Mono, enlarged spleen, lifting safety

[stronger]

Hi Rip,

I spent the days after Christmas with a lovely bout of mono, leaving me less 15lbs and with an enlarged spleen. Standard medical advice is to avoid contact sports for 2-3 months after mono, the fear being that the enlarged and tender spleen may rupture. Obviously barbell training isn't a contact sport unless you're doing it wrong, but do you have an opinion on the safety of lifting heavy loads and a compromised spleen?

Thanks, and looking forward to the seminar in Westminster at the end of March

[Mark Rippetoe]

I have no experience with it. It doesn't seem to be in a position where the pressure would adversely affect it. We'll ask Sully, since he's seen more fat spleens than I have.

[Jonathon Sullivan]

Fat spleens are bad, and you shouldn't lift with splenomegaly.

I don't know if you've read any of my other posts, but if you have, that statement should make an impression. For God's sake, I actually think people with Parkinson's should lift. I strongly believe that people who can lift weights should lift weights, with very few exceptions. Splenomegaly would be one of them. That is not based on literature, but (Paul would be proud!) common sense, medical prudence, and clinical experience. True, lifting is not a contact sport, but proper lifting markedly increases thoracoabdominal cavitary pressure and mono spleens can be unreasonably fragile. Fat spleens can rupture with relatively trivial instigation, and when they do...watch out. I would guess the risk of rupture from lifting is quite small, but the consequence of rupture can be catastrophic. I have seen a case of spontaneous rupture--no trauma whatsoever--of an enlarged spleen (from leukemia, not from mono). It was....memorable. But not in a jolly way.

There are reports of splenomegaly in contact athletes with mono being followed with ultrasound to monitor splenic size; it appears most can return to play within 2-6 weeks. So, God Willing and The Creek Don't Rise, you may be good to go in March. Strength is a persistent adaptation. Catch up on your chess openings or something.

See your doctor, do what he tells you, wait for it to go down. Two cents from a paranoid ER doc.

And don't steal any more kisses from Mary Sue Rottencrotch, or she'll get it too. You wouldn't want that.


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This post is offered for instructional and educational purposes only, and does not represent medical advise for any specific patient, disease or condition. Medicine does not happen on the Internets. I'm not a real doctor, I only play one on television. Don't get any big ideas.

[hatmanii]

Yeah, mono is bad juju. That shit sucks. Had a month long bout with it during college where it was misdiagnosed by two doctors. Get better, the iron and strength will be there when you get back.

[stronger]

Thanks for the input Sully. I think I might fall asleep with the bar on my back if I did try right now, so I won't press my luck and will rest for a few months.

[Calvo]

Sully,

I had a mono scare a few months ago and found an old thread here in which Rip mentioned the possible use of Valtrex to combat mono caused by Epstein-Barr virus. Any thoughts?

[calmasahinducow]

How the fuck would one lift with mono? I had that shit senior year of high school and it caused me to miss my entire 4 months wrestling season. Easily the single worst disease I have ever had and hopefully will ever have.

[Jonathon Sullivan]

Sully,

I had a mono scare a few months ago and found an old thread here in which Rip mentioned the possible use of Valtrex to combat mono caused by Epstein-Barr virus. Any thoughts?

I have seen some material claiming that valaciclovir is effective against EBV and mono, but I have not looked closely at the literature on this topic. Sorry. I will say that I have seen no rush to definitive treatment (or even definitive diagnosis) of mono in adult emergency practice. (I don't see kids.)

Paul1 is an infectious disease specialist; he would be better qualified than I to answer a question about antiviral therapy for mono.

[Calvo]

Got it. Thanks.

[Paul1]

I think splenomegaly with mono is a situation where doctors are more risk averse than they need to be -- on the other hand a ruptured spleen is a potentially fatal surgical emergency, so at least eschewing sports with potential abdominal trauma makes all the sense in the world given the stakes. We also see people with mono get spontaneous splenic hemorrhages with no trauma at all, though it's rare.

I would not even consider antiviral therapy for an immunocompetent patient with mono. Even for our transplant patients and AIDS patients who get absolutely horrible complications of EBV infection there is precious little evidence that antiviral therapy helps. The only time I ever would use an antiviral to treat EBV would be an organ transplant or bone marrow transplant patient with both post transplant lymphoproliferative disease AND a very high copy number of virus in the blood, and this is because these patients have no immune mechanism to control the infection.

Also, valtrex (valacyclovir) is probably considerably less effective than its horribly toxic cousin gancyclovir (oral version is valcyte or valgancyclovir).

Basically EBV is an infection of B cells, and you end up getting a shitload of systemic inflammation and sick inflammatory tissue during mono (though many cases are mild and the diagnosis is never actually sought). Tissue injury and inflammation can take a long time to heal from, which is why mono can be so damn miserable.

At the same time, if you feel well enough to lift then I don't think having mono is per se a contraindication (nor do I think Parkinson's is for people who are still functional from it!). Most doctors would say that once your spleen can no longer be felt, then you don't need to be restricted anymore. In truth, who the hell knows. Just don't squash a lifting belt under your ribs while squatting and don't drop weights on yourself.......