Let's overthink my gallbladder!!
September 17, 2015 9:41 PM Subscribe
I am pretty certain I am having gallbladder attacks and probably need my gallbladder removed. However, my symptoms don't sound like textbook gallbladder disease. Have you had unusual gallbladder or other gastro issues? Can you help me analyze this and tell me if this is all in my head somehow? What's throwing me off is that these "episodes" happen 5 hours after I eat, which seems like too much time has passed for it to be gallbladder. I'm going to the doctor next week, so if you can help me think of questions to ask please do so!
The symptoms: It starts with feeling “funny” (at this point I can tell when one of these “attacks” are coming on). I then start feeling very shaky all over, and if I stood up would probably black out (I did once so now I know better). I also feel sweaty and cold at the same time, and I physically shiver. Sometimes I feel extremely nauseous, sometimes I vomit, and sometimes I don’t feel very nauseous. Sometimes there’s typical gallbladder pain, sometimes not. Last night there wasn’t really any nausea, but it did feel like either my esophagus was tightening up or I had some weird heartburn feeling. I had three sharp pains in my ribs before the episode, but I wouldn't call them severe. Today I feel bloated, especially after eating something small and bland. My right side is also sore, especially when you touch it around the ribs.
Frequency: This type of episode usually happens 5 hours after I have eaten something that I shouldn’t (usually high fat/greasy foods). I can almost set my watch by it…5 hours after I’ve eaten. It doesn’t happen after every meal though…if I am eating low fat/low grease, these things can be weeks apart. But if I start eating too much fried/greasy foods, I wind up with one of these episodes. So far I’ve learned that I can only eat 2 pieces of bacon at a time, and only twice a week (or I start feeling sick). Chicken strips are OK but not in the same day as pizza or a greasy hamburger. Breakfast sausage is no longer an option.
These things have been going on for years now. I had a classic textbook gallbladder attack several years ago, and a HIDA scan showed that my gallbladder ejection was at 30%. Apparently you have to be below 30% for them to do surgery. The ultrasound showed no stones, but a thickened gallbladder wall with either a tiny stone or a polyp on it (it didn’t move around). I also have what appears to be fatty liver. *I will also add that the right side of my abdomen seems to stick out more than my left. If you really pay attention to my waistline, there's a little bit less definition on that side. It's not obvious with clothes on, but I've noticed it. I do have a scoliosis curve, so that may be contributing to the weird shape.
So…I’m going to the doctor next week and will request another HIDA scan and ultrasound, but wanted to query the HiveMind to see what you thought. Is this some sort of weird gallbladder problem, or does it sound more like something else? What else do I need to be paying attention to? I honestly think I need convincing that I DO need to followup with a doctor and actually commit to treatment/surgery because I tend to put things off and just tell myself that if I took better care of myself I wouldn’t be like this. So yeah…always putting myself last. (And I’m kinda scared of surgery).
The symptoms: It starts with feeling “funny” (at this point I can tell when one of these “attacks” are coming on). I then start feeling very shaky all over, and if I stood up would probably black out (I did once so now I know better). I also feel sweaty and cold at the same time, and I physically shiver. Sometimes I feel extremely nauseous, sometimes I vomit, and sometimes I don’t feel very nauseous. Sometimes there’s typical gallbladder pain, sometimes not. Last night there wasn’t really any nausea, but it did feel like either my esophagus was tightening up or I had some weird heartburn feeling. I had three sharp pains in my ribs before the episode, but I wouldn't call them severe. Today I feel bloated, especially after eating something small and bland. My right side is also sore, especially when you touch it around the ribs.
Frequency: This type of episode usually happens 5 hours after I have eaten something that I shouldn’t (usually high fat/greasy foods). I can almost set my watch by it…5 hours after I’ve eaten. It doesn’t happen after every meal though…if I am eating low fat/low grease, these things can be weeks apart. But if I start eating too much fried/greasy foods, I wind up with one of these episodes. So far I’ve learned that I can only eat 2 pieces of bacon at a time, and only twice a week (or I start feeling sick). Chicken strips are OK but not in the same day as pizza or a greasy hamburger. Breakfast sausage is no longer an option.
These things have been going on for years now. I had a classic textbook gallbladder attack several years ago, and a HIDA scan showed that my gallbladder ejection was at 30%. Apparently you have to be below 30% for them to do surgery. The ultrasound showed no stones, but a thickened gallbladder wall with either a tiny stone or a polyp on it (it didn’t move around). I also have what appears to be fatty liver. *I will also add that the right side of my abdomen seems to stick out more than my left. If you really pay attention to my waistline, there's a little bit less definition on that side. It's not obvious with clothes on, but I've noticed it. I do have a scoliosis curve, so that may be contributing to the weird shape.
So…I’m going to the doctor next week and will request another HIDA scan and ultrasound, but wanted to query the HiveMind to see what you thought. Is this some sort of weird gallbladder problem, or does it sound more like something else? What else do I need to be paying attention to? I honestly think I need convincing that I DO need to followup with a doctor and actually commit to treatment/surgery because I tend to put things off and just tell myself that if I took better care of myself I wouldn’t be like this. So yeah…always putting myself last. (And I’m kinda scared of surgery).
IANAD, IANYD, etc. I just know people who have been through this. So it's not very common, but you could have sphincter of Oddi dysfunction. The sphincter of Oddi is where the biliary tree connects to the duodenum, and if it's spasming or blocked, you can experience this sort of problem. Because it's where bile enters the digestive tract, its behavior can be directly related to what you eat—fatty foods stimulate production of bile, which can affect both the gallbladder and the sphincter of Oddi. If either of them isn't functioning properly, bile can start to back up or cause pressure and you can experience the symptoms you describe. But sphincter of Oddi dysfunction is most often a diagnosis of exclusion, and a lot of people don't find out they have it and/or don't develop it until after they have their gallbladder removed (cholecystectomy), when they find that they're still experiencing the same symptoms.
What you are experiencing sounds a lot like either a gallbladder attack or a sphincter of Oddi attack. The way you find out whether you have sphincter of Oddi dysfunction is to have an ERCP and manometry, to measure the level of pressure in the sphincter, then a sphincterotomy if there's a narrowing or blockage of this duct. There's a significant risk of getting pancreatitis from the ERCP procedure if anything goes wrong, so it's best not to go there unless your condition becomes much more severe. That's actually the other thing this could be, without any of the other stuff: You could have pancreatitis. But it seems like you would probably be in more pain if so...
Anyway, those are a couple of other possibilities. I hope that at worst you just have a simple gallbladder issue that's easlly solved. Removal of the gallbladder can cause more issues than people think, but you need to work with a doctor to really assess the risks involved.
posted by limeonaire at 10:24 PM on September 17, 2015 [1 favorite]
What you are experiencing sounds a lot like either a gallbladder attack or a sphincter of Oddi attack. The way you find out whether you have sphincter of Oddi dysfunction is to have an ERCP and manometry, to measure the level of pressure in the sphincter, then a sphincterotomy if there's a narrowing or blockage of this duct. There's a significant risk of getting pancreatitis from the ERCP procedure if anything goes wrong, so it's best not to go there unless your condition becomes much more severe. That's actually the other thing this could be, without any of the other stuff: You could have pancreatitis. But it seems like you would probably be in more pain if so...
Anyway, those are a couple of other possibilities. I hope that at worst you just have a simple gallbladder issue that's easlly solved. Removal of the gallbladder can cause more issues than people think, but you need to work with a doctor to really assess the risks involved.
posted by limeonaire at 10:24 PM on September 17, 2015 [1 favorite]
Removal of the gallbladder can cause more issues than people think
Word. If you are able to control your attacks with diet, I would encourage you to do that. There is zero guarantee that after having your gallbladder removed, you will be able to eat bacon or breakfast sausages or pizza on the same day as anything else.
There is also a non-null chance that having your gallbladder removed will resolve your abdominal pain while giving you IBS symptoms from hell. I now eat like a Hobbit: fist dinner, second dinner, sometimes third dinner in pursuit of a meal that will stay where it is put and not exit stage left, pursued by a bear. It is absolutely charming and it makes very little difference what I eat. It is (literally) a crapshoot every time.
posted by DarlingBri at 12:58 AM on September 18, 2015 [2 favorites]
Word. If you are able to control your attacks with diet, I would encourage you to do that. There is zero guarantee that after having your gallbladder removed, you will be able to eat bacon or breakfast sausages or pizza on the same day as anything else.
There is also a non-null chance that having your gallbladder removed will resolve your abdominal pain while giving you IBS symptoms from hell. I now eat like a Hobbit: fist dinner, second dinner, sometimes third dinner in pursuit of a meal that will stay where it is put and not exit stage left, pursued by a bear. It is absolutely charming and it makes very little difference what I eat. It is (literally) a crapshoot every time.
posted by DarlingBri at 12:58 AM on September 18, 2015 [2 favorites]
Just to offer some contrarian advice: I was diagnosed with gallstones after an excruciating episode about 10 years ago, and a second less painful one a few years later. I have the ultrasounds to prove it.
Since then, I observed that the biggest trigger was sugar and fat together (eg doughnuts). I then read that wheat might be involved in problems with the sphincter of Oddi. I also reasoned that gall stones are a precipate out of the bile solution. Precipitates in solution happen when solutions are at rest (try growing crystals if you shake the container continuously). So logically, if I ate more fat, but consistently, then my gall bladder would be squeezing out bile much more often, dissolving existing stones, and preventing new ones from forming. I have since eaten more fat, more consistently, and dialled back the baked goods intake, and the symptoms have never recurred.
I am not a doctor and in fact am a classic diet crank, so follow this advice at your own risk.
posted by i_am_joe's_spleen at 2:46 AM on September 18, 2015 [1 favorite]
Since then, I observed that the biggest trigger was sugar and fat together (eg doughnuts). I then read that wheat might be involved in problems with the sphincter of Oddi. I also reasoned that gall stones are a precipate out of the bile solution. Precipitates in solution happen when solutions are at rest (try growing crystals if you shake the container continuously). So logically, if I ate more fat, but consistently, then my gall bladder would be squeezing out bile much more often, dissolving existing stones, and preventing new ones from forming. I have since eaten more fat, more consistently, and dialled back the baked goods intake, and the symptoms have never recurred.
I am not a doctor and in fact am a classic diet crank, so follow this advice at your own risk.
posted by i_am_joe's_spleen at 2:46 AM on September 18, 2015 [1 favorite]
Also, I was advised that pain is often a tiny grain passing through. "Sand". That tube's really small. So the fact you can't see big stones doesn't mean it's not gall bladder pain.
Having said all that, sounds like a problem that bears more investigation. Pain + asymmetric torso bulges = serious worry for me. Do what you need to to get a diagnosis that makes sense. Which could well be gall bladder.
posted by i_am_joe's_spleen at 2:52 AM on September 18, 2015 [1 favorite]
Having said all that, sounds like a problem that bears more investigation. Pain + asymmetric torso bulges = serious worry for me. Do what you need to to get a diagnosis that makes sense. Which could well be gall bladder.
posted by i_am_joe's_spleen at 2:52 AM on September 18, 2015 [1 favorite]
When my gallbladder "attacks" happened, my symptoms were very atypical, according to my skeptical primary doc. I'd get stabbing pains starting in my lower GI tract that moved up my center line toward my diaphragm and esophagus. She reluctantly ordered a HIDA scan and I was found to have as near to 0% as you can get. So they removed my gallbladder, and I've not had one problem since then--that wasn't already there.
So I'd say that no matter how atypical your symptoms might seem, you already know from your previous HIDA scan there's probably cause to check it again. I think you're overthinking it. Just ask for another scan.
posted by ImproviseOrDie at 2:55 AM on September 18, 2015
So I'd say that no matter how atypical your symptoms might seem, you already know from your previous HIDA scan there's probably cause to check it again. I think you're overthinking it. Just ask for another scan.
posted by ImproviseOrDie at 2:55 AM on September 18, 2015
I actually had similar symptoms AFTER the removal of my gall bladder, turns out I had problems with a sphincter I can't remember the name of it (it may well have been the Oddi one mentioned above). They simply drugged me up put a tube down my throat through my stomach & did a simple snip of the sphincter to fix the problem and was home the same day trouble free. Well except for waking up from twilight anesthesia & punching the doctor in my confusion. Go find a doctor who will take your concerns more seriously.
posted by wwax at 7:41 AM on September 18, 2015
posted by wwax at 7:41 AM on September 18, 2015
Are you taking any heartburn medicine at all? If not, start on one of the pills today (omeprazole, ranitidine, famotidine) because that may be the first step they want you try, which just means more waiting to get to the real problem. Also, it will offer real relief from any acid reflux issues and help you see what issues are stomach related versus something else lower down in the digestive tract.
Is this some sort of weird gallbladder problem, or does it sound more like something else? ...I need convincing that I DO need to followup with a doctor and actually commit to treatment/surgery because I tend to put things off and just tell myself that if I took better care of myself I wouldn’t be like this.
IANAD - but my husband just went through a gallbladder problem and his issues cleared up after surgery. Nausea was his one and only symptom! But it was chronic, every day and seriously affected his mood (and then mine). It did not respond to acid reflux or nausea meds either.
Surgery sounds scary and it will hurt while you recover, but you are the youngest you will ever be right now and probably in the best position to recover quickly. Medical science does have ways to treat gallstones that don't require surgery, but surgery is still the most common treatment, so that tells me the other treatments aren't as effective. Surgery isn't cheap or risk-free but it still the standard way for a reason.
posted by soelo at 7:45 AM on September 18, 2015
Is this some sort of weird gallbladder problem, or does it sound more like something else? ...I need convincing that I DO need to followup with a doctor and actually commit to treatment/surgery because I tend to put things off and just tell myself that if I took better care of myself I wouldn’t be like this.
IANAD - but my husband just went through a gallbladder problem and his issues cleared up after surgery. Nausea was his one and only symptom! But it was chronic, every day and seriously affected his mood (and then mine). It did not respond to acid reflux or nausea meds either.
Surgery sounds scary and it will hurt while you recover, but you are the youngest you will ever be right now and probably in the best position to recover quickly. Medical science does have ways to treat gallstones that don't require surgery, but surgery is still the most common treatment, so that tells me the other treatments aren't as effective. Surgery isn't cheap or risk-free but it still the standard way for a reason.
posted by soelo at 7:45 AM on September 18, 2015
IANAD, listen to me at your own risk, etc....
If you want to avoid surgery and try alternate treatment, I have been managing a nasty gall bladder, thereby avoiding surgical removal, for about a decade through dietary management (most significantly maintaining a low fat diet - but not too low). One thing that has helped with being able to tolerate high fat indulgences is ox bile (there is also a higher dosage version, I use both).
So, say, if I want to eat pizza one evening, I just pop a 500mg about 30 minutes before eating, no pain, no bloating, easy peasy. Whereas if I just eat the pizza, I can expect to be in agonizing pain with projectile vomiting until the wee hours of the morning.
posted by slipthought at 9:05 AM on September 18, 2015
If you want to avoid surgery and try alternate treatment, I have been managing a nasty gall bladder, thereby avoiding surgical removal, for about a decade through dietary management (most significantly maintaining a low fat diet - but not too low). One thing that has helped with being able to tolerate high fat indulgences is ox bile (there is also a higher dosage version, I use both).
So, say, if I want to eat pizza one evening, I just pop a 500mg about 30 minutes before eating, no pain, no bloating, easy peasy. Whereas if I just eat the pizza, I can expect to be in agonizing pain with projectile vomiting until the wee hours of the morning.
posted by slipthought at 9:05 AM on September 18, 2015
If you want to know about the surgery, please feel free to memail me. I had mine out exactly one month ago today.
Good luck!
posted by bibliogrrl at 7:49 PM on September 18, 2015
Good luck!
posted by bibliogrrl at 7:49 PM on September 18, 2015
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In addition (feel free to message me about it, others have) I got mine removed when ALL my tests were normal, but I had ALL the gallbladder symptoms. (That included a CT, 2 ultrasounds, and a 51% HIDA scan, not to mention colonoscopy to rule out anything else.) Once they removed it they sent it to pathology and it showed issues.
That said, my symptoms included horrible stomach issues for about 10+ months, that kept being diagnosed as GERD/IBS, then insane gallbladder pain and attacks for about 3+ months before I finally got it yanked out.
I'm pro-gallbaldder removal. I personally think it causes more issues than people think. This is not a medical opinion or advice, it's just been my experience. You should find a better doctor or consult with a surgeon.
When I went to my doctor and said "I think it's my gallbladder, I have all the symptoms listed under Functional Gallbladder Disorder." She sent me to the surgeon. The surgeon told me they think of it as another test but he was happy to take it out, and I was in surgery the following Monday.
posted by Crystalinne at 10:16 PM on September 17, 2015