Why do I suddenly feel SO MUCH BETTER after gallbladder surgery?

September 8, 2012 4:32 PM

Does anyone have any possible explanations for this medical curiosity: Why do I suddenly feel SO MUCH BETTER after gallbladder surgery? There follows a long story with an (inexpliably) happy ending. Can you help explicate?

Backgound: I'm 60. Once upon a time I was healthy and active, practicing and teaching law and yoga. Over the course of a year or two in my mid-40s, I got sick enough that I had to stop working, and I've struggled to be able to care for myself since then. I've been mostly housebound for the past ~2 years, and had to give up driving because I couldn't stay awake enough for long enough to feel safe about it. I was eventually diagnosed with a bratty little gang of autoimmune diseases (scleroderma, Sjogrens syndrome, autoimmune hepatitis, kidney disease, GERD, mild COPD). Organ involvement (esophagus, liver, kidneys, heart, lungs) has been mild to moderate, but the most debilitating symptoms, which have made most normal activities (physical or mental) nearly impossible, have been "brain fog" and "fatigue," just the symptoms that doctors don't understand and can't do much about. Happily, except for manageable reflux, my digestive system has been (or seemed to be) functioning well and comfortably all along.

At times I've been briefly sad, scared, and/or angry about this turn of events, but mostly I've been coping well and my emotional state was dominated by contentment and optimism. So, depression or relief of depression haven't been a big part of the picture at all.

Over the past few years (like so many people of my vintage) I've had a few episodes of gallbladder pain. My doctors had various opinions about whether or not I should have the thing out, since the scleroderma might complicate the surgery in unpredictable ways. Then a recent ultrasound showed that the GB was totally clogged up with lots of stones, so I decided, with doctors' agreement, to have it out now. I had no signs of pancreatitis, no fevers or infection, and lately only trivial elevation of liver enzymes; my diet, weight and digestion were fine, so it did not appear that the GB was causing any active, serious disease other than about half a dozen of those classic attacks of gallbladder pain. So I had the surgery (4 wks ago), keyhole version, same day home.

Well, WOW.

Starting right from the evening of the surgery, I felt amazingly different. CLEAR-HEADED, for the first time since the day 18 years ago when my boss sent me home in a fog of sick. Only one symptom has changed -- the "brain fog." It is GONE. The fatigue and all the other physical annoyances of the autoimmune diseases are still very much present, but my brain is back on line. This state has persisted without interruption for a month now, and it's feeling pretty secure.

At first I thought it might be the euphoric effect of the nice pain killers they gave me, but the effect has lasted way too long for that to explain it. The experience reminds me of cases I've read about where someone in a long, deep coma was given an Ambien (why? dunno), and suddenly woke up and said "hi." It's like I was in a demi-coma for 18 years, and the general anesthesia cleared it away somehow. Is there such a thing as a "demi-coma"? It also feels like when your computer's been running for a few weeks and gets all slow and clunky, and you restart it and it's all fresh and quick and perky. It also feels like the gallstones must have been in my brain.

Or, maybe the mostly clogged GB was somehow putting enough low-level stress on my body that it was somehow affecting the brain? Maybe some chemical was building up in my system that slowed down connections in my brain? It certainly has been my experience that the state of my gut strongly and clearly affects my emotional state -- I would almost go so far as to say that the gut is an extension or part of the brain. Certainly strongly connected. But this strong?

Or maybe it's this: in the ten days after the surgery, I lost 12 pounds (from 154 to 142; so BMI down from 26 to 24), without particularly meaning to. I was eating well every day, though quite a bit less than usual, with no nausea or diarrhea. I certainly wasn't any more active than before. The post-surgery weight loss seemed more like a loss of excess fluid than fat -- I'd been feeling increasingly puffy over the years, like many middle-aged people afflicted with the sluggyness of being unwell. So maybe there was extra fluid in or affecting my brain, too, and the removal of the gunky GB let that all clear out? I'm just guessing.

I've talked to my brilliant primary doctor, who is as delightedly flummoxed as I am. I haven't yet had the opportunity to kiss my surgeon's feet and get his insights, or to talk to my rheumatologist.

Of the (many!) people I've heard of who've had this surgery, I've never heard of anyone getting any overall or cognitive benefit from it -- just relief from the painful GB attacks. I've gotten that and so much more. How? Why?

Has anyone had, or heard of, any similar experience of mild cognitive impairment suddenly, dramatically improving after general anesthesia, or after gallbladder removal? Can accumulation of gallstones somehow cause years and years of deep, thick brain fog? Anyone have any theories? can anyone point to any relevant research or case reports? Anything from stories about your Aunt Gertrude, to cutting edge medical research, to wild speculation would be helpful.

If I had any more gallbladders, I'd have them out, too.

[And if anyone within range of Albany, NY, ever needs surgery in or around the gut: Carl Rosati MD is the bees' knees.]

Thanks for any thoughts.

posted by Corvid to health & fitness (16 answers total)

Yes, I have heard this from several (everyone I know who's been through it) friends who have had emergency gallectomies. It's a heavily-invested participant in the digestive process, but that doesn't mean you can't be far healthier without it.
posted by Lyn Never at 4:37 PM on September 8, 2012

I'm about to have mine out, and I certainly hope I feel better too!

Only thing I can think of is that the stones were severely compromising your ability to digest certain essential nutrients, and now whammo, your brain car has gas in it again. This theory could be bolstered by the weight loss, if you're now digesting everything properly (so less waste going to storage and more energy burning).

I've had fuzzy episodes also (as in apathetic, 2+2=wha?), usually caused by low potassium and cured by bananas. Not saying that's what you have, but just to say the body depends on a lot of little things working just right for everything to work right.
posted by L'Estrange Fruit at 5:00 PM on September 8, 2012 [1 favorite]

Is it the lack of pain? Getting chronic pain dealt with can remove a constant source of distraction.
posted by Blazecock Pileon at 5:02 PM on September 8, 2012 [2 favorites]

As someone who has my own share of autoimmune anomalies, there often seems to be no rhyme or reason as to why things get worse or things get better. I know I'm often searching for hidden explanations and meanings behind my physical symptoms and signs. If nothing else seems likely, I would just chalk it up to the vagaries of the immune system and be thankful that it caused an improvement instead of the opposite. I hope you continue to improve as time goes by.
posted by SweetTeaAndABiscuit at 5:45 PM on September 8, 2012

If it was causing you to sleep poorly, I'd expect this result.
posted by kindall at 5:47 PM on September 8, 2012 [2 favorites]

I seriously believe that I not only had gallbladder stones but that my gallbladder was also infected. I normally run a subnormal temperature and during that time I ran 98.6, which is high for me but the Drs. didn't think anything of it. Had no appetite, not only to keep the gallbladder pain down, but just wasn't hungry. Felt puny and pooped. After my gallbladder was out I felt like a million dollars. Hungry, clearheaded and once again a lower temperature. Yours too may have generated a small infection and now that everything is out you're yourself again.
posted by PJMoore at 6:41 PM on September 8, 2012

I had the same thing happen to me. Getting the pain and infection out was a mind-blowing relief.
posted by batmonkey at 6:57 PM on September 8, 2012

Did they give you a bunch of antibiotics? I know someone who claims that a large dose of antibiotics cured their crippling depression. It may be that you've had a long term infection that finally got cleared out.
posted by The Light Fantastic at 7:03 PM on September 8, 2012 [1 favorite]

The reduction of frequent low (or greater) level pain that you may have been ignoring for years and the resulting improvement in sleep can make a huge difference in quality of life. I experienced 6 months of intense chronic pain and it wasn't until I got it under control that I realized how much every area of my life was improved. It was like half my brain power was devoted to dealing with pain and it was wonderful to be fully functional again.
posted by saradarlin at 7:08 PM on September 8, 2012

My overall level of pain is about the same as before. I only had 4-5 fairly brief "attacks" of the GB pain over the past 3 years. All the other naggy discomforts of the autoimmune conditions are still very present, and constantly annoying.

The surgery was not considered an emergency at all -- the doctors said I could safely put it off for up to a few months, though the risk of infection would increase as more time passed.

My sleep has certainly NOT improved. It was bad before, and it's even worse now. That has been a constant trajectory.

If I had any infection from the GB, it was very, very low level (could be, though). I've had gazillions of blood tests over these years, and none have ever hinted at any infection. I haven't had an elevated temperature (except for the hot flashes) in longer than I can remember. My appetite was fine before, still is.

I'm sure they gave me some IV antibiotics during the surgery, but I don't know what. I'm damn well gonna find out, cause I may want more of that some day.
posted by Corvid at 9:58 PM on September 8, 2012

I am not a doctor, etc, etc...but I just had some thoughts reading over your question...

Did you ever have your ammonia levels checked during this time? if your liver was at all impaired, i.e., as a result of a dysfunctional gallbladder causing your liver distress, it's possible you've had a somewhat elevated ammonia level, which causes hepatic encephalopathy. Signs and symptoms of this problem include lethargy, confusion, "fogginess", etc, and at extremely high levels (such as in full-blown cirrhosis) can cause coma.

elevated ammonia levels are caused by an inability to fully process and excrete the byproducts of protein metabolism in the body, one of the hundreds of things your liver does. As this substance accumulates in the blood, it can cause cognitive dysfunction. Getting your gallbladder out has improved bile outflow from the liver, and therefore took a little of the stress off your otherwise taxed liver. The sudden return of ammonia excreting/processing ability can manifest in a marked and near-immediate return of full or mostly full cognitive function.

If you've ever had your ammonia checked, has it been high and were you ever prescribed a drug called lactulose (it's a laxative that causes your large intestine to excrete a larger than normal level of ammonia)? If so, did you ever feel better afterward?
posted by doogan nash at 8:56 AM on September 9, 2012 [1 favorite]

L'Estrange fruit: yes, my brain car has gas in it again, exactly. Having grown up in a family of mechanics, I often told my doctors that I felt like a car with a powerful V-8 engine, a tank full of premium gas, and a clogged fuel filter. I think I just had my fuel filter replaced! Vroom.

doogan nash: Your ammonia theory sounds very plausible. I looked over my old blood tests, and I don't see that ammonia levels were ever checked; never had lactulose prescribed. Since the beginning of my illness, though, I have always had elevated liver enzymes -- not alarmingly so, but enough that they did 2 liver biopsies, and decided it was stage 1 autoimmune hepatitis (no treatment required), so my liver has definitely been limping along. My kidney function is about 1/2 of normal (Dr: "No problem! you have two! EX-Dr, now). And, about the same time I first started feeling ill, I developed an aversion to meat -- I felt even more yucky and sluggy whenever I ate it, and I've been vegetarian since then. Perhaps my liver was impaired enough that my system couldn't prevent build-up of ammonia.

And here's an even more intriguing angle: since I started feeling sick, I've had an overwhelming, irresistible compulsion to REST, all the time. Exercise makes me feel dangerously ill. I see that physical exertion raises ammonia levels, and ammonia is absorbed by muscles at rest. So it seems my body knew exactly what it needed. Good thing I (mostly) listened to it, especially when it said "lets chuck this rotten gallbaldder.")

Perhaps the doctors have taken just one fat straw from the camel's back, and she will race again.
posted by Corvid at 2:52 PM on September 9, 2012 [2 favorites]

corvid,
ammonia levels are rarely checked in an outpatient setting, i think. the blood sample has to be kept on ice after it's drawn, so i only ever see it in the inpatient setting where i work and we can immediately ice down the blood and take it for asap testing, so it's quite possible yours was never checked.
well, regardless of the cause, it's great that you're feeling better now.
posted by doogan nash at 3:23 PM on September 12, 2012

update: sadly, the improvement didn't last. After 8 - 10 weeks of delightful clarity, the brain fog rolled back in. Which makes me think that the change must have been an effect of either the anesthesia or (more likely?) the antibiotic used with the surgery. I don't know yet what that was. Some people believe that antibiotics are an effective treatment for autoimmune disease, though that approach is generally frowned upon by mainstream medicine (and by me, so far). Perhaps there's something to it. I'll discuss it with my doctors when I see them.
posted by Corvid at 1:22 PM on November 2, 2012

I finally tracked down all my medical records, and it seems that the improvement can be attributed to a corticosteroid, Decadron (dexamethasone), that was given during surgery to prevent inflammation. It's an immunosuppressant that's sometimes used in treatment of autoimmune diseases. I found a story of a British writer who used the mental energy he got from a dose of Decadron during surgery to write his first book, and there has been a bit of research using it for treatment of scleroderma (and also, sadly, pretty persuasive studies showing that corticosteroids can have especially risky side effects in scleroderma). Time for a long conversation with doctor.
posted by Corvid at 10:06 AM on December 24, 2012

Oh, poo. Seems it wasn't the Decadron after all. My rheumatologist agreed that, of the drugs I had during the surgery, it was the only thing likely to have had that effect, and he gave me a few days' worth to check it out. No good effect at all. I'll see what he thinks about giving the antibiotic a try.
posted by Corvid at 11:37 AM on February 2