tag:blogger.com,1999:blog-30499448.post4433775646834883126..comments2024-02-18T13:53:30.168-08:00Comments on Surgeonsblog: Rocks in a Bag: what I know about gallbladdersSid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.comBlogger391125tag:blogger.com,1999:blog-30499448.post-58139561044914747702017-04-06T16:08:37.586-07:002017-04-06T16:08:37.586-07:00That ultrasound is significantly different from wh...That ultrasound is significantly different from what you described in a previous one: thickening of the gallbladder wall indicated inflammation and is among the signs considered pretty solid for gallbladder disease. Same with being "full of sludge." As usual I hesitate to make specific recommendations to specific readers; but the latest findings tell a much more convincing story.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-28923515088348228802017-04-06T15:40:44.728-07:002017-04-06T15:40:44.728-07:00Hi Doc----after a few more tests my gastro did a M...Hi Doc----after a few more tests my gastro did a MRCP that showed a filling defect. He decided to do a EUS and possible ERCP for a stone in my bile duct. Turns out I didn't have a stone but my gb is full of sludge and the walls are thickened. This didn't turn up in any of my other tests (CT, ultrasound etc,). My HIDA did show delayed visualization from my gb to my small intestine. I am in constant pain. He recommended I get my gallbladder out. What are your thoughts? Is this now sufficient evidence that I need it removed?Anonymoushttps://www.blogger.com/profile/09871810162366725665noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-30023728326243436492017-03-15T17:32:40.250-07:002017-03-15T17:32:40.250-07:00Rachel: I understand the hesitancy of your GI doc....Rachel: I understand the hesitancy of your GI doc. With a normal ultrasound and normal HIDA scan, it's hard to conclude that your symptoms are related to your gallbladder. OTOH, a normal HIDA doesn't rule out gallbladder origin because even when there are stones, if they aren't blocking the outlet of the gallbladder at the time of the test, it may empty normally and without pain.<br /><br />I can't really go further than that. A better surgical opinion would come from a surgeon who can actually see you and your records.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-79858608660098761272017-03-15T11:46:47.677-07:002017-03-15T11:46:47.677-07:00Hi Doc,
I just wanted to gather your thoughts abo...Hi Doc,<br /><br />I just wanted to gather your thoughts about the recent HIDA scan I had. No pain during the scan but came back as 80% EF. That night I had a gb attack in the middle of the night w/ low grade fever and chills. The pain still wraps around my back. Have you performed surgery on high EF patients? My gastro is not convinced. I am constantly in pain. Ultrasound shows no sludge, stones. Any insight would be appreciated. Anonymoushttps://www.blogger.com/profile/09871810162366725665noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-58871952159172881212017-03-13T07:45:00.809-07:002017-03-13T07:45:00.809-07:00Great thanks for your response. It's reassuri...Great thanks for your response. It's reassuring to hear that you've never had reported incidents with all the procedures you've done. Just recently I've started an ox bile supplement that's eradicated all of my gastroparesis symptoms, which leads me to believe that my gb is not functioning at all due to the lack of bile flow. <br /><br />I have my HIDA scan tomorrow. My previous ultrasound revealed no stones, polyps, or wall thickening. If my scan reveals a low EF and a replication of an attack I will feel much more confident of getting that thing out :). Thanks for all the info you've provided on your blog!Anonymoushttps://www.blogger.com/profile/09871810162366725665noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-82532033593998039342017-03-12T12:59:40.599-07:002017-03-12T12:59:40.599-07:00Rachel: weirdly, having gone back through about fi...Rachel: weirdly, having gone back through about five years of comments here, I can't find your original one, so I'm unaware of any details of your situation. In general, though, I consider all of those diagnoses (biliary dyskinesia, SOD, and, to a lesser extent, gastroparesis) often over diagnosed and under-defined. Gastroparesis is a little more specific. As a consequence of cholecystectomy, it's very rare, enough so that it might be coincidence rather than a result. It's hard to damage the nerves controlling stomach musculature when removing a GB. Having done at least a couple thousand cholecystectomies, I don't recall a specific case of it. <br /><br />I'd say, however, that there likely are instances of gastroparesis that were misdiagnosed as biliary dyskinesia. Maybe vice versa, too. I'd suggest there's overlap between the conditions that cause delayed gastric emptying and delayed gallbladder function, some of which are transitory: other illness, medications, etc.<br /><br />Similarly, I'm not sure how many cases of SOD are real; and of those that are, which might have been caused by the operation or which had masqueraded as gallbladder disease. It's all very iffy and there are no tests that are 100% reliable.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-6129663906678619692017-03-12T12:35:31.779-07:002017-03-12T12:35:31.779-07:00Hi Doc,
I had one more question. I still have my...Hi Doc,<br /><br />I had one more question. I still have my gb but I'm starting to have symptoms that resemble gastroparesis. I want to get tested before I have my HIDA scan. I read a study about a group of people diagnosed with biliary dyskinesia, they had gb surgery, and most ended up with gastroparesis at some point after surgery. <br /><br />What are your thoughts about this condition? Do you see this much in your practice?<br />Is this less prevalent then SOD post surgery?<br /><br />Thanks again. Anonymoushttps://www.blogger.com/profile/09871810162366725665noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-39953943076931881632017-03-06T18:19:33.067-08:002017-03-06T18:19:33.067-08:00Thanks for your reply, sadly I have to see a GI Dr...Thanks for your reply, sadly I have to see a GI Dr before I can see the surgeon :( public health system! I am back at my specialist end of March and she said if I hadnt heard she will be on the phone. <br />My cousins only had theirs removed in the last few years at 20 and 35 yrs but my mum had hers out in her late 30s and she is in her 60s now, she still ended up with IBS but all reflux dissapeared. She did end up with a colostomy bag but highly likely completely unrelated, as her bowel almost ruptured after many many years of constipation and laxative use.<br />I am using the naturopath just for gallbladder support until I am seen but will take the surgery as soon as they offer it me. Symptoms progress to bloat after most meals ( ox bile suppliments are helping) and gas and pretty much nausea most of the time, so hopefully when i am finally seen it wont be long until they remove it! NatXhttps://www.blogger.com/profile/14893271523206863246noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-85175522066519788922017-03-06T16:47:00.461-08:002017-03-06T16:47:00.461-08:00Glad you found the blog, NatX, and that you've...Glad you found the blog, NatX, and that you've found it useful. Seems you have at least two live sources in your cousins; I assume they haven't gotten cancer or those other nasty things about which you've been warned. <br /><br />As you must have inferred I place naturopathic remedies at about the same level as flushes. In fact, flushes seem to be a favorite of naturopaths. It's all bogus. <br /><br />I can't be in the business of diagnosis here, or even specific treatment advice, nor can I or anyone predict the future; but I'd say the appointment that you need is not with a GI doc but with a surgeon.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-25934707362408689122017-03-06T14:55:25.668-08:002017-03-06T14:55:25.668-08:00Great blog and refreshing find in all the forums a...Great blog and refreshing find in all the forums and groups I am in telling me too flush!<br />I am a mum of 4, not overweight except when pregnant and afterwards until loosing baby weight but am now 42, fair and female :) I have a mum, grandmother needed it but had cancer so they didnt remove, two cousins who all needed gallbladders removed at a young age due to stones.<br />I started with chronic IBS symptoms in July caused by higher fat healthy foods such as nuts and coconut with tummy cramps. I had been paleo/primal for many years but gaining weight. after being diagnosed with IBS, 4 mths later awoke with reflux, never had an issue with reflux unless pregnant and certainly wasnt that, it stayed and lasted all day every day, meds did little to help. After seeking the Dr again, she felt my tummy and found it tender above the GB, so went for ultrasounds, Multiple mobile gallstones upto 1.5 cms have been found and I was referred too gastro in October ( still waiting and its March!)<br />Since then I have lost 14kg, can hardly eat most foods as it triggers IBS and/or GERD symptoms ( all this also occurred in my relatives due to gallbladder too) Constant feeling of a bruised/cramp in my rib and tummy pain. I get very little real pain, only occurring once for 2 hrs after a lamb sausage. Foods I can tolerate are getting less and less with causing reflux now. I am fine with dark chocolate though? and pork sausage? But cannot eat much else, so live mainly on chicken and rice. My specialist for another disorder isn't happy as I feel ill, I have episodes of back pain and shoulder ache over the past years but have always put it down to physical job and kids and being busy. My specialist has said I should be seen quicker so has referred me internally, that was in Jan, so will see as I am back there this month to see if I have been booked. I have been told any pain, go straight in, however I dont seem to get that knee dropping excruciating pain? The worst i had was a knife feel at xmas on a scale of about 5-6, my normal crampy bruised feel is only mild and constant. I have since had a full CT scan by my specialist but all was clear and normal.<br />I have been told all about how flushes will save me but I have been working with a naturopath since October and getting worse not better, taking liver and gallbladder herbs and supplements, chanca piedra tea and trying to heal whilst I wait my appointment, I have no interest in the flush which I deem unsafe. I also read about all the issues afterwards which has scared me, such as chronic bowel issues, pain, leaking bile, cancer etc.. infact told by one person I will get cancer if I remove my vital organ and be sick forever, so this blog is great and puts things into perspective.NatXhttps://www.blogger.com/profile/14893271523206863246noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-74063039622732010992017-01-17T11:59:33.473-08:002017-01-17T11:59:33.473-08:00That is good to hear about low chances of adverse ...That is good to hear about low chances of adverse consequences - thank you! There are plenty of horror stories online from people who've had bad experiences, but of course people for whom it went smoothly aren't very likely to bother posting about it. <br /><br />I will be thrilled if the pain goes away. Like I said before, I've generally been fine during the day, but the pain at night is bothersome, and it's starting to seep into daytime hours (mostly back pain). The prospect of not having this frequent pain AND getting to sleep through the night is actually pretty exciting. Heatherhttps://www.blogger.com/profile/15813481578211255708noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-21592812707556623032017-01-17T11:50:08.145-08:002017-01-17T11:50:08.145-08:00As I've written, Heather, people who've ha...As I've written, Heather, people who've had symptoms from gallstones are among the most happy and grateful patients I've had. And the odds of having adverse consequences from gallbladder removal are extremely low.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-88933136033633186652017-01-17T11:43:58.757-08:002017-01-17T11:43:58.757-08:00Yes, at this point clarity is looking pretty appea...Yes, at this point clarity is looking pretty appealing. And, as I mentioned, sleep. It's taken almost a year and a half since the first symptoms (upper back spasms at night only) to get what I hope is a definitive diagnosis. I was initially very leery about the prospect of surgery but at this point I may be coming around.<br /><br />Heatherhttps://www.blogger.com/profile/15813481578211255708noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-74013439920923486592017-01-17T11:28:47.339-08:002017-01-17T11:28:47.339-08:00Well, Heather, maybe it's finally becoming cle...Well, Heather, maybe it's finally becoming clear! This started with a question about sludge and my comment that it was sort of gray zone stuff, but when combined with typical symptoms of stones, I considered it a significant finding. Now they see stones, which makes it more so. Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-54639141193865572512017-01-17T10:52:46.200-08:002017-01-17T10:52:46.200-08:00Hi Dr. Schwab,
The saga continues! So, the benef...Hi Dr. Schwab, <br /><br />The saga continues! So, the benefit from taking Carafate and Protonix for reflux was short-lived. Long story short, saw a gastroenterologist who originally agreed with acid reflux diagnosis. Had an endoscopy that showed gastritis but no reflux damage. Took increased doses of Carafate for the gastritis (plus other meds - antispasmodic, etc.) but at a follow-up several weeks later, I was still waking up almost every single night in pain. <br /><br />So off for a functional gallbladder ultrasound last week. And this time they found stones - I haven't seen the report so I don't now the extent of it. I just know that the radiologist nixed the idea of a Kenovac injection to stimulate the gallbladder after seeing the first scans, so they had me drink Ensure instead. I have no idea whether they simply missed these stones at the ultrasound in June or if they actually developed since then, how many or how big they are, etc. <br /><br />I've requested a follow up appointment with the gastroenterologist so I can pepper him with questions and see about other options, but at this point I think a surgical consult is in the cards. As loathe as I am to remove body parts, the promise of sleeping through the night again is starting to look pretty darn good to me. Heatherhttps://www.blogger.com/profile/15813481578211255708noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-78206834112944665212016-08-31T10:51:32.115-07:002016-08-31T10:51:32.115-07:00Far more likely, in my opinion, that if there'...Far more likely, in my opinion, that if there's stone there it's been there since before surgery. Significant surgical damage to the duct would cause other things; far as I know, not stone formation.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-77330958821724550752016-08-31T10:45:00.685-07:002016-08-31T10:45:00.685-07:00I read your blog for quite a few years while searc...I read your blog for quite a few years while searching for answers before I had my gallbladder removed in 2012. I had every test known (mri hida ct x ray ultrasound etc) all came back normal. <br />Finally got a surgeon to take a look and gallbladder was adhesed to liver duodenum and intestines. Final diagnosis chronic cholecystitis. <br />I suffered terribly for 10 years and I guess because I never had "classic" symptoms (vomiting fever elevated labs)<br />most doctors brushed it off as IBS.<br />Fast forward to 4 years later and again am having radiating pain where gallbladder was. <br />I was able to get surgeons notes from surgery and noted abnormal cholangiogram that showed folling defect in mid common bile duct and also stated he had a difficult time shooting the dye and made 3 attempts to get it to go. <br />I sent this info to my current GI and he is concerned a stone may have been left in the duct and has scheduled an MRCP.<br />My question is<br />Is it possible to have a stone in the duct for 4 years after surgery or is it more likely the duct was damaged by surgery?geishagurlhttps://www.blogger.com/profile/14077904442710529079noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-76305734085866283372016-08-07T11:01:47.028-07:002016-08-07T11:01:47.028-07:00Thanks for taking the time to follow up, Heather. ...Thanks for taking the time to follow up, Heather. Sounds promising!Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-6933400759704455202016-08-07T10:30:08.586-07:002016-08-07T10:30:08.586-07:00Hi again,
Thought I'd give you an update. Rer...Hi again,<br /><br />Thought I'd give you an update. Rereading my earlier comment I realize I left out that I've also been having back spasms off an on for about a year in the upper middle of my back. Since the abdominal pain started, on the few nights I didn't have abdominal pain, the back spasms would wake me instead. I told the first doctor I mentioned before about it and he seemed to discount it. Saw the new GP a couple of weeks ago and she also discounted it. She ran blood work (normal), said maybe it's a hiatal hernia and gave me a choice between barium swallow, abdominal CT w/contrast or referral to surgeon. I opted for the CT scan (no offense) but it took FOREVER to get the insurance to approve it and get it on the schedule. (BTW, none of the exams have found any tenderness around the gallbladder.)<br /><br />Meanwhile, I was still waking up in a lot of pain every night (abdominal and/or back spasms) and getting frustrated with not having answers. Out of desperation, I made an appt with my ob-gyn Dr. W. Not because I thought it was a gyn issue, but b/c he's a wonderful doctor who knows me pretty well, and I trust his opinion.<br /><br />So, went to see Dr. W. and he had a totally different take: acid reflux setting off esophageal and back spasms. Apparently he's seen this before. He sent me off with prescriptions for Carafate and Protonix and instructions not to eat late at night and to elevate the head of my bed. And I have found that even just sleeping propped up has been enough to make a difference - I made it through Friday night pain-free for the first time since mid-May, and again last night. Started the meds yesterday, too. I'm really hopeful that this is the issue. And I am really looking forward to calling the hospital in the morning to cancel my CT scan!<br /><br />Anyway, I just wanted to share since you were so kind to respond to my earlier comment.<br /><br />- HeatherHeatherhttps://www.blogger.com/profile/15813481578211255708noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-32447783289053175522016-06-29T08:16:55.893-07:002016-06-29T08:16:55.893-07:00Thank you! I guess we'll see how things evolve...Thank you! I guess we'll see how things evolve and maybe get a HIDA scan? I'd really like to avoid surgery if I can. Fingers crossed.<br /><br />Thanks re: the baby, too. Took a while, but we got there eventually. She was born about 6-7 weeks before I turned 43. Congrats to your niece on her little one!Heatherhttps://www.blogger.com/profile/15813481578211255708noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-3659693336695943812016-06-29T08:07:39.321-07:002016-06-29T08:07:39.321-07:00Good questions, Heather; not so clear answers.
&q...Good questions, Heather; not so clear answers.<br /><br />"Sludge" is one of those findings that's hard to interpret: might or might not be significant. In my practice, though, if I was pretty convinced a person's symptoms were consistent with gallbladder origin, and sludge was the only finding, I felt fairly confident that surgery would be effective. "Subtle" isn't a descriptor I've dealt with, though.<br /><br />Diets to prevent gallstones are more fantasy than fact, I think. There are some indications that, unintuitively, high carb lo fat diets are more prone to gallstone formation than the other way around. <br /><br />I don't want to comment very specifically about your symptoms, because I'm too far away. But I'll say that several aspects are consistent with biliary origin. It's possible a HIDA scan would be useful; but, as you've read, they're hardly perfect. And somewhere in the process, seeing a surgeon might be in the cards, for additional input and insight. <br /><br />Congrats, by the way, at having a baby at 42. My niece just did it at 44! Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-21919038903978123402016-06-29T05:11:03.019-07:002016-06-29T05:11:03.019-07:00Dear Dr. Schwab,
Thanks for much for this blog an...Dear Dr. Schwab,<br /><br />Thanks for much for this blog and for continuing to respond to comments. These gallbladder posts have been a nice oasis of solid information in a sea of gallbladder flush recipes.<br /><br />So, my question is basically whether "subtle sludge" would be enough to account for what I think is biliary colic? <br /><br />Me: 44 yo woman, generally healthy, had a baby 19 months ago. I've been having pretty intense pain in the epigastric area and/or RUQ every night for a month - intense enough to wake me up. It feels like a spastic or contracting pain - reminds me a bit of my unmedicated labor. At most it has lasted an hour or two, but over the course of the month, the intensity and duration have lessened a bit. This week it's been waking me up but subsides if I get up and move around/sit up rather than lie down; heating pad helps, too. None of these attacks are accompanied by nausea, fever, etc. and I don't see a connection with eating particular foods. I'm totally fine during the day. <br /><br />Had a abdominal ultrasound last week which showed "subtle sludge" in the GB and mildly fatty liver, but no other issues. <br /><br />Turns out my regular GP's office is more alternative-leaning than I'd realized and their recommendation was a gallbladder flush and going vegan. Cue me looking for a new PCP, but that appointment is a few weeks off.<br /><br />In the meantime, I wanted to ask whether "subtle sludge" could be responsible for biliary colic, if that's what this is, or should I be asking about different possible causes? (I will ask for a referral to a gastroenterologist if the new PCP seems stumped.) If so, am I right in thinking that sludge may resolve on its own. If there's a decent chance of that, I'm willing to wait it out for a while in the hope of avoiding surgery.<br /><br />Also, how much relationship is there between fat in the diet and the formation of sludge and stones? I get that a fatty meal can trigger an attack in someone who already has stones, but does it help cause them? (Hoping I can dismiss current doc's exhortations to become a vegan....). <br /><br />Thanks so much for your thoughts!Heatherhttps://www.blogger.com/profile/15813481578211255708noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-49755339185655145762016-03-24T06:12:32.842-07:002016-03-24T06:12:32.842-07:00I understand your dilemma, Patricia, and you'v...I understand your dilemma, Patricia, and you've hit upon a central problem with cancer treatment: we can quote statistics for large numbers people, but to make a perfect recommendation for an individual is impossible. Some who undergo chemo and/or radiation will be cured by it; others won't. Some who undergo it would have already been cured without it. At this stage in our understanding, we can't test an individual in advance to know. This applies to pretty much any cancer, not just gb.<br /><br />You're right that you're lucky to have been found at an early stage. I assume that your surgery included taking a swath of liver around the gb. That's, I'd say, considered the minimum requirement in most situations. If not, then radiation is a strong consideration. <br /><br />Chemo, as I suggested, is sort of a crystal ball thing. Given the generally aggressive nature of the tumor, I'd guess you'd find a majority of opinions favoring it. As you've said, it could be a waste of time and a source of misery if, in fact, you're already cured, or if you're not and the chemo won't make the difference. There's no perfect way to decide, and, having had many patients in similar situations (though mostly with other kinds of cancer) I sympathize with you greatly. Some day, I have no doubt, there'll be ways to determine much more specifically which people will benefit from which kind of treatment, and which won't. At this moment in our understanding of cancers and their treatments, you're forced to make a decision based on recommendations, trust, and, I guess, gut feelings.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-90389899744663176872016-03-24T00:00:03.260-07:002016-03-24T00:00:03.260-07:00I wish you were still writing. I was diagnosed wi...I wish you were still writing. I was diagnosed with gbc (T2N0) on 1/8/16. 47 yo female otherwise healthy. Non smoker etc. I woke up in the middle of the night with pain bad enough to want to kill myself, and I'm tough. It was pancreatitis and puzzled the med team as they could not see any gallstones after multiple imaging and imaging with contrast but they did find a tumor on gb. Ended up resected. I feel lucky at T2N0 but confused because the prognosis still looks bleek. Tumor board was 50/50 on adjuvant therapy but oncologist really pushed for chemo and rt. Is median survival really 38 months? If chemo buys me 6 months but takes 6 months and making me sick (I've been feeling 100% since surgery ) why am I doing it? I wish someone would just give it to me straighAnonymoushttps://www.blogger.com/profile/12374493368688680752noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-47053990299139404142016-02-20T10:17:03.208-08:002016-02-20T10:17:03.208-08:00Denise, I don't make specific recommendations ...Denise, I don't make specific recommendations to individuals on this blog, but I can provide generall comments.<br /><br />First, "sludge balls" is a term new to me! Sludge, in general, is a sort of grey-zone finding, although it's toward the end of the spectrum where stones fall. I guess I'd consider "sludge balls" even further in that direction.<br /><br />I usually only ordered HIDA scans when there was suspicion of gallbladder problems but without confirming evidence on ultrasound. If a patient had symptoms suggestive of biliary origin, and if there were findings on US that support the idea, the findings on HIDA wouldn't add much: if abnormal in the way I've described elsewhere on the blog, i.e., if it showed significantly delayed emptying, AND if injection of CCK (the stuff that makes it contract) reproduced the pain syndrome, AND if the pain syndrome was typical of biliary colic, I'd expect high odds (not 100%) of resolution after surgery. But if there were stones or other significant suggestions (like sludge balls?) on US, I wouldn't order it, because if it was normal it wouldn't rule anything out. <br /><br />You've said your symptoms are "typical." I think your surgeon will better be able to evaluate that than I, and his/her thoughts on the interpretation of the US findings will be more on point than mine as well. When I saw patients with typical symptoms and findings on US that I considered significant, I'd generally say I thought they'd be improved by surgery. However, except in particular extra-risk situations, I emphasized that the reason to have the surgery was to relieve symptoms. If the person preferred living with them to surgery, I didn't press; but I pointed out the possible future problems, and the fact that no one can predict with certainty if or when they might occur.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.com