Should I have my gall bladder removed?

September 27, 2011 2:44 PM

GallbladderFilterites: Should I have my gall bladder removed? Write to Dr. Oz? Storm the NIH?

First lemme say: I have already read previous MeFi threads

- about not having a gallbladder and still having symptoms
- about having a more extreme gallbladder situation than my own ,
- life after surgery

I have posted several times over the past three years - and trust me when I say I have had pretty near every g.i. test there is for my peculiar and slowly life-draining stomach problem - but it is only recently that the gall bladder as culprit surfaced. Last week, at my wits end, I convinced a new gi doc to get me a HIDA+CCK scan, one of the few tests left I had not done, and even he was surprised to find the ejection fraction at 19% . Everything else about the scan seemed 'normal', and my previous ultrasound showed no stones. He said "Hm.... I think that could be it."

He was surprised because my problem presents as extreme bloating and pressure in my stomach, and more belchiness in general, with an occasional increase in throat clearing. That's it. It started right when I got a flu which lasted a whopping 2 days, approximately 3 years ago. It hasn't gone away since. I have these symptoms 24/7, whether I eat anything or nothing, or change my diet, or don't, or fast, or don't. I don't have any of the typical gallbladder 'attack' symptoms, no upper right quadrant pain, no urge to vomit or nausea. Not once! Although I can no longer lie on my stomach, it starts to hurt after a few minutes. It pretty much always feels like somebody took a pillowcase of tennis balls to it, and then the soreness that would likely result a while after that.

I already have Hashimoto's, IBS, & celiac, so I eat no gluten, yeast, or dairy, religiously, and only occasionally eat corn containing products or fruit sugars. I don't drink alcohol or smoke.

I have tried most of the ppi's and holisticky things (yoga, tai chi, various proven herbal things, ginger/turmeric, slippery elm powder, mastic gum, DGL, etc, oral immunoglobulins, the fancy super expensive probiotics as well as antibiotics, massage, acupuncture, biofeedback, raising the head of my bed at night, ppi & H2 antagonist combo, multivitamins, D, B12, Metanx, l-glutamine, and the latest suggestion I had from Germany, Iberogast. The Iberogast does seem to calm my lower gi down further, so that's nice.).

Add to that increasing depression and sleep disturbance which I have been unable to successfully treat with a variety of different models & kinds of cpap machines with 3 different sleep doctors and uncertainty about sleep test data (they all said "you have mild apnea, but it's not 100% clear from the polysomnograph"), crappy allergies (although they are treated well), unwanted weight loss, and you have a recipe for slowly progressing into a zombified, unable-to-work state (although I still manage to work).

I suspect getting this latest malady triggered the depression and made sleeping worse than it may have already been, and the fact that it is difficult to do a lot of the things I once loved to do (dance, various regular exercise like yoga and tai chi, swimming, regular singing) because the pressure makes breathing more difficult.

I've tried several neuro meds that I could not tolerate for long before I had to stop (I know that some of them require that initial waiting period for some side effects to lessen and the benefit to be had, if there's going to be any), because it's known that if one has something like

- "post-viral vagal neuropathy"
- "silent reflux"
- "functional/non-ulcer dyspepsia"

neuro meds may help.

I have not given up on the neuro meds entirely because I'm pretty sure I'm depressed enough at this point that I will not dig myself out of this hole without them, especially considering I can't exercise much or sleep right.

I have been to the Mayo clinic in AZ, as well as seen some specialist guys in NY, and were all uncertain. They did a ton of bloodwork though and found little of note. My ferritin was low for a while but then seemed to go back up on its own, better even, than when I started taking iron supplements, initially.

All that's left I know I haven't tried includes

- 1 or 2 brands of PPI's
- very high-er doses of PPI's (if you don't count Dexilant 60mg as 'high')
- prokinetic meds like Reglan
- steroids
- esophageal manometry to test for some other motility dysfunction
- extremely regular meditation (I'm working on this, but no amount of meditation is going to fix a truly busted gallbladder)

Somebody around here suggested the NIH Undiagnosed Diseases Program but they stopped taking new applicants as of July 1, 2011 - about two days before I found out it existed.

I guess my point to all this is: the ejection fraction is considered below normal for a healthy gallbladder. Yet I do not present the typical symptoms for a gallbladder failure. I already have IBS-D, although the D does not appear all nasty and yellowish like people often describe a failing gall bladder to make happen, and I have managed it for quite a while. I haven't ever had what's considered a gallbladder 'attack', and no sign of stones. I realize this does not mean that it is still 'ok' - but once it's out, I can't put it back.

The statistics I can find online appear to indicate that about 75-80% of people who have their gallbladders removed every year have either an improvement, or no change. What concerns me is the other 15-20% of people who appear to get worse, and that these are odds I probably have no chance of bucking should I decide to have it out.

Naturally the surgeon I just saw for a consult yesterday told me that his anecdata of 10 years of gallbladder surgeries shows him that in his experience, he personally has only observed the 75-80% I just mentioned... it is clear though there are people who have suffered adverse effects from gallbladder removal just from the other MeFi threads. Obviously in some cases, people don't have a choice, because they are in extreme pain all the time and can't deal.

While I have no pain at present or attacks, my quality of life has suffered tremendously since this began... my urge to go out is nil, I rarely call any of my friends to do anything. Obviously I'm depressed. This doesn't help me make a decision as to what to do next, though.

Help me Obi-mefites you're... well you're not my only hope and YANMD, but I'm looking for something to point me where to go next.

A zillion thanks.

posted by bitterkitten to Health & Fitness (12 answers total)

I had my gallbladder taken out two springs ago. It affected my diet a little bit especially in the immediate aftermath. My previous love for Chipotle still hasn't bounced back.
posted by dgeiser13 at 2:57 PM on September 27, 2011

I am not a doctor what follows is purely annectdotal so I can't say if this will or won't help you. I had a bad case of gallstones and had my gall bladder removed about 10 years ago. I got a case of pancreatitis afterwards which hurt like hell but cleared in a few days and that was only because some of the stones got "loose" and drifted that way during the surgery. I had it done lapriscopically I was up and about the next day and home in a few days. I have only 3 small scars the largest barely an inch wide in my belly button. I've had no problems since and still eat everything I ate before with no problems.

A family friend had her gallbladder out, they had to do the whole big gash across her belly to get to hers there were problems I am not sure of the exact details, and then the wound got infected so she had to stay in hospital an extra week, but besides her big scar and a bit of a scare when they docs thought she had antibiotic resistant infection she is pefectly fine now.

Oh and my stones never showed up on the ultrasounds it was only when they cut me open they found out it was, in the doctors words more like a fine sand. I did however have all the other standard symptoms of pain up under my ribs and across my back etc so they were pretty certain what they were going after and I did used to feel bloated and burp like mad when I had an attack which made me write off my first attack as amazingly bad indigestion. Maybe I was lucky and in the 80% range.
posted by wwax at 3:30 PM on September 27, 2011

The bloating and burping are really familiar to me, too. I got both before an attack, sometimes a couple of days before an attack, but they came nonetheless. My doctors didn't even order gallbladder scans at the time, because I was "too young" and male, but eventually my Mom convinced me to convince them, because she had gallstones at a young age, and sure enough, that's what it was. I did have massive stones that showed up easily, but still, the bloating/burping were there.

My surgery was lapriscopic, and I had some tenderness that required Vicodin the first night, then Tylenol took care of it after that. I had a bit of trouble digesting fats afterward, but nothing too terrible.
posted by xingcat at 3:55 PM on September 27, 2011

IANAD. Mid-40's male. My father had gallstones and had his gallbladder removed in his early 30's. A few months ago, I started to have persistent, though mild pain (very much like a stitch) in my upper left stomach quadrant, roughly where the spleen and pancreas are. The pain also migrated toward my back. Classic I thought - for mild pancreatitis. I had bloodwork done, all my results came back within norm, including all the liver enzymes. I got sent for ultrasound. They didn't find anything with the spleen or pancreas, but did find - gallstones. But my physician is convinced that gallstones are not responsible for my pain - instead, it's acid reflux. So she put me on PPIs (Omeprazole). Within 10 days, the pain which was there for a full month, was gone, except the occasional twingy reminder. Two months later, I'm still on PPIs, with another month to go.

I discussed the gallstone issue extensively and did some research: the thing to watch for is cholecystitis.

I also had no pain in the right quadrant (instead: I had pain in the left), no nausea, no urge to vomit, no increase in pain after fat-heavy meals. I did have episodic burping attacks.

Note, that cholecystitis need not have gallstones associated with it, there is also acalculous cholecystitis, which follows "critical illness (eg, major surgery, burns, sepsis, or trauma)", but also:

"The mechanism probably involves inflammatory mediators released because of ischemia, infection, or bile stasis. Sometimes an infecting organism can be identified (eg, Salmonella sp or cytomegalovirus in immunodeficient patients). In young children, acute acalculous cholecystitis tends to follow a febrile illness without an identifiable infecting organism."

Now, mind you, acute cholecystitis is quite different - if it's low grade inflammation, you may have symptoms similar to yours that go on for a long time.

There are some specific tests for cholecystitis - but I don't know what you may have already had and what not, or if it's been eliminated as a diagnosis, but it's something to look into otherwise.

In my case the PPIs appear to have worked - so far - but I have not definitely been diagnosed with acid reflux, and I have been shown to have gallstones. The question is, if the gallstones are asymptomatic, as my primary physician claims, or if they cause some of the GI issues I've been having over the past 20 years. FWIW, I did discuss removal of the gallbladder, but my physician thinks that's unwise in absence of definite confirmed gallstone symptoms. You have to ask yourself, how sure you are - or your physicians are - that your problems can be traced to the gallbladder, before you contemplate surgery.
posted by VikingSword at 5:29 PM on September 27, 2011

I had a mystery illness for 4 years (that doesn't sound like yours, it is called Achalasia), and one of the things my GI tried was having me talk to a surgeon about having my gall bladder removed. I went to the surgeon (I did have stones, although not a LOT), and he said, "If you don't have any pain, you don't need to have your gall bladder removed." He thought it was very strange that my GI would refer me to him without any pain.
posted by getawaysticks at 6:27 AM on September 28, 2011

FYI
posted by cynicalidealist at 7:27 AM on September 28, 2011

http://www.sciencebasedmedicine.org/index.php/dr-oz-and-john-edward-just-when-i-thought-dr-oz-couldnt-go-any-lower-he-proves-me-wrong/#more
posted by cynicalidealist at 7:27 AM on September 28, 2011

I vote not yet- absent discovering something new (such as what has been mentioned in this thread.)

You've been through a lot as far as changes in diet and meds and exercise levels and the prudent course would be to take a few months to try and find your new normal before you have something removed.
posted by Lesser Shrew at 11:52 AM on September 28, 2011

Response by poster: Shrew - all these things have occurred over the course of 3 years - not all in a row - sometimes with a few months between modifiying anything. At one point I just stopped changing anything, or trying anything, except for some mild yoga which I could still do at that point, just to see if it would go away on its own.... but no dice.

Thanks for everyone's answers so far.
posted by bitterkitten at 2:39 PM on September 28, 2011

Years ago I had gallbladder problems (after the births of both of my children ages 23 and 10 now, it was particularly bad) and did a gallbladder flush. I don't know why it worked but it did - strange things really did come out and I have no idea if they were actual gallstones or not. It has been 10 years since the last flush and I haven't had a problem since. It's maybe worth a shot?
Here's what I did:
http://www.relfe.com/gall_stone_cleanse.html
posted by jacqjolie at 3:49 PM on September 28, 2011

Read the blog of Dr Jack Kruse and then see if you still want your gallbladder out. Be sure to check out the comments, too. I've noticed that if you post he will often address your specific question or condition.
posted by sugarbiscuit at 9:03 PM on September 28, 2011

The Kruse blog is a good idea. Is it possible that you are extremely sensitive to gluten? The glutenzap forum has some discussion of really low level cc sources.
posted by egk at 3:33 PM on October 3, 2011