Thursday, October 05, 2006

My gall bladder dilemma

Last June, I had severe chest pains, that turned out to be a gall bladder attack. A sonic scan revealed that my gall bladder was lined with sludge, and filled with stones.

I have attempted to treat the condition with diet changes and health supplements. I recently had another scan, and it showed that the sludge has cleared away, so I think the diet changes helped thin out the bile. However, the gall bladder still has a number of small stones. It is roughly about 20 percent filled with small stones.


The Medical approach is to remove the gall bladder. My doctor, and the surgeon I spoke with, both insist this is the way to go. My concern is, that removing the gall bladder simply deals with the symptoms, and does not address the cause, which I would say is the thickening of the bile which caused the stones to form in the first place. My inclination is to do that; correct the imbalance that was causing the bile to thicken and the stones to form.

Since the sludge has been washed out, I think I have had some success. However, the stones may be another matter. Some alternative medicine sources recommend various versions of a "gall bladder flush" to force the stones out. Others say the stones can be dissolved over time.

The technician who did my last sonic scan said he has seen several people try to dissolve their stones by various methods, but has never seen any of them suceed. That leaves me the option of the flush, which both my doctor and the surgeon advise against. The surgeon warns that a flush could actually cause a stone to became stuck in the biliary system, requiring emergency surgery. My doctor warned me that if a stone were to obstruct the opening from the pancreas, that organ could be seriously damaged, and it could even be fatal.

So on the one hand, I'd like to make the gall bladder "well" again. On the other, I have medical doctors advising me that it would be risky and unnecessary; that the gall bladder is nothing more than a holding chamber for bile, which is used to dispense bile when large amounts of fat are eaten (and I should not be eating large amounts of fat anyway). The doctors believe there are no negative health consequences to having the gall bladder removed.




I have read that when the gall bladder is removed, the liver makes less bile, because there is nothing to hold it. I am concerned that, over the long run, this could affect my bodies ability to absorb vitamins that need to be digested with fat to be absorbed (A, D, E and K). I know the doctors don't think this is a concern, but I also suspect that if I did have such problems later in life, they would just perscribe drugs to treat those symptoms, which would just mask the problem but not cure it. But is the vitamin absorbtion issue really a legitimate concern?

I do think the doctors concerns about stones blocking things and causing problems are legitimate. Also, I read some where that if the stones have already caused scaring in the lining of the gall bladder, that may increase the chances that stones will continue to form, no matter what diet I maintain. If that's true, if that happens, then this becomes a chronic condition that would have be be managed and monitored the rest of my life, requiring repeated scans and periodic flushes of stones, with all the attendant risks. If that is the case, then having the gall bladder removed would solve a lot of problems.

I would be interested in hearing from anyone else who has faced this situation, and hearing about what you decided to do, and how it has worked out for you. Thank you.


Related Links:


SHOULD I HAVE MY GALLBLADDER REMOVED?
... The gallbladder does facilitate and regulate the flow of bile in your body. When that facilitator is taken away it is quite possible that the flow will be not as efficient, ie. too much at one time, or more commonly, not enough. ...

... You are/were already having trouble digesting fats. So why would removing the organ that regulates the metabolizer of fats improve your digestion? It may help with the pain, but know that 34% of people who have their gallbladder removed still experience some abdominal pain.

This site seemed to be the most balanced and informative. It's not entirely against surgery, but does address potential side effects in detail, not only for people experiencing gall bladder problems, but also for people who have already had their gall bladder's removed. The site has several pages and offers a lot of information.


Gallbladder, and Gallstone Clinic of Denver, Colorado
... Once they remove your gall bladder, then you will not be able to digest vitamins A, D, E, K. These all have to do with skin, immune system, circulation, and blood clotting, and sexual performance.

You need to weigh it out and realize that you do need a gall bladder no matter what the MD says.

That is a pretty serious statement. But how true is it?


Avoiding Dangers of Gall Bladder Surgery
The advent of laparoscopic surgery, which uses small instruments guided by a television camera, has made many types of surgery safer and less invasive.

In the case of gall bladder surgery, though, it has led to some unintended consequences. Surgeons could previously navigate the area around the gall bladder by feeling structures with their hands. But now, guided by a television image, surgeons can mistakenly damage the bile duct, the tube attached to the gall bladder.

"We've lost the ability to feel the structures in the abdomen," said Dr. David Flum, assistant professor of surgery at the UW. "Because of that, the risk of an injury to the bile duct is very real. It doesn't happen often, but when it does happen, it's devastating." ...

... Flum and his colleagues set out to illustrate the impact of bile duct injuries. They studied the records of more than 1.5 million Medicare patients who underwent gall bladder surgery, including the nearly 8,000 patients who suffered bile duct injuries. Nearly one-third of patients suffering a bile duct injury died within a year after the surgery. Researchers also found that repairing the injury requires a great deal of skill.

Flum's team then examined ways that bile duct injuries could be prevented. They reviewed the usefulness of a cholangiogram, an X-ray of the gall bladder and the surrounding area.

"It's like a road map," explained Flum. "A surgeon can see whether what he or she thought was the right tube was actually the right one, or if the assumption is wrong."
The researchers learned that the risk of bile duct injury dropped by half when patients had a cholangiogram before the surgery. A cholangiogram is performed only about 40 percent of the time. ...

(bold emphasis mine) An interesting article on the surgical aspects.

I refer to this as a dilemma, because I don't relish the idea of trying a "flush" and risking a stone blockage, or having to do multiple flushes the rest of my life. But neither are the risks associated with surgery, and the possible consequences afterward, an attractive alternative. I'm tempted to do nothing, but even that could have consequences of a continuing problem which could worsen later. There is also the insurance factor; I've used up my large deductible for the year. If I am to have the surgery, it would be advantagous to have it before the year end.

I know there are no guarantees with anything. But it would be easier to make a decision if I could just feel more right about choosing one of the options over the others.

UPDATE: 11-19-06
I had the surgery performed on November 15th, and I'm at home now recuperating. You can read the details in my latest post on the subject:

My gall bladder surgery
     

23 comments:

Bob said...

Get it out. And stop reading chiroquakkers. Nobody's ever flushed their gall bladder.

The surgery is a piece of cake, and you can take bile enzyme supplements afterwards

Anonymous said...

I had mine removed several years ago. It was a fairly simple procedure and I was home that afternoon. Four little ibcisions. I remember the pain of the gall bladder attack was excrusiating. I thought at first I was having a heart attack. Since the operation, I still can get an attack that centers on the right side just under my ribs near the bottom of my sternum. Some I'v talked to say I am lactose intolerant. The pain can almost make me throw up. Doctors have no answer and I have since gone back for tests and they found nothing. I never could point to any one food that was the cause or any activity. I have not had an attack now for 6 nonths. Would I do it again? You bet!

The Cheezer said...

I had mine removed Monday Oct. 2nd and have had all of my symptoms go away. Here I am on the 5th and only taking Advil for the discomfort.
I say have it removed...
But I also suggest you alter your diet to eat healthier and also get more exercise.
Follow the instruction of your naturopath for health, but accept that the damage to your gallbladder is permanent. There are many things you have been exposed to in your life that could have done this, maybe not just diet.
I have heard of great success with the “liver flush” and I will be doing it soon myself.
Something to ponder: Life is short and if you don’t enjoy it, you lose it.
All of our actions have consequences. The consequence to enjoying fried foods, rich or fat foods, processed foods or anything else unnatural, is the damage to our organs.
The consequence of denying yourself the foods you love is boredom, resentment and self loathing.
Moderation in everything in life is a good thing and I think, the only answer.
Mind you, this comes from a guy that is fat and knows it is my own fault.

Chas said...

Thank you everyone, for the great responses. It's late right now, but I will post a proper reply tomorrow.

Walker said...

I don't know anything about the gall bladder.

But I am naturally skeptical about doctors and I have zero interest in what chiropracters have to say. Remember, regarding doctors, that two seconds ago they would have prescribed leeches.

Here is how I evaluate a doctor's advice when it involves removing something:

1. Since I think doctor's don't know shit, I am loathe to let them remove something UNLESS without its removal I might die. Case in point: I had my appendix taken out.

2. Since I think doctor's don't know shit, I am suspicious if they want to make me dependent on something.

If they are going to take something out and then make you dependent on a drug or a machine for your life, think twice my friend. Tomorrow, they might think you should really keep that thing they took out.

3. If there is a VALID pharmaceutical alternative, give it a good run before you let a doctor cut on you.

A valid pharmaceutical alternative doesn't involve something from a health food store. If this is your alternative, ask yourself why, if the alternative were so effective, why hasn't a drug company put it in a bottle?

The exception: If the pharmaceutical alternative won't keep you comfortable and out of pain, don't torture yourself.

4. For everyone who says "it's easy!" there is another person who says it was the worst thing they ever did.

Find the one who doesn't like the results before you let a doctor do anything. I'd check out yahoo groups.

5. Remember doctors are like wooden soldiers. They say what they say and do what they do because they have been taught to do nothing else. They are all lined up following the advice of the guy before them. If the first guy in line was wrong, they all freaking are.

I think doctors are useful idiots. Sometimes you have to do what they say and they are even occasionally right. But, for general health issues (I'm not saying your gall bladder is one of those issues), you'll be just as well off if you ignore them.

But chiropractors are actual criminals. That whole philosophy is utter nonsense. I wouldn't go to one for a back rub.

Dionne said...

My friend just had her gall-bladder out and is doing a 100 times better. She was having a lot of problems beforehand. My understanding was your body can learn to live without your gall-bladder and bypass it but it can't live with a diseased gall-bladder. I think you need it out!!

Chas said...

Hilemanhouse:

The majority of people agree with you. I've read that 60 percent of people who have the surgery report no negative side effects whatsoever. Those are pretty good odds. Makes me feel kinda foolish for being so apprehensive about it. But once the organ is gone, it's gone for good, and I guess I'm just looking for some reassurance that it is the best choice.


Bob:

There is some debate about wether flushes work or not, but even if they do, there is some danger involved and it's not something I would like to have to keep on doing. As you say, bile emzyme supplements are available if needed, if it comes to that. Thats not as bad as dying of a stone stuck in a bile duct.


Movermike:

You have addressed something I was afraid of... continued problems after surgery. Yet you still say you would do it again, so I would guess the situation is more bearable than it was.

The website www.gallbladderattack.com has some information about why some people still have pains after surgery, and offers several approaches as to what can be done about it. Maybe you should check it out.

I found it reasuring that there are some things that can be tried if pain continues to be a problem.


The Cheezer:

You have hit on something that I've been been reluctant to accept, but has also kept me from not dismissing surgery as an option; the fact that the gall bladder may be permanently damaged, and the best results I'd be able to achieve is to be monitering a chronic condition that may improve, but will never be completly healed (scar tissue, making it easier for new stones to form).

I've done an herbal liver flush I bought at a local health food store, and drank lots of organic apple juice. It seems to have thinned out the bile and cleared out the sludge, so I'm happy about that. I think it pays to take good care of your liver and give it what it needs, even after the gall bladder is removed. The liver still produces bile, and I've read that without a gall bladder, the liver can form stones, so it's important to keep that bile thinned out, healthy and flowing.


Fish:

Those Edgar Case treatments can be really weird. Yet many people have claimed they work, so it's hard to know what to think of them. I'm glad it worked for your friend, and she's not had further problems. I've wondered though, that even if I could get rid of the stones, how often I would have to monitor (have sonic scans) to see if they have come back. It would be terrible to find out that they have come back by having another attack again some day. My gall bladder was actually inflamed, and I dare not let it get that way again. I've got some history of gall bladder problems in my family; one uncle even died of a gangreen gall bladder. It makes me fear that by avoiding surgery, I might be playing with fire.


Walker:

I take both doctors and alternative medicine with a grain of salt. I like to say that generally it's best to avoid both doctors and lawyers; but when you need one, you need a really GOOD one.

The gall bladder situation is potentially a deadly one; no one can say for sure how deadly or risky. Some argue that the chances of a stone getting stuck are small, but nobody can say for sure it won't happen, which is why I think they generally recommend removing it.

As for chiropractors; when I was 5 years old, the doctor said I had to have my tonsils removed. My parents took me to a chiropractor instead. He did one treatment on my neck. The next day the swelling was gone, and I still have my tonsils today.

Years later in Boston, I had a back problem, due to a spinal curvature I was born with. I went to an old fashioned chiropractor in the city, for one treatment, which put everything right again.

In New England, there is an old and long tradition of chiropractic. You go to the chiropractor with a specific problem, and he fixes it, usually in one treatment.

When I went to California, it was a whole nother story. There, chiropractors use all sorts of "tools" and machines; they never fix anything in one treatment, they just keep wanting you to come back again and again for expensive treatments, that are more like massage than what I knew as chiropractic. It was often mixed up with New Age alternative crap, too. I've given up on it out west; I've never found a practitioner like the ones I knew back east.

If you have only experienced the New Age ones, then I can understand your attitude. If they don't do any good, then what good are they?

I guess it all comes down to "buyer beware". Wether it's medical or alternative medicine, I try to find out just what works best, what has worked for other people, and see if it's applicable to my situation. Sometimes that means separating the wheat from the chaf, and making and informed decision, based on facts and a bit of intuition. I suppose that is what I'm trying to do here. ;-)

I'm probably leaning toward having the surgery done at this point. Thank you everyone, for you input on all this. I'll have to update this as I go along.

Chas said...

LMC:

Yes, I'm starting to think that is why the conventional wisdom is to have it out; leaving it in once it starts having problems could lead to too many future problems and dangers.

Attesa said...

Chas, you probably already know about this, and I only scanned your post after reading Pat's link to your blog...
My former roommate had a couple of laser surgeries to remove the stones. She said they were fairly painless, and the stones were passed quickly. She took some meds for a little while to help her body not create anymore stones, and she's fine now.
Not sure if that's of any help...

You're in my thoughts! Be healthy!

Anonymous said...

First, a couple of medical facts:
The gallbladder holds 1 to 2 ounces of bile between meals.
When you eat anything, but expecially food with fats in it the gallbladder contracts, and emptys the bile back into the bile duct, and then into the intestine.
Meanwhile, the liver is beginning to produce 1 to 1 1/2 lliters of bile for each meal.
removing the gallbladder DOES NOT cause less bile production by the liver.
Gallstones (and sludge) form for various reasons, some of them (female) hormone related.
Once the gallbladder has been surgically removed, the chance of new stomes forming in the main bile duct is very small (less than 1 in thousands)
BTW, I am a n MD, General Surgeon, so my bias is towards having your gallbladder removed.
Good luck.

Anonymous said...

How I (a progressive Democrat) got here, I'll never know. Regardless, I hope to offer some helpful info and wish you a successful outcome. My younger sister had a problem for several years - severe abdominal pain, inability to eat, tenderness in the stomach area- her diagnosis was acute and chronic pancreatitis. This happened due to blocked ducts caused by gallstones that were not properly diagnosed two years earlier. She spent a lot of time in the hospital practically debilitated. She finally had her gallbladder removed. The point is that her pancreatitis was probably 60% caused by blocked ducts from gallstones. She has gone thru hell and has been on more pain meds than Rush Limbaugh (altho hers were legally obtained!), anyway, she is finally doing better and on a slow road to recovery although it has not been easy. Not having her gall bladder doesn't seem to be an issue in her life healthwise. Not having it removed would have ultimately been fatal to her. Nevertheless, because of the pancreatitis and the damage caused to her pancreas, she now has to take enzyme pills before every bit of food she eats so she can digest her food. Otherwise she will be in terrible pain. Also, due to past and continuing eating difficulties, she has lost a ton of weight. She is only 39 and weighed 97 lbs not too long ago. Do not take the gall bladder issue lightly. Blocked ducts can lead to all sorts of additional problems. Hope this helps. Good luck-
Arlyn

Chas said...

Attesa:

I have heard of lasers being used to remove the gall bladder itself, but not to get rid of stones. I know there are options like using sound waves to break up stones so they can pass. But they are not common treatments. I live in a rural area, and the nearest town with a medical center only offers standard surgeries.

For the more unusual treatments I'd have to go to one of the bigger cites, take time off from work, find a doctor, a place to stay, etc. It could get pretty expensive, and there would be no guarentee the stones would not form again.

The guy who did my last sonic scan described my stones as "the dangerous kind"; small enough to pass into the billiary duct system, and possibly get stuck. Even if I could get rid of them, I would have to be monitored for stones the rest of my life, and deal with any that appreared, and hope they don't pass and get stuck. The more I read about it, the more it doesn't seem worth the risk.

Thanks anyway, for posting, I still like to hear about options.


Anonymous One:

Thanks for the facts about the bile production. That actually was a big concern of mine, about how the bile flow would work after surgery. It was an important question for me. Thank you Doctor, for explaining it so clearly.


Anonymous Two (Arlyn):

I had been pretty determined to not have the surgery and try alternative methods to get rid of the stones, but the last thing my Doctor said to me, was a severe warning about what could happen if a stone blocked the opening from the pancreas, and the digestive enzymes became trapped inside, it could cause severe damage and even death.

I went home and looked up the details on the internet, and the possibility of that has been haunting me. Now, you have told me your sister's story, and it has just underscored the warning the doctor gave me. Reading about it as a statistical occurance is one thing; hearing the actual story of someone who has been through it, underscores the danger and makes the case for surgery more convincing.

Your poor sister, she's lucky to be alive but I'm sorry to hear she has suffered so much. I hope she can gain some weight back; I'm wishing her a speedy recovery.

Gall bladder problems are a bi-partisan concern, so I'm glad you took the time to tell your sister's story here. This post is getting pulled up in searches by people looking for gallbladder information, so hopefully her story will reach a lot of people who need to know about it.

Thanks for sharing it, and best wishes to your sister for a thorough healing.

Anonymous said...

The Mrs had hers out 3 years ago. It turns out it was probably unneccesary, because she was misdiagnosed and it turned out something else was causing the pain in her ribs. However, she has had ZERO problems from lack of a gall bladder since. No supplements. No enzymes. No problem. Considering you have (I assume) conclusive proof of stones, there is no misdiagnosis on your end. And should one of those stones start to move, the pain from will drop you in your tracks. Get it out.

Chas said...

Thanks Gullygorg. It looks more and more like surgery is what I will be having.

Anonymous said...

Hi Chas. I have just returned from the hospital and after a 2nd bout of abdominal pain (attack) and high white blood cell count I was sent for an ultra sound. They diagnosed my problem as gall stones and the dr has told me my gallbladder has to be removed.

Since returning home awaiting surgery, I have been reading and searching various sites and came across your site.I to am in the same dilemma and after a few hours of reading other peoples experiences have concluded that surgery is the correct way to go.

Being that it is now mid November i was curious as to what you decided to do. Did you opt for surgery? if so how do feel?

Thanks

Chas said...

Gallstoned,

Sorry to answer this so late, I must have gotten busy with other things and forgot to check back here. You've probably had your surgery by now, I hope it went well for you.

I'm doing great! No negative side effects whatsoever. In fact, I've had one positive side effect; I no longer need to wear my reading glasses! I've experienced a big improvement in my eyesight. That started to happen about 3 to 4 weeks after the surgery.

I've made some diet changes, avoiding trans-fats, hydrogenated oils, and cutting way back on white flour. I'm including lots of liver-friendly foods in my diet, to maintain healthy bile flow. I have no complaints!

Chas said...

Oops, I forgot to add, I also cut way back on refined sugar, and feel much better for it.

Anonymous said...

I found out over two years ago that I had gall stones and sludge. I have resisited the surgery many times because the pain only lasted for an hour and with pain meds it just wasn't worth taking out an organ. I wanted my gall bladder.

I sit here in the hospital writing this blog as I am scheduled for surgery tomorrow to have my gall bladder removed.

On Super Bowl Sunday I started experienceing pain in the abdomen like I never had before. I couldn't take it and finally ended up in the hospital. What a smart move. One of my stones had made it out of the gall bladder and into the duck. Within only hours my pancreatic enzymes were 50 times normal rates and my liver enzymens were not doing much better.

My doctor told me the next time I could have much worse problems and the word fatel is not unheard of.

For two years I was not getting my gall bladder out. No way. Tomorrow, I am going to make sure I am not one of those fatel statistics.

It is all a matter of statistics. There is the possiblity of nothing happening...or the possibility of an attack being fatel.

I am not gambling with my life.

Good luck with your decision.

Hadashi said...

This has been a very useful post and a string of comments. Certainly, it is one of the first sites to put up on a search for 'gall bladder removal'.

I first had an attack about 14 years ago, in Japan. I was mostly insured, and I underwent some sonar blasting treatment. There were a couple of stones then, and they were pulverized into fragments.

I then had a couple of painful periods of about 10 minutes over the next week or two as the 'gravel' was passed out.

Recently after a very strenuous day of lifting, running for two hours and eating the wrong foods (cream buns) I suffered an attack that caused me to be seen to in A&E. A subsequent X-ray revealed what appeared to be at least a dozen 1-2 cm stones.

I have an outpatients appointment tomorrow, presumably to advise me to have surgery. I don't know - I've lived with it for so long without hassles. And I can take part in ultra-marathons without bringing on any of the symptoms. The stones are probably too large to get caught in the ducts.

Hm . . . still thinking.

kat said...

Hi! Can you give us an update all these yeas later, about any further experiences you had recovering from the surgery or about life without a gallbladder? I am about to schedule my surgery and would love to hear a bit more about your experience afterwards. Thanks!
Kat

Chas said...

All these years later... I'm doing ok. I've found that it I drink a glass of cold liquid (like fruit juice) first thing in the morning, it can suddenly trigger a very loose bowl movement.

I avoid this by setting out a glass of fruit juice when I first wake up in the morning. When I get around to breakfast an hour or two later, it has warmed to room temperature, and does not have that affect on me. I can drink cold liquids during the rest of the day, without any problem.

I take digestive supplements with meals. I take one Lipo-Complex capsule (by Progressive Laboratories) with every meal. If the meal has a high fat or meat content, I also take an ox-bile capsule (by NutriCology, 125 mg). There are larger size ox-bile capsules, but I find they give me heartburn.

Everyone is different, so you have to experiment and find out what works best for you.

maggie.danhakl@healthline.com said...

Hi,

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It would be much appreciated if you could include this tool on http://chasblogspot.blogspot.com/2006/10/my-gall-bladder-dilemma.html and / or share with friends and followers. Please let me know if you have any questions.

Thank you in advance.
Warm Regards,

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p: 415-281-3124 f: 415-281-3199

Healthline Networks, Inc. * Connect to Better Health
660 Third Street, San Francisco, CA 94107 www.healthline.com

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