Remember the game, Clue? “It was Professor Plum with the wrench in the kitchen.” I loved that game as a kid. Maybe that’s why I watch shows like Dateline and 48 Hours way too much.

Anyway, you will recall that R woke up early in the morning on November 4th, stood up to take some medicine, and collapsed on the bedroom floor. This–after he’d been his usual walking, talking productive self the day before.

After 11 days in the hospital, erratic blood pressures (mostly low), fevers, abdominal swelling, pain on his left side, pain in his upper left shoulder, fevers, dizziness, shortness of breath, massive night sweats, extremely low red blood cell counts and headaches, the doctors finally came up with a diagnosis, but first…

A bit of background for those who don’t know: people with Myelofibrosis often wind up with larger-than-normal spleens. It’s a hallmark of this cancer, which I’ve written about in prior posts. A spleen should be no larger than about 12 cm for a man (roughly the size of a palm). Initially, R’s had grown to 24 cm; then, with a trial drug study, reduced to 18 cm, and then back up to 21 cm three weeks ago. Via ultrasound while in the hospital, we learned that his spleen had grown from 21 cm to 24 cm in just two weeks — a significant growth in a short period of time.

Q: Why not simply remove the spleen? Other people live without spleens, right?

A: (UPDATED) People with Myelofibrosis face greater risks from splenectomy surgery than others, up to and including death, and people with no spleen have a greater chance of early mortality after a stem cell transplant—for a variety of reasons related to the spleen’s role in fighting infection and blood cell production.

So, here’s what happened to R, as explained by CHTGPT. The short version is that R’s spleen “leaked” blood into his abdominal cavity. Read on if you’re interested in *medical stuff.

1. Splenic Infarction (stoppage of blood supply, often from a clot)

A splenic infarction can cause fever for 5–10 days and is extremely common in MF with massives splenomegaly. It occurs when part of the spleen loses its blood supply and dies. Symptoms include fever, left upper quadrant pain, left shoulder pain, elevated LDH (Lactate Dehydrogenase), worsening spleen pain, and sometimes blood that pools under the organ. Dead tissue triggers inflammation and sterile necrosis, resulting in a persistent fever.

2. Splenic Hematoma (Bruise) Fever (R may have gotten this when he hit the floor)

A splenic hematoma can also cause fever, body aches, night sweats, and fatigue. This occurs because blood trapped inside an organ is inflammatory. Fevers from hematomas commonly last 3–10 days and often are not associated with infection.

3. Blood in the Abdominal Cavity

Even a small amount of blood in the abdominal cavity can irritate the peritoneum and diaphragm, causing fever, severe pain, shallow breathing, elevated inflammatory markers, and shoulder pain (called Kehr’s sign).

R is finally home and recovering. His stem cell transplant got delayed. Chemo starts November 28th with the transplant on December 4th. Thankfully, the donor in Germany stuck with us, despite the timing hiccup.

Love to all for the support!

PS: *I am not a doctor and may make medical interpretation mistakes. You should do your own research and talk to your medical team. I write these posts for 2 kinds of readers: family/friends and those with Myelofibrosis and their caregivers who want to hear about other people’s journeys with the disease.