Severe Back Pain, Shoulder Pain, Stomach Pain (Gallbladder)

Hi there,


  For about the last year and a half, I have been having back pain (mostly lower right side) that goes up into my right shoulder, as well as stomach pain that sometimes is right below my right rib or on my left side.  I had a colonoscopy done, which revealed a polyp. I had an upper endoscopy done which revealed crystals on the biopsies that they took.  The ultrasound they did after they found the crystals was negative.  My dad has a history of gallbladder so I was wondering if you think this could be the cause?  I am scheduled for a hida scan soon, so I am anxious to talk with someone before then to hear their thoughts.  

About once a week, I have VERY bad diahriah then right after I vomit.

I've got all of my pathology reports with me if needed.

Thank you

[jmadzula1]

I also forgot to mention that I was diagnosed with IBS.  AS soon as I eat something, about 15 minutes later, I have the abdominal pain and have diahriah.  ABout once a week is when the pain gets severe and I have diahriah and vomit

[jmadzula1]

I should also mention that I am a 24 year old male

[Christopher R Watters, MD]

Since a HIDA is planned I assume that an ultrasound was negative. I think the HIDA is a good idea. I am amazed how many patients labeled as IBS without any real testing are magically cured when their symptomatic gallbladders are removed.

[jmadzula1]

Yes sir, the Ultrasound was negative.  Since I had crystals under the microscope from the upper endoscopy biopsies, would your first thought be the gallbladder?  The GI I had before, that did the upper and had me get an ultrasound following the biopsy results, never did the HIDA, and I ultimately stopped seeing him for a few different reasons.

My Dad has a history of gallbladder, as well as pancreas issues.  I mentioned this to the new GI doc and asked him to give me a HIDA.  

Also, can GB pain be relieved by bowel movement?  

I've been getting discouraged by a lot of doctors, because it seems that if I am not having "textbook symptoms" then it must not be this or that.  I am no where near textbook as we can see this from my having a Polyp at 23 years old.  

The abdominal pain, back pain, right shoulder pain, neck pain, and extreme fatigue are really getting to me, so I am really hoping that after the HIDA, we will have some true answers.  

Thank you for your assistance!

[Christopher R Watters, MD]

I am a little confused on the crystals "on biopsy". Twenty years ago they used to collect bile in the duodenum during upper endoscopy and look for crystals. I haven't heard of this being done in quite some time. In those days, seeing crystals was considered an indication for cholecystectomy with good results.

[jmadzula1]

I am not sure, I am just passing along what I was told.

I had the HIDA scan done today and am waiting results.

[jmadzula1]

If I may ask...

   I am having (I am trying to think of the best way to describe it) coffee ground like bowel movements.  It looks exactly like coffee grounds in the bowl (very dark black) but when I wipe it is yellow on the TP.

  What are your thoughts on this?

[Christopher R Watters, MD]

Not very specific as long as there is no evidence of GI bleeding.

[jmadzula1]

For as long as this has been going on (about a year and a half) I have always had bloody stools.  Sometimes mixed in with the stool, sometimes before I have stool (just drips into the bowl) and sometimes after I have stool.

[jmadzula1]

Here is my Upper Endoscopy Results:

If I understand what you said, and what this said, this is a good indication for GB removal?

"
Bile for Crystals, Duodenum:
-Plate like Cholesterol Crystals Identified with Compensated Polarized Microscopy.
Yellow Granular Debris Suggestive of Calcium Bilirubinate Present"

[Christopher R Watters, MD]

Yes it is but your gallbladder would not explain blood in your stool. Is there a plan for a capsule camera exam to complete the workup?

[jmadzula1]

Already had the camera capsule.  This was done after the upper.

"Normal Transit Times. One possible erosion noted in small bowel, approximately 1/3 of the way into the small bowel.  A redundant fold is noted in the small bowel.  Otherwise unremarkable exam"

What are the redundant folds?

[Christopher R Watters, MD]

This sounds pretty much negative. Time to get a gallbladder out.

[jmadzula1]

Alright, I will talk with the doctor.

Thank you.  Will update anything new on here.

[jmadzula1]

HIDA Scan came back with an ejection fraction of 82% and no other abnormalities...

I don't think the doctor is going to do anything from here on out now with those results.  

What should I do doc?

[jmadzula1]

HIDA Scan came back with an ejection fraction of 82% and no other abnormalities...

I don't think the doctor is going to do anything from here on out now with those results.  

What should I do doc?

[Christopher R Watters, MD]

Were any of your symptoms reproduced when they infused the CCK for the HIDA test?

[jmadzula1]

Yes, I got nausea and the abdominal and back pain.  It went away though, its not like it lasted for a while like it usually does with

[jmadzula1]

Yes, I got nausea and the abdominal and back pain.  It went away though, its not like it lasted for a while like it usually does when I have these "attacks"

I told her I was getting real uncomfortable but I guess she didn't care she didn't do anything...

[jmadzula1]

I am sorry -- Correction on that, 92% Ejection Fraction.

Doing some research, overactive Gallbladder??
Hyperkinetic Gallbladders????

Thanks for your help sir, I really do appreciate you taking the time to talk with me.  I just don't know what to do anymore... The stress and pain are killing me

[Christopher R Watters, MD]

Current opinion is that you would have a very high chance of resolving your symptoms if your gallbladder were to be removed. We have had several discussions of hyperkinetic biliary dyskinesia in this and other forums. It is a relatively new diagnosis. The data would argue that symptom reproduction during a HIDA with CCK is a better predictor of improvement following cholecystectomy than the ejection fraction.

[jmadzula1]

Okay, that is such a relief, thank you.

Is there anything (documentation or something) that I can show my doctor regarding hyperkinetic biliary dyskinesia?

It seems he doesn't know about this I guess! :(

[Christopher R Watters, MD]

http://www.ncbi.nlm.nih.gov/pubmed/22648109

[jmadzula1]

Dr. Watters,

   Thank you so much for your continued assistance.  My family and I certainly appreciate you taking the time out of your busy schedule to answer my questions (and the questions of others on this forum).

   At this point, I will demand surgery.  The percentages are enough for me to believe that I will see vast improvement post-op.

Thank you, if I have anything else I will be sure to ask you!

[jmadzula1]

Spoke with GI.

He agrees with the high ejection fraction not being normal and told me to find a surgeon.  He said it will be hard to find a surgeon who agrees, but he said to come prepared with the research you have given me (and another article I found) and hopefully we can get in to get it done ASAP.

Not sure how long surgery "turn-around" times are (from consult to actual procedure)... My consult is tomorrow so hopefully he can yank it out soon and I won't miss too much work.

Curious to see if you know any surgeons in the DC area if the surgeon I made an appointment with won't do it.

Thanks again!

[jmadzula1]

Dr Watters,

  Spoke to a surgeon on Thursday.  He got me into surgery yesterday (Friday) and I am doing wonderful!  Have some pain, but nothing too too bad!

   I was out of it of course, but I think he said that my cystic ducts were too small... Let me know if that sounds right...?  If not, I will ask him again when I go to see him on my follow-up visit.

Thanks again for all of your help!

The surgeon absolutely LOVED the research you gave me!

Thank you so much!

[Christopher R Watters, MD]

Fabulous. I am happy you are doing so well.

[jmadzula1]

The thing that I mentioned that he said "Small Cystic Ducts..." what does that mean?

[Christopher R Watters, MD]

It is an interesting observation that may well relate to the mechanism of pain generation. Otherwise of no consequence.

[jmadzula1]

Dr Watters,

   Do you recommend patients take pancreatic enzymes after having their gallbladder removed? The GI doc wanted me to try it before having it removed, but since I got it removed so quickly, I never did.  I read somewhere online that someone had relief of their diarrhea after having their gallbladder removed from taking the pancreatic enzymes.

   The name of the medication he gave me was Prevalite.  He gave me a huge box of samples...

Here is the posts I read online from people saying it helped, so I was wondering if you feel it is okay to take...

http://www.webmd.com/drugs/drugreview-5027-Prevalite+Oral.aspx?drugid=5027&drugname=Prevalite+Oral&pageIndex=1&sortby=3&conditionFilter=-500

Thanks again

[Christopher R Watters, MD]

There is no reason to think that pancreatic enzyme supplementation would benefit anyone unless they have somehow damaged their own pancreas such that it can't produce sufficient enzymes. If there ave been multiple bouts of pancreatitis for example. The diarrhea that is sometimes seen following cholecystectomy appears to be due to colonic motility issues probably due to increased delivery of bile salts. Pancreatic enzymes would have no effect on this process. With this said, there isn't much of a down side to a trial as they are basically harmless. Rarely, oral ulcers can form but few other potential complications are seen.

[jmadzula1]

Dr. Watters,

  Quick Question for you --

If I lay on my stomach, turn a weird way around (maybe to stretch my back or so) I get a pretty intense pain in the area of where the gallbladder was.  The incision bumps have mostly gone down, a little bit raised but not much as before...

Is this normal... I guess I am about a month post op...

Also, just FYI... pathology showed inflammation in the gallbladder after they removed it.

Will contact my surgeon here shortly if you think this is out of the norm, but wanted to check with you first.

[jmadzula1]

Also to report... 100% symptom improvement post surgery.  Hitting the fiber supplements pretty hard is helping me have normal bowel movements...  LOVING IT!!!!!!!! Awesome to finally get rid of everything that was causing this stuff!