Gall­stones the big­gest rea­son for gall­blad­der re­moval

The Western Star - - LIFE - Keith Roach Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual let­ters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGood­[email protected]­nell.edu or re­quest an or­der form of avail­able health newslette

DEAR DR. ROACH: My hus­band’s doc­tor is telling him to have his gall­blad­der re­moved be­cause some­times he has pain in his right side. They did all kind of tests, but he has pain when he drives long hours or when he eats sal­ads, not fried or fatty foods. Can you tell me more about the surgery, and what it might be like for him af­ter the surgery? — A.M.

AN­SWER: Al­most ev­ery time a gall­blad­der needs to be re­moved, it is be­cause of gall­stones. Gall­stones are com­mon. Six per­cent of men and 9 per­cent of women have them, but most of the time, peo­ple have no symp­toms. It isn’t al­ways clear whether the symp­toms peo­ple have are due to the gall­stones that are found on imag­ing stud­ies, such as CT or ul­tra­sound, but there are some clues to help de­cide whether a gall­blad­der that con­tains stones needs to be re­moved.

The clas­sic symp­toms are pain in the right up­per ab­domen, es­pe­cially af­ter eat­ing a fatty meal, such as fried food (some peo­ple eat sal­ads with lots of fatty dress­ing). Some­times gall­blad­der pain is not food-as­so­ci­ated. Symp­toms at night­time are not un­com­mon. Nau­sea, bloat­ing, lower chest pain, belch­ing and burn­ing pain are all well-de­scribed with gall­blad­der dis­ease, and the proof comes when surgery re­lieves the symp­toms.

Some­times, the imag­ing test can give clues. Thick­en­ing of the gall­blad­der wall or pain with pres­sure on the gall­blad­der (Mur­phy’s sign) are sug­ges­tive of acute gall­blad­der in­flam­ma­tion.

Un­for­tu­nately, doc­tors aren’t al­ways right. Oc­ca­sion­ally a per­son’s gall­blad­der is re­moved, and it doesn’t help the symp­toms at all. Then, a new search needs to be done to dis­cover the true cause of the symp­toms.

Most peo­ple do very well af­ter gall­blad­der surgery. The liver it­self takes over the job of stor­ing bile, in the ducts of the liver, and bile is re­leased into the in­testines ap­pro­pri­ately af­ter eat­ing. How­ever, it takes time for the sys­tem to get ad­justed to not hav­ing a gall­blad­der, and only 60 per­cent of peo­ple are com­pletely back to nor­mal af­ter three months. A few peo­ple have per­sis­tent symp­toms for years. Thus, it’s wise to be as sure as pos­si­ble that symp­toms are due to gall­blad­der dis­ease be­fore un­der­go­ing surgery.

DEAR DR. ROACH: I’m 85 years old. I have numb­ness in my hands — some­times the right, some­times the left; some­times both hands or not at all. It lasts only a while. My doc­tor feels that it’s a pinched nerve in my neck. Can you give me any ad­vice? — J.B.

AN­SWER: A pinched nerve in the neck be­comes more preva­lent as peo­ple age. The nerve can be com­pressed by bony struc­tures in peo­ple with os­teoarthri­tis in the neck (this is spinal steno­sis), or by disk ma­te­rial in some­one with a her­ni­ated disk. Hav­ing symp­toms on both sides is less com­mon than hav­ing symp­toms con­sis­tently on one side only. A care­ful phys­i­cal exam can give clues that this is the case, but an MRI or other imag­ing study is the best way to be sure of the di­ag­no­sis.

Hand numb­ness also may be caused by the nerve be­ing “pinched” in other lo­ca­tions: in the carpal tun­nel in the wrist or in the cu­bital tun­nel in the el­bow. An EMG test can help sort out where this is com­ing from. It’s cer­tainly pos­si­ble to have carpal tun­nel syn­drome on both sides.

My best ad­vice is not to rush into surgery at any age, but es­pe­cially not at age 85. Phys­i­cal ther­apy can pre­vent many peo­ple from need­ing surgery. How­ever, if numb­ness pro­gresses to weak­ness, it’s time to re­con­sider.

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