DEAR DR. GOTT: My friend who lives in another state indicated her mother was diagnosed with an enlarged spleen.

This is a woman in her 80s, still tall and slender, never smoked or drank alcohol, doesn’t consume caffeine and doesn’t take drugs of any kind. Her diet is exemplary with no white sugar, bread, flour, starchy foods, red meats or luncheon meats. She has always eaten a lot of fruits and vegetables, buying organic whenever possible.

Lately, she has complained about being very tired, she fell a couple of times, and now she has a constant fear of falling. How could someone who took such good care of what she put into her body end up with an enlarged spleen? What purpose does it serve, anyway?

DEAR READER: The spleen is an organ located in the upper portion of the abdomen. It is purple in color, about 4 to 5 inches long and weighs about 6 ounces in healthy people. Because it is protected by the rib cage, it generally cannot be felt unless it enlarges. The spleen acts as a filter for blood, destroying old and damaged blood cells. It fights bacteria such as meningitis and pneumonia by producing white blood cells known as lymphocytes. It stores iron from old cells, returning the iron to our bone marrow, where hemoglobin is made. Oddly enough, with all the important things this organ does, we can live without it if necessary.

An enlarged spleen, known as splenomegaly, can occur because of infection, parasites, liver disease, lymphoma, leukemia and a number of other conditions. When the condition occurs, this relatively small organ can weigh up to 4 pounds and becomes palpable on examination. Symptoms can include frequent infections, fatigue, anemia and pain in the left upper abdomen that radiates to the left shoulder.

Diagnosis, other than through palpation, can be made by ultrasound, CT scan or MRI and will often provide a physician information such as how large it is and whether it is crowding other organs in its proximity.

Treatment is directed toward determining the underlying cause for the enlargement and may be as simple as antibiotics to cure infection or chemotherapy and radiation if Hodgkin’s or another more complex disorder is discovered.

Sadly, an enlarged spleen can occur despite doing all the right things. A healthful diet, plenty of exercise and abstaining from smoking, drinking and drugs has likely kept her well all these years. Now, however, she should be under the care of a physician, who can get to the bottom of the issue and get her back on the road to recovery. She should also address her fear of falling. It might be that she has been so well for so many years that she now perceives the falls to be the beginning of a massive decline in her general health. Her physician can order appropriate testing to rule out any concerns he might have in this regard or, if appropriate, she might speak with a therapist in an attempt to regain her independence if no medical basis is discovered.

To provide related information, I am sending you a copy of my Health Report “Medical Specialists.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.