posted
Hi. My husband (after thousands of dollars worth of tests) was called the other night by his gastroenterologist's nurse who said that the doctor would be referring him to a surgeon because on his CCK-HIDA test his "ejection refraction" was abnormal.
I've read all about gall bladder surgery and I'm wondering, is taking the gall bladder out really the best thing? I know that the alternatives sound absolutely insane, but there are so many stories about people who had problems after gall bladder removal. The whole liver flush thing sounds like complete quackery to me, but the cholecystectomy seems downright scary. And if he still has the same symptoms after it, he'll be really pissed.
We are a bit annoyed that they haven't even told us what the problem is (no gallstones, though) but instead have to wait for the surgical consult.
My question is, for what reasons should the gall bladder be removed? There are no gall stones, like I said, but he has had progressively worsening symptoms. The original "heart burn" started 25 years ago, but the acute nausea started about a year ago (intermittent) and the heart attack symptoms have only occurred a few times. I just don't want to sound like a complete idiot when we go to the consult tomorrow. From what I understand, the liver did it's job, but the gall bladder was slow to fill and very slow to empty. He has felt a bit better since starting Atkins (and losing 50 pounds so far!) but still has occasional nausea/vomiting (though that has been limited to "hot wing" nights, which generally include a very tense sporting event, so who knows if it's the wings, or the sports causing that problem. )
Oh, and if after having his gall bladder removed he can't eat "real food" we may as well just shoot him now.
So, if it's not gall stones, what else could it be? I'm wondering if the gall-bladderlike-pain is a symptom of something else. Is that possible? His liver function blood work was normal, and the scan said it was working correctly. His white cell count was "a little high, but nothing to be excited about." Could it be his pancreas that is causing the problem? Do gall bladders just go bad for no reason?
posted
And by the way, the "heart attack" symptoms happened before Atkins. They are the reason for Atkins, so the diet wasn't the cause of the problem. (I know gallstones are mostly cholesterol and that a low-fat diet might help. Trust, that ain't gonna happen in this lifetime.)
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I can't answer the medical stuff but I can give first-hand experience of gall bladder surgery.
Mine was removed because of gallstones. It was done outpatient and I was in a lot of pain and laid up for about two days. On the third day I was just weak. I never took even half the quantity of pain pills I was given. So, I can honestly say the surgery itself was not a big deal, at least not compared to my hysterectomy that is.
Now, as to after. I have had zero trouble. I've not had any change in my eating habits, and I never once "missed" my gall bladder. Except for the fact that I didn't have any gallstone attacks, which was a welcome blessing.
On the flip side, my aunt finds that since hers was removed she has trouble with high fiber foods, she says if she eats a salad she needs to be near a bathroom because her body will "process things" very quickly. I did not have any major change in bowel habits. (and that was a lovely sentence to post on a public forum, wasn't it?)
If there's any questions I can answer directly, feel free to email me. bamawards@msn.com
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quote:Cholescintigraphy — Cholescintigraphy (generically referred to as a HIDA scan) is indicated if the diagnosis remains uncertain following ultrasonography. This nuclear medicine examination uses a technetium labeled hepatic iminodiacetic acid (HIDA), which is injected intravenously and is then taken up selectively by hepatocytes and excreted into bile. If the cystic duct is patent, this agent will enter the gallbladder, leading to its visualization without the need for concentration. The HIDA scan is also useful for demonstrating patency of the common bile duct and ampulla. Visualization of contrast within the common bile duct, gallbladder, and small bowel occurs within 30 to 60 minutes (show radiograph 3). The test is positive if the gallbladder does not visualize, which is invariably due to cystic duct obstruction, usually from edema associated with acute cholecystitis or an obstructing stone.
Cholescintigraphy has a sensitivity and specificity of approximately 97 and 90 percent, respectively [28,32]. Cystic duct obstruction with a stone or tumor in the absence of acute cholecystitis can cause a false positive test. Other conditions can cause false positive results in which the gallbladder does not visualize in spite of a nonobstructed cystic duct. These include:
Severe liver disease, which may lead to abnormal uptake and excretion of the tracer.
Fasting patients receiving total parenteral nutrition, in whom the gallbladder is already maximally full due to prolonged lack of stimulation.
Biliary sphincterotomy, which may result in low resistance to bile flow, leading to preferential excretion of the tracer into the duodenum without filling of the gallbladder.
Hyperbilirubinemia, which may be associated with impaired hepatic clearance of iminodiacetic acid compounds. Newer agents commonly used in cholescintigraphy (diisopropyl and m-bromothymethyl iminodiacetic acid) have generally overcome this limitation [33].
False negative results are uncommon, since most patients with acute cholecystitis have obstruction of the cystic duct. When they occur, they may be due to incomplete cystic duct obstruction.
The sensitivity and specificity of ultrasonography for detection of gallstones are in the range of 84 (95 percent CI 0.76 to 0.92) and 99 (95 percent CI .97 to 1.00) percent, respectively [28]. Ultrasonography may not detect small stones or sludge as illustrated in a study that compared ultrasonography with direct percutaneous mini-endoscopy in patients who had undergone topical gallstone dissolution [31]. Ultrasonography was negative in 12 of 13 patients in whom endoscopy demonstrated 1 to 3 mm stones or fragments (show endoscopy 1) [31].
posted
If the gallbladder is "sluggish," (i.e., not functioning in a coordinated and appropriate manner to squeeze out the bile), then I believe cholecystectomies have been of some benefit. I will try to read up on this and see if I have anything to contribute, Kayla, but I suspect that Theca will do a much better job.
posted
So, he could actually have gall stones that just didn't show up? Is removing the liver really the only thing to do?
(Belle, thanks for the info. It's the people who had bad reactions that scare the heck out of me. But, as long as you're here, do you have any problem digesting fat? Also, you probably don't eat food in the quantities that my husband does, but have you had any problems with digestion in general? I know that the bile leaks into your stomach slowly all the time, but when you need a lot of it, like after eating a lot, you can't produce it fast enough, so I'm wondering if you've had any problems in that area.)
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posted
I have no trouble digesting fat, and no trouble eating large meals. I wish I did in some ways, LOL!
I honestly didn't have any poor reaction. My weight did not change, I didn't have to change my diet, it just didn't bother me in the slightest.
Now, I was on a non-fat diet in the weeks between my diagnosis and the surgery, but it was a very short period of time. After having one gallstone attack, I was willing to do whatever the docs said would prevent another one!
CT and I have had this discussion before, about hearing stories about medical diseases or procedures. You probably had no idea I'd had a cholocystectomy. I've never had any reason to mention it. It's the problems that get talked about. When I was heavily involved in support for women with endometriosis, I was exposed to nothing but negative stories about doctors, about the drugs, about surgeries. I didn't get a whole picture and get to see the people who responded well to treatment. I was almost surprised when I had no problems after my hysterectomy, because I'd so many accounts of women who had the surgery and then still had problems, I expected to be one of them.
So maybe you're just getting a skewed look at experiences? It's fairly common, isn't it Theca? The procedure I mean. I think there are thousands of success stories out there that you just may not have seen.
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posted
Abdominal pains are very weird and often hard to figure out. 15% of appendixes that get removed are normal; 15% of folks that get gallbladders removed have no improvement of symptoms. Best thing is probably to see the surgeon, discuss symptoms, let him do an exam, see the labs/tests, and discuss pros and cons. He can give you an opinion on how likely he thinks the surgery will help.
Sure, pancreases can have pain...usually acute episodes have elevated labs, and I assume he has not. The GI doc must have examined his GI tract thoroughly, I'm guessing he already did endoscopy and xrays, right? So less likely to be an ulcer or gastritis or something. I'm assuming they are sure it isn't his heart. If the surgeon isn't sure he can always do a CT scan, if one hasn't been done already....
Gallbladder removals are pretty simple; they kicked my grandma out of recovery in 2 hours because they needed the bed and sent her home. (age 75). Any surgery can have complications, of course. As for symptoms afterwards, I am not the best to ask. People like Belle, and surgeons will know the best. I can tell you I haven't met any patients who had their gallbladders out before I met them and deeply regretted it...they all seem to have done just fine. There are oral medicines I give to a few patients to take when they plan to eat out to prevent diarrhea; it seems to work well.
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posted
It's not his heart. That was checked out quite thoroughly before this latest round of tests started. They haven't done an endoscopy, surprisingly. They did an upper GI and stomach emptying study and the Cholescintigraphy with the cholecystokinin modification. (After all the heart stuff, of course.)
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posted
I'm willing to throw in my experience, if it's wanted. I had gallstones, and well, pretty much the same experience as Belle. Simple surgery, relatively easy recovery, no problems since. I am not in the habit of eating, say, large portions of pig at one sitting, but I've never had a digestive problem since.
FWIW, the attacks felt just like how I thought a heart attack must feel. I was pretty sure, the first time, that I was having a heart attack and was gonna die.
OTOH, a woman of my acquaintance has told me far more than I wanted to know about her gallbladder experience, and she only has a BM about once a week now, no matter what she does. Just so you know.
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posted
He doesn't have what would be described as "normal" gall bladder pain. He is nauseous, has constant indigestion and occasionally will vomit. The "heart attack" symptoms didn't include actual "pain" either. It was a numbness of his left arm, a cold sweat, dizziness, nausea, all of which are symptoms of a vagal response.
posted
This is the only thread I've seen her in, Farmgirl, so I'm afraid it may be one of those "for a limited time only" type things. The trick, now, is to lure her into some of the other threads, and post things that she'll feel compelled to respond to. All we have to do is keep it up for a few days, and she'll be hooked again.
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posted
Kayla I'm now 25. I had my gallbladder out at 24. I can assure you that gall bladders do go bad for no immediately obvious reason. Though once they got in they found out that my gall bladder was totally full of gallstones and I may have even been passing them.
I had the symptoms you are describing but in a much accelerated fashion, heartburn probably started a year before, getting more and more frequent. Then over a two month period I had attacks that caused extremem nausea, and hurt so badly that I was curled up in a fetal position on the floor of the company bathroom. (It always happened in the evening after most employees were gone though so I never asked for help or went to the doctor.) I just thought it was really really bad heartburn.
The last attack was so bad that I didn't think I could live through the pain again. I had Steve take me to the ER where they promptly put me on a morphine drip and wouldn't let me leave because my liver counts were way off. Within 24 hours apparently I would have had an even more major crisis, and they were amazed that I had withstood the pain for as long as I had.
The gallbladder came out the following morning. I stayed in the hospital one more night and came home the next day. Walking was fine. I was totatly ok other than a bit of soreness though I did take the vicadin for two days, before I decided I didn't need it. We closed on our house that same week, and I was packing and moving boxes the entire time I was "recovering" though I didn't do extremely heavy lifting till the following week when we moved the couches.
The surgery was laporoscopic. I have three little tiny holes one in the belly button, and about a 1.25 inch scar just below the breastbone. The doctor I had, actually crushed up the gallstones while they were in the gall bladder inside of me so that he didn't have to cut a larger incision (gives you an idea of how big my gallstones were). Theca said that most doctors though would slice you open just a little bit more. I'm glad mine didn't, it made recovery that much quicker.
If you do a search you will find that Gallbladder removal is the most common surgical procedure in the US, and it is really hard to mess it up.
If they are wanting to do more exploratory surgery at the same time it would definitely be a bigger deal.
The thing is, if it is the gall bladder and it is removed, the major pain is gone in a very easy *poof* The pain of recovery was nothing compared to what I was experiencing with the attacks. In fact it was so simple I wondered why I had been willing to deal with the pain for so long! (but of course I didn't know it was my gall bladder before the last attach which was a textbook attack with pain radiating through the breastbone to the spine)
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posted
The only lingering side effect I have, is actually that of occasional mild heartburn, except it is true heartburn and responds to antacids. It feels like a bit of stomach acid just lodges itself into the little niche where the scar is and kinda irritates it. But it isn't anywhere near the order of magnitude of the prior pain.
posted
Oh, and dangermom, too. I'm mostly worried about bile duct damage. I guess we'll just wait till tomorrow for the surgical consult. (We found out last week, and I've been avoiding thinking about it, but now that we are actually going to the surgeon, I need to be prepared. It does seem that the complications are fewer now than they were a decade ago when the laparoscopy for this surgery was still pretty new (first one done in 1998.)
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Like Belle I haven't had major problems eating greasy foods. I mean the only greasy things that has every given me heartburn is something so greasy that people WITH gallbladders have heartburn too. I did gradually ramp up after the surgery though, didn't eat many heavy foods to begin with.
And if it is the gallbladder causing the problems, getting it out NOW is the best thing to do.
I found out that I actually do have a family history of gall bladder issues, back in my Great-Grandmother's generation. She actually died from cancer that started in the gall bladder. She had gallbladder issues and attacks for years but never had it out. The docs said that it was highly likely that the constant irritation was one of the things that made that area succeptible to the variety of cancer she had. If she'd had it out, the irritation would have subsided and not been ongoing for years.
The sister to my great grandmother, my great great aunt Irene, is still alive today and quite active though I think she is approaching her nineties. She had her gallbladder removed probably over 30 years ago back when it was a much more major surgery, and still hasn't regretted it a day.
quote: The doctor I had, actually crushed up the gallstones while they were in the gall bladder inside of me so that he didn't have to cut a larger incision
..umm... except gallstones aren't truly "stones" in the sense of being hard and rock-like, like the more common kidney stones. Gall stones are like blobs of fat -- kind of putty like; firm putty. So he wouldn't have had to really "crush" them, just kind of "mush" them up to make them smaller.
posted
The dry ones I extracted cholesterol from, a long time ago in chemistry class were definitely hard, though more protein-like than bone like.
Either way he took the slightly more difficult way to do it rather than just widening the incision which is what Theca said she would have done in the same circumstance.
posted
I can't help with any gall bladder experience, Kayla, but I'm glad to see you, and I trust all turns out well for hubby.
I also had a question for you, but with you being away it seemed awkward (which just looks wrong no matter how I spell it, ironically) to write just to ask for information. You know, kinda like calling someone to help you move, even though you haven't seen them in a long time, but they own a pick-up? It's kinda like that.
<Prayers happening. For your husband, that is, not that you'll help me with the other info.>
posted
What's up Moose? You can always e-mail me. I try to check this address everyday. I read up on what's going on with your family. I'm hoping things are better than they originally seemed to be. Sometimes it feels like it's never-ending, doesn't it? If it's not one thing, it's another. There is a quote from Taken that seems apt. Something about liking to think we have some control over our lives and all. Posts: 9871 | Registered: Aug 2001
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quote:It does seem that the complications are fewer now than they were a decade ago when the laparoscopy for this surgery was still pretty new (first one done in 1998.)
That can't be right...I helped with several laparoscopic cholecystectomies as a brand new third year medstudent. That would have been summer 1996 because I graduated in summer 1998. They let us students do the scopic camera work, guiding the camera around to follow the surgical work going on inside. And sometimes they let me sew up the little holes afterwards. I loved lap choles.
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Anna Jo, the appointment isn't till 4:30 this afternoon! Y'all have made me feel better about it though and I've pretty much resigned myself to it's inevitability. However, I know our luck, so I'm not looking forward to it.
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posted
Okay, we met with the surgeon yesterday. The ejection refraction was 27% on the scan. The surgeon, however, feels this test is a bad test. Without actual pain, the nausea and other symptoms alone aren't enough to warrant taking out the gall bladder without first doing the endoscope.
So, I'm happy with that, as I agree with him that the gall bladder is a symptom of whatever the real problem is. If, after the scope, they find nothing wrong, then he'll take out the gall bladder to see if that fixes the problem. (Though a placebo effect from removal of a gall bladder seems extreme to me.) And, he said that there is a small chance that he's got very small gall stones that aren't showing up on the scans, but his opinion is that if there were stones, they would show up.
So, it's back to the gastro guy. Hubby is not happy, but at least I feel better about it all.
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posted
*hugs* Thinking of you. Since they don't know for sure that it is the GB causing the problem, the endoscope sounds like a good idea (though I'm not a doc!)
When he has the "heart attack" type pain does it radiate through to his spine? In all the reading I've done, that is characteristic GB pain though not always present.
The way my pain was it felt like someone was stabbing me with a knife in my chest all the way through. It wasn't straight through, the pain was angled down from front to back though. And it was lower than my heart so I really didn't think it was a heart attack.
posted
The "heart attack" didn't actually include pain. It was tingling/numbness in his left arm with the nausea, dizziness, cold sweat, etc. No pain. That's why the surgeon is hesitant to take out the gall bladder.
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posted
Okay. Today, we had the endoscopy. I'm sooo glad we did that before removing the gall bladder. My husband refused to do it unless I was in the room, so they relented and let me in. Now, knowing that I'm in the room, I would have thought the doctor would have refrained from so much, "What is going on here?" and "Where is that blood coming from?"
His esophagus looks fine. 2-3cm hiatal hernia (small, I'm told?) and most of his stomach looked good. Lots of foamy gastric acid. But once past the pylorus (which is what was bleeding) the duodenum was just ugly. It looked like. . .well, I can't even begin to describe it. Like a cross between blisters and canker sores. They took a biopsy of the pylorus and are running some blood tests (h. pylori, something else that has to do with the parathyroid? and something else that measures gastric acid and would show if he had an acid-producing tumor in his intestines somewhere,) and we might know more by the end of next week. Yay!
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posted
Wow. Sounds miserable (his duodenum, I mean). Congratulations for getting some answers, Kayla, and be sure to keep us posted.
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