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biliary dyskinesia
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biliary dyskinesia

I have biliary dyskinesia with an ejection fraction of 23%. I am on a very low fat diet and I eat very little dairy or wheat.I have become very skinny since this began-- about 2 years ago. My symptoms include stomach pain that moves all over my stomach area after almost every meal, but especially dinner, nausea, bloating, gas, intestinal pain, sore throat, sometimes a feeling of heaviness/pain at my sternum, but I do not have upper right quadrant pain. Isn't that the most common gallbladder problem symptom? The doctors suggest surgery, but I don't understand why it would be helpful to remove an at least partly functioning gallbladder? I understand why removing the gallbladder might help relieve pain in the gallbladder area if the gallbladder is irritated, but how will removal help with my symptoms? And, why will removing the gallbladder help reduce the the overabundance of acid in my stomach? Nobody has been able to answer these questions for me, and thus, I've refused surgery and have been getting acupuncture instead for the past 6 months. I'm flirting with the idea of surgery again because I'm not sure that acupuncture is going to be able to heal the problem. It hasn't so far, but it has helped to relieve some symtoms (symptoms). I would be very grateful if you can help answer my questions, and I am open to any suggestions you have to offer.

Sincerly, amy
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I was also diagnosed with biliary dyskinesia, and had all of those symptoms plus the right-sided pain. But I also have GERD w/Hiatal hernia, and that can also produce the symptoms that you listed. Have you been tested for GERD or had a PH study or endoscopy done? If not, I would get it done before having your gallbladder removed.

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Are you intolerant to wheat and the casein in the diary? Are you celiac?
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An ejection fraction below 30% is something to be concerned about regarding your gallbladder.  You may find your symptoms go away with gallbladder surgery - but maybe not.  For whatever reason, your gallbladder isn't functioning the way it should.  Some patients have what is called "referred" pain.  All that means is that pain from a given medical condition shows up somewhere that is not typical.  For example, when my appendix went south on me, my pain was in the upper abdomen (epigastric) area instead of the lower right pelvic area.  Referred pain makes a condition much more difficult to diagnose.

If your docs are telling you to have your gallbladder removed, I think that is a reasonable suggestion.
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My husband has the symptoms coba37 described (nausea, sore throat, chest heaviness/tightness, plus: diarrhea immediately after eating but not always, dry eyes, fatigue). This is interesting b/c we haven't seen anyone else with the sore throat and chest thing.

He has been seeing various doctors. Mostly they were concentrating on the chest heaviness looking for asthma/lung problem. Also have investigated allergies but not come up with anything yet. Had chest x-ray. Also PFT but results not back yet.

The difference is that he already had his gallbladder removed several years ago and the symptoms have come and gone for all this time but more consistently in the last 2 months. It's been on all his medical forms but no doctor has mentioned gallbladder related issues at all. He is frustrated b/c he takes great care of himself, eating well, no smoking, regular exercise. Any thoughts are welcome!
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My husband justrecently got diagnosed with this condition. Has anyone else had this diagnosis given after a hyda scan? Another question....What are some helpful hints on food that are low and fat and ones in which he should avoid?
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I have!  

In fact, the Hida Scan is the only thing that saved me!  My ejection fraction was 18%.  After an ERG and colonocopy to rule anything else out, I had my GB removed.  During surgery it was discovered that the fluid surrounding my GB was gone and it was literally peeled off of my liver.  I do not know what would have happened if I had waited and tried to manage the situation with a modified diet.  

I am happy to hear that he was able to have a hida scan!  I fought with several physicians before my test was ordered.  Because I did not have stones (as evident in my ultrasound), it was determined that the source of my symptoms was something other than my GB.  

You can have gall bladder disease without the presence of stones.  

I am one week post surgery, and still recovering.  It is a tough road, but I am happy to have found some answers.

Hang in there!
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I recently had a Hida scan after spending the day in the ER for Rt quadrant pain, mid chest pain and I have had sever bloating for many months - I look 5 months pregnant.  I now have intermittent right quadrant pain but the biliary ducts came back normal as did the gallbaldder. The intestine results state Enterogastric refulx with and EF of 14% at 20 minutes (normal ef is >35% at 20 minutes.) The conclusion of the test a decreased gallbladder ejection fraction suggesting biliary dyskinesia. Enterogastric reflux. I am just not sure I want surgery. I have no gallstones and the pain in not every day. I am tired of the bloating. I've been trying to lose weight but not very successful - and I haven't been cheating. Any suggestions or thoughts? Thanks in advance
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I have suffered from this condition for 22 + years. I went in thinking it was my gall bladder, classic symptoms but was told I had IBS. Over the years the symptoms have come and gone. I finally got a doctor listen to me and this questionable diagnosis of IBS. (I have no bowel dysfunction, never have.) the new GI ran a HIDA scan with CCK and it showed a very low injection fraction around 15%. Since I did not have a violent reaction when the CCK was injected the GI said I could wait on surgery.

Over the past 6 months, the pain/ attacks have been daily and I have grown a polyp in my gall bladder. I am thinking it is time to remeve the GB and end this feeling of having a knife in my back all the time.
Reta
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I just had a HIDA scan 2 days ago and was told my gallbladder was operating 20%. I have all the same symptoms that you have and my Dr. has already scheduled surgery for next week. A couple of people I know had the surgery, its in and out in the same day and they said that was exactly what fixed their problem. I didn't have any reaction to the CCK.  I am all for the surgery. I'd rather be sore for a week or two then deal with the pain.
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I am so glad I found this forum. Im glad Im not the only one. Ive had gastro issues that are documented since I was 16,but have always had a "nervus stomach". Anyway. I have been having HORRIBLE reflux. at 16 I was diagnosed with reflux disease. Anyway, in the early summer I went to see a Gastro Doc. He did an endoscopy. It showed gastritis, inflamation (inflammation), But no real reason for my reflux. He also checked my gallbladder via ultra sound for stone. None were there. He prescribed me medicine, and the main one for refulx my ins. wont pay for so Ive been popping Prilosec like Pez. and taking ranadine too. lots of that stuff,to no avail. So on the first I went back to see my dr. I had been researching my symptoms, pain in my chest, fatigue,nausea,vomiting,diarreah (diarrhea), extreme indigestion no matter what I ate. He set me up for both a HIDA scan and colonoscopy. The latter is due to fam history of early colon cancer. I had my scan and my GB is only working at 2%. The first part of the scan was not bad at all.But when I had to lay still and they injected more meds into me,I had an uncontrollable physical reaction. THought I was going to puke, my abdomen clinced up,and my knees involuntarily drew up. I thought I was dying.  Im glad now that I know what the results are. The surgeon wanted to take it out the day I went to see him. It just was not possibe. {2 small kids and we live away from family to help} So its set for tomorrow. He is also going to do a scope to see if I have a hernia. and that could be the cause of my reflux. We will see if removing the gallbladder helps, and surely it will help somethings! But if the reflux continues I will have the hernia stapled. Im nervous about recovery. My 2 y/o bounces on me all the time and he will only be at my inlaws for 2 days.{they both work}. So now we shall see how things go!
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Good luck with the surgery. I am seriously looking at surgery, I have been hestitant to have surgery because of other health issues and possible complications. I have done enough research to be comfortable with the surgery now.

I have my URQ ultrasound next week I am curious to see what this GB polyp has done over the last 6 months.

One of the things that have been most puzzling for me is the lack of some symptoms. My main complaint has been pain and cramping. They always ask about food and my reaction to fat, I can say I don't think I really had any.

I am hoping to get a new primary soon, my last one was forced to retired because of his age (77). He was a great doctor and we had gotten my health back on track. He worked 3 days a week and read journals the other 2. he was the most up to date doctor I had ever met.
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I am also 27 years old and am struggling with daily symptoms.  I have had the same diagnosis (biliary dyskinesia) resulting from the HIDA Scan.  I was intensely uncomfortable upon the injection of the CCK - felt nausea, right side cramping, the need to sit up to belch and breathe easier - I wanted to jump out of there!  My test results determined that my ejection fraction was 8% at 10 minutes, 12% at 20 minutes, and 6% at 30 minutes.  The recommendation is surgery, but I'm told I am not guaranteed a cure for the continuous belching I am currently experiencing, as something else may be causing this.  I cannot digest anything anymore; been on a low-fat and bland diet for over one month (no ground beef, nothing fried, no oil, no mayo, no cream sauces, no butter, etc.).  I still have symptoms daily and am always uncomfortable with belching, whether I have had a bland meal or even a glass of water.  Symptoms last for hours on end.  The newest symptom is diarrhea after meals, sometimes, when I have not even yet finished eating.
I am really hoping that surgery is the answer and that we will not have to search for another cause.  
For those who have had the laparoscopic surgery due to low ejection fraction/slow GB emptying, how quick was the recovery, and when could you begin to eat more normally?  Are you really feeling better?
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I have had reflux problems for years with continued tenderness to the upper gastric area. For the last 18 days I have experienced mild to severe pain in the upper gastic and right quatrant abdominal area. I have been to the ER and had abdominal xrays that showed nothing. I have had an ultrasound of my abdomin (abdomen) that should fatty liver filtration  and was + for Murrphy to the gallbladder (a pain response to a technic used by the tech). I had blood work that was poitive for H pylori with a result of 5.5 I am on day 2 of my antibiotics . I also had a hida scan that was normal except a 15.8% ejection fraction. When given the CCK I experienced severe nausea and severe abdominal pain and cramping immediately upon the injection. I went to see a surgeon yesterday and he said that there is nothing wrong with my gallbladder because there was no stone or apparent infection. He said a low ejection fraction is not a reason for surgery. He thinks that my problem is the stomach bacteria caused from the H pylori. I really want a second opinon, can someone please tell me what I should do. Should I wait and see if the antibiotics help or should I seek another opinion.
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I too just found out that I have biliary dyskinesia and after reading about some of the symptoms that still existed in patients after gallbladder removal, I'm not so sure myself. My problems started in July 2009 and since then, I have been to the hospital 5+ times and I've had numerous tests and exams done and everything came back negative. I finally found a great GI Dr who found this problem. I'm not sure if removing the gallbladder is the answer, but I do know that I'm tired of feeling sick eveyday. Wish you the best of luck in your case.  
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I am 30 yrs old and have biliary dyskinesia with a Hida scan result of 13%. I have had symptoms (bloating, nausea, vomiting, pain and other problems) my entire life and just thought that it was normal until I found out earlier this year that everyone on my mother's side of the family had their gallbladders removed for biliary dyskinesia. The docs say that it's not hereditary, but my youngest son has the same symptoms as i had and he's only 10 yrs ols and has been diagnosed with IBS, the GI docs say he's too young for a hida scan. My GI doc said that my weight gain (I've gained over 80 lbs ov er the last 2 years) is because my gall bladder is toxic and my tissues have been absorbing the toxins, the more my gall bladder continues to fail, the more toxins spill into my system, thus the reason for the fatigue, bloating and weight gain. We are hoping that after my surgery next week, that my system will slowly get rid of the toxins and my body can get back to normal. My mother lost 50 lbs in 6 months after her surgery. I just hope that I'm as lucky. Good luck to all of you, I hope you all start feeling better soon.
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I too have been having the same symptons-- Back in april i was in the hospital for a blood clot in the lung(right) and ahve been doing great since. I went back to the dr due to right quadrant pain and thought i had another clot. He sent me to do an bunch of test and one was an ultrasound. During my ultrasound i told the technician it was tender in certain areas and she noted it- My doctor informed me I have a Fatty liver, kidney infection, and possible gall bladder disease and was going to send me off for a HIDA scan.. First part was a breeze the 2nd part of the test ooh man i thought i was going to ralph all over that machine.. my stomach cramped soo bad

We got the results back and he informed me my gall bladder is only contracting 14%. He is going to refer me to a surgeon.. I am nervous and want to be back to normal!! I have been feeling bloated since atleast Jan of this year.. I feel like im 7 months pregnant, my stomach sticks out and my legs feel like they are going to explode when i sit on my knees!! I read in a post from someone on here and they gain 80 pounds from the toxins( i have gained 40lbs)  and i feel it in my heart thats whats going on with me!!  I asked the dr. and he says no. no way.. but seriously, i havent changed my diet ( I eat pretty healthy) and play softball 3 to 4 nights a week. PLUS i have been exercising and no luck with that! its like hitting a brick wall....

Do you guys think the weight gain is related? Anyone lose weight after the surgery?
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hey did anyone have exessive sweating?
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Hello All,
I had my ultra sound in September and my mysterious polyp disappeared. I finally got a referral to a surgeon. He was very positive about the surgery at our first appointment. He refered me to a hematologist because a family history of clotting. When I went to see him to schedule the surgery, I complained that his exam caused me pain for several days and has made my symptoms worse. Now everything  is on hold while I go see a pyschologist about my pain. He tells me that the symptoms do not get worse but I have been dealing with this for 22+ years. I really think I should be referred back to a GI, if he thinks this something else instead of a pyschologist. This makes me think he doesn't believe me.

I can't see the pyschologist until December 15, almost 3 weeks down the road. Meanwhile, I am left to manage my pain on my own. I am trapped in my house since I am having clothing issues. I can only wear a bra for a short period of time, it starts feeling like I am in a vice.
Reta
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Does anyone has shortness of breath?  I feel like a have the flu, the weight gain, bloated belly and nausea but have also been having breathing problems for a few months.  Drs can't seem to find anything wrong.  Maybe its the bloating pushing on the lungs but I can't wait to have the dang thing out next Friday.
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I to have had trouble with the vomiting and nausea etc.... went to many drs and they basically told me I was crazy,  Did the ultrasounds they came back fine, did catscans they came back fine ( get the picture)  I finally found a doctor who order me a Hida Scan and my gallbladder was only empting less than 10%. I had my surgery last week and am still recovering but I know now that I am not crazy.
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Hey all,
I finally found a surgeon to remove the GB and I am very happy. The back pain, you know the knife-in-the-back pain, was gone the first day. I have four small incisions that look like they were super-glued and taped shut. I am still a little sore but it has only been 4 days. The belly button incision is the most painful one. The difference between day 2 and day 3 was amazing, 1000% diference in how I felt.

My surgeon told me I would be in recovery and could not go home until I was up walking around and peed. After 1 hour in recovery, they told my husband he could take me home. He dressed me, I rode in a wheelchair and rode in the car, none of which I remember. I was in pre-op around 7:00am and the next thing I know I am home and it is 4:00pm.

Having this surgery has so far been wonderful and a blessing. I can even wear grown up underwear (a bra), which I haven't been able to wear since November.

Reta
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About four years ago I was living in Brazil and got terrible bleeding Ulcers.  I was very sick.  And returned to the states and went through a series of the "prev-packs" to get rid of the ulcers and every kind of anti acid.  After two years of being back I was still having a lot of abdominal pain.  I went in for an endoscopy in winter 2008 because I had terrible pain, vomiting, diarrhea attacks every few months.  But it came back negative for ulcers and negative for H. Pylori.  I moved shortly after that and they still weren't sure.  I am one to push through pain and not see doctors if I don't absolutely have too.

I was seeking for new answers.  I had another endoscopy in June 2009 because I thought it was Celiac disease.  My vilias came back blunted.  But not entirely.  The DNA test came back negative and I had little relief living for many month with a gluten free life. I have been through most of the GI book of problems with negative results. I turned to food allergies and was skin tested for those.  I stopped eating the list of the 19 things they told me I was allergic to: among them rice, cucumbers, onions, garlic, beef, cow's milk, fish, soybean, and corn (the last two eliminated all things in a box because they have been processed and contain corn syrup and or soy lethicin).  But from August to December 2009 I had daily diarrhea.  

In November 2009 I went to the doctor again for help of abdominal pain.  I  had another endoscopy with no results.  This GI doctor shrugged his shoulders at me and just wanted to give me meds for the pain.  Still no answers! Honestly I was praying intensely to find out why I was in so much pain.  I went into the primary care clinic to the hospital after a painful attack and my own personal conclusion that it was my gallbladder and as luck would have it got the "best resident" in the hospital.  She actually listen.  I had a HIDA scan the following week that when I was injected with the CCK caused terrible stabbing pain.  But oddly my ejection fraction was at 72%.  She still thought it was unmistakably biliary dyskinesia (and I have read it can be even if the ejection fraction was normal).  She sent me back to the GI specialist who disagreed with her again but followed her recommendations of a CAT scan. He didn't think it was my gallbladder. The radiologist kindly took me back after the scan and checked them with me.  We found a HUGE gallstone. Ta-dah.  I am confident that it is biliary dyskinesia accompanied with gallstones.  My wonderful resident told me they don't know much about biliary dyskinesia and was confident that what has been my problem with the gallstones (that didn't show up in an ultrasound in September 2009).

So my word to all of you with real pain-- keep going.  And be persistent and pray until those doctors find out what is wrong!

Meg
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Hello All

I just had my gallbladder removed Friday June 18th. I'm hoping I made the right decision. Anytime I eat anything like a cheese burger and fries, or say maybe I go to a birthday party and have cake and pizza. I will feel sick after wards. Usually about 3 to 4 hours after I eat. I am a very healthy girl. I don't eat this way all the time. Just on occasions and I do workout. Also if I decide to have a glass of wine or a margarita. I become very sick as well.  Again I only drink on occasions as well. And the same thing will happen I will feel very nausea, will burb some and have a sharp pain right in the of my stomach. Right between my rib cage. It feels like my stomach is on FIRE!! This will usually last about 5 to 6 hours and can be relieved a lil when I go to the bathroom. I do go to the bathroom allot when this happens. I feel like I want to vomit but never do. Just diarrhea. My question is does this happen to anyone else with Biliary Dyskinesia? I am doing very well after surgery. No complications. Just sore. Thanks!!
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p.s.

they said my gall bladder was only functioning at 2% of the time. Something with it contracting only 2% of the time.
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Yes to all the symptoms and including the excessive sweating!.... it's so embarrassing.   I've decided to have the surgery.  Acupuncture helped immensely however I can't get to him every time I have an attack (the last time was the worst one yet and he was out of town ).  The pain and bloating is relentless and I'm sick of it (no pun intended...)
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How have you been since the surgery?
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Congratulations on your surgery!  I had the same symptoms and struggled with my Dr. to get additional tests.  I explained to him that my father and two of three sisters had their GB removed due to very low EF readings but he wa not convinced that my sypmtoms were GB related.  He finally relented and I had the CCK/HIDA test done and my EF was 12%.  He was shoked and told me that an EF of <30% typically was referred for removal surgery!  I am a 49 yo man in good health otherwise and still have some reflux but no longer have the intestinal issues or bloating like I did before.  Post surgery recovery was a cinch and I had the operation on a Friday and was back at work on Monday.

Good luck to you I hope you have great results.
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I am waiting for the results of my CCK HIDA scan that I had yesterday.  After many years of suffering all of the symptoms you all have related, I began having eccessive sweating and shortness of breath this spring which urged me to try to find the reason once more.  My chiropractor told me she felt it was a bile problem, either from the gallbladder or liver/pancreas.  she told me to take Milk Thistle which has really helped.  I have told doctors for years that I am sure this is a gallbladder problem but they refused to listed because the ultrasound did not reveal stones.  So frustrated.  

I really appreciated reading all of your entries.  Thanks for posting.  If my scan suggests removal of the gallbladder I will definitely do it.
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Three years ago I had a HIDA scan done...44% was my EF, but I too was diagnosed with biliary dyskensia. When the CCK was injected I became very sweaty, and horrible pain, and started to vomit.  I have been symptomatic since the age of 15 (I am now 31 yrs old).  I have had colonscopies, Upper GI studies, alot of barium and CT scans with contrast, all with no answers.  I never know how I am going to feel hour to hour.  It doesn't matter what I eat (or don't eat) I bloat...my weight will fluctuate around 5 pounds a day!   My bloating is completely across my abdomen and at times I can't put my arms down to my sides because I am so bloated.  I get short of breath, sweat horribly, and the passing of gas is horrible...its like I have to bear down to pass it.  I spent the night in the ER the other day and I am finally going to get another HIDA scan to determine if it has went below the 35% mark...I'm keeping my fingers crossed because I truly feel removing my gallbladder with give me relief.  I have no stones, nor do I have any cysts or growth on my gallbladder or liver.  I have a family history of Primary Biliary Chirrosis (cirrhosis) and I am nervous that I might be heading that way if something isn't done soon :(
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I also have a galbladder EF of 23% and my EGD reveiled minor gastritis. I have spasms where my entire abdomen cramps up and I become severely nauseas and bloated after eating. I have always been on a low fat diet, so now even the smallest amount of fat can bother me. I was told that with my biliary dyskinesia (EF of < 30%) I also have reflux of the bile through my stomach, which explains my gastritis. The doctors want me to have my gallbladder taken out. Like you, I am hesitant since my EF is not super low (my mom's was 7%), but anything less than 30% is bad. They are pretty sure that my symptoms will be resolved after the surgery. Until you decide what is best for you, try mint supplements. Pepogest is great; take it on an empty stomach to help your intestines or with food to help your stomach. Hope that helps you make a decision.
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I have been experiencing symptoms for a while now but just within the past two weeks around 5-10 min or even immediately after eating I get immense pain in my right upper side and nausea and bloating. It doesn't matter what I eat, the result is the same. I went to the er yesterday after eating a turkey wrap and the ultrasound showed no stones, and my abd/chest xray was normal. The er doc suggested I get a hida scan because she still thinks its my gallbladder. I've noticed other posts about weight gain, I've gained about 40lbs over the last year, and constantly bloated and fatigued. I'm wondering now if this is all related to my gallbladder.
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I was also diagnosed with Biliary Dyskinesia as during my HIDA scan it took over 2 hrs for it to drop through the duct, but my EF was normal at 54% so they have decided they want to check the ducts now... they dont think removal of my gallbladder will help since it drained at proper rate once it finally started to drain... its frustrating.. i am now waiting for my MRI and then off to another GI to see if she wants to do an ERCP with manometry, I have lost 35lbs and was told this procedure might be risky for me becasue I am to skinny now... (its like hello im skinny from this)  just want to feel normal again...but they could be right and could be the ducts... fingers crossed.
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I've just been diagnosed with the same thing at 14% and the surgeon told me that it's totally up to me.  He said that the pain might not go away after the surgery.  Also the risks of the surgery which are small but still there. He said I can wait, get it done later on, or just not at all.  If I can live with the pain which is on and off, it's totally up to me.  I've decided to not have it done.  Why risk something going wrong.  He told me all that can happen and yes it's rare but why take the chance if it's not really necessary.
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I am currently waiting for my appoinment with the surgeon on the 9th.  I have had symptoms for over 15 years that just get worse by the day and the Dr did no think anything was wrong. In March my new Dr. thought maybe gallbladder then started treating my for reflux.  The meds did not help at all.  In September I had a ultra sound no stones.  Complained enough until I was refered to a gastro specialist.  They thought it was IB, meds still didn't help. They did endoscope in October which was fine. Dr wan't to do a colonoscopy I requested a Hida first. They did make me get checked for wheat allegies, negetive. My EF was 5% they have decided that the gallbladder must be causing all the problems and refered me to a surgeon.  I ran onto this post online and have been amazed with how many people are going through what I am. Specialy since the Drs. didn't feel that all the symptoms that I have could have been my gallbladder until they got the Hida scan results. I can't wait to have it removed. I am hoping it will get rid of the nausea, bloating (extreme weight gain in my mid section), shortness of breath (can't stand to were a bra), stomach pain and tenderness, chest pain and indegestion just to name a few. Since seeing alot of my symptoms listed in other peoples posts I did want to see if anyone else had cholesterol problems.  I have high cholesterol that has been diagnosed as a hereditary type that my brothers and I all have been checked and diagnosed with in March since my mother had been diagnosed and had heart surgery last Dec.  My cholesterol is now in normal range with medication all but my triglicerides (triglycerides) which are still extremely high. I  want to know if this could be caused by the low EF level since the bile is not being released? Please let me know if any of you have had anything like this as well.
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I am another person with the same type problems.  For many years (at least 10 or more) I have had reoccurring pain in my back on the right side and sometimes moving around to the front right side.  If I am pain free, which is rare, I can always bring it on with activity such as walking, running, twisting my body or doing exercises.  I never have any nausea, vomiting or jaundice but I do have abdominal bloating and some belching sometimes (but not always) associated with meals However I raely eat food with high fat content.  The pain is not sudden or severe but is moderate and chronic in nature.  Sometimes it will get better when I sit in a comfortable chair or lie down.  Lately it seems worse when I get up in the morning.  Over the years I have had all the usual tests (ultrasounds, cat scans, gastric emptying test, blood work, xrays of the spine, etc.) and all have been normal except that in 2006 I had a series of tests including an endoscopic test which was normal except that it reported no flow of bile after Kinevac injection.  The path report revealed "amorphous, slightly refractile crystals that may represent bilirubin."  No cholesterol crystals were seen and no stones.  A HIDA exam at that time was normal at 55.  However on the basis the endoscopic test my doctor suspected it was my gallbladder but it was not completely clear that was the problem.  I consulted a surgeon who thought it was about a 50% chance of being my gallbladder.  In 2007 I had another HIDA test and this time it was 22.  The surgeon then said the odds increased it was the gallbladder and suggested I may want to consider the laparoscopic surgery.  I was still not convinced because of the strong relation to activity as opposed to the usual symptoms associated with gallbladder disease.  In 2009 I had yet another HIDA test and this time it registered 33%.  I continue to have bloating  and the back pain is just about constant.  I am again considering removal of my  gallbladder.  Has anyone had a similar type experience with the pain being in the back, moderate not severe but constant and not related to eating high fat meals? Thanks for reply.

Don
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Yes with my biliary dyskinesia I constantly get RUQ pain that goes around to the back...definitely is the cause.  I decided to go ahead with surgery and pray to God it solves all my symptoms.  Good luck hope yours works out too. :-)
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I am so tired of this shooting knife stabbing pain thru to my back.  I haven't found any anwers.  I have had 2 HIDA scans over a period of 2 years the 1st showed 59% and the 2nd 86%.  Bizarre.  I'm seeing my 1st gastro dr in 2 weeks can't wait.
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I have had bouts with stomach upset, headache and fatigue for about 8 years. These episodes are sporadic. I could go 3,4 or even 5 months without a problem. However, when it rears its ugly head, it's debilitating. The fatique is overwhelming. I can not eat "real" food, and will eat just crackers and tea for up to a week (but I don't lose weight!). I never pursued this with a doctor because I felt that by the time I'd see one, I wouldn't have the symptoms.
During the past year, I started having an ache in my back. I also have excessive sweating, which I had blamed on menopause.I finally went to a gastro doc.After an abdomininal scan (nothing abnormal),and  an endoscopy (just slight gastritis inflammation), I finally had the HIDA scan with a result of 12%. He said that he's leaving it up to me. Some of my symptoms don't seem to be part of the usual GB complaints. I am now trying to decide whether to have my gall bladder removed. When I am not symptomatic, I can live with the back discomfort. I just don't know whether the benefits of this surgery are worth the risks (though I realize they are minimal).
Thank you to all who post, as I hope to continue reading to help make up my mind.
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You have responded to an old, outdated thread from 2008.  The people who originally posted these comments may very well have moved on.  Rather than reply to an old thread, we recommend that people start a new topic to discuss the subject anew.  To do that, please click on the green "Post a Question" button at the top of the page.  This will get your post the attention it deserves.  Thank you.
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I have been searching for the answer to my discomfort for years and FINALLY got the hida scan. My gall bladder currently has an ejection fraction of 15%. I'm 19 years old and can't remember a day without some kind of abdominal discomfort. My symptoms are like my stomach is expanding and it starts to hurt my ribs and my spine and I feel like I can't breath. This can happen 4 to 5 times a week then disappear completely for months, then return. I have been dealing with this my whole life and want to know honestly from someone who has had their gall bladder removed (due to biliary dyskinesia) if it was more beneficial than detrimental. Since I finally have the answer to my problem I now need to know how to fix it and be normal for the first time.
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Hi, I have had a lot of problems with gastroparesis, a stomach condition where the stomach empties food too slowly in to the intestines, my whole life. I recently had a really bad time with it and was going to the doctors and I had a surgeon that found that I have a gall bladder with an ejection fraction of 8%, he said this may be a cause to some of the problems.
So I was looking into the two problems to see if there was any correlation. I did find that some thyroid disorders can cause both problems, and biliary dyskinesia by itself. A thyroid problem, such as hypothyroidism, could be causing a sore throat because mine was swollen one time and it felt like a very sore throat. I would see if he could get blood work done not only on T3, T4, and TSH but also on the thyroid antibodies to make sure it is not his immune system attacking his thyroid. I think its called Hashimoto's disease if you would like to look into it.
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I am so glad I found this site. I thought I had lost my mind.  For over 23 years I have been told I have acid reflux, IBS, lower back problems, dairy intolerance, allergy to eggs and nuts, and the list goes on.  Went to a gastro, best in the DC area, did all the blood work to check for all the bowl and intestinal diseases, did a colon and endo, 2 sonograms, a cat scan was told nothing was wrong with me.  After coming home and feeling defeated and crazy. My daughter called and told me she was having a gallbladder attack and her doctor told her "my story".....so after all of that and a trip to er and the er doc doing a cat scan....she said you are having a gallbladder attack, then after not seeing gallstones said ohh, look here "it must be your food allergies and IBS, after looking at your records"....really did you go to med school!!!! So I went to my pcp and asked for  a HIDA scan and my gallbladder has a refraction of 22%....so thank God I see my surgeon next week!! After 23 years of severe pain, weight gain, severe gas pains so bad I thought that something was wrong with my back, told the headaches were migraines from stress, crapping myself....etc...I have lost faith in the medical community. NO one in 23 years could connect the dots???
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This was my story, except for the food issues. I kept telling them it was gallbladder but the GI said it was IBS. All my tests were normal, which is common for this disorder. I was treated for back strain during one of the attacks. I had URQ ultrasouds every 6 months for years: clear, no stones, no sludge. I finally got a GI to listen to me in 2007 and he ordered a HIDA Scan. My ejection fraction was 15%. I put off surgery until 2010. That last year was difficult because of the daily pain.

There is a 20% chance that it will not help your pain. I told the surgeon that I liked those numbers, because I would have 100% chance of being in pain without the surgery. I fell into the 20%. I was painfree for 6 months. The returning pain is the cramping and tightness in the URQ area and is nothing like it was before. I am convinced I have this pain because it took so long for them to figure out what the problem was. Like you,  it was 23-24 years of suffering.

Now, I can't get them to remove the IBS label.
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Dear forum with gallbladder pain,
I have this diagnosis of biliary dyskinesia and cannot eat dairy or certain medications otherwise I will have an acute episode that lasts for 12 hours of awful, horrible pain that makes me want to kill myself (doctors have told me that gallbladder pain is worse than childbirth pain). My GI doctor and surgeon told me the only option is to cut my gallbladder out; however, after reading the post gallbladder removal surgery posts, I don't want to have the terrible side effects that they have. Moreover, my GI doctor gave me this amazing medication that takes away the awful gallbladder pain within a few minutes. I think that I would rather take this medication once in a while than live with the possible awful new side effects of removing my gallbladder. The medication is called Hyoscyamine (0.125MG sublingual tablets, dissolve 1 to 2 tablets under the tongue every 6 hours as needed)! I have absolutely no side effects with this medication and it makes the pain go away fast and stay away!
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My daughter had similar .. her HIDA Scan rate was only a 4 and after her Gallbladder surgery her reflux was almost gone and all her issues resolved!

I know this post is old but the topic comes up and is a valued thread!

C~
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I had all the symptoms you all seem to have for years, and was told IBS, acid reflux, etc.  I just got to where I couldn't just keep living with it and changed doctors.  My symptoms weren't "classic" gallbladder - no stones.  The HIDA Scan showed a poor ejection fraction and surgery was recommended.  I appreciated the surgeon's honesty about the possible effects after the surgery, etc., and decided to go for it.  I just celebrated the one month anniversary of the surgery, and I do not regret it.  There are times that I eat something particularly greasy that sends me running for the restroom, but generally, I eat everything I did before the surgery.  My energy is back, and I am finding that many of the other issues that were diagnosed as something else are either gone or tremendously reduced.

The decision whether or not to have surgery is one you have to make based on your own circumstances - except for those emergency situations.  When I did go in for the procedure, the surgeon told me my gall bladder was inflamed, and that it could have become an emergency situation in a short time.  For me, it seems like the right thing to do.

Also - if you are a laparascropic candidate, check into your surgical options.  My surgeon was trained in the Spider system, which is just one incision at the navel.  The recovery is quicker and you have one scar instead of four.  It is not an option for the very overweight, and there may be other limiting factors to be discussed.

You have to go into something like this with the right mind set too.  If you are convinced you are going to have all the side effects you've heard about, or that the surgery will just create other issues, you might need to work on a pros and cons list to help you decide.  

Sign me - Taking two less medications and no more pain!
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When I read your example about your knees feeling so full of fluid you thought they'd explode, I had to respond.  I had bariatric surgery 10 years ago and have held a fairly steady weight since then.  Lately, weight has crept up without ANY change in diet or exercise.  It feels like fluid to me.  I cannot even put on my wedding ring.  My middle has been bloated to the point that I look pregnant.  13% function with my HIDA scan.  Legs swell and burn at night.  Other symptoms like fatigue, nausea, gas, etc...bother me daily.  Was diagnosed with bilary dyskinesia and am seeing a surgeon in three days.  Anxious to see some improvement.  This pain and discomfort is awful!  I'm also experiencing severe shoulder pain and am wondering if it is related to all this gas!
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I've been feeling sick and throwing up in the mornings about once a week. Sometimes twice or thrice a week. This has been ongoing for about half a year now, and what confuses me is that nausea (and occasional diarrhea and constipation) is my only symptom. No bloating, chest pain, cramping, or any other discomfort.

I had been on antacids and ulcer meds for the past few weeks that my doctor prescribed, and none of those helped. I finally got an upper endoscopy, and they couldn't find anything there, either, so my doctor put in the order for a HIDA scan.

During the scan I just laid there, feeling bored and crummy, and when I got the CCK injection I threw up within thirty seconds! Twice! Again, though, that was my only symptom - just nausea. I did feel tingling in all of my extremities like all of my body had fallen asleep... the doctor finally called me a few days ago and informed me that I had an ejection fraction of 18% and reccomended surgery. I'm meeting with my primary doctor this Thursday for a second opinion, or perhaps a confirmation.

I'm not so sure it's gallbladder dyskinesia though, based on the fact that I only have a few of the symptoms. I'm also very nervous about having it removed, because it might not even help. I don't have an 'official' diagnosis (i.e. the doctor didn't say I had gallbladder dyskinesia, but I'm sure that's what he meant)

Any advice? I'm scared and confused and not sure what to do next.
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Hi your story is identical to mine!! im still waiting for doctors to either remove my gallbladder or make an incision in my sphinctor muscle. I have two specialists whom cant decide! did you start to have water infections with blood and protein presant?
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Hi,

I had intermittent upper right quadrant pain for a while before it started to get worse.  My doctor ordered a HIDA scan and the gallbladder ejection fraction was 17%.  The pain got worse and worse, and I was getting close to finally scheduling gallbladder surgery when I found an article in a medical journal about PPI's (like Prilosec) causing low gallbladder ejection fractions even in healthy people.  Once I stopped the medicine (ironically all the doctors I talked with had been prescribing higher doses of PPIs when I started to have problems since they were worried about gallstones; I did ask my doctor first before stopping), the pain was mostly gone within about two weeks, and I have been pain free for at least 8 or 9 months.  I don't know if that will help anyone reading this post, but I am just so grateful that it worked out that way and I hope it can help someone else!  Best wishes to everyone who has posted! Biliary dyskinesia is no fun.
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It is April 2012. I am going in for GB removal in the morning. I've been having issues in the GB area since at LEAST 2006. I am tired of feeling like the Goodyear blimp! I'm done and it's coming out. In late Feb i had an x-ray -nothing, then an ultrasound-nothing. The GB scan showed my ejection fraction to be 19%, which is extremely low. I know 4 people who have had the surgery done and are glad they did.
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Sounds like you could be having peptic ulcer. it is typical to have pain 3-4 hours after food. Ask your doctor to have it checked just to make sure.
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Dear sweetG18,
   I am the mother of 2 children who have been through the same stuff. My 19 yr old just had her gallbladder out in Sept. and now eats anything she wants occassionally having diaherria, but thats a symtom post-surgery. Her scan number was 21%. My 11 yr old had hers out in October after dealing with this for 6 yrs. Medicine after medicine, hospital after hospital, years of pain and sickness. Missing school wks and months at a time.  Had the biliary scan done and was working at 14%. Thank goodness we had this done, she has put on weight and is back to normal. She has only had 2 bouts since Oct. of just her stomach hurting and diaherria. I am so glad for talking to the dr. that told us to have the scan done, otherwise I feel we'd still be dealing with this. The reason they said they never did the test was because they thought she was to young to be having that kind of problem already and she is not obese. He said it is becoming more common now then it was before. I hope this helps you in some sort of way!
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I have had all the same symptoms as many of you....lots of urq pain (after just about any meal), sometimes in my right shoulder or around to my lower back, lots of diarrhea (3 x per day for 2 months now), headaches...migraines for years. My primary doctor sent me for blood work, and ultra sound. I have no fever, no stones showed up in ultrasound and no hightened liver enzymes in blood work. She also had me give stool samples. I have mucus in my stools. Which points to colitis, but I have no results from thelab yet. I went to the ER a coulple days ago b/c of the pain in URQ and shoulder blade along with nausea and headache and was treated for dehydration and released. Yesterday, I had a CAT scan. I have no results yet. I have an appointment with a GI doctor in about a week.
My concern is they are going to tell me I have colitis (which is possible I suppose) but it doesn't explain the intense pain under my ribs or in my shoulder blade.
Did anyone else have mucus in their stools?
And how did you convince your doctors to give you a HIDA Scan?  Because that is what I believe I need.
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It took 20 years of complaining something was wrong before I found someone that really listened to me. Everyone kept saying it was IBS. I kept arguing it couldn't be because I did not have bowel dysfunction.  I found out the regular tests used for gallstones are often normal for us. I was going every 6 months for an URQ ultrasound.

I was treated for back strain during one flare. I came home and sleep for a week on painkillers and muscle relaxers.

Just ask your doctor to do the the test. You have the classic GB like pain. It might be time to see how well the GB is functioning. A HIDA Scan is the only test that will tell you that.

I think I had mucus in my stool a few times.

Be warned a low ejection fraction is associated with chronic infection, which may not show up on the bloodwork. My only abnormal lab was a slightlty elevated (about 10-20 points higher) alkaline phosphatase, which no one thought significant.

My biopsy report said signs of chronic infection. I showed the report to my Primary and told her I felt vindicated because no one believed anything was wrong . She believes me when I tell something now, no matter how small.
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I guess it isn't the GI doc with the pain. As a surgeon, I would point out that the recommendation for or against surgery should come from a surgeon rather than from someone who has never held a scalpel. We take these decisions very seriously. The recommendation for surgery is based on a large amount of solid research in this situation. I have grown tired of primary care and GI docs that refuse to recognize this problem. I had one patient that was looking into a European pain clinic because his primary care (who was handing him narcotics for 8 years) had misinterpreted his HIDA test.
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If you have to convince your physician to order the correct test it may be time to change physicians. An endoscopy would be in order to rule out other causes of your symptoms but a HIDA with CCK stimulation would be the next exam to get. Is this a Gastroenterologist or Surgeon? If not you should see one as biliary dyskinesia is beyond the usual realm of the Primary Care Physician.
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Hi
Just reading your info! I have the same symptoms as you. I had 4 ultra sound scans on my gallbladder over four years. I also had a background of suspected IBS since being a child. As my symptoms of low energy and pain increased over the years, I got worse this year being admitted to A&E several times. After my own research I suspected I still had severe gallbladder pain and possibly Sphinctor of Oddi Disorder. Doctors did not want to do anymore test due to negative scans on my gallbladder. I argued I heard about a HIDA scan and with reluctance booked it at another hospital as they did not have the equipment. To my relief they found low ejection rate and I have just had the gallbladder removed. The histology reported gallbladder fibrosis, no sludge,no stones(new I was wright) I have had continuing problems post removal, which have not gone away so now we are going down the route of maybe Spinctor of Oddi Dysfunction. I had the MRCP which showed the pancreatic and biliary tree was normal(but that means nothing they said my gallbladder was fine too) I have read you can still have pressure and pancreatic scans be fine, so i'm on the nxt path to sort this nightmare out with hopefully an ERCP nxt even though the specialist is reluctant to do it. I have been off work for a year and am now applying for disability. My daily life is a nightmare still, as I still cannot eat normal portions and live on liquid meal supplements. So my advice is believe in how you feel and do you own research and demand investigation.


Good luck everyone
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I am sorry I missed your comments. I was not in daily pain when I saw the GI. One of the unusual aspects my disorder was the intermittent aspect. I also had just been in a car accident 2 weeks earlier, so being able to put off surgery was fine with me.
I saw my primary in June for my GB pain but waited until September to have another URQ ultrasound because they had found a polyp in the March URQ ultrasound. It turns out it was not a polyp but Cholestrosis. I started the process for a referral to a surgeon.
I was very a
nry when the surgeon told me about my primary had sent me with reservations. This one of the main reasons I got a copy of the biopsy to share with her. I had dealt with no one believing for too long.
I will say my surgeon was very honest  and told me that there was a 20% chance this would not help me. I was quick to point out that 80% was a very good number and that I had a 100% of being pain without the surgery. I was 53 and still had all my body parts (minus 3 wisdom teeth). I did not approach surgery lightly but I was in a lot of pain on a constant basis and it was looking better everyday.
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I was doing some research tonight and discovered that GERD and gastritis are are associated with this disorder.
The GI that ordered the HIDA Scan also did a endoscopy and discovered mild gastritis and treated me for GERD. I argued with him about the GERD, My husband has suffered with GERD for years and I did not have nay of his symptoms. Now I know why I had gastritis.
I had been sent to the GI because they suspected Celiac.
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I am with 3% ejection fraction. Lots of gas. Feeling pressure to chest and stomach area especially with a full meal. Burping a lot which helps relieve my chest pressure. Can not have a decent vreath
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I am with 3% ejection fraction. Lots of gas. Feeling pressure to chest and stomach area especially with a full meal. Burping a lot which helps relieve my chest pressure. Can not have a good breath with all the air press against my chest. no pain, but two episodes of stomach ache. One GI send me to surgeon to remove my gall bladder, one GI told me it is GERD and IBS. Do not know what to do ? Are there anyone there with similar symptoms get better after the removal of gall bladder?

An
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You comment on the opinions of several specialists. I assume that you have had an upper endoscopy if you have been seen by two gastroenterologists. I also assume that either one of them or your PCP has put you on some form of acid suppression. I see a lot of folks with gallbladder dyskinesia and the majority of smptomatic patients have ejection fractions in the teens. To have a single digit EF puts you in a very small subset of patients. It is hard to ignore such an abnormal result. Unless erosive esophagitis was seen on EGD or symptoms were significantly improved with acid suppression you should strongly consider cholecystectomy.
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i just had a hida scan today and i was referred to a surgeon because i have been diagnosed with biliary dyskinesia... wont know too much until tuesday, july 10th.. (my visit with the surgeon) will keep all posted as to what the surgeon suggests is the best option for me.....
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Fundragon,
biliary dykinesia has been linked to gastritis and GERD. I felt immediate relief of my pain symptoms with surgery. Unfortunately, my pain returned due to SOD but is not as bad as before.
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Finally got a diagnosis!! I was getting no where with my former doc and now fortunately found great health care providers who scheduled surgery based on recurrent subjective symptoms, even with an EF on HIDA of 71%..I feel its worth having my Gallbladder removed and examined and hopefully will find symptom relief (bloating, belching, weight loss, cramping, nausea, vomiting, fatigue, back pain, RUQ discomfort, diarrhea,constipation) Extremely important to advocate for yourself....unfortunately mixed in with us "normal" folks are a bunch of seriously crazy patients who have left a majority of the medical community skeptical of us all. (I believe we were taught not to judge patients!) Additionally, due to corporate pressure from insurance companies, the doctors hesitate to order tests or schedule surgeries unless completely convinced of medical necessity. The Health care system is a big mess and until there is a significant changes (not happening anytime soon) everyone needs to be strong self advocates...complain, call, research, get 2nd, 3rd, 4th...opinions and vote! I will let you know my post-op results.
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I think you are wrong giving the medical profession the benefit of the doubt. As a surgeon dealing with patients with gallbladder disease, I think it is one of the most mismanaged problems that I see. I am amazed how often I am called upon to emergently deal with patients not because they have failed to follow up but because their primary care providers have either mismanaged the problem or given them bad advice. This especially holds for patients with biliary dyskinesia. PCPs are working from studies that are frequently misinterpreted by radiologists or poorly performed. For example, the most frequently used protocol for HIDA w/ CCK administers the CCK over 3 minutes. This saves the technologist some time but has been shown to give an abnormal result in 30% of normal patients without any complaints. The literature strongly supports giving the CCK over 45 minutes to an hour but this is rarely done in practice. Symptom reproduction is frequently not recorded by the radiologist because the technologist failed to pass it along to him. After 20 years of seeing frustrated patients who had been tided along without completing a workup we are moving forward at Duke with the creation of a bilary dyskinesia clinic to appropriately manage patients with functional biliary pain.
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Hi, Dr. Watters - I have had stomach problems for over 30yrs. Have been diagnosed w/ IBD, IBS, Illeitis, early Crohn's, Microscopic Colitis, Colitis, Ulcerative Colitis, & possibly Tsetse Syndrome! Believe me, I only went to a doctor when I had severe diarrhea or more than normal pain or discomfort. Each doctor knew of my prior history, but always came up with a new diagnosis term! All wanted me to medicate, which I am very reluctant to do. I have learned to "live" with my symptoms, and have adjusted my lifestyle around my digestive style, and base my intake on what is comfortable. I eat in small amounts, also. This seems to get me past most difficulties. BUT, over the past 6 to 8 months, I have been having a lot of upper abdominal discomfort under the rib cage by the sternum, and continue with my daily 10 to 15x a day diarrhea. Had to go to the ER one day with bad discomfort, and the exrays and scans showed nothing. Having recently met a wonderful, LISTENING colorectal doctor when my husband had recent problems, - I made an appointment with him to ask for his opinion. I brought in ALL my records showing the diagnoses as noted above, and he suggested an abdominal scan and HIDA w/ CCK. Well, BINGO! the HIDA came back at 3.5%EF showing most probable Biliary Dykinesia. It helped to know that I wasn't crazy, but I am beginning to wonder if all the gastro problems that I have had all these years weren't due to my gallbladder issue?? I am not ready to rush for removal since I am not in constant pain, just discomfort here and there. I still adjust my eating to help with the belching, gas, bloating, fatigue, etc. Based upon this LONG comment ;-) ....do you think that I can go without having my GB removed until it becomes a major problem? I am so worried about having surgery, and all the "what if's" that are involved! I am 66, also have Hashimoto's, but otherwise am in really good health. I really would appreciate your opinion, and understand that it is so difficult to advise someone that you have actually not examined - but, you sound VERY logical and ready to listen! Thank you so much.....
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Wow, what a saga!

My first question is what is your thyroid function? With the Hashimoto's I am assuming that by now you are on some supplementation. If you are hypothyroid your gallbladder function could be adversely affected when the gallbladder isn't the real problem.

It is always a difficult decision when the patient's main long term complaint is diarrhea. While diarrhea is frequently the result of a diseased gallbladder the fact remains that some patients develop diarrhea as a result of gallbladder removal. I would never recommend a cholecystectomy based on diarrhea alone. Without typical pain, I would not pursue surgery. With this said, when patients with chronic diarrhea develop typical gallbladder pain and are shown to have abnormal function undergo cholecystectomy, I have seen the diarrhea resolve in the majority.

In your situation, if your thyroid function is in the normal range and having typical gallbladder pain, I would seriously consider gallbladder removal.

Hope this helps.
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Thank you so much for answering so quickly! I never expected that... I am on 100mg synthroid per day. It has been upped as needed over the past few years since diagnosis. This has helped my fatigue a little, and my TSH seems to be staying in normal range at this point - it had always been very high. Thank heavens I do not have severe pain in my upper abdomen, and as I said, I am very aware of what I eat to control discomfort. The diarrhea is normal for me at this point after 30 years. With a 3.5%EF result from the HIDA, and having the TSH under control with meds, I am doing my research and appreciate your advice under these circumstances. I know if I see a surgeon, he will automatically want to go in for the GB removal. Just measuring my steps carefully as you can tell. I will watch for your reply, and also follow your comments for others with this problem. Are you on any other posts?
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Oops! My typo - I meant to say in the previous comment that I am on 100MCG (not 100mg).... Sorry, my goof!
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I am a little confused. Your original post said that you were having a lot of upper abdominal pain. The last one says no severe pain. I think the colorectal surgeon was going on the pain when he ordered the HIDA scan. In non-stone disease the indication is the pain. If you are really not having much discomfort I don't see a problem with delaying. However, if there really is significant pain under the right costal margin as previously described, I would encourage proceeding. Just realize that the effects on your diarrhea is unpredictable.
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My original post did mention that I had had some pain in the past, but mostly very bad discomfort in the upper abdominal sternum area. Over the years, I only went to the doctor if it became worse. I am sorry if I was unclear. I have never had sharp knife-like pain, but varying very bad upper ab discomfort. I don't know when the word "pain" is to be used - I was just hurting or feeling horrible! I have been feeling OK for the past few weeks, and being very careful not to sit too long and to watch what I eat. I very much appreciate that you have taken the time to write back, and I will delay removal of my GB for as long as possible. You have been very refreshing in your open opinion, and understanding in your comment delivery. Your patients are very lucky! :-)
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Dr. Watters,

I am pleased to see an actual MD on here and am hoping maybe you can help me in my decision to proceed with gallbladder removal or not. I have suffered 4 bouts of gallbladder attack and ended up in the ER once over the last 6 months. The pain in 3 of the 4 attacks occured at night (waking up in extreme pain around 2 or 3 A.M.), many hours (4 or more) after I had eaten something triggering (in my case, fatty foods). The daytime attack occured 10 minutes after I had ingested a trigger food. I have lost approx. 50 lbs via a change in diet and exercise in these 6 months and my primary Dr. noted that biliary dyskenesia can occur as a by product of weight loss. I went from a high fat diet to a low fat diet quickly. I feel like my body doesn't know how to properly digest fat anymore.

I had gallbladder ultrasound completed in May and the report noted some small stones and possible sludge-like material. My HIDA scan gave me an ejection rate of 10%. I have consulted with a general surgeon who let me know gallblader (gallbladder) removal for biliary dyskenesia does not always relieve the symptoms. He suggested I meet with a GI (scheduled for 09/24) to have an endoscopy done to rule out a peptic ulcer or some other digestive/gastric issue causing my gallbladder to not work as it should. My general symptoms (apart from the attacks) are as follows: general dull ache in my upper right quadrant, nauseous (at times, but never vomit), feeling of fatigue/unwell, general digestive issues (bloating, cramping, etc.). I have been to my primary physician for this and all tests come back normal. I do not have attacks if I limit what foods I eat and do not eat past 7:00 P.M.

While I know you cannot diagnose over the computer, what do you think of the above? Would you recommend me as a candidate for gallbladder removal? I am a 28 year old female with no other health problems that I am aware of and have never had surgery. My surgeon pretty much left the decision up to me. I think the GI is a good place to start and will hopefully help in making my decision. I wish there was a way to reverse the biliary dyskenesia as I would preferably not want to proceed with surgery (it terrifies me), but the surgeon had no knowledge of such things and thus referred me to the GI. Your thoughts on any of this are appreciated. ~Tonya
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Kats,
It does not have to be the knife stabbing episode to be pain. Does it causes discomfort that interferes with your daily activities? At first, my pain felt like I had been poked with a stick. It progressed to feeling like I had a knife stuck in my back. And finally, just before surgery, it progressed to feeling like a piece of molten rock burning a hole through me. Sometimes the dull constant aching is harder to deal with because it is 24/7, not like the attacks that while intense may be hours or days apart.

As the pain progressed, I found it difficult to sleep because you can not get comfortable. I could not stand to wear a bra because the strap went right across that area. And my GB did not like the doctors examining it and made me pay for each exam with increased pain.

I found that walking helped at first and a heating pad helped those muscles to relax. Later nothing helps.

Reta
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Tonya,
Your surgeon is correct about surgery not always helping with biliary dyskinesia. Mine surgeon told me there was a 20% chance of it not helping. I told him 80% chance sounded really good because I had a 100% chance of being in pain without surgery.

I have never heard of biliary dyskinesia  being caused by weight loss. I have heard that gallstones are extremely common after a significant weight loss. In fact, it was very common after a diet plan like Jenny Craig.

One of the problems with this disorder is the standard tests used for gallstones will come back normal. The HIDA scan is the only test that will tell you how the GB is functioning. It only took me 20 years to get a doctor to run one to find out why I kept complaining of URQ pain.

What type of reaction did you have to the CCK during the HIDA scan? It made me nauseous but not violently ill. My GI said I could put off the surgery, if I wanted. I put off surgery for 2 years.

My surgery provided me with 6 months of being painfree. My pain has returned but is not as bad as it was and is manageable. Some days are better than others.

Reta
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Tonya,
I am confused by your evaluation. You should not even have had a HIDA with CCK stimulation as it can be extremely dangerous if there are documented gallstones, especially small ones. The contraction induced by the CCK can shoot stones down the common bile duct and expose you to the most dangerous complications of gallbladder disease such as pancreatitis. Most radiology departments will refuse to do the study unless there has been a negative ultrasound within six months.

You have calculousngallbladder disease. The fact that your ejection fraction was only 10% does not matter. This is an entirely different algorithm for treatment. If your have typical biliary symptoms and are shown to have gallstones (size does not matter here) then you have about a one in three chance of landing in the ER with a serious complication such as cholecystitis, cholangitis, or pancreatitis. When we are forced to care for patients in the face of one of these complications the mortality rate goes up as much as one hundred fold. The reason that we recommend cholecystectomy in the face of symptomatic gallstones is that their gallbladder has a greater chance of shortening their life than we do.

There is no question in my mind. You should have your gallbladder removed.
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Dr. Waters,
I have had pain to the right of my belly button and below my ribs on the right side but no other "typical" gall bladder symptoms (attacks, nausea, bloating, back/ shoulder pain.) However, this is what my general surgeon seems to think is wrong with me.
My ultrasound came back negative (yay!) and I am scheduled for a HIDA scan next week. My main question is this: IF I have to have my gall bladder removed, how long should I wait to try to get pregnant? I am 30 y.o. and want to have a baby in the worst way! Also, if the tests come back inconclusive, should I wait to have it removed and risk something happening with it while I'm pregant or go ahead and get it removed?
This is all I can think about and I would love some insight!
Thank you!
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IF the HIDA shows the gallbladder to be the likely source I would not delay. Once the gallbladder is out there is no reason to wait regarding pregnancy. It would be best to have this taken care of prior to pregnancy because gallbladder issues are frequently aggravated during pregnancy.
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Thank you so much for your quick reply! That makes me feel so much better... This all started as a small comment to my Endocrinologist (I have Hashimoto's) that I have a little pain in my side, now here we are talking about possible gall bladder removal! It's all happened so fast... It wasn't a big deal- the pain is not bad and it's not all the time but just didn't really feel right. I really don't want any unneccesary surguries, especially since I don't have any of the bad symptoms- sounds like digestion issues might even get worse after removal. ugggh... I guess I'm just nervous! sorry for the rambling...
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Dear Dr. Watters,
I am thrilled to find this thread. I am 42 yo white female thin (108-115, go up and down from flares of diarrhea), non-smoker and non-drinker, with a long history of IBS (was typically diarrhea dominant until this past February, around the time I had laparoscopic surgery for Endometriosis (the surgery showed very little Endo but lots of scar tissue and adhesions from C-Section/Tubal Ligation 5 years ago) and then became constipated dominant. In addition to suffering from IBS since my teen years I also have as long of a history with migraines, ovarian cysts and very painful periods and over the last 5 years very painful mid-cycle/ovulation pain. Over the last 5 years I have developed a very long list of symptoms, won’t list them all but some of the most bothersome are chronic nagging lower back pain, joint pain in knees and sometimes wrists, acne/cystic acne, very oily skin, extreme fatigue, irritability, mood swings and the list goes on and on. I lived in NH and complained to my doctors for years and was dismissed with IBS, migraines. I moved to FL in January and finally was taken seriously by new doctors down here. After the lap surgery in Feb. for Endo  did not relieve IBS symptoms, fatigue or the chronic lower back pain I was referred by my PCD to a GI Specialist. Until this point I was given the following diagnosis: IBS, likely microscopic colitis, Anemia, Migraine & CFID/CFS-saw Dr. David F Bell in Cambridge MA (then a leading doctor in the field). The lap surgery in Feb was a huge disappointment, although lots of adhesions, scar tissue and small amount of Endo was removed all symptoms persisted and the surgeon said my organs looked healthy and did not recommend Hysterectomy at this time but would monitor symptoms. I was already avoiding dairy, gluten, red meat, alcohol, spicy food and most fatty foods and fried food, my weakness is sugar and sweets particularly chocolate. PCD also did back x-ray showing normal osteoarthritis in lower back for someone my age, but was told it was not the cause of the pain I am having, sent me to a few weeks on PT that didn’t help at all, in fact some days made it worse.  I then saw GI doctor, then down to 108 lbs. (5 feet 5 inches tall) and still anemic and exhausted he ordered Endoscopy & Colonoscopy, had this done July 30th, diagnosis: Severe GERM, Gastritis of the upper Atrium, Stomach hernia, Internal & External Hemorrhoids, and 1 precancerous semi-pendulated (sp?) polyp removed from colon (said it was more rare for someone my age to have this type-precancerous and a good thing it came out), I think that is everything…………was negative for colitis from what he can see and negative for celiac. So I added gluten back into my diet. Saw the OB/GYN again and now he says if pain persists I should consider complete hysterectomy, which confuses me because he said the organs were healthy during lap and should not come out, now he says they should? At the recent follow up I complained of the same symptoms: chronic gas, chronic uncomfortable bloating, nausea (after eating, never vomiting), mild pain in sternum area and sometimes URQ, most bothersome is the nagging lower back pain and joint pain (particularly my knees), fatigue, very painful periods and midcycle/ovulation paid, migraines, irritability and constipation dominant IBS with occasional diarrhea flare he ordered the ultrasound, showed all organs looked normal and then scheduled the HIDA Scan which showed my GB if functioning at 9%, no symptoms during the test. I am referred to a surgeon and awaiting that apt. My GI doctor says the GB should come out to see if my symptoms resolve and if not they will do an MRI on my back and internal organs to get a better look than the ultrasound. My questions are, should I have the GB removed given all the other problems I am having? I don’t have any gall stones or severe GB attacks. I just worry about more surgeries, do I have the GB out and a hysterectomy? Is the GB likely the cause of my chronic lower back pain and fatigue? What about my knees being in pain, can this have anything to do with my GB? Any insight or guidance is greatly appreciated. Just torn as to whether I should have surgery or attempt to monitor with diet? Any effective medications to use for treatment? The GI seems to want the GB out and didn’t offer any other options, just referred me to the surgeon who I see next. Should I first have MRI’s on my organs and lower back? I am just sick and tired of being sick and tired. The IBS, migraines, severe PMS/Periods and female issues and fatigue are already having a major effect on my quality of life and interfering with normal activities. Thank you very much in advance!
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Dear Dr. Watters,
I am thrilled to find this thread. I am 42 yo white female thin (108-115, go up and down from flares of diarrhea), non-smoker and non-drinker, with a long history of IBS (was typically diarrhea dominant until this past February, around the time I had laparoscopic surgery for Endometriosis (the surgery showed very little Endo but lots of scar tissue and adhesions from C-Section/Tubal Ligation 5 years ago) and then became constipated dominant. In addition to suffering from IBS since my teen years I also have as long of a history with migraines, ovarian cysts and very painful periods and over the last 5 years very painful mid-cycle/ovulation pain. Over the last 5 years I have developed a very long list of symptoms, won’t list them all but some of the most bothersome are chronic nagging lower back pain, joint pain in knees and sometimes wrists, acne/cystic acne, very oily skin, extreme fatigue, irritability, mood swings and the list goes on and on. I lived in NH and complained to my doctors for years and was dismissed with IBS, migraines. I moved to FL in January and finally was taken seriously by new doctors down here. After the lap surgery in Feb. for Endo  did not relieve IBS symptoms, fatigue or the chronic lower back pain I was referred by my PCD to a GI Specialist. Until this point I was given the following diagnosis: IBS, likely microscopic colitis, Anemia, Migraine & CFID/CFS-saw Dr. David F Bell in Cambridge MA (then a leading doctor in the field). The lap surgery in Feb was a huge disappointment, although lots of adhesions, scar tissue and small amount of Endo was removed all symptoms persisted and the surgeon said my organs looked healthy and did not recommend Hysterectomy at this time but would monitor symptoms. I was already avoiding dairy, gluten, red meat, alcohol, spicy food and most fatty foods and fried food, my weakness is sugar and sweets particularly chocolate. PCD also did back x-ray showing normal osteoarthritis in lower back for someone my age, but was told it was not the cause of the pain I am having, sent me to a few weeks on PT that didn’t help at all, in fact some days made it worse.  I then saw GI doctor, then down to 108 lbs. (5 feet 5 inches tall) and still anemic and exhausted he ordered Endoscopy & Colonoscopy, had this done July 30th, diagnosis: Severe GERM, Gastritis of the upper Atrium, Stomach hernia, Internal & External Hemorrhoids, and 1 precancerous semi-pendulated (sp?) polyp removed from colon (said it was more rare for someone my age to have this type-precancerous and a good thing it came out), I think that is everything…………was negative for colitis from what he can see and negative for celiac. So I added gluten back into my diet. Saw the OB/GYN again and now he says if pain persists I should consider complete hysterectomy, which confuses me because he said the organs were healthy during lap and should not come out, now he says they should? At the recent follow up I complained of the same symptoms: chronic gas, chronic uncomfortable bloating, nausea (after eating, never vomiting), mild pain in sternum area and sometimes URQ, most bothersome is the nagging lower back pain and joint pain (particularly my knees), fatigue, very painful periods and midcycle/ovulation paid, migraines, irritability and constipation dominant IBS with occasional diarrhea flare he ordered the ultrasound, showed all organs looked normal and then scheduled the HIDA Scan which showed my GB if functioning at 9%, no symptoms during the test. I am referred to a surgeon and awaiting that apt. My GI doctor says the GB should come out to see if my symptoms resolve and if not they will do an MRI on my back and internal organs to get a better look than the ultrasound. My questions are, should I have the GB removed given all the other problems I am having? I don’t have any gall stones or severe GB attacks. I just worry about more surgeries, do I have the GB out and a hysterectomy? Is the GB likely the cause of my chronic lower back pain and fatigue? What about my knees being in pain, can this have anything to do with my GB? Any insight or guidance is greatly appreciated. Just torn as to whether I should have surgery or attempt to monitor with diet? Any effective medications to use for treatment? The GI seems to want the GB out and didn’t offer any other options, just referred me to the surgeon who I see next. Should I first have MRI’s on my organs and lower back? I am just sick and tired of being sick and tired. The IBS, migraines, severe PMS/Periods and female issues and fatigue are already having a major effect on my quality of life and interfering with normal activities. Thank you very much in advance!
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* 5 feet 6 inches tall/ 108 lbs weight
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Hi Dr Watters,

My name is Beth, I'm a 3rd year medical student and 30 years old.   Here's my 'bullet':  30 year old with history of Common Variable Immunodeficiency, Polycystic Ovary Syndrome, Sleep Apnea, GERD, Growth Hormone deficiency, constipation since age 3 (causing me to be tested for CF).   Chief complaint:   Have had repeated 'attacks' over years often following ingestion of fatty foods (cheese, rich foods, etc.), causing pain in RUQ (also some central/diffuse pain but lately more focused RUQ), extreme gas/belching, nausea, and back pain.    Current attack started 6 weeks ago with what was called 'viral gastroenteritis', that also had vomiting and diarrhea.   After 5 days, continued to have extreme nausea/gas, lost 10 lbs in 2 weeks.   Now 2-3 weeks ago after bridal shower, 1-2 hours after eating started having the severe pain, gas, nausea. Around that time had positive UA with bacteriuria and was put on cipro for a week.    Have cut out gluten and dairy, continue to lose weight (total of about 15 lbs).   Saw ID Dr and GI, had 1 visit to ER - dr and I worried about pyelo when back pain started getting really bad.   Now have constant pain/tugging sensation in RUQ, and continue to have gas though it's gotten better since the new diet and double dose PPIs.    Had EGD that only showed mild gastritis.   U/S (abd & pelvic) only showed fatty liver, said gallbladder was normal.   Had HIDA scheduled for tomorrow with EF, but fighting with insurance, now they are saying they won't cover it with EF, that I have to have a plain HIDA first, then repeat with EF which makes no sense.   My GI is not in the office and staff won't call him at home to call insurance company, I'm having ID doctor try to fight for it because I know it's the EF that's important.   I had to take medical leave from med school for past 2 weeks because I've been so sick and to try to get tests done, and can't afford to take any more time off (tho if it's positive may have to take off for surgery).   Do you have any advice?    Never had colonoscopy, would you reccomend that with chronic constipation?   Had 1 grandparent die in 30s, don't know if it was stomach cancer or colon cancer.   The nausea/gas is often worse in AM and late at night.    Also been running fevers past few weeks, originally around 101-102 before antibiotics, now 99.3-99.5.

Beth
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Generally, I pay attention when the ejection fraction is below 10% because that is so uncommon, even in the population that I see. But......... You have numerous symptoms that would not be explained by a diseased gallladder. It sounds as though you have rather diffuse motility issues. Why would the gallbladder be spared. I would consider a rheumatologic evaluation if you haven't had one yet. There are several auto-immune conditions that could produce the diffuse array of symptoms that  you have. We love patients where all their complaints can be explained by a single malady but it is also possible that there is more than one present. A wise old professor of mine once told me that it is possible to have fleas and lice.....
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Beth,
I have never heard such nonsense from an insurance company. I recently had to have a "peer-to-peer" discussion with a medical director about one but all he needed to hear was that an ultrasound had been done and was normal. As you probably know,myhe only utility of a HIDA without CCK stimulation would be to rule out the cystic duct obstruction seen in acute cholecystitis. I have a hard time believing that any insurance company would require a useless test to be performed before having it repeated the right way.
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I recently noted that you have kindly answered questions on this blog.  For many years I have had a medical issue similiar to some of those that have been discussed.   In December 2009 I wrote the thread shown below.  Since that time its been more of the same.  Periodic pain (not excrutating but moderate and steady) in the back where one would expect Gallbladder pain to occur.  Also some bloating and belching but no other symptoms. As previously stated twisting my torso will bring on the pain but it can and does appear without any such activity.  One thing I didn't mention in 2009 is that a surgeon I had consulted did diagnose Biliary Dyskinesia.  Had a Esophagogastroduodenoscopy in 2011. No abnormal biopsy. Still fighting this and wondering whether to have my Gallbladder removed.  I would greatly appreciate your thoughts on my problem.
Don
WRITTEN 12/10/2010
"...For many years (at least 10 or more) I have had reoccurring pain in my back on the right side and sometimes moving around to the front right side.  If I am pain free, which is rare, I can always bring it on with activity such as walking, running, twisting my body or doing exercises.  I never have any nausea, vomiting or jaundice but I do have abdominal bloating and some belching sometimes (but not always) associated with meals However I raely eat food with high fat content.  The pain is not sudden or severe but is moderate and chronic in nature.  Sometimes it will get better when I sit in a comfortable chair or lie down.  Lately it seems worse when I get up in the morning.  Over the years I have had all the usual tests (ultrasounds, cat scans, gastric emptying test, blood work, xrays of the spine, etc.) and all have been normal except that in 2006 I had a series of tests including an endoscopic test which was normal except that it reported no flow of bile after Kinevac injection.  The path report revealed "amorphous, slightly refractile crystals that may represent bilirubin."  No cholesterol crystals were seen and no stones.  A HIDA exam at that time was normal at 55.  However on the basis the endoscopic test my doctor suspected it was my gallbladder but it was not completely clear that was the problem.  I consulted a surgeon who thought it was about a 50% chance of being my gallbladder.  In 2007 I had another HIDA test and this time it was 22.  The surgeon then said the odds increased it was the gallbladder and suggested I may want to consider the laparoscopic surgery.  I was still not convinced because of the strong relation to activity as opposed to the usual symptoms associated with gallbladder disease.  In 2009 I had yet another HIDA test and this time it registered 33%.  I continue to have bloating  and the back pain is just about constant..."    
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I can understand the frustration of both you and your physicians. The relation to activity is not typical for gallbladder problems but can be seen. I had a patient a few years ago that was an Olympic level marathon runner and would develop a painful lump in her right upper quadrant after running. We did everything we could to demonstrate the hernia that we all assumed was there but finally realized that she was thin enough that it was  her gallbladder that she was feeling. Her symptoms went away after a cholecystectomy.

Were your symptoms reproduced with the CCK infusion? If this was the case the decision would be much easier. It sounds like pretty much all the other possibilities have been looked at which would increase the chances that the gallbladder is the culprit.

Despite all the fancy tests it can still be a tough decision sometimes.
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Thank you for your prompt response.  As I recall the symptoms were not reproduced with the CKK infusion.  MRI in 2006 did show mild disc space narrowing at L1-2 & L5-S1 but no disk protrusion.  I have not had a ERCP and wonder if that would tell anything new.  True that I have had a lot of fancy tests and the doctors I have consulted are in conflict as to whether the Gallbladder is the culprit.  I have considered going to a medical center (Duke, Hopkins, etc.) for fresh review but not sure that would end with different result.  Thoughts?

Donald66
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Hi Dr Watters,

Thanks for your comment.  I have had previous rheum evals....always have high CRP and occasionally high sed rate (but not super high, like 40s).  

I had the one HIDA scan Friday, but after 4 hours they could not visualize the common bile duct and could only very very faintly see the intestines (and that was marked as questionably seen faintly).    They were worried about an obstruction.  I had an immediate repeat ultrasound, they said there was no obstruction.  Today I had an MRCP, it was also normal, and am having the HIDA repeated tomorrow AM.  They had refused to do the ejection fraction Fri. due to not visualizing the CBD.   The GI thinks it is biliary dyskinesia.  (I think there may also be motility/gastroparesis issues as well, but some of that may be caused by meds I am on for chronic pain).   Quick question, what is the reason for no pain medication 4 hours before the test?  If the medication has a long half-life, is missing just 1 dose going to make a difference?  (ie would it need to be stopped longer)?  

And what causes lack of visualization of the CBD after 4 hours if there is no obstruction - could that be due to biliary dyskinesia?

I thought all or most of my symptoms could be explained by gallbladder: nausea, RUQ pain, back pain, fever, gas/belching, and fever (with previous episodes of vomiting too); always worse after eating fatty food and often worse after eating anything at all (within 1-2+ hours).

Thanks so much

Beth
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Dear Dr. Watters,
Thank you very much for your response. A follow up, I saw the surgeon and like you, he said EF below 10% is not common in practice although he has had patients with EF of 0%. I felt it was a thorough consultation. Initially he said due to absence of gallstones and absence of gallbladder pain I could try and manage with diet but then he told me it would need to come out at some point and due to all my other problems and symptoms he suggested it come out so my doctors can move forward with trying to diagnose the causes of the other problems I am having. He said the lower back pain, knee pain, etc., wouldn't have anything to do with my gallbladder, so we decided to take it out right away, I have outpatient surgery tomorrow morning. It is comforting to hear similar comments here from you.  I did have a blood work up done by my PCP and he said I don't have Lyme Disease or Rheumatoid Arthritis. Once I am recovered from surgery I am supposed to have MRI's done. My back pain and knee pain has only gotten worse and become more frequent :( I will take your advice and request the  rheumatologic evaluation. Could all my symptoms be from Fibromyalgia? I have spent hours researching and my research points in this direction......this is my gut instinct (pun intended). Thank you again. I wish I was fortunate enough to be your patient.
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Hope all goes well.
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More detail on the HIDA - did the gallbladder visualize? As to the pain med issue, you are right. Narcotics are known to produce spasm of the sphincter of Oddi. In a standard HIDA done to rule out acute cholecystitis, it is not unusual for the radiologist to give a dose of morphine to produce the spasm in an attempt to make the gallbladder show up. If the narcotic's half-life is longer the four hours should be extended.
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The morbidity of removing a gallbladder is very low. Sometimes, despite all the tests, we are left with nothing but a strong clinical suspicion that the gallbladder is the culprit. I would consider a cholecystectomy as it represents the only abnormality that they have found that would explain your discomfort.
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Thank you very much for your advice

Donald66
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Welcome to our Community!  Hope you are feeling better soon .. you have gotten great advice by Dr. Watters ... please keep all of us posted!

C~
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Hi Dr Watters,

Just had the 2nd Hida Scan, was so frustrating...again gallbladder showed up quickly, got pretty large, but never saw common bile duct or bowel after 3 1/2 hours.  Radiologist wanted to wait 4+ hours before injecting the CCK because he was worried about being sued if I had an obstruction, they actually made me sign a waiver to get it done a half hour earlier.  CCK caused increased biliary pain and nausea, but EF was 94%!.   Is it possible my body is not producing CCK on its own but responds properly when it's administered exogenously?   Or could it be sphincter of oddi if I have biliary type pain and twice now common bile duct couldn't be seen after 3.5-4+ hours?   I'm at the end of my rope, I've had to miss 2 more days of med school (not even sure I'd be able to get thru a full shift anyway, after 3-4 hours at school started feeling really bad).     I appreciate your advice.

Sincerely,
Beth
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Hi Dr. Watters,
I just heard back that my EF on the HIDA Scan was 11% (eek!) BUT my symptoms were not reproduced with the CCK. The CCK did make me feel crampy and nauseaus, but I don't have those symptoms normally. As I said in an earlier post, I don't have "attacks" like most people describe. The only reason that I was being checked out is bc my original doctor thought it might be a hernia. So I have this dull pain that mainly comes when I've been sitting for a while or when I bend over but no other real symptoms. I haven't spoken to the Surgeon about my results yet, but I'm worried he might suggest getting my gall bladder removed. What would you recomend? Also, I really would like to get pregnant in the next year and of course, don't want any complications there. I really appreciate your advice!
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The indications for cholecystectomy with a diagnosis of dyskinesia are different than for stone disease. Cholecystectomy in this situation is primarily indicated by the level of symptoms. If symptoms are minimal, I don't care what the measured ejection fraction is since I wouldn't recommend surgery.
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Please see post in Expert Gallbladder Forum. It is always possible to have more than one problem but fever would not be expected with gallbladder dyskinesia. The prompt visualization of the gallbladder would argue against acute inflammation. There would appear to be dysfunction of the sphincter of Oddi but this may be a direct result of the chronic meds. Are your liver function tests normal?
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I recently read in one of your posts that there are serious risks involved with a HIDA/CCK scan if gallstones are present in the gallbladder, especially if they are small.  My husband is scheduled for the HIDA/CCK scan first thing tomorrow morning, but an ultrasound done earlier this week showed what might be two small gallstones, though it looks like they MIGHT NOT be calcified.  The GI Dr. said they could also be polyps.  Based on what you wrote, I'm extremely concerned that we should not proceed with this test.  My husband did ask the Dr. whether there were risks should the stones dislodge during the test, and the doctor said no, that wouldn't be a problem.  Could it the particulars of what was seen on the ultrasound really not be cause for concern????  Thank you in advance!  
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Please see response in Expert Gallbladder Forum.
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I am 40 years old, thin, eat healthy, and exercise often. I began having upper right abdominal pain probably 6-7 months ago. This pain would come and go and orginally I thought it was a muscle strain from strength training. Finally, the pain came and didn't subside and I went to my PCP and told him I thought it was my GB. He felt my abdomen and felt something and agreed. I went for an ultrasound and HIDA scan. Ultrasound was normal, HIDA scan revealed EF of 17%. I have been eating a low fat diet and have the pain somewhat under control but it hasn't totally gone away. I feel tired, experiencing headaches, intermittent tenderness in the upper right abdomen, recent nauseau, bile like taste in my mouth, achey (achy) joints. When I was injected with the hormone I felt a little cramping and a feeling like I had to go to the bathroom but nothing really bad. I have really been trying to get my GB to feel better with my diet and it has helped some. I also have Hasimoto's and I am on meds for that. I recently had to up my medication as my level was low. I know there can be a connection between Hasimotos and GB issues. When my thyroid acts up I get achey (achy) joints so I am wondering if maybe my thyroid is low again and maybe that is what is causing my GB problems? If that were the case and I had the meds increased will that fix the GB problem and maybe I could avoid surgery? Can you ever fix a low EF %? I have an appointment for surgery consult tomorrow. Just unsure about what to do. Really don't want surgery but don't want to cause anymore problems to my health if I don't. Any insight would be appreciated. Thank you!
Karrie  
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Also, I am confused about the Spincter of Oddi. What if that is the problem and then I get my GB taken out? That won't solve the problem. How do I find out which is causing the symptoms Spincter or GB. Thanks!
Karrie
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The results of following patients with pain and low ejection fractions indicates that very few spontaneously improve. With the ejection fraction of 17%, the literature would argue that you have a greater than 90% chance of resolving your symptoms with  cholecystectomy. Don't worry about sphincter of Oddi issues as the evaluation is difficult with an intact gallbladder and actually has a higher risk than removing the gallbladder. Of patients who undergo cholecystectomy, about 1.5% are ultimately found to have sphincter of Oddi dysfunction.
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Thank you so much. I had my surgery consult today and my surgeon didn't think I had a sphincter of Oddi issue from how my GB functioned on my HIDA scan. He said if I was on the fence about surgery I could wait, check my thyroid level and see if that helps and if not have surgery. So I think I will do that but will probably ultimately end up having the surgery in the next few months.
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I'm a 24yo female with biliary dyskinesia. HIDA scan showed 17% function. Always ate healthy, always was average to thin as far as weight goes. This began 4 yrs ago when out of nowhere I developed bad reflux. I was put on 40mg omeprazole. After few months of being on that I started getting really nauseous when eating, and I would be full for hours after meals. Even though I wasn't trying the weight gradually came off of me. This past spring is when I found out about the GB issue. I recently(3 wks ago) weaned myself off the omeprazole, and to my surprise my reflux is little to none. I still get decently nauseous when eating, and I still am so full hours after eating. I also have gotten bouts of diarrhea lately. I am still gradually( very gradually) losing weight despite my efforts to eat more. I am disgusted how thin I am. I miss being able to pig out sometimes, those lazy sundays where you feel like a bottomless pit. That NEVER happens anymore. Thyroid levels are fine. No gluten allergy just soy. Abdominal ultrasound came back fine. Here is my assumption at this point in time. I feel my gallbladder function was a result of the high dose of PPI I was put on for years. Could this be possible? I go back to my Gastro in 3 weeks... not sure what they will want to do from here. All I know is I'm scared I'll never stop loosing weight.. and I really miss having a good appetite, enjoying food, and working out. I don't trust my gastro.. is this dumb of me? should I be seeking someone who specializes in GB issues? Could it be something besides GB?
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Frustrating predicament. Did you have any symptoms when the CCK was given during the HIDA scan? One possible problem that would explain your symptoms is alkaline reflux gastritis. We generally equate reflux symptoms to acid refluxing from the stomach into the esophagus but 10% of reflux patients actually have bike from the duodenum refluxing into the stomach and subsequently into the esophagus. Acid suppression can actually worsen their symptoms because the alkaline bile is no longer neutralized by stomach acid. In my experience, this is common in association with gallbladder dyskinesia. You don't mention an upper endoscopy but I can't imagine that one hasn't been done. Was there any comment on gastritis? If one hasn't been done it needs to be before deciding about your gallbladder.
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I recently had a hyda scan with cck and it was found I have Bilairy Diskinesia with a function of 1%. I am dueto have surgery in one week. Are there any suggestions for me to be "comfortable" until then.
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Low fat diet is about all that can be done to reduce the stimulation of the gallbladder.
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Did your vomitting and nausa got better after Surgery??? How are you feeling now?? Can you please email me your details @ ***@**** as my wife is going to have the surgery today?? Please reply ASAP
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Dr. Watters, I'm 46 yr old female, 5'2", 118 lbs.  I've had gallbladder pain off/on for 6 years.  I know my triggers (coffee and if I've been eating a lot of high fat foods/deserts for a good stretch of time - say over the course of 2-3 weeks - this will bring on an episode).  

When I have the episodes, I feel a very distinct pain/pressure under the right rib cage with significant rebound when I push in.  The pain is not bad enough to go to the ER.  I know, from the years of experiencing this, exactly what I'm feeling. I've had ultrasounds done when I'm in the throes of an 'attack' and it shows the gallbladder distended but no stones.  

I've then had ultrasounds done when everything is 'quiet' and the gallbladder appears perfectly normal (no distention).  In the past 2 months I've had an URQ abdominal ultrasound - normal, a gastroscopy - normal , all blood tests including liver function/pancreas - normal.  Finally I had a HIDA scan - EF of 26%.   (I also had a colonoscopy 4 yrs ago - normal)

The EF of 26% is no surprise to me.  The pain I get is classic URQ gallbladder pain that wraps around to the back, is tender upon palpation and feels almost like there's a 'hot balloon' stuck up under my right ribs.  The last few episodes I've had (past year) however sometimes the pain seem to move from the right to the center (epigastric) when it's occuring.

Here's my quandary:  I only get these 'attacks' perhaps 3-4 times a year.  When they happen the first day is the most acute, the discomfort gradually lessens and the pain is completely gone by day 3.   During this time I DO eat, just lightly and in small amounts. Interestingly, I tend to be constipated right before the attacks happen.  I have never had nausea with this, just decreased appetite, some acid reflux and the URQ pain.  The pain has never awakened me at night and, interestingly, seems to abate by the time I go to bed.

My primary doctor is strongly urging me to get a cholecystectomy.  His fear is if I have crystals or very tiny stones that one will lodge in a bile duct and will result in a surgical emergency which, as you say, carries much greater risks.  I am reluctant because I don't want to trade one set of problems for another (diarrhea or digestion issues without the gallbladder).  I've had stomach issues my ENTIRE life since childhood.  

My question to you is this: if I do NOT have a cholecystectomy, am I risking permanent damage to my gallbladder (scarring, calcification or worse) by just living with a sluggish gall bladder and occasionally have these attacks?   I feel I can manage my symptoms if I am diligent with my diet.  I've gone as long as 6 mos without an episode when I've been most diligent with my diet.

I have a consult with a gastroenterologist to discuss this but am curious, from your perspective as a surgeon, what your suggestion might be.  Interestingly I have only talked with my primary about this but am not going to make a decision for surgery until I've consulted with a gastroenterologist.  

Thank you very much for your time and thoughts.  
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The chances of an acute complication in the scenario of non stone gallbladder disease is low. Whereas symptomatic patients with gallbladder disease and gallstones should undergo cholecystectomy due to their increased risk of early death without surgery the data doesn't support this for dyskinesia. It is my belief that the majority of these patients eventually go on to form gallstones though. If this is the case, they will then meet criteria to recommend cholecystectomy. In your situation, I would let you make the call. In the mean time, repeating an ultrasound every other year or so would be prudent. If you do develop gallstones, time to stop delaying.
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Thank you for taking the time to read my post and respond.  It's greatly appreciated.  The idea of an every-other-year ultrasound to check for stones is such a prudent one and something that has not been mentioned to me before, so kudos to you. :-)   I will discuss that with the gastroenterologist next week.  Again, thank you for your time.
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I have ejection fraction of 14% with no gallstones.  Symptoms are Bloating, mid gastric pain to the back.  The main symptom that landed me in the ED one year ago was severe left upper abdominal pain from back to front.  CT normal.  No diagnosis.  3 weeks later I had diagnosis of EBV.  After splenomegaly reduced, left pain reoccurred with abdominal distention and pain after fatty meals.  I have been on low fat, gluten free diet for 2-3 months and lost 15 pounds.  Pain mainly on left and abdominal bloating occur with almost any foods now. Surgeon is not sure cholecystectomy will cure symptoms.  Colonoscopy, EGD with internal ultrasound were all negative.  What do you think?
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I have ejection fraction of 14% with no gallstones.  Symptoms are Bloating, mid gastric pain to the back.  The main symptom that landed me in the ED one year ago was severe left upper abdominal pain from back to front.  CT normal.  No diagnosis.  3 weeks later I had diagnosis of EBV.  After splenomegaly reduced, left pain reoccurred with abdominal distention and pain after fatty meals.  I have been on low fat, gluten free diet for 2-3 months and lost 15 pounds.  Pain mainly on left and abdominal bloating occur with almost any foods now. Surgeon is not sure cholecystectomy will cure symptoms.  Colonoscopy, EGD with internal ultrasound were all negative.  What do you think?
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If your ejection fraction were 25-30% I would have my doubts but one of 14% is profoundly abnormal. With a thoughtful workup being otherwise negative I would strongly consider cholecystectomy.
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Hi Dr. Watters. I had an ultrasound that showed my gallbladder was contracted, with my CBD at 1.6mm. My HIDA scan showed a 19% reading with the CCK at 20 minutes. I was nauseous when it was injected with pain in the center of my abdomen by my ribcage, but as the minutes went by and by the time I left the hospital, my typical pain was there. My typical symptoms are pain in the back - upper, left-middle -right - and the front right. I have some nausea, but mostly it's a dull ache on the left, while the right side ranges from a small ping to squeezing pain (after eating). I feel better eating small meals, or for a few weeks it was better not to eat. Lately I feel a little better with eating, but then the pain comes back. My surgeon gave surgery as an option, the other being seeing a GI. I've already modified my diet to manage my pain. I feel like I should have it out, but since I wasn't told directly to have it out, I'm doubting my decision.
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I would recommend gallbladder removal based on multiple studies in the literature. There is an extremely high likelihood that this would resolve your symptoms.
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Dear Dr. Waltters,

I've been diagnosed in 2010 with Autoimmune Hepatitis and Sclerosing Cholangitis (confirmed with liver biopsy and antibodies tests). I have also Type 1 Diabetes and Moderate Gastroparesis, and I am on several medications including synthoid (no narcotics). I had the Hida Scan with CCK done 2 weeks ago and I have 22% ejection fraction. . I am very concerned about surgery. I've been having stomach pain and nausea for about 10 months. It got very bad mid August. Since them I have pain daily, nausea is really bad and vomiting,  with a full stomach or not. Becase I have so many health issues, I don't know how to make a decision to go for surgery because I'm not sure that my GI knoes exactly what is causing pain, nausea, vomiting, bloating and all the above.... at one point, before my HIDA SCAN test, my GI asked me (with my husband as witness) that what  is so bad about vomiting couple times a week? I (said him) have seen patients that vomit 10 times a day due gastroparesis... in that same visit he ordered the HIDA SCAN and now he is talking surgery... I need more info in order to make a final decision... any suggestions on how to find out exactly the cause of so much pain and vomiting?? Thank you so much for your time.
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You have a very complicated situation. I don't know who is following you but I would strongly recommend that you establish a relationship with a dedicated hepatologist at a tertiary care center where liver transplants are performed. This does not mean that you will need one but you need to be followed by folks with all tools available. Your combination of problems is far too complex for the local general GI doc to be following. These guys are far more focused on directing as many straightforward screening colonoscopies to them than dealing with complex medical challenges.
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Thank you for your prompt answer. The AIH and PSC were diadgnosed at SHANDS - Gainesville and my insurance covers 1 follow up visit with the hepatologist according to his notes (every 6 months or 1 year). All tests, biopsies, etc have to be done local :( . So I will get in touch with this doctor and see If I can see him sooner. I will post how things worked up. I do appreciate you taking time to answer my question. I know how busy life can get and I am surprised that a MD would  take time to answer questions free of charge. You've got my admiration :) Thanks!
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I was in the hospital 2 months ago and I believe they did that test on me HIDA (is this the test they do with nuclear medicine were you are in a machine that looks like a ct scan for 1 1/2 hrs)and my gallbladder was @ 15%, but at that time they said it was an infection and they treated that.  They did not want to remove my gallbladder because of fluid on my heart and lungs that they did remove.  They say I can wait to have the gallbladder removed.  Can I wait a year or should I go ahead and have it out asap.
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The decision to remove a gallbladder for low ejection fraction is largely dependent on symptoms. The first thing I would suggest would be to repeat the study in a month or two. The fact that you sound like you were in some degree of congestive heart failure would adversely affect your gallbladder function due to some back pressure and edema. It is entirely possible that you don't need surgery.
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He should avoid high fat foods (fried, cheeses, fatty meats, avocados), cauliflower, and for some, citrus.  
Coffee and other caffeinated foods including chocolate.  Alcohol should be avoided too.
Eat grains and lots of veggies, lean meats/fish.

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I had a Hida scan and was scheduled to have CCK. After a few hours, the nuclear medicine wouldn't release from my gallbladder. The radiologist had me get up and walk for 1 hour. I was placed back under the machine and it still hadn't released from my gallbladder, so no CCK. I have all the same symptoms for gallbladder problems as the many people have posted. In do not have stones. Would this be a good indication that my gallbladder is not functioning properly?
Thank You
DRM
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I don't quite understand the HIDA. They don't wait for it to leave the gallbladder before giving the CCK. Did the tracer never enter the small intestine?
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The tracer never entered the small intestines.
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The tracer never entered the small intestines.
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It would be wise to have a MRCP before deciding on the gallbladder. Your study would imply that there is a problem downstream where the bile duct joins the duodenum.
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Mrcp was normal. I have pressure and severe nausea. I've lost over 15 pounds and unable to eat any fat. I've been told this is most likely biliary dyskenisia?
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Hi Everyone!

My symptoms have been constant since August. They consist of pressure in my chest on the right from my ribs up to my shoulder and even my neck. Many times after I eat (no matter what I eat) I get a burning between my shoulder blades that then settles behind my right scapula. Burping is constant, and brings up food, sometimes all the way into my nose! In the beginning, I had a lot of diahrreah, but now that I hardly eat anything I am more constipated. I have lost 55lbs since August.

I have had an ultrasound(showed tiny gallstones, but nothing big), upper endoscopy(mild gastritis, esopheageal reflux, possible spasm of valve to the stomach), barium swallow study (normal, although it wasnt a modified, so didnt include any food), HIDA scan (just found out it came back at 8% with a diagnosis of bilary dyskinesia), CT scan (normal). I have been seeing both my family Dr and a GI Dr.

Although the HIDA was done 5 or so weeks ago, neither Dr thought it was my gallbladder at that time. Yesterday, back for followup at the GI Dr, and he said since I was not getting total relief from the Dexilant at the mega dose, that it may be my gallbladder afterall and referred me to a surgeon.

Huh???? I am so confused!!!! I called my family Dr, and he would like to meet with me. I am so tired of not feeling well, not eating (although I enjoy the weight loss, I dont think my nutrition is good at all), people asking me whats going on etc. My asthma has also been worse, and my asthma Dr has put me back on Advair and Singular plus generic Claratin and an albuteral inhailer as needed. Also wondering about possable anxiety - lol!! Although all this could cause that, right? I do remember several weekends since last February where I did not feel well - 2 times specifically were very bad. Could these have been gallbladder attacks? I currently have such a limited diet -small amounts of lettuce, corn chex, a slice of whole wheat bread, baked potato, slice of low fat american cheese, tiny bit of roasted chicken...not much more at all - and I still dont feel well after I eat - the symptoms get worse - I rarely feel symptom free......

What should I ask my familiy Dr? I dont know what he will say! The surgeon doesnt have an opening until 12/27 - which stinks because that means I will have to pay  my deductable again if I need surgery. I have no medical history with the exception of the astma at all!!! UGH!!! Any advice is greatly appreciated!!!
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I feel your frustration. I would ask to see my results and have your doctor review everything with you. I've been told my Hida Scans (I've had 2) were normal, but have all the same symptoms of biliary dyskenisia. The surgeon won't even see me although my GI doctor wants my gallbladder removed. I requested a copy of all my scans....to my surprise the radiologist that read the report stated there was indeed a problem with my gallbladder. I am frustrated with the medical field and lack of care. Be persistent and ask as many questions about your care and future care. I will be changing insurance in January due to this matter. You are also right about your deductible starting over.....it's all a ploy. I wish you luck in this battle. You can also call daily to see if there are any cancellations . I'd bug them.
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Scheduled on November 12 for cholecystectomy.  Thank you for reassurance
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For 8 months having upper right rib discomfort daily, sometimes stabbing. I have daily sudden nausea that comes and goes. I sometimes get woke up usually around 3 am grabbing my right side in pain then horrible sweating and i dont know if I'm going to throw up, pass out . a few times have had this horrible cramp in upper right rib that brings me to my knees until it goes away which is not too long. Have hade ultrasound w/no stones detected. Bloodwork only showed a high white count. Hida scan 74% no problem while testing but when i went to leave i almost got sick in the vehicle. felt sick all day and a little sore in right rib area. any suggestions ?
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I forgot to mention I'm 46, female and have 6 people in my family with gallbladders out.
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I had the same symptoms and I had my gb removed.  The recovery was quick but it didnt solve the problem. I still have the same symptoms.  I asked my dr to refer me to a new gastro dr because they tried to say it was ibs when the gallbladder removal didnt get rid of the problem.  He is doing some new tests and says that it may be diverticulitis.  I will update in a few weeks when I know more.  I have been dealing with this for over 3 years and the pain is worse than labor sometimes.  I am making sure they have the right diagnoses and that its really going to help before I have anymore surgeries.  
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Dear Dr. Watters,
I wanted to give you a follow up about  my question to you on October 25, 2012.  I've writen  the Hepatologist at SHANDS and explained to him what has been going on. I faxed him the reports and told him that I would meet with my local GI and I need some advice or maybe see him earlier in order to make a decision towards gallbladder removal. He was polite and answered my e-mail telling me he would check my history and get back to me. I've writeen twice and even though he wrote me back a 2nd. time,  he didn't  an answer about the situation He is words were again, I will get back to you. I have seen my local GI and after discussing my history and the results of the HIDA SCAN he told me that he wasn't sure that the gallbladder is causing all the symptoms taking in cosideration AIH and PSC. He wants to hear the opinion of the  Hepatologist from SHANDS before we make a final decision which I agreed. The problem is my visit with Hepatologist is scheduled to Jan/10/2013 and I was not able to have an earlier appt. Meanwhile I have been vomiting on weekly basis (2 x at least) and taking 40 mg of Zofran a day in order to keep from vomiting on daily basis :( I am in pain, regardless if I eat or not and I am actually eatling very little. So as you see I am stuck at least until mid January :(. So this is the update.    
I do have one question for you...
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One thing caught my attention. In order to make an educated decision and be informed of all the consequences of removing or not the gallbladder, I asked my local GI what would be the  consequences of having e.g. a non functioning gallbaldder. In other words,What  if the fraction ejection is 0 or next to 0? What should we do? He said that we could leave the gallbladder there without a problem (in other words do not remove the organ). It would be just a "non functional organ"... So  my question for you is: Is that right? A non-functional gallbladder can be left alone whithout serious consequences/side effects? Thank you for taking time to answer my question.
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Dear Dr Watters,

I am so tired. I have just come out of the hospital after spending 5 days there for acute pancreatitis. I am a 42 year old female who has been experiencing incredible pain for the last few months under both my ribs which is there constantly. Last Saturday the pain became so bad that I went to the ER because the burning pain in my upper abdominal region became too much for me to bear. I was diagnosed as suffering from acute pancreatitis and was hospitalised for 5 days. However because the pain was radiating towards my right side the doctors decided to do a HIDA scan. The scan shows an ejection fraction rate of 20% and the conclusion is 'The Poor Contractile response is consistent with acalculous cholecystitis or gall bladder dyskinesis. ??? Now from reading the posts I understand what Dyskinesis means but I am not sure what is meant by Acalculous cholecystitis ? Are these descriptions used interchangeably? The Gastroenterologist at the hospital now wants me to go through an edoscopy and possibly a colonscopy which I am booked to have on Thursday. I am also wondering whether pancreatitis and gall bladder issues that I am having are related.Can Dyskinesis & or Acalculous cholecystitis be related to pancreatitis? My doctor says he would like to wait and see but my gastro surgeon wanted to operate straight away. I am so tired of all this. I have come home and after having a small meal of boiled rice with yoghurt I have gone to the toilet several time within a span of 2 hours. I am exhausted and I feel so lost. I have a 6 year old son to look after. I would rather that my gall bladder be out then suffer from constant pain that feels like someone has stabbed me in my ribs. I belch all the time and I can feel bubbles rising inside my tummy so bad that you can actually hear them. Can you please please advise what should be the best thing to do please.

I will be very grateful to you.

Regards

Smita
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I just had the hida scan 5 days ago, i had a bad reaction to the enzymes and later that night had severe pain in my upper right quadrant, right side, my back, and into my chest.  I have since seen my doctor and found out my gallbladders ejection factor is only 8 percent, i am scheduled to have it removed after the holidays.  I have been dealing with abdominal pain 24 years and I finally found a doctor that was able to give me a diagnosis.  I also suffer from gerd.
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I have had the exact same experience, and ended up in emergency surgery since no one would do the Hida scan first which I asked for.  Nothing else showed gallstones or disfunctional gallbladder.  I lost so much weight and had migrane (migraine) headaches for six months everyday.  I felt as if I was dying.  I finally ended up at a surgeon office demanding it to be taken out, and then in the ER, and they called him.  He admitted me right away, and did the surgery the next day.  It has been a difficult recovery since I was so sick prior for at least six months, and I am sixty years old. I had no choice since I was in serious pain and actually could not eat any more, since it would not digest.  I seriously felt like I was dying, and as sick as any terminal cancer patient. My primary physician at UCSD in San Diego, California was awful, and didn't help one bit.  I was on my own.
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I was just diagnosed with biliary dyskenisia - I had a HIDA scan and my ejection fraction was 10%.  I am scheduled for surgery next week  As for weight gain...yes, I've been gaining weight non-stop.  I am a runner (I run 4 to 5 days a week and train for races - 5Ks up to half marathons) so I am definately healthy and should not be gaining weight, but losing it.  In the past month I gained 10 pds and no matter what I do I can't lose weight  Last year I weighed 128 pds I am now up to 146 (with continued running and exercise and healthy eating).  Other symptoms I have are bloating, gas, extreme pain in my right side all the time - I'm taking 3 ib profin every 4 hours so I can move and still exercise.  I'm tired all the time. I thought the fatique was from working full-time, taking care of 2 kids and training, but now I see gb disease causes fatique as well.  I also have right shoulder pain (esp. when I run) and a hard time breathing.  I'm hoping after surgery I can finally lose this weight, feel better and start training for my upcoming half marathon.
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Hi, turtlelah,  I had weighed 145 and now am down ten pounds but actually should weight 150.  I have been trying to gain weight for over a year.  My HIDA scan ejection number is 14, and I have been diagnosed with biliary dyskinesian.  I follow a low-fat diet to help my gall bladder to digest food which (I think) helps prevent my nausea.  HOW ARE YOU GAINING WEIGHT???  Are you eating avocado, cheese, nuts, oils, and fried foods or just what?  Thank you.  
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Dr Waters
first thank you for the help you have given to evryone on this blog.  I have read it for years and you have even responded to me in tha past.  I have had right sided pain in my back for many years(in gall bladder area). However the pain is never severe (maybe 5-6 at most) but cronic (chronic) and after 12 years is affecting quality of life.  Is often brought on by twisting torso (swinging golf club, exercise) but not always.  May be related to eating but not always either.  Also I often have extreme bloating with the pain & also sometimes belching. 4 HEPA exams 2006 55%; 2007 22%; 2009 33%; Jan 2013 5% but pain never reproduced during any HEPA. In 06 had GB empting study & no bile flow after Kinevac injection. Many Ultra Sounds but never any stones.  CT scans and many other tests normal. Over years several Dr's have suggested Biliary Dyskinesia.  Now with last HEDA so low am being strongly urged to have the gall bladder removed ASAP.  On this quick summary of the facts (particularly no pain with HEDA and pain not overly severe as most) would you agree GB most likely culpret and agree with the recommended removal.  Thanks in advance for reply
dpatten
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I have been having several symptoms for the past 5 months now, including: it started with diarrhea and a burning, gnawing pain in upper abdomen every morning. The diarrhea subsided after 3-4 days but the burning continued. When eating, I would suddenly feel very full after just a few bites, and often like something was going to get stuck in my esophagus. I experienced bloating and excessive burping any time I ate. All these symptoms were accompanied by pain or at least a nagging ache in my right side under my ribs. At times it was in my back, and when it was really bad, the pain was through my entire mid back region. There were at least 2 occasions when the pain was so intense in my right back  and ribs I was brought to tears. My Dr put me on Nexium for reflux treatment and the burning and the feeling of esophageal discomfort have subsided but the pains continued. (About 6 years ago I had an upper endoscopy and they found a very mild hiatal hernia and very mild gastritis.) Since several women in my family had their gall bladders out, my Dr looked into that as well. Ultra sound was fine, but HIDA scan showed that my ejection fraction rate was 1.4%. My Dr very casually suggested removal of the gall bladder, since it basically doesn't work. I have my consult with a surgeon in 3 weeks, but after reading some of these boards I wonder is there any danger of this gall bladder worsening or becoming septic since it doesn't work? Should I be following a particular diet as well? My Dr did not really explain things or go into details but she said take it out because it doesn't work and then you'll feel better. That's about it. I live with some sort of back pain (especially in the mid back) every day and it seems I can at least feel something (a fullness if not a pain under my right ribs.)
Any suggestions or information you could provide me with would be very much appreciated. Thank you!
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you need to get the hida scan and h-pylori test you might need your gb removed drs try to play that crazy stuff with me do not go see the funny farm dr if you know you are normal also get some prilosec but do not see a funny farm dr go to a gi specialist ok get the hida scan with chemical and get blood test for h-pylori if it is positive do the course 2 times as you may had it for a long tim i did and i still have to get my gb taken out places try to send me to funny farm because they dont believe me so forget that see anotther dr and another till you get the 2 test i siad done ok if your gb fraction is less then 40 remove it, im 44 and had this crap since 1999 before that so called gerd but i think all along i needed it out my mom had hers out when shes was like 20 and i was 4 years old but please keep trying a new dr till you get one that works with you and not againts you i had to repot one dr who denied my surgery that i needed he said you dont need it i said did you look at my hida scan cd he said no, i said so how do you know i dont need surgery? i was suppose to make an appontment when i was ready to get it cuz i was scared so i went to Guam he said i needed it urr long story but i think gerd and h-pylori and gb disfuntion are all linking to each other
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Also do an h-pylori test i had all those problems when i was young, acid reflux then they said gerd, but i think if i was diagnosed when i was young it wouldn't led to h-pylori and since 1999 i had gb problems i knew it but the drs couldn't find it, it does not show up on mri or ultra sound it will show up hida scan get that and check for h-pylori if that is positive take the meds double course do one course when finshed repeat it so you can kill all the crap that messed you up since you were 16 like me and then get a scope in your tummy test for cancer then do the hida scan if you have a low fraction get it removed lower then 40% mine is at 26 i been suffering since i was young now im 44 so all that time being pusshed to one dr to the next oh its gerd yeah ok well it was alot of stuff so please get those things i told you also take prilosec in the morning when you wake up every day
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oh and take acai berry pills white and purple lable that will help and water now i dont like water so that could be a factor eat salad with shrimp and eat good food do not eat junk food or fried foods
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I have been dealing with this for 11/2 years, got really bad in the last 5 months, lost 23 pounds.
I have almost constant stomach/ chest pain, pain in Lower right rib cage that radiates to my back/right shoulder.
Sometimes feels like I swallowed a bone..when the pain gets bad, I get short of breath, my hands go
Ice cold, I sweat and get rapid heart beat. I feel dizzy most of the time. I wake up with right occipital headache
that radiates to my right eye almost every morning. I also get night sweats.
I had 2 endoscopes, colonoscopy, CT SCAN of chest/ abd/pelvis, had 2 ultrasounds, brain MRI,
saw neurologist, rheumatologist, had full cardiac work up, ruled out pheochromocytoma, carcinoid tumor.
Had HIDA scan 1 1/2 year ago, blood test...everything comes back negative, except the endoscopy showed mild
Gastritis both times. My stomach is so tender I can barely touch it.
I'm about to repeat the HIDA scan in 3 days. If it comes back negative, I really don't know what to do after this.
The only other background I can give you is that when 1 1/2 years ago everything came back negative, I had a parasite test and came back with Blastocystis Hominis, I took a round of Flagyl and I was feeling normal in 3 days
And was fine until 5 months ago. I did take antiprotozal medication again Tinidazole, Nitazoxanide, even tried
Diflucan in case it was candida...not better. My last parasite test came back negative.
I have been an acupuncturist for 20 years, so I'm drinking an herbal brew to calm inflammation in liver, gallbladder and stomach, it is helping, stopped my pain from being constant but still comes back after meals.
I have been on Dexilant for a month with no improvement.
Wondering if this sounds like anything to you and what other tests would you recommend?
Any insight would be much appreciated!



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I was advised a couple of years ago I have pancreatitis. It was found during an eus to look for gall stones at that time. Polyps were found & I go periodically to have them removed. I had an attack last week that my DR said was text book gall bladder symptoms. My blood work was all normal including my pancreatic. (I take creon currently) I had an ultrasound done & no stones or abnormalities (small amount of fatty liver only) were found. I am having a HIDA scan tuesday & my surgeon has prepared me he expects to remove my gall bladder.  I am curious if it is possible if the pancreatitis could have been caused by an ongoing gall bladder issue?  I havent had the massive pain of pancreatitis, mainly mild pain & discomfort occasionally. I went gluten free and discovered I am intolerant there also.
I am wondering what the chances are that the gall bladder could be the main source. Also if it is will the pancreas go back to normal?
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I sense that I am missing some of your history since one does not simply undergo an EUS to look for gallstones without a significant history. Also, this is generally not a method to detect pancreatitis. In the US, 95% of pancreatitis is caused by either gallbladder disease or alcohol consumption. The remaining 5% is a collection of medical issues or medication sources. In the absence of an alcohol history, surgeons generally advocate cholecystectomy for patients with recurrent pancreatitis. It is thought that many of these form either small stones or sludge that passes down the duct, causing the pancreatitis.
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How have you been since surgery?  Pain gone away?  Weight loss possible again?
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Hello, I had severe gall bladder pain on and off for about 18 months. I had a HIDA which showed about 25% ejection rate.
I have used gall bladder flushes by Hulda Clark, and also done alot of juicing.On evenings where I could feel a bit of pain starting up, I drink hot water with ginger powder and sweetened with honey or stevia.  Fresh lemon juice in hot water is also helpful.
One thing that helped immensely was LYMPHATIC massage, by a trained professional.  Within hours the symptoms would go away for up to a week or more, and eventually they were gone for months.  In combination with the above treatments, I consulted with a professional homeopath and continue to be under his care.  I can now eat popcorn, butter, olive oil, and even bacon.  I watch it and don't eat alot of these foods at once, but I have to say I am very happy with my progress. I am an advocate of JUICING, watch "FatSickandNearlyDead" film and that website.  It has helped me alot in this area.  
I have heard from several people that they continue to have pains after surgery, I believe that this is NOT addressing the core issue, simply pulling  out the complaining organ.  I am committed to keeping my gall bladder. I believe that part of the issue is the lymph system.  
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Avatar_m_tn
yes especially at night
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Hi Dr Watters,

I have been having issues for about a year now.  I had an EDG which showed gastritis and erosive esophagitis (sp?) and a CT scan which showed a hiatal hernia, too.  Ultrasounds and bloodwork were negative pertaining to my gallbladder.  My HIDA scan last year came back at 30% which I realize is on the low end but not extremely low either.  I have right upper quad pain and a pain in my back below the shoulder blade, nausea after eating, shortness of breath, heart rate above 100 many days, gas/indigestion and bloating, neck pain, left sided upper quad pain, fatigue and diarrhea after eating fatty foods.  I can't drink alcohol anymore without having exaggerated symptoms for weeks.   I had a baby Feb 2011 and my symptoms started about a year after.
My GI Dr is on the fence about removal b/c it's at 30%.  What would your recommendation be?  
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I had my gallbladder removed 2 months ago and i'm still having the same symptoms as before. The burning isn't as bad though. I can't seem to eat a normal amount of food three times a day. I need to gain at least 6 pounds back. Please help. The symptoms slowly started happening around early march and really got bad in june/july. The burning sensation started the last week of june when I was in Belgium. I ate a lot of chocolate and ice cream. I was diagnosed with mild stomach irritation in august and has been on omeprazole 20 mg twice a day since the middle of october. I was put on sucralfate before and I had bad burning with that medicine
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Avatar_m_tn
Hello Dr. Watters,
My question is if one has biliary dyskinesia (HIDA Scan showed EF of 11%) can this elevate my cholesterol level?
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Hello Dr. Watters,

  I am wondering if my 8 year old son is having gallbladder issues.  Every time he eats he has pain on the right side.  Right after he eats he's always in the bathroom with diarrhea.  He has had a CT scan, ultrasound and bloodwork to rule out appendicitis last weekend.  Everything came back ok.

  Last year I was diagnosed with biliary dyskinesia and I had my gallbladder taken out July 2013. My son's symptoms remind me of how I was before my diagnosis.
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