off duty and out of beeper range. Long time to recover respect for profession when $$ meant more patient welfare and safety.Thank you. Hope this helps
Customer: replied 4 months ago.
PS: had very severe case of mononucleosis my sophomore year in college which kept me hospitalized for 10 weeks. Spleen palpable from sternum to posterior rib cage. Incidental hepatitis. Liver palatable similar to spleen. Took a year to recover fully.
Platelets began slow decline afterwards. Did not begin any ETOH until after age 31 while in AF. Now retired with loss of half of discs in spine. C5-6-7 fused. Bulging discs at C3-4-5 and C7-T1. T1-T2, T4-5, T8-9. Both shoulders reconstructed due to sports, marathons and falls.
Expert:  Neuro Doctor replied 4 months ago.

Hi, you are very welcome, and I am very sorry I couldn't reply earlier as I was away from the computer and just returned. Thanks for the waiting.

And thanks for all these additional details. You have indeed provided abundant and very useful information.

However after carefully going through all these additional information I feel I am not sure whether I could be of much help to you with your unfortunate health situation. You yourself have medical background, you have done extensive literature survey/referred standard medical books like Harrison’s etc, you have already seen Drs, you have tried myriad treatments, and also due to your underlying health situations you have restrictions for certain treatments too (for example seroma drainage etc). Considering all these points I am really not sure at this moment if I could offer anything useful to you to manage your health situation and sufferings. I really wish I could be of some help but unfortunately I am not able to do so. So I have decided to Opt-Out from your case and this will enable you to discuss your case with another expert at this site. After posting this reply I will opt-out from this question and you may please wait for another expert to take up your case. It may happen quickly or it may take some time depending upon how comfortable other experts are in managing your health situation. And please try to avoid replying to this post because then the question can get locked to me and it will make difficult for other experts to assist you.

I wish you all the very best and I earnestly hope you can get very useful health assistance from some other expert at this site.

Best regards,

Neuro Doctor

Expert:  khagihara replied 4 months ago.

I will try to help you. What is the diagnosis of the low platelet number? When did you have the fusion surgery?

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