Gilbert syndrome vs. gallstones

Dear Dr. Roach: I was diagnosed with Gilbert syndrome after I had a blockage of my common bile duct and became jaundiced. This was three months after I had my gallbladder removed (via an open surgery). How was it possible for me to develop a stone after the surgery? Was the Gilbert syndrome caused by the blockage? J.E.

Let’s start with gallstones, the most likely cause of the blockage. Surgical treatment of gallstones is the most effective treatment, but it is possible, about 10 per cent of the time, to develop a stone after surgery. This happens sometimes when a stone is retained in the bile duct and is not noticed during surgery. It is more common in laparoscopic surgery than in open surgery. It also is possible for new stones to form, if any remnant of the gallbladder is left. These can be treated with endoscopic removal or with medication to dissolve them.

Gilbert syndrome is caused by a deficiency of an enzyme used to conjugate bilirubin, a component of bile and a breakdown product of red blood cells. It leads to elevated levels of bilirubin in the blood (specifically, a type of bilirubin called unconjugated: the blood tests can distinguish between conjugated and unconjugated).

Under times of stress — such as exertion or dehydration — people with Gilbert syndrome can become jaundiced — they exhibit a yellow colouring, which is easiest to see in the sclerae (whites of the eyes) or in the mouth.

However, Gilbert syndrome usually does not cause any problems, and does not need treatment.

People with Gilbert syndrome (which runs in families and is very common) are at higher risk of developing gallstones. So, the blockage didn’t cause the Gilbert syndrome: You’ve had it your whole life. The Gilbert syndrome might have put you at risk for the gallstones.

Dear Dr. Roach: My cardiologist referred me to an ophthalmologist to check my eyes for damage. What follows sounds like fantasy, but I assure you it is a true account of what happened. The ophthalmologist to whom I was referred — as far as I know a respected physician — walked into the room and his entering statement was: “You are not going to like me, and I am not going to like you.” I initially laughed, thinking this physician had a strange sense of humour. However, the encounter continued to be quite unpleasant. When I tried to ask a question, I was told to be quiet, and so it went.

I eventually was allowed to ask my question, and was then informed that I was having hallucinations and that nothing was wrong with my eyes. On leaving the room, this physician said: “I don’t ever want to see you again.”

I am 84 years old and not always diplomatic when I speak. Perhaps I said something to the first assistant I saw, which might have been (unintentionally) offensive, and she relayed the conversation to the doctor. I do sometimes speak too bluntly.

Anon. I can’t imagine what you could have said that would deserve this treatment, which is unprofessional and reprehensible. I would strongly recommend that you report this physician to the local medical board. I also would not trust the diagnosis.

Finally, you should report back to your cardiologist so that he or she can decide whether to refer to this physician again. This is deeply disappointing and an embarrassment to my profession.