Monday, March 26, 2007

Rocks in a Bag: what I know about gallbladders




Finally I'm getting around to writing about the gallbladder. Don't know what took me so long, seeing as how, next to hernias it's the thing upon which I operated most (if you don't count breast biopsies). And I liked it. When a person came to see me with a clear-cut gallbladder problem -- which was the case at least 90% of the time -- I could be quite confident that I was going to make him or her happy and, most likely, have a little fun while doing it. But there's the rub: it's not always a Tenantoid "slam dunk," nor is it always fun. A mysterious little bugger is that bag of bile: perhaps more than any other organ it's able to elude or confound diagnosis despite such apparent simplicity. And more than any other category, I sent people home from my office without surgery despite being referred with the idea of separating them from their gallbladders. Rocks get in your head.

First, some basics.

Among the many functions your liver performs for you (in addition to feeling neat) is the manufacture of bile, which is a clarified-butter-yellow liquid of complex composition and which serves to help with the absorption of fatty substances into your bloodstream. (The ancients believed it had something to do with emotions: "melancholia" means, literally, "black bile.") About a quart of bile per day is produced and flows from the liver through a tube called the bile duct, entering the duodenum just below the stomach. Of that quart, a few tablespoons are sidetracked into a pouch that hangs under the liver, and is called the gallbladder. It doesn't make bile; it stores a bit of it, with the intention of squirting a dose into the intestine once in a while, particularly after eating a fatty meal. (The picture to the left, by the way, is not to scale. It makes the gallbladder look much huger than it usually is.) There's some complicated anatomy involved, particularly since the south end of the bile duct passes through the pancreas, where it's joined by a duct therefrom, carrying digestive enzymes made therein. We'll get around to the implications thereof, later.

Here's my theory: the gallbladder evolved before refrigerators, when people might starve for a day or two or three while they hunted their next meal. After a kill, they'd gorge on a big greasy meal, at which point a supplemental blast of bile was useful. (During starvation, the gallbladder can get impressively large and full of bile.) Compared to those days, we eat more or less constantly: two, three, four meals a day, a few snacks. Bile remains a necessary component of digestion, but storage isn't really called for. Our food sort of steadily drips into the intestine, so constantly dripping bile works fine. Which is why the vast majority of people who have their gallbladder removed never miss it at all.

Bile is composed of many chemicals which are supposed to remain dissolved in the liquid medium. In some people, for various reasons (genetic, diet, certain prior operations, certain blood diseases, etc) one or another of the components of bile are in too high a concentration to remain dissolved, and they precipitate out, forming crystals, which tend to grow larger and larger -- like sugar candy on a string. Stones. Trouble.

Well, not always. Some people have gallstones all their lives and never hear from them. It's muscular contraction of the gallbladder that sends the bile into the bile duct. If a stone happens to be near the opening of the gallbladder when it squeezes, it clamps down and cramps up on the stone, gets plugged up, and that hurts or causes other problems. If the stones are out of the way during the squeeze, there may be no symptoms at all. Which means not everyone with gallstones needs surgery, a decision made easier with the use of a crystal ball. I'll see if I can do justice to that, and other concepts, in the next few posts...

[UPDATE: many readers who find this post by a web-search may be unaware it's the first in a series. The others are here, herehere, and here.  Answers to remaining questions might turn up within them. Please check them out.]

349 comments:

1 – 200 of 349   Newer›   Newest»
Vicki Small said...

Dr. Kevin linked to this post of yours. Having had my gallbladder removed almost 5 years ago, I tho't I'd see what I could learn.

Count me among those g-b patients who never miss the ol' bag. Given that mine was totally non-functioning, before surgery (yes--zero function when tested), I can't imagine why I would miss it.

I look forward to reading more.

SeaSpray said...

My daughter-in-law just had her gallbladder removed in January. She had it done laparascopically and recuperated quickly.

She is only 25 and I didn't realize that someone so young could suffer from the disease.

She suffered for awhile with symptoms of the disease and is another classical case for why not to put surgery off because she is so much better now. :)

Midwife with a Knife said...

The one thing I always kind of wanted to see as a medical student (you know, in that way where you don't want anything bad to happen to someone but are really curious to see something for real) but never got to was a porcelin gall bladder.

Sid Schwab said...

I've seen two porcelain gbs. Impressive xrays, even more impressive in the flesh: truly looked like porcelain. (To other readers: it's a situation where the wall of the gallbladder is totally calcified.)

Kathleen said...

I'd give anything to have my gallbladder back. I think docs should have to tell people about what COULD happen, I think they should talk about the oddi, where those stones can migrate too, etc..You don't always recover, it can open up a huge can of worms to say the least. Trade ya 1/2 of panc for a working gallbladder..:)

Sid Schwab said...

I've posted in the past about gallstone pancreatitis, and will add to it in this series. Informed consent is required, of course. The problem with pancreatitis is that once you get it, it can recur on its own. When a person has pancreatitis due to gallstones, the danger of further problem is so great if the gallbladder is left in that it would be a rare set of circumstances indeed whereby it would be advised not to have it out. So gallstone pancreatitis is one of those near no-brainers in terms of removing the gallbladder: timing of the operation can be a matter of tough judgment. Stay tuned. I'll have more to say which, hopefully, will shed light.

Joy said...

Thank you for this! My dad has his gangrenous gall bladder removed just a few days ago. Having this information is really helpful.

Kathleen said...

Oh I know. I know the GB has to come out in cases lke that. I know... everyone I know with CP says the say thing, it all started with GB removal..and we all mourn our GB's...It's one thing to know it in your head, and clearly, nothing can prepare you for pancreatic jounry... I know, I know, I know...

Anonymous said...

I hate gallbladders. My mother went in for the rather nonchalant surgery and ended up being diagnosed with gallbladder cancer. She passed away nine months later. Two months prior to her death my father (knowing she was dying) committed suicide rather than live without her.

Hence, I became an orphan. Although I am long past childhood it still hurts to be without parents.

So, I hate gallbladders.

Thank you for being such a kind and wonderful surgeon. I am a professional writer (novels) and I am very impressed with your style.

Saint M*

Jamie said...

I am a 40 year old female who just had her GB removed 4/30/07. Never had a symptom until the Saturday before. I woke up just feeling that I had an acid stomach and shouldn't drink coffee that morning. Within 2 hours I was doubled over with stabbing, burning pain just under my right rib. Was admitted to the hopstial and had to wait 2 days to have that aweful scan. No stones but GB was functioning at 0.5%. Recovering well but nervous about eating. Will my liver know that it is all up to it?

Sid Schwab said...

Jamie: in the vast majority of people who've had their gallbladders out, digestion carries on perfectly well, since the liver keeps making all the bile it ever did. So the odds are you'll be just fine!

undertheknife said...

Hello! I love this blog, it's nice to find some medical professionals who speak it like it is.

After dealing with crazy shooting heartburn-like pains for about a year and a half that progressed to what just seemed like bloating I went and got an ultrasound. I was told I have a very abnormal gallbladder for my age. No other info has been afforded me from my PCP and I was immediately told I should have it taken out. I am a late 20's male, fairly healthly all my life with possibly not the best diet, but not the worst. I was not told yet if I have stones.

Some other poster mentioned her daughter-in-law was 25. What would cause gallbladder issues in such young people such as us, if there is any such theory.

What really got me was that my PCP didn't even seem to consider other options since the radiologist seemed concerned enough to call him right after reviewing the sounds.

They said there was some vasculitis(?). What does that mean?

Any input is greatly appreciated. I want to know all I can before I make a decision. I have the opinion that so called modern medicine is too quick to cut things out of us or give us a pill without knowing the full story.

Sid Schwab said...

undertheknife: it's really hard to speculate from such a distance and without knowing exactly what was found. In general, it's not that unusual to have gallstones at your age. If there are stones, and if the story fits, one and one makes two. If there are not stones but the wall of the gallbladder is thickened it's still abnormal. As I said in some other posts in this gallbladder series, it's when not everything falls into place (suggestive symptoms but normal gallbladder; abnormal gallbladder but unusual symptoms) that outcomes are less clear. It sounds like you aren't entirely comfortable with nor fully understand what you've been told so far; you need to let your doctor know that and get the uncertainties cleared up.

undertheknife said...

Sid: Thanks for the reply. I completely understand you can't speculate. I almost wish someone like you was my doctor, I'd feel better. We'll see how the specialists do. I am already starting on the path of asking questions and getting more answers. Hopefully that will work itself out.

It is interesting that you are telling me it's not that unusual to have stones at my age. Would it also be not that unusual to have an abnormal gallbladder? I'm sure that's a question you may not be able to answer.

In hindsight, I am thinking I have had problems for years, such as not digesting food, etc, and maybe I just didn't pay any attention.

Again, great blog! As someone who played with the idea of being a doctor at one point it's very interesting information.

groovy girl said...

I have had problems with my GB for months, and despite me saying to 3 docs "I think it is my gallbladder", I finally had a HIDA scan today that showed that it is pretty much nonfunctional.... So now the gastro doc is scurrying around referring me to a surgeon and my question for all of you with more experience is - since I have sort of learned to live with the constant abdominal pain and nausea, is there any urgency in having the thing yanked out because now it is pretty inconvenient for me to drop everything and suddenly just go have an operation! I need to plan this a little better, since I have been telling them for months that it was my GB and no one listened to me - I am in grad school now and working and well, you get the picture. Help......

Sid Schwab said...

Impossible to predict the future: even with stones, true emergencies are rare. Most people with gallbladder problems have intermittant pain but no emergency situations. Absent stones it's even less likely -- but not impossible -- that something would happen that could become critical. I can't give any meaningful recommendations from afar. Most people who pick a convenient time don't end up regretting it; some do. The only predictable urgency is when there's jaundice or infection, or a history of pancreatitis.

monniele said...

I am 27 and have had gallbladder problems since I was 15. I am finally getting it removed next month!! I have lived with this pain and discomfort for too long! I took a long time to get a diagnosis. I have had many scans & ultrasounds and doctors have never found any actual stones, just sludge and my gallbladder has thickened walls and fluid buildup. I had to see a specialist to rule out other possibilities before the surgeon would remove it.

Here is my question. I feel like my gallbladder has been contributing to me feeling like crap physically. I have joked with my husband that sometimes I think my gallbladder is slowly poisoning me. Has anyone else ever felt like this. I sure hope to feel much better after my surgery!

Sid Schwab said...

when there is chronic inflammation it can rob you of energy. I've had many patient say how much better they felt -- more energy, etc -- when it was removed. Can't say if that'll be the case with you, of course; but here's hoping!

luisguillen@sbcglobal.net said...

I had my first "attack" back in 1989 and have suffered with it ever since. Earlier this year, I was finally diagnosed with gallstones. My specialist found me a good surgeon and I am scheduled for the surgery tomorrow. I'm a little nervous because of the side effects, but I always go back to those long nights with excruciating pain that remind me that I'm doing the right thing. Thanks.

sippigrrrl said...

Wow. Dr. Schwab, I wish you were my doctor. I am a 30-year-old female, and I had my first "known" GB attack two weeks ago, after enjoying a tasty (and probably my last) bacon cheeseburger. My primary care doctor has blown off my painful abdomen for years, but a late-night visit to the ER finally diagnosed this problem and I am getting it plucked in two weeks! Do you think they'll let me keep it?

Sid Schwab said...

sippigrrl: they likely won't let you keep the gallbladder, because it needs to go to the lab and get chopped up for microscopic exam. Assuming there are stones, you can probably get some or all of them.

And once it's out, the odds are you can still eat cheeseburgers (although we all know they're not good for you!)

Anonymous said...

I've been suffering with unspecified stomach spasms for the last year. Spasms build up for 4-6 hours, sometimes, but not always, I vomit, though usually just a little fluid, then spams taper off over next 4-6 hours. I suffer anywhere from mild spasms to severe and usually every 2-3 days. Never 2 days in a row. After many tests (endoscopy, small bowel, gastric emptying, and HIDA), the only one that showed anything was a HIDA scan at 18%. My doc is recommending gallbladder removal, but I don't think he's certain that's what's causing the problem. Ultrasound last fall didn't show any stones. The symptoms can start any time...middle of the night, after a meal, in the morning. I've recently had some minor pain in the gallbladder area, but not much and not really any during the past year except the last month. Any thoughts?

Michelle said...

I'm very grateful I found your blog. I'm 23 and will be facing gallbladder surgery probably in the next few weeks and I'm scared S$#*-less for several reasons. I'm hearing about alot of cases where people still have significant pain after having the surgery. In addition, my mom was an army nurse and had alot of medical issues that had to be addressed. Unfortunately, she was also a malpractice magnet - so I've lived with horror stories growing up. She was one of those cases that while under anesthesia, she couldn't move, but she still felt EVERYTHING. Anyway, I've had 3 attacks, the last one lasting for 12 hours, and I've had enough. I tried a gallbladder flush through my chiropractor which didn't do jack squat. It's going to suck, but I also have a 2 month old that I'm nursing, so I don't know how the surgery will interfere with that...anyway all concerns I'll discuss with my surgeon. Just thought I'd see if you had any thoughts on the actual stats of people who still have significant problems after having the surgery.

Sid Schwab said...

anon: I assume, given the workup you've had, that you've been under the care of a gastroenterologist. In these grey areas, that's always a good idea. I can't diagnose anything from afar, and can only make the general comment that given the HIDA, your problem could be due to gallbladder dysfunction. Especially if the injection of CCK reproduced your "spasms." In circumstances like yours, I told my patients that given the other things that seem to have been ruled out, it's reasonable to have surgery; but it's a long way from a sure thing that it'll help. The advice of a gastroenterologist is important.

michelle: when the case adds up strongly that the symptoms are due to gallbladder, the chance of persisting pain after surgery are very low. Having some sort of side-effect (most often diarrhea, usually a mild problem) isn't as rare; but the vast majority of people who have well-documented gallbladder trouble are very happy to have had it out. We were just talking today in surgery about stories of people who claim to have been awake during the operation. I've done thousands of operations; the anesthesia person today is my age and has given tens of thousands of anesthetics. Neither of us has ever had a case of it. It can happen; it's so rare as really not to be a thing to worry about.

I told my nursing mothers to store some milk ahead of time, pump their breasts for 24 hours post op, and then have at it.

And, for the record, "flushes" are among the most bogus of the bogus treatments. Tell your chiropracter to stick to backs.

Anonymous said...

Thank you. It's disappointing to me to know that no one seems to have come across anyone else with my exact symptoms. And since my gastroenterologist isn't sure what the problem is, I am reluctant to have the surgery yet. I'm going to take a wait and see attitude. It hasn't gotten worse in a year, so unless the symptoms get dramatically worse, I'll think I'll put off surgery.

Are there usually reasons why the gallbaldder doesn't function properly (i.e., stones, cancer, ...) or can it just stop functioning well or at all for no apparent reason? I don't want to think I could have gallbladder cancer that I'm ignoring.

Sid Schwab said...

gallbladder cancer is quite rare, and it occurs nearly exclusively in people who've had gallstones for many many years. You don't have stones, I assume.

Michelle said...

Thank you very much for your response. Just that re-assured me alot

Michelle said...

k, so new twist to the saga. My ultrasound revealed a hemangioma on the right lobe of my liver. Yay. So, I'll be meeting with my surgeon tomorrow to see what exactly we're looking at. Thanks again.

Anonymous said...

I started having gallbladder attacks a week ago - went to the doctor, and was told I have stones. I think they automatically want to take it out (I meet with a surgeon this week)...
I was just wondering if there are alternative ways to treat gallstones that don't require surgery.

Sid Schwab said...

There are pills that can be tried that may dissolve stones. They take a long time if they work at all, and in most cases stones will recur after stopping the pills. People who form stones tend to form stones, so anything that gets rid of them without removing the gallbladder is unlikely to work permanently. Other methods, such as lithotripsy or directly infusing chemicals into the gallbladder have been tried; they aren't used much anymore because the results weren't great. And one thing that's certain: the "natural" cures you'll find online, such as various flushes, taking lemon and oil, etc, are 100% bogus.

Anonymous said...

Thanks for your quick response.

I'm glad I asked - because I had been interested in the flushes that I'd come across online. Since I'm still pretty young (24) my main concerns are digestive problems and/or weight gain after surgery - do you know how common these sorts of side effects are...or anything a person can do to mitigate them?

Anonymous said...

I would like to let Anonymous from 6-12-2007 know that im a having pretty much the same symptoms that you are. My symptoms started all of a sudden and within a weed my surgeon told me that in needed to have the surgery because my gallbladder was functioning at 29%. I am having my GB removed on 7-5-07!

Anonymous said...

IN MAY I RECENTLY HAD MY GALLBLADDER REMOVED IT CAUSED ME ALOT OF PAIN PRIOR TO HAVING SURGERY..WE ARE NOW IN JULY AND I'M NOT TOTALLY RECOVERED.

BY THE END OF THE DAY I USUALLY CAN'T FUNCTION BECAUSE OF A PAIN IN MY RIGHT SIDE BY MY RIBS

I WORK FOR A MEDICAL BILLING SERVICE AND HAVE BEEN TOLD I SHOULD GO BACK TO THE DOCTOR.

HOW LONG COULD A RECOVERY TAKE???
OR COULD THERE BE A DIFFERENT PROBLEM GOING ON
??

Sid Schwab said...

I agree that you should be back in touch with your surgeon.

E in Atlanta said...

I'm so glad to have found this site! I'm 38 and due for GB surgery next Wednesday, 7/18. I've been having pain off and on since early March, and finally found out about 3 weeks ago that I've got gallstones. I've never been seriously ill, had any kind of surgery, or been under anethesia before. I've heard from so many people that it's a simple surgery and no big deal and that everything will be fine...but I'm starting to get a little freaked out. You hear about all the things that can go wrong, so of course that's what you think of and remember. I'm trying to stay positive and remember that this really could be a lot worse (I lost my dad to COPD and my mom to lung cancer). It's great to find a site from a real doc, and to get that perspective. Thanks!

Sid Schwab said...

E: glad to have helped. Sure, you can hear all sorts of things. Fact is, surgery is pretty darn safe nowadays, and gallbladder patients are among the most satisfied customers I've had: it's a good operation.

Anonymous said...

I am 46 and had my gall bladder removed three months ago. I have had discomfort on and off but in general have recovered, but unlike most that have posted on your blog, I am experiencing bloating and constipation rather than loose bowels. My doctor recommended a stool softener, but now I am experiencing a lot of discomfort/cramping in my abdomen. I have also noticed my body fat has significantly increased although my diet is unchanged from prior to the operation. High fiber foods (cereals) seem to exacerbate the situation rather than help. Any suggestions?

Anonymous said...

Hi,

I am a 36 year old healthy female scheduled to have my gallbladder removed next week. I was diagnosed with pancreatitis a few weeks ago (am recovered) and have gallstones. I have IBS and have read stories of problems with constant diarrhea following gallbladder surgery. Does IBS make this more of a risk for me, is there anything to do for that problem following surgery? Thanks so much!

Sid Schwab said...

anon and anon: in general I don't want to make specific recommendations from this blog. I'm happy to provide general information, but I can't know enough about an individual to make suggestions. As to IBS, I don't know of evidence that surgery would make IBS worse. I doubt it. But clearly anyone with IBS would be expected to have problems continue with or without their gallbladder.

Anonymous said...

I am scheduled to have my gb out tues next week and now have more questions.I have had lots of back and chest pain but not too much stomach pain.The ultrasound showed a stone and now they want to take out my gb.Does that mean my chest and back pain will go away?Also i have read that you can develop stones in your liver.Can you die from it?I am 31 years old and have a son and now am worried.Is it safe to have the surgery?

Sid Schwab said...

gallstones can certainly cause chest and back pain. I can't tell you if yours will go away, because I don't know your medical history. But when they are caused by the stone, they can be expected to go away. Stones forming in the liver is extremely rare; by that I mean it almost never ever happens. Gallbladder surgery is among the most common operations done; hundreds of thousands are removed every year. If it weren't safe, that wouldn't be true.

Anonymous said...

I am so glad to see this web site.I am having my gall bladder out next week.I was fine about it until i started reading up on it more and i read that your body can't absorb all the good foods you eat and omega-3 and all the vitamins.Is this true?And do you need to be on a special diet for your liver after to help it?I have also read that the attacks can come back.Thanks

Sid Schwab said...

this is the first of about four posts I wrote here about gallbladder stuff. If you read the next two or three, I think you might find the answers. You should be able to find them by looking in the archive in the right column.

monniele said...

I had my gallbladder out June 12th and I have been having a reaction to the internal sutures. 3 weeks after surgery, I noticed that some of my incisions began to seep and I developed a rash around my incisions. I called my surgeon and went in this past Thursday. He said my body was rejecting the internal sutures and he actually took some of them out. He didn't seem too concerned about the rash. The rash is getting worse, and I am still seeping. I have done some research online and read about having a allergic reaction to the sutures. I am worried that this will only get worse. Can you give me any insight or advice? How common is it to have such a reaction to internal sutures?

Jean said...

Hi Monniele,
I just wanted to respond to your rash post. I had surgery on July 3rd and although my incisions are healing well, I had a terrible rash around my belly button. I saw my doctor on Monday(the first check in since surgery) and she said she has seen rashes quite frequently. I had replaced the sterile strips after about a week with some new ones I got at the drugstore. She seemed to think that the steri-strips are causing the rash. I have had the strips off for about 4 days and along with some hydro cortisone the rash is healing up nicely. Hopefully, that helps a bit.

Anonymous said...

I just met with a surgeon today to finally have my gallbladder removed. I was told that my gallbladder contains many, many stones, is inflammed and the walls are quite thickened. He said that he will start with the laproscopy surgery but thinks that my gallbladder will be to big and will have to do open surgery. So basically I won't know until I wake up what procedure was actually performed. Is this normal? I always feel like I have a softball under my ribs, constant pain.

Sid Schwab said...

Although the need to convert to an open operation is less common now than in the earlier days of laparoscopy, it still happens sometimes: most surgeons would tell patients that it's not guaranteed that they'd be able to do the procedure with scopes.

monniele said...

Jean,

Thanks for responding. Actually, the rash is not from bandages. I never had bandages on most of my incisions. I have now been to 3 doctors, all have said something different, and the rash is not getting better.

Sid Schwab: Do you have any advice. 5 weeks out of surgery and & feel my incisions should be healed and I shouldn't have a rash.

Nina in New Mexico said...

Hi...so, I've been reading this blog and found an interesting twist. Michelle earlier mentioned they found a hemangioma on her liver. It was found incidently when I had my gallbladder removed at the age of 22. I immediately stopped birth control pills as I was told that they may make them grow. Without bc pills, I now have a hemangioma that is 6.5cm on my right lobe near my diaphragm. I have intermittent shoulder pain on top of my shoulder near the collarbone which we think is being caused by the thrombosis of the hemangioma and the possibility of it irritating the diaphragm. Sometimes, it hurts to breath. What is particulary interesting is that the pain is always worse around my period. (Hormonal fluctuations maybe?) For pain relief, I take ibuprofen, or, if it is really bad, I take ultracet. Due to its position, I cannot have radio-frequency ablation or embolization. My only option is resection of the right lobe of the liver. I am 29 and have been following my hemangioma for years. I have two others on my liver as well that are insignificantly small. Here is the thing...I would like to have children someday and due to the pain, I think I want to have if removed. Of course I am scared about this decision. What is recovery like after a liver resection for an otherwise healthy woman? Is it possible to return to work within a month? Do individuals have a lot of water retention after surgery? I have a good dr. at baylor university med center in dallas. But I am just looking for other feedback. Any info or insight would be appreciated.

Sid Schwab said...

nina: I can't say much without knowing details of location. If a true right hepatectomy is necessary, the recovery could take longer than a month. With most kinds of major surgery, fluid retention occurs short-term, but there's no reason, assuming a normal recovery, why it would be a long-term problem.

Sometimes it's possible to "core out" (enucleate) the tumor, which might be a decision that would have to be made at the time of the operation. If so, recovery would likely be quicker.

shock4952 said...

It started about 17 years ago. About 5 to 6 hours after an incorrect meal, I'd end up on my knees, vomiting. With pain radiating into my back 100% of the time, these attacks would last anywhere from 6 to 8 hours. After 2 years of that… I was finally diagnosed with gallbladder problems, but had already learned to control the frequency of attacks with diet and the strict limitation of certain foods. This worked rather well until the middle of this year, at which point limiting my percentage of fat intake didn't seem to help anymore.
I met with the Dr, and we made the decision to have my gallbladder removed. The ultrasound (pre-op procedure) was vague at best, as it detected either many stones, or one very large stone. They also could not determine if my gallbladder was inflamed. I'm fairly certain the Dr's tell everyone that they'll begin the procedure laparoscopically, but there's no guarantee it won't end up being converted to traditional open surgery. I'm kind of a big guy, but healthy and strong (ex weightlifter), and I've never had trouble carrying my own weight. The Dr mentioned that my overall health and strength would play a huge roll in the end result.
Surgery was performed on Thursday, July 19th. When I woke up, I was pleased that they were able to do everything laparoscopically. The Dr had taken a photo of the single gallstone that was about the size of one and a half golf balls (nearly as large as the gallbladder!). They explained that in order to extract a stone of this size, the incision around my naval had to be somewhat larger. He also informed me that my gallbladder was, in fact, inflamed, and the walls were thickened. There was significant scar tissue that told the surgeons that I had gone through multiple gallbladder attacks.
I spent some time in the recovery room, but within an hour of being brought up to a regular room, (with the permission and assistance of the nursing staff) I was up and walking the hallways of the hospital, pushing my IV rack before me, and was out of the hospital before 24 hours had elapsed since my arrival for surgery. Today is the fifth day since surgery, and other than some tenderness, I’m feeling great. I’ve already enjoyed a number of foods that I haven’t been able to eat for 15 years. If getting on an airplane wasn’t necessary in my line of work, I’d of already been back on the job. I’m glad I had the surgery. Now it’s time to get back to LIFE ! Good luck to any readers.

adrian said...

I am 40 years old, and my PCP told me I have gallbladder stones, after and ultrasound and and xray, I have been having pain in the abdominal area for years and in my chest, but they test me for the heart and nothing showed up, 3 years ago I had my first attack, but I did not have insurance then. Everytime I ended up in the hospital for severe abdominal/chest pain, but was sent home everytime, they would say that I had stress. could it be that they did not want to tell me because of being uninsured? I now have insurance and the problems was identified right away!...whats up with that?

a really big sissy said...

Dear Dr. Schwab,

I'm really glad I stumbled across your blog today. The information you provide on these pages is a real gift.

I am a 33-year old mother of two little boys. I have to have my gallbladder removed on September 10, 2007. To say I am scared to death would be the understatement of the century!

I began having gallbladder attacks about 10 years ago but have avoided treatment because of my fear of the surgery. I've had an ultrasound, MRCP, and an ERCP this past month. I have a large quantity of small stones in my gallbladder but none in the bile duct. I wish there was some way to just live with my gallbladder so I did not have to have it removed. I fear the general anesthesia and worry most about dying during the surgery. The ERCP found "the cystic duct occluded with calculi." If you get a minute...what does that mean? Do you think my surgeon will be removing the cystic duct too along with the gallbladder? How much do you feel obesity increases the risk of gallbladder surgery? I am 5'4" over 200 lbs. I am incredibly worried about going through with the surgery if my weight is going to greatly increase my risk of complications. Thank you again for all of the information you have provided here.

Sid Schwab said...

Sissy:"calculi" is the fancy word for stones. Being in the cystic duct, which is the outlet of the gallbladder and which will indeed be removed as it always is -- no consequences -- just means it's even more sure that they are indeed causing problems which would be expected to go away after surgery. So it's all good. As to risk: obesity per se is not a huge increased risk, if there aren't other associated issues. The risk of death from anesthesia in a planned (as opposed to an emergency) operation is less than one in 250,000 or so. Making it pretty darn safe. From what you say, the odds are extremely high that you'll not only emerge safely but that you'll be really glad you did it.

The Sissy said...

Dear Dr. Schwab,

Thank you so much for your response to my questions! I definately feel better and have learned so much from reading your series on gallbladders. Thank you again for your kindness and the information!

Anonymous said...

Had my HIDA today. Then they did the bag (actually two bags) of CCH and the gallbladder did not empty - it's still nice and fat. I watched the monitors and went "Welllll, I guess I have to get the little beastie removed."

It's pretty routine surgery as I understand it, but what changes the procedure from laparoscopic to open surgery? I ask because I was diagnosed and unsuccessfully treated for HCV in 2005. My liver was 'staged' at halfway between 2 and 3. Does this condition present any potential to change how the gallbladder removal will be done?

Don't care about the scars or any of that, but if I'm going to be home recuperating longer than a week, I'm going to have to file some disability paperwork at place of employment before I go have the little beastie removed. Also have to put my health club membership on medical hold so they don't pay themselves for a month of workout I didn't get to do!

Sid Schwab said...

The factors that could make a surgeon convert a lap chole to an open one would most commonly be when there's so much inflammation that the anatomy can't be seen well; or when the anatomy is abnormal in such a way that it's not certain what's going on. Rarely it could be bleeding, or problems dealing with the size or shape of the liver, but not often. As time has passed, techniques and skills have evolved to where opening is much less common than it was a few years ago. But it remains always a possibility.

Anonymous said...

Thanks for your answer on lap/open gallbladder removal.

I like this blog. You talk human!!!

While I was having the Hida today, I heard one of the techs trying to calm down an elderly man who was going to have a PET scan. Poor guy, I know it can all be so scary.

Blogs like this do a great service - they help take the fear away! I found out during my HCV treatments that knowledge truly is power, the more you find out about something you're facing, the more you can dialogue with your MD instead of sitting there in silence, as so many people seem to do, especially the elderly, God bless 'em.

Anonymous said...

I really appreciate your information. I am waiting for the results of my HIDA. Ultrasound doesnt show any stones but I have had symptoms for years. Now at 57, had a bad spell where it hurt to breathe so I guess its time.... Having a real concern about the aftermath.... I already have a spastic colon that has a mind of its own. Can the GB removal add to that problem???

Sid Schwab said...

Some people who have their gallbladders out have problems with diarrhea. "Spastic colon" is a fairly non-specific disease, so it's hard to say what symptoms are due to it, and what might be due to something else. In general, I'd not say that removing the gallbladder can specifically make spastic colon worse; But people who need HIDA scan to diagnose gallbladder problem are already in a category where things aren't entirely clear nor the results perfectly predictable.

Anonymous said...

I am a 32 year old female scheduled to have my gallbladder removed on 10/8/07. I had my first gallbladder attack last November when I was 8 months pregnant. I experienced extreme pain between my shoulder blades and in my chest. Although I thought I was in labor, my midwife suspected it was my gallbladder. I had an ultrasound and gallstones were confirmed. I've had recurring gallstone attacks ever since. I've postponed the surgery for many reasons, but mostly because I fear the consequences of having my gallbladder removed. Is there a greater risk of developing diabetes or any other serious health problems as a result of having the gallbladder removed?

Sid Schwab said...

Your description suggests you are as certain as it gets to find relief of your symptoms by the surgery. There's no relation between absent gallbladder and developing diabetes (there's actually a slight risk of getting it from gallstones, in that they can cause pancreatitis which, if severe enough, can lead to diabetes). If you read all my posts in this series, you know that most people who have the surgery have no side effects. Nothing is certain, of course. No outcome can be guaranteed. But my gallbladder patients, as a group, are among my most glad they had surgery: relief with no significant consequences.

Anonymous said...

I'm 23 and have been very sick this past week. Feeling nausa, fever, chills, can't eat anything. But I'm not having the sharp pain described. This has happend several times before and only lasted a couple days. This time it has lasted for just about a week and still going. I had an ultrasound back in July and it showed I have a small gallstone. So now I've been sent to the surgeon in Oct. Are these symptons due too my gallbladder or could the doc be missing something else?
I am still nursing my son, if I do have the surgey you mentioned you have to wait 24 hours to breastfeed again. why, what could happen if you don't wait that long?

Sid Schwab said...

I can't diagnose symptoms from this far away. As to breast feeding, the issue is that some of the anesthetic drugs get into the milk and could be passed to the baby. If you pump and save some milk before surgery, and then pump a couple of times after surgery and throw the milk away, giving the stored milk to the baby during that time, it should be fine. The amount of time, and number of pumps is between you and your doc.

Anonymous said...

I'm at an absolute loss. Firstly, I read your blog every single day, and have come to enjoy it so much. I had my gallbladder removed August 27. No gallstones, but before it was revealed by a HIDA scan that it was functioning at 8%. It was also infected. It was a lap-chole.

Recovery has been miserable. I felt better before I had my gallbladder out, than I do now. At least then, I had more energy. I've lost over 35 pounds since August. I was pretty overweight beforehand, but now, I'm down to a healthy weight, but I'm still losing. I'm on a very low/no fat diet now. I still have the awful pains, loose stools, nausea, awful gas.

I'm 22 years old and at my wits end!!! I can barely attend class because I'm so exhausted, and a lot of time, I'm in so much pain. The surgeon told me at my follow-up after the surgery that I should give the healing process about two months before I really start investigating other causes, but I don't know what to do.

Do I press for testing? Can it really take two months to heal after having my gallbladder out? I'm so frustrated with this. I feel like I'm more or less being told that there's nothing wrong with me, but I can't shake this feeling.

Should I go with my gut and press to have something further done? Do I talk to the surgeon, the GI or the primary? I don't know who would be the best to get me results at this point.

I just want to feel better. :(

-Mia.

Sid Schwab said...

mia: what you describe sounds very much out of the ordinary for recovery from surgery. Any comment I make is from so far away that it can't be considered very useful, but I'd think you should press for investigation, and would start with the surgeon, since it first needs to be established that there aren't specific surgical complications. If there are none, then I'd go for seeing a GI doc, although that depends on your relationship with your primary, so maybe you ought to discuss it with her/him.

Anonymous said...

Your blog is so great. I am a 34 yr old female, 5'4 285# and have a 3.4 cm calcified gallstone. Despite my obesity, I have always been in good health. My PCP referred me straight to the surgeon, I have never seen a gi dr. 2 months ago I had a horrendous pain in my left chest and went to ER believing I was having a heart attack. They have done EKGs and chest Xrays and say no heart problem. I can live with the right side pain but do gallstones cause the same pain on the left side? It radiates into my back a lot. I have minimal discomfort on the right but it is similar to what I am feeling on the left. The left-sided pain has caused me to suffer a lot of anxiety. Any thing you can say on the left sided pain is of help. I see the surgeon this week and dont want to have surgery if it is not the cause of the left side pain.

Sid Schwab said...

Gallstones absolutely can cause pain on the left that mimics heart pain. I had many consults over the years in the coronary care unit, on patients admitted for possible heart attack who turned out to have gallbladder problems. It's important, of course, carefully to rule out the heart as the source before going ahead with gallbladder surgery. People can have both!

Anonymous said...

Thanks for an informative site! I had my gallbladder removed 2 weeks ago. No more pain, just some diarrhea that just started a couple of days ago. If you are contmeplating surgery - do it! You'll be glad you did!

Sid Schwab said...

And much of the time, diarrhea occuring early in the recovery phase is related to local inflammation and goes away.

Cpeach78 said...

I am a 29 year old female, and I had my gallbladder removed on November 28, 2007. I had been having problems since the previous January. I would experience intense pain throughout my abdomen and back on about a monthly basis. Long story short, I was terrified of the surgery. I have to say that the pain after surgery was very minimal. While I did take pain medication, I was able to get up and down by my self the entire time, and found that the pain was less than a typical gall bladder attack. I was up and walking 2 hours after surgery and discharged the same day. It's 5 days later and I feel like a new person. I hope this is helpful to those of you that are nervous about the procedure.

Susan said...

Dr. Schwab,
I was told today by my GI that I need my gallbladder removed. He said the test showed my GB is functioning at 29% but no stones were visible from the ultrasound. He said that I should be functioning at about 35% and that it is rare for at my young age (23 years old), and my small frame (110 lbs), would have GB problems. I first went to the GI specialist because of problems with constant stomach pain, diarrhea, gas, and bloating; the last thing I thought I was going to hear today was that I needed my GB removed. I am very scared of surgery and unsure of what to do. Is a functioning rate of 29% really low and something to be concerned about? Are there any other tests I should have done? Should I get a second opinion? Thank your for your time and I would appreciate so much for your opinion Dr. Schwab.

TE said...

iTS BEEN ALMOST1 YEAR SINCE MY OPEN GB REMOVAL AND I EXPELLED 1 STAPLE 4-5 MONTHS AGO THEN A SUTURE HAS COME TO THE SUFACE PRODUDING OUT OF THE SKIN THEN AGAIN 2 DAYS AGO A SMALL MATCHHEAD SIZE OPENING ERUPTED WITH SOME BLEEDING AND TISSUE PROTRUSION. THE AREA IS CLEAN AND NOT WEEPY BUT ITCHY ON EITHER SIDE. THIS SURGERY WAS DONE IN PANAMA ON AN EMERGENCY SO IM NOT SURE WHAT IS IN THERE . IS IT COMMON TO LEAVE STAPLES AND NON DISSOLVING SUTURES? HAD A SUB TOTAL CHOLECTOMY AND HE USED THE SAME INSION LINE WITH THE GB REMOVAL. PLEASE ADVISE

Sid Schwab said...

It seems likely non-dissolving sutures were used. For various reasons, in some people such stitches can become infected or a source of irritation such that they act as you describe. Usually they can be easily fished out: I used a crochet hook. Nowadays, since most surgeons in the US don't use permanent sutures, younger ones may not have done that trick. In any case, it sounds as if you need to be looked at by a surgeon. It's not likely to be a big deal.

Sis Sarah said...

Love your blog. I started to have problems with my gal bladder with the start of my 2nd pregnancy. It totally felt like heart attack. They happened alot, for hours at a time and nothing I did helped. I felt like I had a friggin elephant sitting on my chest. I ended up miscarrianging the baby a few weeks later and realized around the same time, that it was probably my gal bladder. I'm so glad it is gone. That pain is horrific, worse than labor (and i had my water break 33 weeks and was in labor for 76 hours no epidural so I know what i"m talking about). I tell people if you have to have an organ removed, choose your gal bladder. Very little post op pain. In fact the only pain for me was the "gas pain" that you get up in your shoulders. I was told because I had lost weight quickly before the pregnancy and/ or because I got pregnant that that probably set it off. Wondering what other things they find put you at a higher risk for gal stones?

Sid Schwab said...

Sarah: various risk factors include sex (more common in females), heredity (higher when it runs in your family), age (the older, the more common), some medications, some blood disorders (where blood cells are destroyed more rapidly than normal), diet (rapid weight loss, in particular.)

kimandandy said...

I have a question, I have been suffering for years with abdominal discomfort, upper abdominal pain, nausea, and I get sick a lot after eating, I have had numerous scans for GB stones and nothing, A HIDA scan showing my gallbladder working at 37% , so 2% above the abnormal rate. I finally had an EGD done today and it turned up nothing more than a small area of gastritis, but the last few weeks have been so bad I just curl up in a ball and do nothing all day. I meet with a surgeon on tuesday, do you think this sounds like my gallbladder, even though the tests come back relatively normal? I am also worried about weight gain and chronic diahrrea after the procedure. My other health problems are PCOS (polycystic ovaries), which is why im worried about the weight gain as we are going to try for a baby later this year. I have bipolar disorder, asthma, sinus tachycardia, high blood pressure and mennieres disease. I am on medication for all those. I am 23, does it sound like it needs to be removed, I SO need an answer from someone Im scared to death over this, I just lost 12lbs in the last couple months and am not looking forward to gaining it all back and more....

Sid Schwab said...

kimandandy: I can't really venture an opinion from across cyberspace. I'll say this: the weight gain idea after gallbladder removal is mainly a myth. There's no physiological reason for it to happen, other than the fact that some people are able to eat things they weren't able to eat before without pain, so they eat more. Other than that, there's no truth to the belief.

And, as I wrote in this series of posts (there are a couple more about gallbladder disease following this one), removing the gallbladder when there aren't stones is iffy: if a person's symptoms are pretty classic for gallbladder disease, and the HIDA scan is definitely abnormal (meaning it shows abnormal function, and if injecting the CCK reproduces the symptoms), there's a reasonable chance it'll help. Likewise, when there aren't stones but the ultrasound shows the gallbladder to be inflamed.

insomnia said...

Sid,

I am 40 years old and have been diagnosed as having multiple gallstones, after what seems to me to have been a mild gallbladder attack that lasted only a few hours and didn't require hospitalization.

Surgery was recommended, but before I go down that path, I would like to see what, if anything, I can do to avoid it and deal with the problem in other ways. Unfortunately, flushes are 90% of what I hear about.

Assuming that you personally wanted to avoid surgery until the situation absolutely demanded it, what would you recommend in order to hopefully improve gallbladder problems? I hear that there is a pill treatment, that some doctors have broken up stones with ultrasound, that some diets could help, that statins may help, etc. but my own doctor hasn't been all that helpful in offering alternatives.

Any suggestions?

Sid Schwab said...

insomnia: those are good questions; in fact, I'd thought I'd addressed them in my other posts on the subject, but looking through them, I guess I didn't. I should add a post about it. Meanwhile: there are pills that dissolve stones. The problems are two: first, it depends on type and size of stones, whether they work and second: people who form stones tend to form stones. So if you get rid of them by pills, eventually the odds are very high you'll get them again. SImilar with smashing the stones with ultrasound (lithotripsy). It was a fad for awhile, but the long-term success was low, and sometime making big stones into small ones led to the complications that arise from stones passing out of the gallbladder.

Of all the methods, gallbladder flushes are the most entirely, totally, unrepentantly bogus. It's true if you take oil and lemon (or various other similar potions) you can curdle some stuff and pass it in your stool: patients have proudly brought little containers of their poop and showed it to me. It has nothing to do with stones.

Diet can help, in that typically attacks come after eating fatty meals. So avoiding fat can lower the incidence of attacks. It works for some people; but not all attacks occur related to eating fat.

As to avoiding surgery until it was absolutely demanded: that's tough. The really serious complications of stones are really serious, and one would like to have surgery BEFORE that occur. On the other hand, most people with stones don't have the really serious things happen. Many, in other words, could put up with the occasional episode of pain and never have anything worse happen. It's sort of a crystal ball thing, although it's probably true that people with one or two very large stones are less likely to get the severe problems than people with lots of small ones. So I'd tell people who really didn't want to have surgery to avoid fatty meals and keep their fingers crossed, and if they got something more than the occasional brief pain, to get in touch right away. It's an iffy thing. But in my opinion, the options are to put up with what you have, modifying diet, or to have surgery. The non-surgical treatments aren't very effective as a long-term solution.

Thanks for the question. I think I'll write an actual post about it. Should have a long time ago.

Anonymous said...

Great blog...thank u so much. My 29 year old sister has recently been diagoned GB stones after jaundice was noticed. Her MRCP report says that she has stone in bile ducts as well. Doctor hasnt given the dsate for surgery yet.

My questions are: Does jaundice makes operation n recovery more difficult? Will she be able to conceive baby after this surgery esily?(as she had planned for a baby this year). Does stone in bile ducts can be harmful? And does she need to stop taking contraceptive pills after her surgery??

Thank you so very much doctor for being so considerate to all of us. Waiting for a reply asap.

Sid Schwab said...

anonymous: having the gallbladder removed should have no effect on ability to conceive. Nor should it affect the ability to take BCPs (once the gallbladder is gone, there's practically no risk of further stones.) Stones in the bile duct can be quite serious. As to recovery from surgery, it depends on how the stones in the bile duct are removed: often they are removed before surgery, by passing a scope down the throat into the stomach and beyond. If successful, the subsequent surgery is routine. If the stones are removed during surgery, then it also depends on what it takes to do it: sometimes it would end up with no difference from routine surgery and recovery; sometimes there would be a tube left in place that would be removed (without surgery) later. Her surgeon should be able to explain all this, knowing her exact situation.

Anonymous said...

Thank you so very much for replying...

However, I would like to know if the presence of stones in bile ducts n pancreas very dangerous for my sister?
Does it have post surgery complications as well? Hope its not such a serious case...

Regards

Painful in NJ said...

Thank heaven I found this blog! I had my first "attack" January 5 of '08. It felt like a heart attack and I writhed in pain for 5 hrs. before it mysteriously went away. Ever since that initial attack, I've had reoccurances on the 12th, 18th, 20th, 23rd, and last night the 27th. The attacks last from a few hours to 5 hrs. and the pain starts in the middle of my chest and goes to my right shoulder blade in back. I recently saw a gastro dr. who sent me for an ultrasound but said he believes it to be biliary colic caused by gallstones. We are still waiting for the results before scheduling surgery but he's confident I will need the surgery.

My questions are: I have almost constant warmth and discomfort in my upper right abdomen between my hip and my rib cage. Does this indicate something more than just the colic in your opinion? Also, should I get a second opinion about this surgery or do the attacks kind of make surgery a no-brainer? I already have IBS,constipation and reflux. Can I expect any or all of these conditions to get better or worsen after surgery? Thank you for making this blog.

Painful in NJ

Sid Schwab said...

painful: getting a second opinion ought to be based on your level of comfort with what you are being told. Your description is pretty classic.

I don't want to venture opinions on the other symptoms you have, because I don't know your situation personally. But they are good questions, and ought to be brought up with your surgeon and/or your gastroenterologist.

canadianchick05 said...

Thank you so much for this blog, i was getting quite depressed hearing about the complications after gb surgery as opposed to success stories. Here's a little history i am a 37yr old healthy female who suddenly became ill losing 51lbs in 2 months, chronic nausea, diarrhea, loss of appetite and severe fatigue. Underwent endoscopy, colonoscopy, small bowel followthru, several untrasounds, blood tests and stool analysis for my symptoms. All came back normal except for mild inflammation of the colon and possible gastritis. I was referred for a HIDA scan but had to wait almost 2 months due to the isotope shortage. Finally received results that the ejection rate was 11% and i had huge cramping and tenderness under the rib cage as well as my back. Do people with low ejection rate such as myself get relief from g/b removal? Could my symptoms be due to this? I haven't found many stats indicating success or failure. My g/b removal is booked for Feb 19th guess they think its serious enough, usually the wait it about 3 months. Is it possible for ejection rate to improve with time? Any help would be greatly appreciated!!

Sid Schwab said...

c/c05: I covered some of your questions in here. It's a difficult area: I told my patients that if their symptoms were typical of biliary colic AND their HIDA was abnormal AND the injection of CCK during the scan reproduced their symptoms, then the odds were good that removing the gallbladder would help (this, of course, refers to people who didn't have gallstones). It gets less and less certain when the symptoms aren't classic gallbladder symptoms, and/or if the CCK injection didn't reproduce them. Much as I'd like to help, I hate to go further than that without knowing your situation as I would if I were your doctor.

MishaTx said...

Hello Dr. Schwab,

I really enjoy reading your blog, it's so informative and a great service to people such as myself(the general public). I was diagnosed with biliary dyskinesia recently and referred to a surgeon.

My situation is this: I'm currently dealing with a mild tooth/sinus infection, would it be safe for me to proceed with gallbladder surgery?

I've been taking antibiotics, but some of the infection is still there, and I am due to see my surgeon next week.

Is there a significant risk in proceeding with abdominal surgery when there is a tooth/sinus infection present?

Thanks,

Michelle

Sid Schwab said...

Michelle: there is some increased risk, partly related to seeding the surgical field, and partly related to having a breathing tube inserted. That's a general statement. You should mention it to your surgeon; depending on the stage of your response to treatment, it might or might not be considered significant.

Painful in NJ said...

Hi again,

My gastro doctor called tonight to tell me the ultrasound showed a gallbladder full of stones. Even though he wants me to consult a surgeon, he first wants to schedule me for an endoscopy in order to rule out an ulcer. Given that my "attacks" are happening every 5-7 days, I'm anxious to stop the pain but I also don't want to jump the gun and have unecessary surgery.

Do you think the symptoms I described before might be caused by an ulcer or are you pretty sure it's gallbladder? What are the risks of waiting too long for surgery? Can I expect the attacks to increase in intensity and length?

Painful in NJ again

Sid Schwab said...

painful: these are questions better answered by your doctors. I will make a general statement which, I emphasize, should not be construed as advice or as an opinion about your particular case, about which I don't know enough to opine:

In my experience I've seen lots of people with classic gallbladder problems, confirmed by ultrasound, who underwent what I considered unnecessary endoscopy to rule out ulcer. But I'm no gastroenterologist.

MishaTx said...

Dr. Schwab,

Thank you for your quick response! I will discuss this with my surgeon during my appointment next week.

I was also wondering - what is the mortality/complication rate for
laparoscopic cholecystectomies?

Thanks,

Michelle

Sid Schwab said...

mortality and complication rates vary depending on specific factors. It's another good question to ask your surgeon.

Jenn said...

Hi there! I just wanted to thank you for your blog. I am a 35-year old female and I'm having my gallbladder out in 2 days. I've been doing a lot of internet research on the subject and really enjoyed reading your blog and the above comments. One thing I seemed to find with others that have had GB issues is that a lot of them were females and had recently been pregnant or were pregnant. Any connection in your opinion?

I have a 3-yr-old, a 20 mo. old, and a 6 week old (oh and no family history of GB issues). During pregnancy #2 I had what I thought was a food poisoning attack after eating a chicken sandwich and french fries. Horrible pain and vomiting for a few hours. That happened a couple of times during the last trimester and they scheduled an ultrasound to find two small stones. At the time they said pregnancy can "irritate" gall stones and it might subside after the delivery. I stopped eating french fries for the last two years because of that.

During pregnancy #3 I had no problems whatsoever. I was also on a modified weight loss plan (low sugar, low carbs, good protiens and good fats) and slowly lost 45 pounds over the last year (while pregnant) I found out later of course that weight loss can also cause GB problems. (Nice it's like darned if you do, darned if you don't).

Three weeks after my baby was born (three weeks ago that is)I had a hotdog for dinner and about 9pm started to have severe back pain between my shoulder blades. Soon it shot through to the front under my sternum bone. It actually felt like a sword was shooting through my body! The pain got worse and worse. I felt like I was having a heart attack. I told my husband either my heart was going to blow up or I was going to burp. It got even worse than that. I told him I was going to die. This time there was NO nausea or vomiting, so I thought it was more of a heart attack and we called 911.

After a battery of tests (and some blessed morphine in the ambulence) they did an ultrasound in the ER and found "Several large stones" that were moving, but luckily none in the duct. They recommended removal right away. Having just had a C-section a few weeks before I was a little worried of having another big proceedure back to back. No one really seems that concerned about it, so I guess that's ok. Your thoughts? Many people came out of the wood work to talk about doing the "cleanses" of lemon juice and olive oil... and that's what I've been researching most, although it seems hard to find the CONS online about it.

I just wanted to thank you for your blog. The part about the GB being used in the past for starving people that would hunt and then feast on a big meal made perfect sense to me. I've been worried about "life after" not having a gallbladder and I'm hoping I'll be one of the people that are better for it after the surgery. THANKS

Sid Schwab said...

Jenn: being female is a known risk factor for gallstones. Being a pregnant one, even more so. As to the "cleansing" concept, I recently posted about it here. In the entire world -- perhaps the entire universe -- there is nothing more bogus.

Absent infection or jaundice, the timing of gallbladder surgery is open. The downside of waiting is the possibility of more problems. I've operated on many women shortly after delivery. And some in the middle of pregnancy, when the situation warranted it.

OUCH in TX. said...

Glad I found this blog! For about 5 months, I've had what I thought were GB attacks. My regular Dr. said it was probably liver, that I need to lose 20 pounds and get my cholesterol (220) down and diabetes under control(blood sugar runs usually 140-180 without medicine). I wasn't happy with that, but was going to get the blood work done when I had another really bad attack. So instead I went to a surgeon who ordered an ultrasound (no stones seen),then after more pain a Hidascan, where it took 2 bags of CCH? before the gallbladder slowly started to empty. The tech who did the test said, well there could be sludge but maybe this will jumpstart your GB to work. The surgeon said, though, after reading the results, that my GB was functioning at 95% (!!?).
He then did an endoscopy and said I have gastritis, put me on Nexium. Still had pains. Then he said it was bad muscle spasms brought on by stress and gave me Levsin to take at the first sign of attack. Haven't taken one yet.
After an attack, I'm sore for days and it feels so bloated on the right side that I feel it will pop. I have no nausea or vomiting.
Can it be hormonal?? The worst attacks have been a few days before my period. It doesn't seem to be worse after any particular food. I'm so tired of this.
Thank you.

Sid Schwab said...

OUCH: All I can really do is make general comments. Endometriosis can be a cause of cyclic pain. The liver, by itself, usually isn't. If there are no stones and the scan is considered normal, it's not likely to be the gallbladder. Some abdominal pain problems are hard to figure out. If nothing is turning up, seeing a gastroenterologist might be useful.

worriedfather said...

Doc, you're a stranger in a strange land when, suddenly, you need your gall bladder removed. As competent a surgeon as you are, you can't do it yourself, so the search for another surgeon is on.
What do you look for in this peer? What's most important? How do you satify yourself that this is the surgeon you trust to do the operation? In face-to-face consultation how does the human factor fit into your equation, and, finally, what are the three most important questions (and answers!)you would ask of your peer? Thanks for the wonderful site and, in advance, for your brilliant and insightful answer.

Sid Schwab said...

worriedfather: they're good questions. Of course, if I were to be very specific to myself, it wouldn't help you, since I have the advantage of knowing my fellow surgeons well enough that I'd not have to ask them any questions. On the other hand, when I had my dad come here to have his gallbladder out, I chose the surgeon with whom I'd trained and therefore who I was pretty sure would do it they way I'd have; and the anethesiologist whom I knew my dad would like a lot, since I knew them all to be good. (Ironically, he didn't like the surgeon at all, but he did really enjoy the anesthesiologist.)

I get asked the essence of your question a lot: how to choose a surgeon. My answer is mostly BS, because I don't think there's any way to be certain. Mostly I suggest relying on one's primary care doc, on the assumption that she or he wouldn't steer you wrong. Then, depend on your gut when you meet the surgeon: does what s/he say make sense? Are your questions being addressed to your satisfaction? The general questions are: why are you recommending the approach you are, and what alternatives are there and why do you reject them? You can ask where they trained, if they are board certified or eligible. Whereas the latter is essential, the former doesn't, in my opinion, mean a hell of a lot. How many of the procedure they've done? Not a really reliable datum, in my opinion. I wrote about the subject here, for what it's worth.

(less)worried(thanbefore)father said...

Thank you sir, for the honest and timely reply. I've forwarded your reply and website to my daughter, and have made an appointment with MY GP, who I very much trust, for a second reference (I'm not so sure I trust my daughter's GP). Best of luck to you and yours.

ladylutz said...

I had my gallbladder out on Fri, it is Mon. I have had virtually no pain
just some discomfort at the site. It was one incision laproscopy. Last night i started to feel some tugging under my right breast & today it feels like something is rolling or moving a bit when i turn side to side or lean forward..again no pain just an odd sensation. I called the dr & the PA seemed to think it was due either to the liver being shifted or was some trapped anethesia. I have not read of this symptom ..does that sound right to you? I have no pain, nausea or fever. I do not want to panic, nor do i want to ignore if it is a potential problem. They said wait 4-5 days & see. Do you agree? Thank you

Sid Schwab said...

ladylutz: I really can't make specific comments about what I think might or might not be going on, because from this far away I could be wrong. In general, when a person isn't nauseated or feverish and the incision looks OK, and it's just some intermittent discomfort, it's not likely to be something serious. The main thing is that if something changes for the worse, to let your surgeon know about it.

David said...

Hi, I had some gas like pressure across my upper chest last week. The last thing I ate was a few bowls of tuna casserole..my favorite!. So the pain continued and I decided visit the ER. I didn't have any other symptoms..no fever, vomiting, nausea and no pain when palpitated around the area. So after 2 days in the hospital and numerous tests - CT, sonogram, HIDA, and Xrays it was determined that I need my gallbladder removed. I was told that there was calcium (stones?) and I think 5mm diameter - not positive, wall thickening. And the HIDA showed nothing after 4 hours ..not sure what that means. No-one ever sat down and went over my test results but decided I should have the GB removed. I decided to change my diet during the last 5 days or so being that I was on an IV. I sort of detoxed myself just drinking water and chicken broth. Recently I started eating oats, grapes, apples, brown rice and baked potato and lots of liquids . Like I said I had no other symptoms and since changing my diet I feel great but I felt good before the GB attack also. I decided not to have the surgery and wanted maybe a second opinion. I just can't believe that I feel so good but I am being told what sounds like I have some stones, and a pretty much non-functioning GB. It has been a few days since I left the hospital and keeping with my diet changes I really feel great and no further pain.

When I decided to not have the surgery I was told by a nurse that I would have to sign a form stating I was leaving against medical advice. SO I pondered the question in my head " Will my insurance cover this if I sign the paper?" I called the Surgeon and told him that I wanted a second opinion and ask about signing the paper. He said not to worry about it as long as I follow up. I asked if I was in any immediate danger..and he said no.
In fact another ER doc said the same thing- its not going to kill me.

So I sit hear wondering what to do. I feel great but have a sense of doom that I have this dead GB.. who knows what its doing. I feel like getting another HIDA scan or something..its just hard for me to believe that I need the GB removed but I feel just fine.

Is it possible to have a close to non-functioning GB but have really no symptoms? I'm just sitting here imagining that my GB is just growing and growing only to burst soon because it no functioning or blocked. And I am now paranoid about my skin/eye color because I don't want jaundice.

Another question I have is whether its possible to stabilize whatever condition I have via a sensible diet?

How do I know if I am in and real danger. Because I feel great...something just doesn't add up here.. oh well enough of my rambling ..nice blog here..I manged to find researching the gallbladder!

Dave..

Sid Schwab said...

dave: my take on some of your questions can be found in the other posts in this series, referenced at the end of this post. Briefly, it's typical that gallbladder attacks resolve just as yours did. Most likely, a scan done in a few days or weeks, assuming you continue to feel fine, will revert toward normal. Since most attacks resolve, the surgery is usually not an emergency, done at some point when the patient is tired of having repeat attacks. Odds are, once they start, they will keep happening. Maybe tomorrow, maybe in a year. Some people are able to avoid attacks by a careful diet, others aren't. Absent an emergency (and were you in that situation, you'd most likely not feel fine), whether and when is up to you. Unless there were some signs of real danger, I'm surprised they had you sign the AMA form.

As I've said, the perfect decision requires a crystal ball.

Finally, this: I'm not there, and your doctors are. I'm giving general information about the general scene. Only your doctors know you, so my words are information, not advice.

Dave said...

Wow..thanks for replying to my post! You have some great information here. I consider myself pretty much an expert researcher and I am certainly going to bookmark this for sure. One of the best gallbladder resources I have come across!

Just to clarify..the DR did not make me sign the AMA as the nurse thought I would have to.

My only concern is that the HIDA scan from what I was told by a nurse practitioner stated that there was no result after 4 hours.
I can only assume that meant nothing showed up in the GB during that time period. I was never given any of the typical HIDA numbers.

If the tracer material doesn't gain access to the gallbladder , a stone is likely blocking the opening of the gallbladder or cystic duct.

I would think I should have some serious effects as a result of a of a blocked GB or duct..but its going on three or fours days so far and I feel fine.

It it possible to have an inaccurate HIDA scan? Something that delays the process and present s false or inaccurate scan?.

Thanks much for you opinion.

Dave

Sid Schwab said...

Dave: the scan shows exactly what one would expect: to have a gallbladder attack, the cystic duct must (in general) be blocked. In fact, when a person has typical pain, and stones, there's not much added info from a scan. And the blockage, as seen on the scan, can last well beyond the pain. The opposite is true, as well: the scan can be normal very soon after the attack; so the scan is mostly useful when it's not clear that a problem is due to the gallbladder. Not everyone episode of pain in someone with stones is due to gallbladder; so when a person has stones and atypical pain, the scan can be useful. When a person has pain suggestive of gallbladder but no stones, the scan can be useful as a way to diagnose "biliary dyskinesia," etc. WIth wall thickening (seen, I assume on a sonogram or CT scan) the diagnosis of gallbladder inflammation is pretty much made. You don't expect the gb to show on a HIDA under those circumstances, nor would the numbers such as ejection fraction be relevant or even measurable. Bottom line: the diagnosis seems clear, based on what you say. The attack has subsided. It's pretty typical stuff, far as I can tell. But as I said, I'm a long ways away. And for some reason, I seem to have nothing better to do than leave really long comments.

Dave said...

Again..thanks much for your comments, I have learned more from your two posts than spending 2.5 days in the ER surrounded by the experts ;

Have a great night!

Dave

Leigh Ann said...

I'm so glad I found this blog. I'm a 35yo female, awaiting a call from my PCP regarding an appt with a surgeon. I've been having pain in my back for some time, off and on, which I assumed was an ulcer, because I supposedly had one several years ago, and it caused pain in my back and in the usual area too. Now looking back, I'm not sure it ever was an ulcer. I think I've had attacks for a long time and didn't know what they were. I often confused them with just general back pain.

Yesterday I had the ultrasound which showed stones and thickening of the wall. My doctor immediately referred me to a surgeon. The idea of surgery scares me quite a bit, I'm always the caregiver, not the one being cared for. which brings up another issue - I have a 12yo daughter who is 60 lbs and requires total care due to severe disability. How long before I'll be able to care for her, if I have the lap?

My symptoms made it harder to diagnose, I think. I've not been nauseous at all, I've only had pain and generally not feeling great. I'm running a low-grade temp, not sure if that has anything to do with it.

Sid Schwab said...

Leigh Ann: it's a good question to ask your surgeon, since he'll know what he plans. In the average situation after a laparoscopic procedure, return to normal activity can be as soon as 24 hours, or, more likely, in a few days. It'd be wise to have contingency plans for help, though.

Leigh Ann said...

Thanks so much. I have an appt with him on Monday. I'll add this to the list of ?'s I have.

Anonymous said...

I have gallbladder dyskinesia, diagnosed by two different doctors (1 gastro, 1 GP) with two hidascans both using cck (6% and 23%). The first scan nearly put me into shock after cck injection. The second reproduced a little pain but wasn't like the first. Both doctors urged me to have my gallbladder removed. This started in 8/06 and came on overnight as I was getting over a stomach bug. I thought in time it might start working again. It did jump from 6% to 23% but its now '08, I’m still sick and I’m considering surgery because it's been holding me back in life. I have to carefully watch what I eat as I had to go to the ER after eating KFC before I knew what this was.

I really worry about some of the post-surgery side effects I've heard about, namely the chronic severe diarrhea. Many who developed it claim it's lifelong. How often do people develop this after surgery? When it happens does it ever get better? What would you say the chances are that removing my gallbladder would fix me? Would it return me to the way I used to be? Also, does the surgery pose an increased risk for colon cancer, heart disease, diabetes or crohn’s disease? Sorry for so many questions but I'd like to know what I’m getting myself into. -Charlie

Sid Schwab said...

Charlie: I can't comment on your particular odds, not knowing your situation. I can say (as I've said in this series of posts) that severe diarrhea is rare. Mild diarrhea with some foods is more common, and is usually easy to control. Most people have no side effects at all. Remember, when you visit patient websites, etc, you're hearing from the ones that had problems. Gallbladder surgery is the most common there is, in the US. So you're not hearing from the 200,000 or more every year who do fine. I know of no relation to those conditions you listed.

Dave said...

Wow...so it's been about 5 days since my ER visit and I am feeling great with my new diet. Just have to get used to eating so healthy. Not that I ever abused food, just loved my pastas etc..I was a carb lover for sure.

During the past few days speaking with co-workers, friends, acquaintances etc.. I am starting to realize just how many of these people either have had themselves or know someone who had their gallbladder removed.

It's like an endemic. An example of an endemic disease is malaria in some parts of Africa (for example, Liberia) in which a large portion of the population is expected to get malaria at some point in their lifetimes.

I just never realized how prevalent
this disease is occurring in our society and talked about by some as
nonchalantly as a tooth extraction.

This is just mind bogoling to me. I really have no need to research this to death for my own satisfaction, but I have to believe
this due to our diets. Conveniently we have our preprocessed, and fast foods available.

My grandfather is 96 and my grandmother is 90 and the types of food they ate throughout their lives is not what most of use consume today.

I'm sure there is some DNA/heredity at work here also that might play a piece in the puzzle.

It just makes me sad to hear so many people accept the diagnosis and move on as usual but never try to identify the root cause and make the necessary changes. I wish I was more informed growing up but I am willing to make the required changes. You only live once!

Ok..off of the soapbox! Have a great day everyone!

Dave..

canadianchick05 said...

Thanks again for your response to my questions and concerns. I did make an appointment with my gastro specialist and he was not convinced that its completely my gallbladder causing my problems. He was considering gastritis which cause a different kind of pain (since my pain is not typically on my right side). He suggested i undergo another set of scopes (which was done yesterday)and wait to see what the biopsies tell us. I'm glad i didn't rush into the surgery as recommended by my surgeon who did my first set of scopes and ordered the HIDA scan. I'm glad i got a second opinion and postponed the gallbladder surgery. My symptoms seem to be under control for the most part and hope that my gastro is correct in his suspicions. Thanks again!!

Catherine said...

Hi Dr. Schwab,

I am a 17 year old female who has suffered from pain attacks for a year and a half now. One night i had a pain attack and then the pain just stayed for days. I went to the doctor and he told me i am jaundice and wanted to admit to a jaundice clinic, but that could of taken up to two weeks. My Mum got sick of waiting and took me to hospital, there they did blood tests and told me my bilirubin was 60 and my amylase was 1600, also an ultrasound confirmed gallstones. They put me on a drip and i was nill by mouth for a few days and then 4 days later my tests came back normal and they discharged me after booking me in to come back as an outpatient for an MRI Scan. Yesterday i had the MRI and they are now going to go back go my surgical doctor for him to decide what to do next. I've heard some people say taking the gallbladder out could create alot more problems so is there anything else availible to me? What would you want your patient to do? What would be the best option?

Catherine
UK, Birmingham

Sid Schwab said...

catherine: by the info you provided, it seems clear you had one of the most severe and potentially dangerous complications of gallstones, namely pancreatitis. What I told my patients who had that is that removing the gallbladder is the proper treatment, and that things could be even worse with repeated episodes. If you read the rest of my posts on the subject, which are linked at the bottom of the post you've read, you'll see what else I've said about it. The last one refers to alternatives. In your case, given your age and your history, I'd have no hesitation in saying surgery is by far the best option, assuming my understanding of your situation is correct. However, you must understand that from this far away I'm nowhere near as useful as your own doctors. As to side effects, please read my comment to charlie, a few comments above, dated 2/6, 8:46 pm.

Catherine said...

Thank you for replying so quickly and yes i think i will just have the surgery if it is offered to me, the NHS is so crap that it might be a good few months away from now anyway.

Anonymous said...

I was diagnosed with many stones in my bladder 02/07. Never had a crippling attack, however have had chronic pain below rt. shoulder blade & right upper quandrant. Was advised to have bladder removed. Did not seem severe enough to have this done. Last few months have been having pain off and on in pelvic area and on both sides where my ovaries are. GYN did ultrasound & pelvic exam, urine tests & cultures. Everything is perfectly healthy. She said problem is not GYN related to see my primary. Saw him he agreed with her conclusion. He did a touch test aound my abdomen, when he pressed on my gallbladder, instantaeously brought tears to my eyes. Extremely tender & painful. Does this mean it is inflamed or possibly infected? He wants me to have a colonoscopy done to rule out the pain in pelvic area although he doesn't feel there is anything wrong down there. Stools normal, no pain, bleeding etc. Could pain in pelvic/ovary area be referred pain? Hesitant to have colonoscopy done as I dont feel (nor does my GP) that there is anything wrong with lower intestine. Should I have this test done. I am a 42 year old female in otherwise good health. Also have a heavy feeling in upper GI area. Assuming its from my GB problem. What are your thoughts?

Sid Schwab said...

anonymous: I try to give general information here, and sometimes generic advice; but I can't render specific opinions or recommendations, because there's just no way I can know enough from over here to do so. I can say that it seems like input from a surgeon would be useful.

Anonymous said...

I have been experiencing extreme fatigue, nausea, stomach cramps,
sleeping problems, weight loss, lack of appetite, increased gas. My primary sent
me for an ultrasound which came back relatively normal with the exception of a
cyst on my kidney which I was told was normal. Blood test were pretty much
normal. Had a Hida Scan on Friday, results came back that gallbladder was
working 16%. Dr told me 35% or less is bad and that removing it would make me
feel better. I took off from work today because I feel so bad. If this is what
is making me feel so bad I want it taken out ASAP! Do these symptoms sound like surgery would be good for me?

Sid Schwab said...

anonymous: I really can't make a prediction or recommendation from this side of your computer. But I have said this in my posts: the diagnosis of "biliary dyskinesia" is a hard one to make. What I've told my patients is that when a person's symptoms are TYPCAL of gallbladder problems but they have no stones, and the HIDA is clearly abnormal, AND the injection you get during the scan reproduces the symptoms, then the chances are good it will help to have the gallbladder removed. When those criteria aren't met, I suggest a consultation with a gastroenterologist.

Anonymous said...

Hello again,

I decided to agree to the gallbladder removal surgery on Feb. 5. As I stated before, I had been having attacks and couldn't take it any longer. The surgery left 4 puncture wounds and the surgeon said in addition to several smaller stones, I had one larger stone that made it difficult to remove the gallbladder hence the 4th wound.

I've been back to see the surgeon and have told him that it's still painful to bend all the way over or move a certain way. In fact, one night as I adjusted my position on the couch, I felt extreme pain on my right side for a moment. It went away after a minute or two and I've been very careful about moving ever since. I also have gurgling and a slight burning sensation on my right side several times a day. He just looked at my stitches and told me that any surgery takes awhile to heal. I should just take it easy and he'll see me next week.

My questions are: Are these normal concerns after gallbladder surgery? Do patients often have residual discomfort bending over? Are the burning sensation and gurgling normal? It's been weeks since the surgery, should I still have pain if I move wrong?

Still a little
Painful in NJ

Sid Schwab said...

anonymous: again, only a general comment about surgery; I can't speculate on your symptoms. In general, two weeks is very early after surgery. Laparoscopic surgery sometimes creates unrealistic expectation because there's only a few small holes and you go home so soon. The healing process, at two weeks, still isn't even fully turned on. So lots of sensations can be noted for many weeks that may be entirely part of the expected recovery. When things seem to be getting worse instead of better, or new symptoms are happening, it's best to re-inform one's surgeon.

Anonymous said...

I am set to have gallbladder surgery next Friday, but I am not sure I should. I have acid reflux, with nausea, bloating, trouble with my bowels, etc. but very little pain. I have problems eating, where I feel if I eat I will vomit (which I never do). That is my biggest problem.
My doctor had me do get a HIDA scan and it shows I have sludge, but no gallstones and my gallbladder is only working at maybe 20 percent. I have still haven't been given an answer as to why the sludge is building up. Do you have to have gallbladder disease to have sludge? And can the sludge cause nausea? I don't feel like my pain is enough to get my gallbladder out, but I am running out of insurance in April, so I feel like I should get it out now before it gets really painful.

Sid Schwab said...

anonymous 3:59 pm: situations like yours can be very challenging, and the fact that you're under time constraint with your insurance doesn't help. Once again, I really can't make very specific comments without knowing you better. "Sludge" is a hard thing to evaluate on its own. It may or may not be significant. I always told my patients (and I did in this series) that to conclude the gallbladder is causing a problem when there aren't stones requires either a very typical pain pattern plus an abnormal HIDA during which the pain is reproduced, or secondary evidence that there's something wrong with the gallbladder, such as a thickened wall on ultrasound, etc, which indicates inflammation. When there are lots of other symptoms and the situation isn't clear, I often got a gastroenterologist involved. These are general comments and might or might not apply to you; I really have no way of going further.

Anonymous said...

I done the bogus gallbladder flushes 6 times. The frst three times I had small green stones, and a load of small sandy colored stones.

The last three flushes that I have performed have produced nothing so the first three flushes deffinitely got the stones from somewhere.

I've read online that experts say teh stones are formed from teh olive oil. If that was the case then why wasn't there any in my last three flushes?

In all fairness to you, seeing as you're a surgeon, you can't suggest a gallbladder flush as surgery keeps you in a job, plus it wouldn't look very professional for you to recommend such a simple procedure for gallstone removal. Too many people have reported success for it to be bogus.

Sid Schwab said...

anon: "success" means having documented gallstones in your gallbladder and then documenting that they are gone. Simply taking a flush when you haven't had stones proven is like chanting to keep elephants away. No elephants? Well, it must have worked. People who see curds in their stools and think something magic has happened are gullible at best. But what the heck? Drink all the oil you want. Keeps constipation away.

Anonymous said...

Dear Doc - I am the concerned mother of a 14 yr old daughter who has been suffering from gallbladder attacks for several months now. She is an avid athlete who is very determined to participate in track season which starts today. We just found out Feb. 5th through testing at the hospital what is wrong. The results came back one percentage point above where the Dr would have recommended surgery but since she is so young he wants to see if he can help her with LV/GB supplement and diet before doing surgery. She did not have stones but apparently a "sluggish gallbladder" but she can't seem to eat ANYTHING without having an attack. I want to avoid surgery if at all possible but I don’t want her to keep suffering. For 3 weeks she has been taking two capsules before every meal and sometimes it helps and other times no luck. Today the Dr. upped the dose to three. We are trying a strict diet but are frustrated about what she actually CAN eat. Do you have a list of foods she can eat?? It is a particularly difficult time with what to eat right now with track season as they are usually required by track coaches to eat foods with lots of carbs such as pasta and pizza. Well, these are the very things Dr told her not to eat so what do we do? She needs the carbs for the strength and stamina to be able to run. I am totally beside myself trying to make the right decision for her. Please please if you have a list of "safe" foods for her to eat hopefully some with carbs I would very much appreciate you sharing the information with me. Also, I would very much appreciate any other advice you have for a 14 year old runner during track season. Thank you so much for your time!

Sid Schwab said...

anonymous: I've not heard of "LV/GB supplement." I've never heard that carbohydrates are bad for gallbladder problems. It's unusual for a 14 year old to have gallbladder problems at all, and particularly with no stones. The above are factual statements about my knowledge. I really have no basis for making recommendations on a person whose situation I don't know in detail, or who is not my patient. Seeing a gastroenterologist would be a consideration if she hasn't already.

Anonymous said...

Have a similar situation with 17-year old, very petite daughter. Has no gallbladder pain after eating, but has severe pain when exercising. Had HIDA scan - showed 0% functioning. Do you recommend gallbladder removal?

Sid Schwab said...

I'm really not in a position to make specific recommendations. Pain with exercise is rare, at best, related to gallbladder. A HIDA with 0% function is significant, but what it means and what to do has to come from her doctors.

Sid Schwab said...

I should add to the above: I assume she had an ultrasound that showed no stones. That usually precedes a HIDA scan. Also, if she'd been taking pain meds it can affect the scan.

Mom of 5 said...

Dear Doctor,
I had my first and only attack so far of excruciating pain last Tues. while at work...an ambulance was called. The intense pain lasted about 1 hour. I was given an ultrasound and CT of my gallbladder, both which came back normal. Then came the HIDA scan. I was told that my functioning was at 35.2 percent, which was normal. I was also told that the terrible pain and naseau I experienced while the tech. put the medicine in the IV to make my stomache think I had eaten and to clear the gallbladder, was normal and that some people have the pain and some do not...that it does NOT indicate anything is wrong with the gallbladder. I have since been having sharp, stabbing pains on and off under both the right and left bottom of my ribcage along with occasional shoulder and back pain. I also feel very distended in my abdomen. My questions are: is 35.2 percent functioning in fact NORMAL along with the other symptoms I have described and also, was the tech. incorrect in telling me that the reproduced pain and naseau produced after the medicine was injected during the HIDA was normal even if my gallbladder was fine. It felt like a mini-attack all over again. After reading your other blogs, I am glad to discover I am not crazy and that these physical symptoms are real. Thanks a million.
Lisa

Sid Schwab said...

lisa: sounds like you're in a grey zone. Injecting CCK during HIDA scan causes cramps an nausea in some people, so it's sometimes hard to tell to what extent it's reproducing underlying symptoms. Whereas it's not possible absolutely to rule out gallbladder problems with most any set of tests, it seems other things will have to be looked into before it would come back to that.

Susan said...

Hi! Glad I found this blog. Today I had a gallbladder emptying scan. I felt some brief cramping and nausea when the hormone was injected. About 15 mins later my right shoulder hurt terribly. I've been having some pain in my right shoulder but I had attributed it to musculo-skeletal problems. Today's pain was 10 times worse than what I'd been experiencing. I thought at first it was because I'd been laying there so long but my other shoulder was fine. Could it have been referred pain from my gallbladder contracting improperly?

Sid Schwab said...

Susan: Yes, that's certainly among the possibilities that you'll need to discuss with your doctors.

Anonymous said...

Wow...I had my GB removed 4 days ago. I have a rash on my stomach...does that mean anything? I called my doc to ask him and the receptionist just told me to take benadryl. Today I am very dizzy and have a headache. Is this normal?

Sid Schwab said...

I really have no way to comment on acute post-op issues. Stay in touch with your doc.

Lisa said...

I know anonymous must stay in touch with doc, but could GB removal at least cause a rash on the stomach? Have there ever been any cases where the leakage of bile or infection after the removal lends itself to a rash?

Sid Schwab said...

Only if bile were visibly leaking onto the skin. Rashes can be from any number of things, including a reaction to the disinfectant that was used on the skin during surgery.

Anonymous said...

I am scheduled to have my gallbladder removed next week after rushing to the ER thinking I was having a heart attack. Hours earlier I was awakened from sleep with severe heartburn, bloating and pain in the upper abdomen and back that was getting progressively worse. A heart attack was ruled out and an ultrasound was ordered which indicated I had gallstones. Consult was done with surgeon and he confirmed I should have the surgery. Funny thing is, since the ER visit, I have not had any further symptoms of severe pain just occasional nausea and bloating. Is this common after a severe gallbladder attack and would you agree the gallbladder should be removed?

Jennifer

Leigh Ann said...

I've been wondering the same thing, Jennifer. I had a week of pain, and had the ultrasound and saw a surgeon, and planned on having the surgery later this month, but now, I'm not so sure. I've been pain free for several weeks now.

Let me also say, thank you to Dr. Schwab for answering so many questions for all of us. I've followed this blog for a month now and I'm amazed that you take the time to do this.

Leigh Ann

Sid Schwab said...

I have no ability to predict the future. People who have gallstones and attacks tend to keep having attacks. For any individual it could be tomorrow, next week, next month, or never. Most attacks go away without the need for emergency surgery, so it's not all that common that a person has no choice. People who have attacks are more at risk, statistically, for the more severe complications, than those who have stones but haven't had attacks. There are things that can happen that are much more serious than episodes of pain. I never tried forcibly to talk people into surgery unless they had signs of perforation or unrelenting infection or had had pancreatitis. I give them the info, tell them in my opinion people who have attacks are better off with surgery, and point out I have no way of predicting. Other conditions, such as diabetes, enter into it as well. I can't make any recommendations for people whom I don't know as my patient.

Jim said...

I am a 47yr. old male who had a sub-total colectomy 4 yrs. ago. Have been doing great, all things considered. Then in Jan. of this year had what turned out to be a gallbladder attack. ER room visit and all. The CT scan showed severel rather large stones. I am scheduled for surgery to remove the gallbladder this Tuesday. Since my system is somewhat different already due to my STC can I expect an other issues related to removal of my gallbladder?

Sid Schwab said...

Jim: it's a good question, and I'm not aware of specific data. The main concern would be the diarrhea issue. Most people don't have a problem, and the odds are you wouldn't either, far as I know. It's possible you'd need to modify diet to lower fat intake, or to use or increase (if you are already), anti-diarrhea meds. I know of no other issues; and given the way bile salts are handled in the gut, I think it's not much more likely that you'd have issues than anyone else.

Farrell said...

I had my gallbladder removed almost 3 years ago. Since then I have gained 40+ pounds and have terrible diarrhea, bloating and cramps. I am 23 have always eaten a healthy diet and used to be happy and healthy...that is before I had mine taken out. There are all natural cures and rememdies that I would suggest anyone who is considering having theirs removed because of a small "inconvience pain" If anyone has had the same problems I have theres a huge Blog about it on Dietpower.com type in weight gain after gallbladder surgery. Its 65 pages long and we are about to start a website. =)

Sid Schwab said...

There is NO -- repeat: NO!!! -- relationship between weight gain and gallbladder removal, other than the fact that some people who couldn't eat certain foods because of gallbladder pain find they can after surgery and eat more. A person who gains weight after gallbladder removal does so because he or she eats more. Period. There's no metabolic connection, other than that. PERIOD. Think about it: how many calories you burn depends on intake, absorption, metabolic rate. Presence of gallbladder has no effect on metabolism. If anything, a person who has diarrhea (whether due to surgery or not, which it might or might not be in your case) ought to LOSE weight because of poorer absorption. It's a myth, pure and simple. People gain weight after haircuts, too. The question is showing a relationship. It isn't there.

Anonymous said...

I was having nausea and vomitting and stomach spasms every two to three days for over a year with no specific diagnosis after many tests, but a HIDA that showed low function. I finally decided to follow recommendations to see if gallbladder removal would help. I did that in October with great results. I still rarely suffer from the spasms (perhaps once a month), but not severely and no more vomitting, so the surgery mostly cured me and I have had no bad effects from it and had a good recovery. The surgeon said that when he removed it, he saw scar tissue that indicated a severe infection sometime previously, but no current infection. Just wanted to let you know I had good results and am happy I had the surgery.

Jim said...

I'm the 47 yr old male who had a STC 4 yrs. ago. I had my gallbladder surgery on Tuesday. Took 45 minutes and I was home a few hours later. So far all is going well with my recovery. The doctor told me that while he was in there looking around he saw that I had a "fatty liver." Great something new to deal/worry about. What is a "fatty liver" and what does that mean medically for me?

Sid Schwab said...

Jim: fatty liver means there are fat deposits within it. Usually it's nutritional, associated with obesity, and is reversible when losing weight and improving diet. It's not often a problem per se; in other words unless it's really severe, it's not about damaging the liver. It's a sign that attention needs to be paid to diet and weight. Best to discuss it directly with your docs.

Anonymous said...

I'm SO happy that I've found your blog! I'm a 23 year old female and I've been suffering from severe gallstone attacks (severe stomach pains, vomiting, chills, etc) since last June - was diagnosed in August. When I found out my attacks were connected to fatty foods, I cut out fat from my diet almost completely and that helped for a while but now it seems that my attacks are now connected to the quantity of food that I'm eating as well. So, I've cut down the quantity of food I'm eating as well and as such have lost almost 20lbs in the last 2 months!

I'm scheduled to meet with a surgeon on March 18th because I've decided that this is really not the way I want to live my life - being scared of eating - but I'm terrified of the surgery. Not so much the surgery itself, but I'm needlephobic to the extreme and I'm wondering what to expect in going into surgery - is there anything that they can give me prior to putting in the iv or needle to sedate me? I'll be completely honest in that I get very irrationally upset when confronted with having to get a needle...

Sid Schwab said...

anonymous: be sure to discuss it with your surgeon. He/she can either let anesthesia know in advance, or put you in touch with them directly. You're not the first who has that problem! I'd guess they'd be able to come up with something.

Dee said...

I have confirmed gallstones (numerous filling the gallbladder) but, in spite of nausea, lightheadedness, tenderness under the right rib cage, pain that radiates from my lower back around to my chest, constipation and diarhea, heartburn and burping problems, ALL after eating, my surgeon refuses to remove my gallbladder because I don't have "classic pain" symptoms. I've had numerous blood tests, a colonoscopy, and an endoscopy which showed nothing except low iron in my blood (less than 10), he wants me to go to the Cleveland Clinic to have everything else ruled out BEFORE doing anything about the gallbladder. I am miserable. This has been going on since October 2007, and I have lost 35 pounds because of the eating issues. Am I being unreasonable to suggest the gallbladder should come out? I hate surgery, but at this point, I'd do just about anything to get rid of this problem. I feel sick most of my day. What can I do to get help?

Sid Schwab said...

dee: if your surgeon is reluctant to operate there must be things going on that I have no way of knowing, nor can I make any very useful suggestion. I assume you've seen a gastroenterologist, who did the endoscopys. What does she/he think? Getting another surgical opinion is an option, as is following the advice of your current surgeon.

Dee said...

Thanks for your prompt reply. The surgeon is also the one who did the endo/colo. It doesn't seem to be anything other than "he waits for other diagnosis", according to my GP. The GP also told me he had two other women patients with similar symptoms and they went through Cleveland Clinic-no answers, came back to this surgeon and he removed their gallbladders and they are fine. Symptoms resolved. It seems terribly expensive, not to mention very miserable, to have to jump through all of these hoops first, in my humble opinion. The Clinic has moved my appointment to April 1st with a gastroenterologist. (I was also sent to an ENT and an endocrinologist who found no other problems either.)

Sid Schwab said...

dee: you might be interested in this post. I can't draw any conclusions from a case with which I'm not familiar. As a general comment, I can say I think there are some patients who, for various reasons, are put through a lot of testing that seems unnecessary. In some cases it is, in others, maybe not. It's very possible not all of your symptoms are due to your gallbladder. But -- again realizing I have no way of judging from this far away -- I'd guess there'd be very significant improvement; I say that based on my own experience with my own patients; people I actually knew. Maybe you should ask your primary doc if he/she thinks seeing another surgeon would be useful.

Dee said...

Yes...the link to your other post's topic entered my mind, too. I asked my GP about a second opinion and he said,"Get to the Clinic-there are few docs locally that will provide..er...diagnosis." Not sure what he was trying to say, if anything more than what he said, but, I was hoping for a local "fix". Sigh. Anyway, only 14 more miserable days to go...
I certainly appreciate your honest and prompt response! (Wish you weren't retired and you practiced near me, by the way.)

Anonymous said...

Just found this blog; thanks for it. I had my GB out one week ago today and amy still having symptoms. Before, I was having chest pains everytime I ate; I am still having them. Additionally, my previous acid reflux is twice as worse. And, in addition to all of that, I have a "stich" tpye pain on my far right side just under my ribs. The same kind of pain you get when you exercise too much right after eating or drinking. Any thoughts?

Sid Schwab said...

This early after surgery, many things are possible. You should be addressing the concerns with your surgeon.

Anonymous said...

Are staples used (and left) internally after Cholecystectomy? I had an IVP performed today for a bladder/kidney problem and see what appears to be five staples where my gallbladder once resided. Is this a normal procedure? I'm a little unsettled by it.

Sid Schwab said...

They're clips, not staples. Perfectly normal, totally harmless. I wrote about it here.

Anonymous said...

I appreciate your response. The surgeon may very well have told me about the clips. The pain was too intense to remember the details.

Thanks for your help.

Deborah said...

I'm having my gallbladder out on 4/2 and I didn't read anything on gastric bypass patients. I know the percentage is higher, but my symptoms are a little different. I had a stomach flu, then the burning started on my left side and didn't stop. I thought I had an ulcer. An upper GI did find a small ulcer below the new stomach pouch, but not enough to cause that amount of pain. I went back to the Dr who performed the gastric bypass 2 1/2 yrs ago, and he said it was my gallbladder. (I had extreme pain and burning on the left side, front to back, diarrhea, chills, nausea and insomnia). He ordered a gallbladder scan that showed small stones, but the gallbladder itself is not tender and there is no pain on the right side. He also ordered an abdominal CT scan. In addition to removing the gallbladder, he will be doing exploratory surgery Wednesday and looking at the remnant stomach at my request, because I am concerned about the burning on the left side. Am I being overly paranoid? The remnant stomach can not be reached by scope anymore and I feel hunger pains and movement in it constantly, so I am worried about ulcers or stomach cancer and don't want that to be confused by symptoms of a gallbladder attack...

rcorbitt said...

Is there any connection between low cholesterol and gallbladder attacks?

I am a 41yo male. My PCP put me on Vytorin in an attempt to lower my triglycerides, and help with elevated AST/ALT. (Last week we discontinued the Vytorin and changed to simvastatin.)

In two months, my total cholesterol has dropped from 190 to 80. My HDL has dropped from 40 to 17; and I am now experiencing gallbladder attacks on a regular, sometimes daily, basis.

(Yesterday, I had an abdominal ultrasound to check the gallbladder. I am waiting for the results.)

Sid Schwab said...

rcorbitt: Yes. Cholesterol is a major component of bile, and some cholesterol drugs can change bile chemistry which can lead to stone formation. Here is an article that mentions it.

deborah said...

Well, I didn't get a response, but I'm back from my surgery, so I thought I'd give my results. The surgeon who did my gastric bypass removed my gallbladder 4/2/08 and said I had lots of small stones, and the gallbladder was abnormally thick.It was laproscopic, so I was in and out of the hospital in 4 hours. As for the pain on the left side, he removed excessive scar tissue from the original gastric bypass surgery 2 yrs ago, he said it was forcing my liver under the ribs and causing pain. I'm eating normal and other than the typical surgery pains, I feel much better.

Sid Schwab said...

deborah: It sounds good. I'm sorry I didn't respond earlier; as you can tell, I generally do, and I don't know where I slipped up. On the other hand, as you may have noticed, I generally avoid commenting on specific medical issues, because I'm not really in a position to do so. As in the comment that followed your unanswered one, I do try to provide general information. I'd not have had much to say about your particular question regarding your pain, which is better answered (and, evidently, treated) by your own surgeon.

Anonymous said...

I just had my gb taken out march 14th. Two weeks later I went for my annual ob/gyn checkup. he did the usual bloodtests and it showed an elevated alkaline phosphatase @ 289. would this be caused from the gb gallstones and surgery? curious in Memphis

Sid Schwab said...

I've noted some patients with slight elevations after gallbladder surgery. If all the other liver tests are normal it may not be important. But since there are various explanations, it may need further investigation.

Anonymous said...

This is the Mormon from your other posting wanting to ask a couple things about gallbladder surgery. I have heard that many people feel a lot better after, but I have also heard some don't-- they have diarrhea and gain weight"like a spare tire on their upper abdomen" I read that there is no link between weight gain and this surgery other than the eating thing, but what other negative things can come about? Would I have to take medications afterwards? I have heard some people do. I don't have stones-- just a 9% on my HIDA and some pain. I am young (20s) and don't even know why this problem has come about. I don't want future problems to occur (would they be likely), but I am a little nervous about the surgery and if it's really worth it-- I don't like the idea of being hooked up to a vent and given a paralytic for the duration of the surgery. I am in PT school, and so I know just enough about those sorts of things to be scared about it I think. Do you have any advice? I thank you very much for your time, by the way and am enjoying your blog. :-)

Sid Schwab said...

anonymous: it sounds like you are pretty well educated about gallbladder issues already. If you haven't, you might check out the other posts here, which are linked at the end of the primary post. I can say (if you were to look through the 170 comments here, you'd probably find it!) a few things: gb surgery is among the most common there is. It's as safe as surgery can be; which is less than 100%, of course. But safe. You are in a tricky category: when there aren't stones, and the decision is based on HIDA scan, the outcome is less predictable, in terms of relieving symptoms. On the other hand, the VAST majority of people who have the surgery have no sided effects at all. You hear about the ones that do; less so the ones that are fine. Weight gain has NO physiologic connection to gallbladder surgery. Diarrhea can. It's seen in a minority of patients, and when it is, it's usually not a big problem, and can be avoided by avoiding high fat foods. Again, not always. The need for long-term medications, unless for diarrhea, which is unlikely, is so small I don't know what it'd be for. I can't think of any of my 2000 or so patients that needed anything related to having the surgery, except for diarrhea medication. And those were very few indeed.

Anesthesia for gallbladder surgery in an otherwise healthy person is straightforward; the chance of anything significantly bad at your age is less than 1/150,000.

As to other advice, I don't know enough about your particular situation to offer much. But in general I think the decision to have surgery when there are no stones requires a lot of thought, including the opinion of a gastroenterologist along with the surgeon. Sometimes more than one each. Whether you need more opinions depends on things I can't know from over here.

Anonymous said...

Thanks for the quick reply. I have spoken with one surgeon only, and he thinks since my percentage is pretty low that the surgery should help. He wouldn't do it if he didn't think so-- in fact, until he knew it was that low he was almost suggesting not to do it as he didn't know if it'd help. My surgery is scheduled in early May, and timing-wise with school and whatnot I think I might as well get it done now if I'm going to go for it. I am just curious what issues could come about later if I didn't have it out, but I know that's probably not predictable. Anyway, thanks again for the information. It does make me feel a bit better. :-)

IMEANREALLY said...

Ugh, I'm having my GB removed this Friday. I tried to minimize my risk by going to the Chief of General Surgery at, who would assumably have a good team working with him. He didn't get into the specifics when I asked him exactly what happens once they put me out, although I'm not sure I want to know. However, what I am curious about is what to expect afterward. How bad is the pain? What is an oddi sphincter? Why do I hear mention of this being an issue? I'm doing the surgery at Cedars-Sinai in LA, and they plan on keeping me overnight (I'm not thrilled with the idea of surgery on a Friday..) Any thoughts or experiences would be great.

Anonymous said...

My husband had his gallbladder out 4 days ago. He is having great gas pains when he eats and can't really even burp. Is this normal and if so when will it go away?

Sid Schwab said...

This soon after surgery, it's really best to address the questions to his surgeon. Let him or her know what's going on and go with the advice that comes.

Mariposa08 said...

I really appreciates the time you spend sharing your knowledge...Your words have helped me immensely.

My symptoms don't 100% gel with the typical list. However, I do have a rock in there that is half the size of my gallbladder so I'm saying "Sayonara" to the whole thing in about a week.

I have two questions for you. The first has to do with "referred pain". I occasionally have the "typical" gallbladder pain on the right but I also have a lot of pain, almost "mirror image" on the left. The pain on the left is more frequent and does not occur at the same time as what I would refer to as the right-sided gall bladder pain. Do you often come into contact with patients who have pain also on the left side of their abdomen and is this pain usually relieved after the gallbladder is removed? (I have had an endoscopy and no sign of acid reflux or ulcer was found).

Secondly, I have had a persistent cough that has been concurrent with the supposed gall bladder symptoms (3 years running now). I've done just about everything to track down the cause or source of this darn cough...nothing yet. The surgeon I spoke to regarding my gallbladder suggested the cough maybe caused or exasperated by the fact that I have gallbladder trouble...I guess by causing reflux, etc. Have you any experience with this?

Thank you...just wondering if you have spoken to patients with left sided abdominal pain and also coughing, and if those symptoms were eased by the removal of the malfunctioning gallbladder...

Sid Schwab said...

Mariposa: it is, of course, impossible to predict in an individual case; however, it's definitely true that many people with gallbladder problems have pain on the left side which is eliminated by removal of the gallbladder. I saw many patients who'd been admitted with presumed heart problems (left-sided chest pain) in whom it was ruled out, gallstones were discovered, and they were fine after surgery. As to the cough: it's true that reflux can cause cough. But I'd consider it a pretty uncommon connection to gallstones. Probably not impossible. Time will tell.

YoungWilliam said...

Here's a weird little gallbladder question that neither my internet searching nor my trusty Merck Manual seem to be able to answer:

As far as I can glean, the gallbladder icks out a little bile when fatty foods are registered as passing through. During the night (or whenever the person's circadian rhythms register it as "night"), the gallbladder wooshes out even more to metaphorically clear out the stockroom.

When I first suspected my mystery abdominal pain to be gallstones a couple of months ago, I thought I'd experiment with a low fat diet to see if that helped (and set up an appointment for an ultrasound since I don't trust the innocence of random abdominal pains). Upon reflection, though, none of the gallstoney actions ever seemed to follow fatty meals, but only decided to take my innards for a spin during the night. Now that the results of the ultrasound are in and my gutters are apparently full of gravel it seems my initial guess at gallstones was correct, but (dramatic pause) I've come to wonder if there's any connection between the gallbladder's nightly bile-purge and the fat eaten earlier that day.

Seems rather silly to continue on a diet focusing on tofu, rice, and multivitamins if the daily diet has nothing to do with the nightly bile-purges. It's not really a question of "what should I do?!" (since I've a doctor with access to my ultrasounds for that) but more just wondering if you have heard of any research establishing connections/correlations/causation between the daily fat-intake and the big nightly refresh?

Sid Schwab said...

youngwilliam: good question, no good answer. It is very typical of gallstones that they announce themselves in the middle of the night. 1 or 2 a.m. seems a favorite time. And, of course, many people have attacks that seem entirely unrelated to meals, either in timing or type. I told patients that I though it could relate to the lying down, and shifting of positions of stones, but I have no basis for saying it other than imagination. The gallbladder contracts most strongly in response to food, particularly fat, entering the duodenum; but it does so throughout the day and night. Topping off, sort of, I guess.

YoungWilliam said...

I've theories as to why it does what it does (and when it does it), but as you mentioned, they're really just theories.

One would think that, in this day and age, one could just dial up a search for "gallbladder" and get the world's wealth of clinical information at one's fingertips. Unfortunately, as you also noted, doing such a thing instead turns up 97% of the results being, "Buy our watercress, applesauce, and snake oil tonic and those gallstones will fly out of you like a squishy shotgun!" (the rest being about 2% of "Don't panic. You're not going to explode. Just see your doctor, and you should be fine in a month" and 1% being "other")

Charming web-log, by the way! I've always adored reading breezy medical/scientific stories.

Mr. Ed said...

My PCP has just ordered a GB scan. For several years I have had increasingly frequent episodes (now about monthly) of middle of the night severe diarrhea followed by mild nausea. The episodes resoleve in about six hours. The most recent episode was more severe and preceded by hot flashes/cold sweats, dizziness and more severe nausea.

However, I don't have the classic "pain in the abdomen" most associated with stones or GB disease. I'm a 47-year-old male, vegetarian with a history of GERD and IBS. I've taken Prilosec and Aciphex for about four years for the GERD and ostensibly to help with the episodes.

Additionally, I've had difficulty for years digesting certain foods: dairy, nuts, seeds, cauliflower, cabbage, and now spicy foods.

Finally, I have a small knot just to the right of my naval. My PCP has twice previously indicated it is merely a fat globule. It isn't painful

Any thoughts?

Sid Schwab said...

Mr Ed: I really can't make specific diagnoses from this far away. I'd say that no matter what the scan shows, if you haven't seen a gastroenterologist yet, that'd be something to consider.

Diagnosing lumps is even less possible, without being able to see and feel them.

gigi said...

I have discovered six month ago, after an abdominal us that i had a stone of 4 mm. at the time i had some pain, no nausea or vomiting.
today I read that i also had a small polyp my doc did not mention. my pain is there more often now and still no nausea or vomiting. my pai is dull, no sharp or excruciating symptoms.it comes and goes. my doc wants it out, do you think i should have another us done for the polyp?
is the surgery really necesary in my case?
thanks
vas

Sid Schwab said...

polyps in the gallbladder are usually not significant; so in your case the presence of the stone is the issue, and there's nothing to be learned from another us. "Necessary" is a relative term: no one can say with certainty what will happen one way or the other. A significant number of people who have a stone in their gallbladder will go on to have more problems. When they are of that size, they can pass out of the gallbladder and into the main bile duct. If that happen, it may pass on through causing pain only, or it could cause jaundice or pancreatitis. When those serious things happen, in most cases it's not life-threatening, although it can be in a small number of cases. Some people with stones will have no symptoms for their whole life; others will have episodes of pain once in a while, or frequently. Some will get acute inflammation or infection of the gallbladder, and some of those will need emergency surgery. So in that sense, calling it "necessary" requires a crystal ball. If you don't have surgery, the possibilities include all of the above, from little or no problems to severe ones.

YoungWilliam said...

Looks like I shan't be able to do any more first-hand investigation into the filling and emptying of the gallbladder, since as of about 36 hours ago, my gallbladder and I parted ways.

They used that slick new Da Vinci machine for the robotically assisted surgery and let me tell you, wow! Under two days later, and I do -not- feel like someone who had an organ removed. Feels more like a hangover and like someone beat me up a few days ago. The speed of this recovery is a thing I'm measuring in hours instead of days.

And apparently, I -will- get to keep one of the gallstones as a souvenir, once the pathology lab is done doing the usual studies.

mariposa08 said...

I first wrote you on May 11th. I had the laparoscopy to remove my gb on the 22nd. I didn't get the cool Da Vinci hook-up that YoungWilliam did but it wasn't the worst thing I've ever been through. Anyway, my surgeon said it was the "real deal"..full of rocks and chronically inflamed. Probably would have become an emergency eventually. Anyway, I was very disappointed that the dreaded and mysterious "left sided pain" did not evaporate immediately upon organ removal. I figured once the gb was gone, that there would no longer be an infected organ to "refer" the pain over to the left side. My doctor said to give it some time and... Lo and behold, after two more weeks...the pain on the left is gone (as well as the typical gb right side pain) !!! YAY! I have dealt with this issue for 3 YEARS...have been diagnosed with all kinds of stuff (and the treatments never helped, of course). My symptoms just were not "typical" gb symptoms until about 6 weeks ago. So, people, there is hope. Thank you Dr. Schwab...your blog is what gave me the impetus to go through with the surgery and I'm very glad that I did.

P.S. I AM still coughing, though...oh well...that was a long shot and 2 out of 3 isn't bad!

Sid Schwab said...

mariposa: don't fret: the only reason to use the da Vinci for a gallbladder operation is to dazzle the patient. It adds nothing -- NOTHING -- to such a routine and anatomically straightforward procedure. Except, of course, cost. It's like laser for laparoscopic gallbladder surgery: at first that's the way it was done. People bought the machines for tens of thousands of dollars. Eventually they started realizing it made no difference. When I learned the technique, at the course was a rep selling lasers. I asked what the advantage was. "That's what patients want," is what he said. Marketing, in other words. da Vinci has a place. Just not there.

Don't tell young william: he'd have done exactly as well without da Vinci. He got dazzled.

YoungWilliam said...

[dramatic voice]
I was dazzled in the name of science!
[/dramatic voice]

Actually, the switch from the regular method to the robotic-assisted method was virtually a last-minute thing. At the time of the initial scheduling, they said there was a slight chance they might use the machine, depending who was on that day. About three days before the surgery, they called and let me know they'd be using the machine.

They've got the equipment, they wanted the practice with the equipment, I had the innards to practice on, I thought, "Might as well"

Sid Schwab said...

Well, yeah, that was my other theory.

Using it to gain experience is a perfectly good reason.

mariposa05 said...

Well, I'm glad that I didn't miss out on anything because these 3 holes on my gut definitely cannot be mistaken for the work of Da Vinci. Although if I stare at my bellybutton for a very, very long time, and squint my eyes, it does kind of remind me of Whistler's Mother....

Sid Schwab said...

mariposa: and at the end of the operation, when they were letting the gas out, it might have actually whistled!

lori said...

Hey doc,
Great blog, and very impressive that you are responding to all of these comments and questions people leave for you.
On that note: wondering if you could comment on my situation.
I am a 41 yr old female, gave birth about 7 months ago and shortly after that, experienced my first "attack" late at night...started as a burning in the upper portion of my stomach, then intensified in pain through my back and shoulders, with a lot of pressure, and yes, definitely like an "elephant on my chest" sensation. I'd never had this feeling before, thought maybe it was acid reflux, but had a feeling it was something else as it was such intense pain. Since that time, I've probably had 6 more "attacks" almost all occuring in the middle of the night, lasting at least an hour, sometimes longer, but all eventually subsiding.
I did have an ultrasound, and gallstones were detected, though I was told that my gall bladder was not inflamed.
In a related note, My doc also did a blood test and I tested positive for h pylori, i took antibiotics for 2 weeks.
Now I have not had an attack in close to 2 months. A surgeon diagnosed me as a "classic case" and recommended removal of my gallbladder, and I am scheduled for surgery this Friday. This is obviously an elective surgery as I am not in an urgent or emergency situation, so of course, now I am second guessing it.
My question: is there any way perhaps my gall stone pain is gone for good? Does it always come back?
Maybe the pain was caused by the h pylori? (though most of the research i found regarding h pylori was not consistent with the symptoms i experienced.)
I guess I'm just wondering if it makes sense to take a "wait and see" approach. I do not see any correspondence btwn eating fatty foods and having an attack, so modifying my diet probably wouldn't have much affect.

Thoughts?

Sid Schwab said...

lori: of course I can't be as accurate as your own doctors. Your description of your symptoms indeed sounds like what I'd call "classic" for biliary colic. As you've noted, it's not always the case that it relates to food, and for many patients diet has no role in causing or managing symptoms. As you also noted, it would be highly unusual for h. pylori to be the cause of those symptoms.

Most people with biliary colic wouldn't show inflammation on ultrasound: that usually is seen with acute cholecystitis, which is a more severe situation than the pain that comes and goes within minutes or an hour or two.

I have no way of predicting your future. It's not impossible you'll never have another attack. The majority of people who have attacks continue to have them; among those, some will never have worse than episodic pain. Some will have more severe and dangerous events, such as cholecystitis, or jaundice or pancreatitis. By far, most people who get those more severe events recover fully. A small number don't.

Those are generally accepted facts. What to do about them is a decision for you, along with your doctors, to make.

lori said...

Thank you SO much for your quick and informative response. My surgeon said pretty much the same thing you did (though I must admit, you said it better)...though I don't know you, I have been reading your blog extensively (as well as the answers to questions/comments you've left) and I knew I'd respect whatever you said.

So I do appreciate your thoughts. And yes, looks like I'll go ahead with the surgery this Friday....

thanks again.

Anonymous said...

I had my gallbladder removed when I was 19 weeks pregnant (March this past year), I was very very ill, liver enzymes were elevated, I was unable to eat or drink anything and I lost over 8 lbs in 5 days. So after three days of clear fluids and still getting attacks...which only happened suddenly, I have never had problems prior to the being pregnant or even earlier in the pregnancy, they operated. Very scary knowing there were risks to the baby, but I was sure and the doctors agreed that waiting was a higher risk to the baby and myself.

Now I am 34 weeks pregnant, my scars are still very red and I have been experiencing pain where the incision scars are. Is this just related to stretching in the third trimester or is there a chance that my incisions may be infected or something now?

Sid Schwab said...

I really don't like to comment on specific issues like that, from so far away. You should address your concerns to your surgeon.

Leigh Ann said...

Dr. Shwab, I wanted to thank you again for this blog. I had my gall bladder out today after years of intermittent pain and mis-diagnoses. I had been in pain quite often in the last month and was unable to eat more than 8 - 10 grams of fat in a meal without pain. My case was difficult to diagnose because it caused pain in my back right next to my spine at about my bra-strap level.

Reading this blog educated me and helped me to know what to expect. My surgeon told my mom while I was in recovery that my GB was about to rubture and he almost had to convert to an open surgery. I'm very thankful I got this done before I had major complications.

I had my surgery at 1:00 today, and it's almost 8:00. I feel okay, not ready to dance a jig or anything, but not too bad. I guess time will tell as I gradually begin to eat normally but so far I've had some soup, crackers and soda.

Thanks again and God Bless you.

Anonymous said...

Hello-I had a lap choly for nonfunct gallbladder, although I really didn't have any pregallbladder sxs other than the RUQ pain and mild pancreatitis at the time. Hida showed 11% so I was told get gb out-you'll be fine. I was for 3 weeks then I dev'd SOD and severe gastroparesis.I'm on tpn as my stomach does not empty it's own secretions. Do you think my vagus nerve was damaged from the lap choly-is that possible or some other nerve. My upper incision was at the sternum-so my thinking is that's the only place the vagus could have been possible injured. thanks for any comment.

Sid Schwab said...

I'd think it'd be nearly impossible to injure a vagus nerve during gallbladder surgery of any sort. The nerves -- at least the truncal portion the cutting of which would affect gastric emptying -- are simply nowhere near where one would be working.

It'd be useful to know if there were any stones found in your gallbladder: if the only evidence for gallbladder trouble was a low emptying number on the HIDA scan, depending on when the scan was done in relation to your pancreatitis, then there might well be another explanation for the pancreatitis, and it could relate to the gastric problems as well.

Remember, of course, that I have no way of giving a useful opinion on a case with which I'm not familiar.

t3h said...

I'm having my gallbladder out in two days (multiple small stones, 1 attack and mild regular symptoms).

My concern is with the supposed "drainage tube" that I will have sticking out of me post-surgery. Does everyone get this tube? How long does it usually stay in? do I need rubber bedsheets just in case?

I have read a lot online but haven't been able to find any answers on this specific issue.

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