Controlling Gall Stone Symptoms, and Misc. Stomach Pain Question

[lkell]

I am a 47 year old, obese female (5’6”, current weight @ 250 lbs) I have been on the Atkins diet for the past 8 months, and lost @ 25 lbs.  

Two weeks ago I had what my doctor believes was a gall bladder incident.  Six hours of severe pain, upper abdomen,  right side, under my breast bone.  Liver function blood tests came back normal.  I had an ultra-sound last week: my stomach, liver, pancreas and bladder all appeared normal, but I do have gall stones. At the recommendation of my doctor, I have a tentative appointment with a general surgeon next week to discuss a gall bladder operation.

I have never been sick, I have never been in a hospital, and the whole idea of this surgery scares me to death.  A web search on cholecystectomy, to try and learn more about it, pulled up hundreds of malpractice attorney sites.  It did not ease my mind.

I have drastically changed my diet, switching from Atkins to a modified Southbeach: omitting most fats and most irritating spice. I have lost 5 lbs in 10 days.  I am willing to forgo cheese and most fats for the rest of my life if it could mean no surgery.  

Question #1)  Is it possible to avoid gall bladder surgery by controlling the symptoms with diet?

I have not had a reoccurrence of the same type of pain my doctor said was from my gall bladder, however, since changing my diet these past couple weeks, I have been experiencing stomach discomfort and pain immediately (within a minute) after eating, with the pain lasting for 2-3 hours before fading.  The pain is located in the upper middle region of my abdomen,  between/below my breast bone.  It is not a burning pain and it is not nausea.  It is more a crampy type pain, and I feel very full.  On a 1-10 scale, I would put it about a 5, as I can still work/function.  My bowels are normal, no gas, no burping, no other symptoms.

The only medication I take is: Previcid, 30 mg, 2X a day (for about a year and a half), and an occasional Tylenol.  I have a history of stomach acid problems, mostly stress related. My weight has been up and down most of my life, with long periods of normal weight.  Six years ago I had a major life-style change, accompanied by a muscle injury that stopped my daily 2 ˝ mile run.  Within two years I had put on 75 lbs, with the rest of the weight coming on gradually over the last few years..

During my running years I was a very heavy user/abuser of Advil. The Previcide has, for the most part, controlled my acidic stomach problems, provided it take it on a regular basis.

Question #2)  What could be the cause of the stomach pain immediately after eating?  Is this from the gall bladder?  Change in diet?  Could I have an ulcer?

Any info you can give would be appreciated.

[Kevin Pho, MD]

Surgeon has kindly addressed your question in his comments below and I agree with his assessment.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[surgeon]

the gallbladder holds a small amount of bile, which is made in the liver and mostly drips constantly into the intestine. The bile stored in the gallbladder gets squezzed into the intestine when the gallbladder contracts, which it does in particular in response to food in the stomach, and especially if the food is fatty. When you have gallstones, if they happen to be in position to plug the gallbladder opening when it squeezes, it causes a "cramp" in the gallbladder muscles, which hurts. Limiting fat in the diet limits the squeezing, but doesn't stop it. Some people get attacks whenever they eat; others in relation to fat; others in no relation to eating at all. So dietary restriction may or may not help. The main reason to remove the gallbladder is to relieve symtoms. People with stones but with no symptoms are usually advised to leave it alone. Having had only one attack, and having modifed your diet, you are not one who would usually be told to have surgery absolutely. The other consideration is complications: gallstones usually just cause pain, but they can cause more serious problems, such as infections, jaundice, etc. People who have stones and who have symptoms are more likely to get complications than those without symptoms; but there's no predicting with certainty. No surgery is completely safe. Gallbladder surgery is very common, and for the vast majority of people is simple, quick, leaving no side effects. Which means if it becomes necessary, there's less to worry about than with many operations.

[tessa0825]

If you do decide to have this surgery after talking to the surgeon, I wanted to tell you that as long as there arent any complications and you can have it done laproscopic (most are) then this is a real easy surgery to recover from...Im 51 yrs old and had mine removed this past March..I had it done one afternoon and came home the next, was off prescription pain meds the day after that and took tylenol for a few days...I went back to work at 5 days post op and felt pretty good...Usually the surgeon will tell you to stay home (off work) until he sees you at about 1 week post op...I remember taking care of my Mom, yrs ago, when she had hers removed, they only did the big open surgery back then. I went through nothing like what she experienced with recovery....

[lkell]

Thank you both for your response to my question.  But I wonder if someone could render an opinion on question #2?  

I currently have moderately severe stomach discomfort and pain immediately after eating.  The pain lasts for 2-3 hours.  Its location is upper middle abdomen.  It is very uncomfortable.  It does not feel like acid, nausea or gas.  It is a crampy throbbing pain, with a slight full stomach feeling, that fades over time.  It does not hurt when I get up in the morning, or when my stomach is empty.

Could this be a by-product of my gall bladder issue?  I have no other symptoms other than the pain.

[surgeon]

As I said in my first response, "some people get attacks whenever they eat." So yes, it could certainly be related to your gallbladder. It's not impossible it could be something else. It's hard to recommend what additional investigations might be needed: I'd say you ought to see the surgeon, make sure he/she is aware of all your symptoms, see if further studies, such as upper endoscopy (looking into the stomach with a scope) ought to be considered.

[bigmal]

good morning, malcolm here in the united kingdom,just a quick reply to your concern, you have exactly the same symptoms as i do, i am a 44 year old male, went on a calorie controlled diet 1000 calories per day,lost 45lbs in 12 weeks,joined a gym, was as healthy as i had ever been in my life, i have 5 children (youngest disabled) and need to be in good health,
then 3 months after starting my diet and exercise POW, starting getting pains in same place as you,lasted between 2-6 hours then faded, this went on for 12 weeks ,chest pains no wind or acid just like you, until i had a larger attack,felt like a heart attack. called ambulance and was taken to hospital,problem is these attacks can go as quick as they come,so by the time youve got to emergency you are starting to feel  not too bad again,
           hospital said it was probably, muscle cramp,or similar,they were not that interested,so i discharged myself and went back the same day for blood tests,these were done nothing abnormal and doctor said i had stomache ulcers, gave me a pill to take,voltorol , 5 days later massive attack came on instantly i had to curl up on the floor,called ambulance again admitted to hospital .blood tests done again,and doctors said acute pancreantitus,they put me on an iv no food or drink, then 24 hours after being admited they puled out the tubes and sent me home,where i collapsed and stayed at home very very weak.feeling terrible for about 3 weeks.after this time i had appointments for ultrasound scan, mri scan, and ercp (camera down the throat,)
all tests normal and doctors gave me the all clear,
i  now suffer attacks like yours, not over painfull but strong enough,centre of chest under rib cage (this is where the stomache etc is) feels like youve been kicked by a horse for a few days then you feel quite normal,ive been back to the doctors 3 times,blood tests done on 2 occasions, 1st test showed i had pancreantitus, second test 4 weeks later showed  i did not have pancreantitus because my blood amulets? were normal but my liver enzymes were slightly raised,i am now on antibiotics (10 day course) fingers crossed i hope this clears it up.i believe that i should have been given antibiotics  at the outset,doctors seem to put these types of symptons together and say,gall stones and that removing the gall bladder is the answer, well its not the answer,personally i think your symptoms are related to weight loss,like mine,my advice to you is to start eating what you used to eat before,dont overdo it on fat stuff,but i believe if your body is used to eating a certain way,it does not like to change,our bodies are used to certain things and types of living,good or bad,my advice to you, is keep a calender  and log all good days and bad days attacks,mild strong etc,if you ,like me are still getting these forms of attacks,i believe it is the bile duct that needs a shunt/stent/small piece of plastic in it to keep it open,this is painless,i had a camera down my throat etc and its the same op, you are put to sleep beforehand anyway and when you wake up you cant remember anything,and feel no different.sorry to be so long winded but i get sick of everyone saying,gallbladder,gallbladder, half the time its not,and its about time doctors started looking further than the obvious,
if you are not on antibiotics go and get a 10 day course as soon as possible.let me know what happens.  malcolm

[surgeon]

If you re-read my posts, Malcolm, you'll note I did not say it was the gallbladder; I described the gallbladder, discussed surgery, stated it could be other things, and that surgery might not be necessary if there was only one episode. As to taking antibiotics: on this side of the pond we tend to like to have a specific reason for doing so before prescribing them. To take antibiotics without a specific diagnosis of bacterial infection is to accept the possible complications without a reason to expect benefit. They are not innocuous.

[McCartjt]

Hello Everyone

I too was following Atkins diet ...What a crock.. I too have ended up condensing  out cholesterol gallstones in to my gallbladder.  I have had a diagnosis of gallstones for about 3 weeks now and have had about 9 attacks.. I have been prescribed Urdisol / Actigall to dissolve the stones by my doctor ( who happens to be an internist) .. I am reliably told that over time the gallstones will dissolve on the prescription that I am taking..

Here's my question.  Bearing in mind that I want to hang onto my gallbladder & that I can stomach the attacks, at what point to I give up trying to hang onto my gallbladder?  

The reason I want to hang onto my gallbladder is that some people after having their GB removed end up with having a second surgery to remove a "Gallstone" from some of the internal gastro ducts.  Also there are is a 1% chance of it going wrong; long term & other implications, do with long term continuous flow of liver bile flowing thru the intestines / colon.  

I maybe wrong but the CDC / other august bodies here in the USA have said that Atkins does work, well sure it works but the number of people that now have gallbladder problems is a newer issue as a result.

John Mc

[lkell]

Everyone has been very kind and very informative and I appreciate the sharing of stories and information.

I went to the surgeon today and was greatly reassured.  He told me that some of the info I read on the internet was exaggerated and/or simply not true.  He told me that: the surgery he performs is outpatient; he and/or his practice has done hundreds of laparoscopic cholecystectomies; that less than 2% of them have had to be ‘open’ surgeries’ (after beginning laparoscopicly), and he knew ahead of time in each case that it would probably be necessary (versus the 15-20% I read on the net).  

He talked about each of the issues I was most concerned about.  First was damage to the bowels; he was honest and told me he did it once, but it was a case where the patient had undergone several other abdominal surgeries in their lifetime, and the bowels were already inflamed.  Second was iatrogenic injury to the bile duct system.  He said he has never done this, although he has assisted in the repair of five.  During the laparoscopi surgery, he performs some type of additional work to properly identify everything before cutting (I don’t remember what he called it).  He said I would be back at work within a week.  I walked into his office scared, and left not scared.  

I have had no more attacks and my stomach has settled down, I am eating LOW FAT and staying away from heavy spices.  So I have decided to wait until I have another attach and/or further problems before having the surgery.

[krisg]

stones in the bile duct or cystic duct can be extremely painful and also life threatening.  Anytime the flow of bile from the liver is stopped (by a stone) it can cause damage.  Hope this helps.

[Camden]

What is the difference between gall stones and liver stones?

[Camden]

What is the difference between gall stones and liver stones?

[Camden]

What is the difference between gall stones and liver stones?

[krisg]

Gallstones are formed in the gallbladder.  Bile duct stones can be stones from the gallbladder that have travelled into the bile duct or stones can develop in the liver ducts or the bile duct itself.

[redneckwife]

A related discussion, gall like symptoms was started.

[sandychris]

A related discussion, Pain but not gallstones was started.