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Gallbladder seems fine but PCP recommends removal
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Gallbladder seems fine but PCP recommends removal

Had a full GI work up: CT scan, Hida scab, ultrasound, endoscopy, blood and stool tests.  A few years ago I also had an endoscopy, colonoscopy, x-rays, and blood and stool tests.  Results of all the tests do not show any problems with my gallbladder, and also no gallstones.  There is some family history of gallbladder issues.

I have acid reflux for at least the past few years and, per my GI at the time, slow motility in my digestive tract.  Per my current GI I may have IBS also.  Most of my symptons were diarrhea, stomach aches/discomfort, and soft and black stools.  Prilosec has made these symptons bearable and has helped relieved them to some degree, however still have some of the above symptoms and gassiness.  In truth, I never really felt that I had classic traditional heartburn or had problems eating certain foods, such as I could eat spicy foods and not have much change in my symptoms.

However,  in the past year I have developed additional painful symptoms:
Alternating pain between my right chest muscle and right under my right rib, like a throbbing or someone grabbing me under the rib - this initially started off as pain in my right upper back, but now it's rare to have the pain in the back.  The pain definitely tends to happen after eating, but also when laying down to sleep and when waking up in the morning.  Pain killers, such as Advil and Vicodin do almost nothing to relieve the pain, however once I tried Vicoprofen and it helped a little, but this is a very potent drug and it felt very addictive as I enjoyed its effect on me, so this drug is out.  I also have nausea, a bitter bile taste in my mouth, a feeling of fullness due to the nausea, some heartburn.  Fatty/Oily foods tend to inflame the pain the worst, but eating in general tends to aggravate it.  The pain is debilitating as I can't concentrate, am ultra sensitive to any noise or stimuli, and in general am not able to function.

My PCP says I have classic gallbladder symptoms and wants to remove the gallbladder.  A GI and a surgeon that removes gallbladders will remove the gallbladder if I insist as I'm at my wit's end, but they think it could be musculo-skeletal, which my PCP says doesn't make sense as I get the pain after eating.  After discussing this with the GI and surgeon, they agree that musculo-skeletal doesn't appear to make sense either.

I will be seeing another GI for a second opinion, but at this point I'm ready/willing to have gallbladder removal surgery.  Thoughts or suggestions on this?  Thanks so much!
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122 Comments Post a Comment
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Avatar_m_tn
School example of gallbladder or biliary tree disorder. When you eat fats, gallbladder is contracted to expell bile, which is needed to digest fats. If there are stones/sludge in the gallbladder, this causes pain on the right side under the rib cage. Ultrasound is not accurate enough to detect small stones. The most reliable test of gallbladder function is a HIDA scan which shows "ejection fraction"  of bile during gb contraction. HIDA may also show eventual problems in biliary ducts.

Black stool, unless you are taking iron pills or Pepto-Bismol, is a sign of GASTRIC (stomach) BLEEDING. Burping/upper abd bloating/heartburn is from excess gastric acid, mostly caused by H. PYLORI infection. So you should also have a breath test for H. pylori.
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Avatar_n_tn
I wouldn't jump into removing the gallbladder.  Especially if there are no signs of stones.  I would seek another opinion and another HIDA scan if you feel strongly it is your gallbladder.  Like Boron said it will show if it is functioning. Even if it's not functioning well and there are no stones you need to rethink surgery.   Removing often does not relieve the symptoms, then you are just left with an unnecessary surgery, scars and nothing gained... and in a lot of cases chronic diarrhea.
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Avatar_m_tn
Beside stones, there may be a "biliary sludge" in the gb, which is a kind of pre-stones bile - stones will eventually develop from it. Ultrasound often can't detect this sludge. CT is much better for detecting sludge, but even this is not entirely reliable. HIDA is most reliable, but it actually doesn't show stones, but only gb function.

So, it is possible that someone have lowered gb function due to stress or "unknown reason". Stress usually affects both ballbladder and main biliary duct. Now, when you remove gb, biliary duct still remains in andcontinue to cause pain. Sometimes this may be resolved by incision in sphincter of Oddi, but not always and it has considerable risk.

If gallstones won't be find by any investigation, I agree that full investigation of biliary tree (by ERCP I guess) should be done before any surgery.
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Avatar_f_tn
If you're willing to try something 'off the beaten track' before you head for surgery, consider contacting a PT or other professional who is well-trained in Barral visceral manipulation techniques. As crazy as is sounds, it can and does work. You can contact the Barral Institute and talk to them about a referral to an experienced person if you'd like to talk to a 'human being' instead of checking the website.

This is not 'schlock' treatment. The techniques were developed by a French osteopath and are used extensively in Europe. They're only becoming more 'known' here in the U.S. as 'the doc' is becoming more well-known. I believe it was a year ago (?), he was named one of Time's 'Man of the Year,' so I think that places him in very respectable company.
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Avatar_m_tn
Thanks for the insights.  My PCP said that sludge is probably the culprit.  I'll ask about checking out the biliary duct as all the tests have not shown any gallstones and the gb appears to be working fine.

The endoscopy I had was an upper endo, so not sure if the bile ducts were checked out.  I'll ask my GI to see what he thinks.
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Avatar_m_tn
ERCP is done during upper endo, but only when necessary. They fill contrast into your biliary tree (from the duodenal opening of bile duct) and then make x-ray pictures. If eventual disorder is find, sometimes can be repaired just during that procedure. Investigation can reveal stones or stenosis in biliary duct or in the area of sphincter of Oddi (exit of bile duct).

Non-invasive alternative of ERCP is MRCP. They simply make a MR pictures of your biliary tree. Maybe this MRCP can also show, is it sludge in your gallblader (gallbladder) or not.

What you want to know first is: is it sludge or not. So, MR or CT can show this. If it is sludge you can expect ongoing problems, if you keep gb. The next thing you want to know, is if your biliary duct, especially its last part (sphincter of Oddi) are working properly. This may be checked with ERCP and sphincter manometry, which I believe it can be at the same time.

All this is a delicate matter. Above suggestion to contact someone experienced may be worthy for you.
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Avatar_m_tn
Talked to my GI about the above discussion:

He said that a biopsy was done during the Upper Endo for H Pylori, no H Pylori was found so that is the definitive answer and thus he does not recommend a breath test.

He recommends a MRCP before an ERCP to check the bi ducts - the ERCP was not performed during my Upper Endo.  If the MRCP comes back normal then he sees no reason for an ERCP.

We talked about the Sphincter of Oddi, but he doesn't do this and is more of a specialty, and if I'm characterizing this properly, he says that there is not much documentation on this.

He also says that the ultrasound is the best initial test for detecting gallstones and sludge, and none was found from my results.

He says my gallbladder is functioning properly per all the tests and he sees no reason to remove it, and all my pain/discomfort may continue even with gb removal.
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Avatar_m_tn
Well, some comments:

1. If you are not BLOATED in upper abdomen, and if you don't burp, you don't have heartburn, then it may be assumed that H. pylori is not the cause. I mean, if no symptoms, no reason to bother.

2. MRCP before ERCP sounds reasonable.

3. Sphincter of Oddi Dysfunction (SOD) is well known disorder. It is diagnosed by manometry (measurment of pressures in the bile duct), ERCP and possibly HIDA scan. MRCP cannot show SOD, since this is a functional, not anatomic problem.
GI maybe wanted to say, that he doesn't deal with SOD, since he is not specially trained for that. Just search online for "Sphincter of Oddi Dysfunction (SOD)" and you'll see how much is writen about it.

4. Ultrasound is officialy always the first investigation in gallblader (gallbladder) problems, but it OFTEN misses small gallstones and sludge. It was reported few times on this forum, that ultrasound showed nothing, but CT did. Ultrasound is really not good for these "borderline" issues. It can show fairly large stones, sometimes sludge, but not always.

I think, you should have MRCP, and ask GI, if this MRCP would also show eventual sludge or stones in gallbladder.
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Avatar_m_tn
You are as insightful as always, thank you.  I will see my PCP to schedule the MRCP as soon as possible.  In the meantime I'll see another GI, although the recommended one's next appointment is in mid-August.

I've been cleared for gb removal, but hesitant to go ahead at this point.  Although, I just ran into one of my sisters who just had hers removed last week and she seems totally fine!  She had a huge gallstone though, so the circumstances are different, at least as a result of the tests, and she only had an ultrasound performed.

In the meantime I'm focused on pain management - one of my doctors told me to use a hot compress and to drink warm water in the evening.  I'll let you know how it all works out.
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Avatar_f_tn
My daughter was having bad abdominal pain and gallbladder appeared okay accorking to ultrasound.  Hida Scan however showed it to ony be functioning at 10%.  She then had the gallbladder surgery to remove gallbladder, but is still experiencing the same pain.  She just had a MRCP mri yesterday and has been diagnosed with Median Arcuate Ligament Syndrome and is to see a vascular surgeon next.  
A good idea to have all possiblities checked out before having gallbladder removed.....
We feel our daughter's was removed needlessly.  
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Avatar_m_tn
After ongoing pain and discomfort and further discussion with my PCP and GI docs, I've decided to go for the gb removal surgery.  The gb is noncritical and many people function fine without it.  I asked about the MRCP and it would take a little while to get it approved by insurance.  While not definitive, the bi ducts would've been seen to some degree with the various tests that I've had (ultrasound, CT, Hida, endo - not sure which ones).  If the MRCP came back showing sludge, removal of gb would be recommended in either case.

The pain/discomfort is more constant and has built up over the past 8 months, and thus does not look like it's going away.  Thus it appears that my chance of recovery is currently 0% ... with gb removal the docs are telling me it's 50% based on similar cases to me that they've seen.  Surgery is for next week, I've at least asked the surgeon if MRCP can be done prior as part of the presurgery testing.
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Avatar_n_tn
I understand you are in a lot of pain and that removing your GB gives you hope that you will get better.  However, I had this same hope and I remain sick after the GB removal.  I urge you not to rush into it.  While they say the GB is not essential it is helpful.  I feel the doctors found mine wasn't working (0%) so it must be causing my left sided pain (even though the GB is on the right side).  Since I am having the same problems I was having prior to surgery I do not believe my GB was the problem and now getting them to look further is almost impossible.

Did you get a HIDA scan?  Just curious what they are basing the reason for removing your GB.  You also posted the GI said it was not your GB... so it's confusing as to the reasoning behind the decision.

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Avatar_m_tn
Hi Cheri70, can you elaborate on why the Dr's say looking further is almost impossible after GB removal?  I have a HIDA ejection fraction of 7%, but no stones under ultrasound nor CT. I am also scheduled to have my gb removed...  I have also heard others who have pain on the left but got their gb removed, and continued to have the same symptoms.
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Avatar_m_tn
All investigations you've had, were to check only gallbladder. If even your HIDA scan was OK (what % was it?), then there's really a question, if it is gallbladder. Your symptoms may all arise from biliary duct - in this case removing of the gallbladder wouldn't help.

I would recommend you have MRCP before surgery. After gallbladder removal, constant diarrhea may be a problem, since bile is flowing into intestine all the time, and because it can't be all re-absorbed in the small intestine, it reaches the colon where it triggers diarrhea.
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Avatar_m_tn
The surgeon and pcp don't feel that MRCP is warranted before surgery, so I guess I'm kind of stuck in the meantime.  I don't know what % my HIDA scan was, but I can inquire as supposedly it was OK.  The surgeon and pcp told me that 50% of cases similar to mine resolve issues.  As I have trouble functioning during day, sleeping, staying asleep, I'm willing to go ahead and try their recommendation.
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Avatar_m_tn
Have you tried low-fat diet?
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Avatar_n_tn
The drs didn't say it was impossible, I'm saying it's almost impossible to get them to see why I am still in pain.  First it was "it takes time to heal" and now it's "we aren't seeing anything - maybe you are constipated" (??), however they hadn't really tested for anything either.  I just had an MRCP on Saturday and I await the results.

If 50% get better, then 50% get worse. Post surgery I had a good 5 months of pain so bad I could not function and at that time doctors telling me to deal with it.  It was way worse than prior to surgery.  Now I am finally back to the way I was prior to surgery, so "back to where I started", although now I also have upper left/center pressure pain.  

I wouldn't remove my gallbladder without at least knowing my HIDA scan results.  Anything over 35% means it's working fine.  I also question removing a gallbladder that does not have stones.  I wish I had listened to boards like this before surgery, I'd be less doctor bills, less scars and less pain.
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Avatar_m_tn
I've been eating pretty healthy for awhile now, I'm guessing a low-fat diet as I've been avoiding fatty and oily foods, sauces, etc.  In addition, with my GERD, I try to eat bland food.  I admit that on occasion I eat a little something sweet, but it's very little and very rare, and symptons do get somewhat worse, but life without a little sweet now and then is not much of a life IMHO.  However, regardless of the foods that I eat, the pain and discomfort is pretty regular and constant: right abdomen below ribs and right chest muscle - the muscle tends to get worse when I turn and when I lie down.
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Avatar_m_tn
I'm not sure about rushing into gb removal on the basis of 50/50 promise of improvement (statistical) without knowing what's behind. Would you mind to get results of your HIDA scan?
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Avatar_m_tn
I was not trying to force you into a "healthy diet". You've mentioned that fatty foods cause you pain. Fats are in: meat, oil, butter, margarine, egg yolk, dairy, nuts, chocolate. It's not about dropping all fat, just to limit it. Fats directly trigger gallbladder contraction and pain. I was not saying anything about sweets in general, only about fat.
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Avatar_m_tn
Just saw another GI for a 2nd opinion.  He thinks it could be microscopic or nonspecific colitus and recommends a colonoscopy.  He was very baffled why gb surgery was recommended and OK'd when all tests came back negative/normal, as they're able to see gb and duct with all the tests that I had.  I will discuss this with my other docs and most likely cancel the surgery and go for the colonoscopy.
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Avatar_m_tn
I agree with all the suggetions made by Boron so far. Surgery for GB removal can always
be re-scheduled later. Right now, I`m suffering thru the 4th day of a mild GB attack. This is now the 4th since 2006. In my case the attacks last about 5 days then re-occur 6 to  9 months later - after a large meal. Pain begins just below rib cage on right side. With all
the tests you have had so far it may be your GB is inflamed. I can offer what works for me when an attack starts. No solid food for 3 days only quality apple and cranberry juices. 4th day, soups, apple sauce, steamed vegetables. 5th day, add small amounts
of lean chicken. I would suggest avoiding coffee, sweets, chocolate, peanuts, eggs, soft
drinks. Drink lemon water and fruit juices. THe black stools are troublesome.Tell me more about the frequency of this condition. Some years ago , I was prescribed Prilosec
for Acid Reflux which i did not tolerate well. I felt nauseated and weak. After a BM, noticed some food that passed thru my intestines undigested. I now use DGL, Deglycyrrhiziated Licorice tablets. DGL has the ability to protect the digestive tract from corrosive stomach acids. A good friend of mine is a pharmacist who said the Proton Pump Inhibitors were never meant for long term use. Maybe 6 to 8 weeks max. Decresing stomach acid can bring on poor nutrient absorption from food causing gas and general body weakness in some people. Have you been using Prilosec for a long time ?

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Avatar_m_tn
Prilosec doesn't seem to have real problems taken long-term from what I hear, as I've been on it for years, maybe 5 years or so.  Also a Net search on this topic seems to confirm this.  While it wasn't supposed to be taken long-term, people have done so and it's one of those things that I generally never hear problems about, at least it's not one of those news stories that shows up where there are lawsuits left and right.  For gas I take Gas Defense that has the probiotics or whatever the good bacteria stuff is called and this helps tremendously.

Without Prilosec I have stomach aches, diarhea (diarrhea), constant needs to relieve myself, bloating, gas, black tarry stools ... thus for me Prilosec is well worth it as it makes all these symptoms more manageable, although it does not solve my problem.

Thanks for the tips on eating/drinking, I'll give it a whirl and see what happens.  I generally try to eat fairly bland and not heavy as it's not worth having the pain on the right under the ribs.  My colonoscopy isn't for a couple of weeks, but will report back how it goes.
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Avatar_m_tn
My GI where I got the second opinion suggested isometric exercises to help with the pain in the right chest muscle.  I've been practicing these and some additional isometric abdominal exercises for a couple of days now.  These do seem to be helping so far at least a little bit, which is the only relief I've been able to have.  The other doctors I've seen gave me 3 options: live with the pain and sometimes it goes away (I've had this pain everyday for 8 months), take narcotic painkillers, have surgery.  At the minimum it's nice to have some other healthy options that I can perform myself.  This in addition to a low far diet and some exercise help to manage the symptoms, although the disease is still present.
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Avatar_m_tn
Misha, I want you understand one thing: throbbing pain under the right rib cage after a fatty meal, can be ONLY from gallbladder/biliary system.

You may have ADDITIONAL problems, like you obviously have some GERD, and you had some problems with digestion, right? (diarrhea).

But the RUQ pain is from gallbladder/biliary system. It's not a muscle, not a colon, not stomach or anything. Even not the liver. You have NOT done all investigation (MRCP) yet. Even if all comes out clear on the end, you may have a functional problem, like "biliary dyskinesia" or "sphincter of Oddi dysfunction" (SOD).

I don't see any reason for colonoscopy.

You have family history of gb issues.
You felt bitter taste in the mouth (bile).
Nausea also goes with gb disorder.

I would really advise you to find out what's with your gallbladder/biliary system. You were intending to have MRCP, right?

Again: there is NO other organ which would cause cramping RUQ pain after a fatty meal.



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Avatar_m_tn
Boron, I hear you.  My PCP, 2 GI's, and a surgeon don't think that the MRCP will show anything that hasn't been shown already as the ducts supposedly have been examined.  This is what they tell me so I'm willing to listen, but if I insist on this they will do this, but there's no harm in doing a colonoscopy in the meantime.  The surgeon says that I do not have a structural problem, but a functional one, such as hormonal imbalance ... again, this is what they tell me.

The PCP and 2nd GI I saw also noted tenderness on my belly (lower right, not lower left, I guess this is along the colon).  The other docs examined for this, but it only happens about 50% of the time that the various docs examined me.

The rib pain/dull ache basically shows up after almost all meals, and I really do try to keep a low fat diet, but fatty/greasy meals make it worse.  Also, sometimes I've have bad pain after a nonfatty meal.  So there's some randomness here in my perception.

GERD and digestion problems are also forever present, which I take Prilosec for, which does help somewhat.  I've also starting taking Gas Defense formula, which also helps with gas and bloating.  I also have bitter bile taste, some nausea now and then (doesn't seem too bad lately I'm assuming from my low fat diet).

jFYI, my research on ERCP and SOD scares the hell out of me, also from what folks report about these procedures sounds scary, so I'd like to avoid these if possible.  I also understand that they need to know first if there are stones or sludge before doing these.

will keep all informed as this progresses.
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Avatar_m_tn
ERCP often causes some mild pancreatitis. Procedures for SOD may be dangerous in some cases, yes.

Anyway, my point was, first trying to determine the organ, from where symptoms arise, and then go into action. Gallbladder/biliary system is sure one of organs where your symptoms originate from. It's the next level of consideration, what to do now. "Hormone imbalance" was mentioned. I could also mention "nerve imbalance". It's like headache mqy occur from no apparent reason other than anxiety or stress. Nerves strongly affect the "mood" of the gut.

Lower right pain may arise from terminal ileum, maybe this is why colonoscopy was proposed to you. Crohn's disease often affects terminal ileum. How old are you?
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Avatar_m_tn
As Boron asked and I will also ask " What was your Hida scan results ? I re-read
all the posts and you say , the results were "normal". If the % is too low, the GB
may not be squeezing properly. THe gb is therefore not emptying as it should- may
cause pain. Your insurance may not cover the MRCP but will most likely pay the
ERCP. Some repairs can be made during this test. Search the Net about this rather
than explaining it all here. In any case , have either the ERCP or MRCP done. THe
ERCP is invasive but no big deal. You will be sedated.

Get the colonoscopy since you already have it scheduled. You mentioned "black
stools". Need to find out what`s causing this. I believe bleeding from the small
intestine will cause this but perhaps Boron can weigh in on this. Are you
taking Pepto_Bismol ? You indicated Endoscopy was normal, didn`t DOC`S
express concern about black stool initially ?
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Avatar_m_tn
"Black, tarry stools" as were dewscribed, are the symptom of bleeding from the stomach (acid turns blood black). Blood from the intestine (from all parts below the stomach) is red.
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Avatar_m_tn
About  test results.

No need to call doctor or schedule a consult for test results. Just call the offfice
and say "This is Mr Smith,I recently had a CT the abdomen and pelvis , can you
please fax  the report to me". If you dont have a fax , they will mail. Doctors` offices
use fax machines all the time. THis is what I do, I then keep my own records of
all my tests. After you get the HIDA results, post info here.
P.S. They may want the date you had the test, in the event you had more than one,so
mention the date when you call.

Boron  - thanks for info
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Avatar_m_tn
Medical records are being mailed to me.  I'll know results of HIDA then.  Docs were concerned about black tarry stools, and said to take Prilosec, which I've done for years.  I'm also taking the Digestive Advantage-Gas product which so far is helping tremendously with all the gas, bloating, need to relieve self several times a day with urgency.  Never really taken Pepto bismal, but take Tums on occasion, which helps somewhat.

Not sure why folks think that ERCP is not a big deal when it's a very invasive procedure and has a high likelihood of causing pancreatitis. Also, there is no justification for ERCP unless you know if you have gallstones or sludge, as the point of the ERCP is to remove the stones or clean the sludge.  Also a SOD is usually done with an ERCP, and there have been so many horror stories about this procedure that it raises so many questions.  Re: MRCP - what will this show that all the tests that I've had not show.  My Docs say that an MRCP will not show anything new or different - any thoughts on what to say to my Docs to convince them to do this will be helpful, as I have no problem doing the MRCP as it's non-invasive.  

Colonoscopy is officially less than 2 weeks away and looking forward to finding out whatever the Doc finds out.
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Avatar_m_tn
I guess the question becomes - is the GB causing the pain or is there a
possibility with stenosis (duct) or SOD problem. I re-read the posts again and
it appears that if the HIDA is normal, the GI's must think the GB is the problem.
But, what is this based on ?. Did either GI say definitively that there is sludge
in the GB based on your tests.Ultrasonography can detect microlithiasis but it
is not as sensitive as MRCP. So if any of your tests proved sludge, this is
probably why they are recommending removal.

ERCP has a techical failure rate of around 10% with a morbidity rate of 1-7 %.
I know of 4 people in the 1980`s that had ERCP no problems but now with
MRCP this naturally beomes risk free. I should not have said ERCP is no big deal.
If you happen to be one of the unlucky ones - it becomes a very big deal.

Your Docs says MRCP will not show anything new or different leads me to think
they see something.However, I wonder - do negative results mean - lets remove the GB
anyway and play the percentages since you`ve had typical GB symtoms (symptoms) for
months.

So my take is this, if no sludge with prior tests, prove it with the MRCP which
is more accurate. Also I believe MRCP can detect sphincter of Oddi dyskinesia,
not sure if spiral CT can. Was your CT with contrast ?

Finally, was there a definitive diagnosis provided to you based on factual info
in the results of the tests. Hopefully the office will send you the results of the
CT and US also.
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Avatar_m_tn
MRCP can show everything what ERCP can. Only I'm not sure if it can show functional problems like SOD or biliary dyskinesia. But at least it can rule out any physical problem, which beside stones and sludge, may be stenosis, adhesion, tumor or pancreas head which presses on the bile duct from the outside, etc.

Your symptoms obviously arise from gb/bile tree area, and MRCP would be just a nice test to rule out physical issues.
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Avatar_m_tn
Maybe we are trying to over-think this diagnosis.
After months of pain, resulting in probable Cholecystitis, caused
by most likely thickened bile, the GB distends, becomes
edematous and inflamed, resulting in pain. If the pain was severe,
similar to a kidney stone, the GB would be out by now.
THe GI is probably using his clinical experience, patient
interview, and test results to recommed removal. If any of those
tests indicate an enlarged GB, time to come out, I believe
Boron, off topic, do you know anythng about Urology, specifically
spermatic cord/testicular neuralgia. I had surgery at Johns
Hopkins in Oct 2007, was unsuccessful.
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Avatar_f_tn
I'm following your input on gallbladder problems. I had mine removed 3 weeks ago due to hida scan showing 10% function with no stones. I've been back to surgeon twice once for stitches and other with complaint of the same feeling as before removal. I was given Trimehobenzamide for nausea  which didn't help to much and yesterday was given Protonix for acid which has helped. Today has been a good day. I think one has to hope for the best. I know it was very hard for me to function before my gallbladder was removed. I was in so much discomfort that I was clenching my teeth and my jaw became sore. I'm doing better and I think when one has the problems over time all of your digestive tract suffers somewhat. It may take some expermintation with meds. I hope things work out for you. If you have any questions feel free to ask. Good luck.

linda
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Avatar_m_tn
Hey, Tom, I think the pain arise from the gallbladder/biliary tree area. I'm talking about the organ, about the spot. Perfectly healthy gallbladder can cause pains. It can be psychological. Or "functional", what actually very often is.

I just do not know for any other disease which could cause cramping pain after a fatty meal, and I want to spare misha from dosens of unnecessary investigations. I'm not talking about what therapy is needed, and I am against jumping in gb removal in this movement. Things just have to be explored to the end. When doctors start to suspect there's no physical there, many of them lose their will, but the problem still can sit there.

Don't by any means read all this, but look:
http://www.medhelp.org/posts/show/434761?post_id=post_3054034


What do you mean with "unsuccessfull" surgery? What was done? And you still have - what kind of pain? Pain in testicles may be refferred from kidney or urethers. Don't rely on me much on this topic though.
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Avatar_m_tn
I read the entire post you noted. I feel so bad for taliaes. i cant believe doc is advising
Neurontin, this is unbelievable. What the hell is happening to medical care in this
country. Misha, read  post 3054034, it will make you want to vomit.


Misha, after further study, get the MRCP even if you have to pay for it yourself.
Your GB may be inflamed as I mentioned above but other problems might be found
in the biliary tree as indicated in previous posts. THe odds favor GB itself, but
I would only consider "odds" at the blackjack table. Once your GB is out, it
cant go back. Thik of the MRCP as that "second opinion" to validate your
previous tests.

Boron, I underwent an inguinal neurectomy resecting the illioguinal and genitofemoral
nerves near/in the spermatic cord. I`LL post in doctors forum at some point. What i`m
trying to figure out right now is the likelyhood of needing testosterone replacement
after a unilateral Orchiectomy scheduled for Sept. Maybe this would be better asked
of an Endo specialist.
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Thanks for your ongoing comments and suggestions.  I've found that Digestive Advantage for Gas has helped me quite a bit so far.  It's not a cure, but it still continues to help.  I still have the upper right chest dull aches/tenderness and the right rib cage is still there as a dull ache now and then, most pronounced when I go to sleep and put some wait on the right side.  These are more manageable now, but obviously I would like them to go away.  The biggest news is that so far I've had no massive pains waking me up early in the morning.

I'm also trying not to take Prilosec to see how it goes.  This is my fourth day without it and I'm managing, a bit quesy now and then, but BM are relatively Ok, no diarhea (diarrhea) yet, some stomach discomfort and aches after eating dinner, which is my largest meal of the day.  I've tried to wean myself off Prilosec in the past and the nasty symptoms of black tarry stools return, very painful cramps, bloating, gas, diarhea (diarrhea), lots of fatigue all return after a few days.  I suppose that sometimes it's worth experimenting to see what happens.  

The only other symptom that I've noticed in the past few months, which I forgot to post, is that I've had a much higher need to relieve my bladder than I've ever had in my whole life, and I'm in my early forties.  Historically I could hold my bladder for hours and hours, only needing to go once in AM, once in afternoon, and once in evening.  Now it seems that I need to go about an hour after drinking liquid.  I'm very careful now about drinking before sleeping as well as making sure that I don't have anything like watermelon in evening as I'll have a huge need to relive my bladder early in the morning.  Don't know if this is related to anything, but if you have any thoughts please let me know.

I also read the other post and can't believe that neurontin is still on the market based on what I've read about it.  I'm still waiting for a copy of my medical records and will be able to provide on Hida and CT scans.  I can inquire further and request MRCP in meantime.

Thanks, misha
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OK, misha, if you are willing to experiment with the gas (this is one thing which can cause chest and under-rib pain). Gas comes from normal intestinal bacteria when you feed them with sugars (glucose, fructose, maltose, lactose...) and simple carbohydrates like starch (potatoes, wheat). So you can have a few days of sugar-free diet:

Limit (for one week, can you manage that?) sweets, cola (glucose), fruits/fruit juices (fructose), dairy (lactose), beer (maltose), any alcohol and maybe potatoes and pasta (starch). Also limit raw vegetables and fruits in general (gas from fibers). This should considerably reduce amount of gas, and you'll see, if this helps to reveal the pain.

About urinating: if you go frequently, do you excrete a lot of urine or only a bit? A lot of excreted water may be sign of diabetes...or simply drinking a lot...alcohol also pushes water out...Frequent urinating with small amount of urine, and with burning sensation may be from acidic urine (vit C, aspirin, fruits, even cola...) or from (even slight) urinary infection, or kidney stones. A simple urine test may bring a lot of answers about all this.
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...*relieve the pain.
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continue to wean off prilosec if possible, take 2 DGL tablets 1/2 hr b4 each meal.
you can find at most health food stores, if not , order from iherb.com. I swear by
them. Enzymatic Therapy is a very reliable brand. Drink a lot of apple juice, unsweetened, the best you can find. I still find apple juice very sweet no matter
what brand so i mix 50/50 with water.

Diet-avoid coffee, sweets, peanuts, peanut butter(use sunflower butter instead), milk.
eggs ok once or 2x weekly. fry in olive oil. no hot dogs , french fries, anything high
in animal fat. no soda or caffeine. Dinner , your large meal, cut down amount of
food. you dont want to overtax your gb .DONT lay down after eating, this causes
GERD.

milk- if you have cereal in am use lactaid brand no fat milk.

meals-  adopt a Mediterranean diet. make stir frys with frozen vegies and small
amounts, 1/4 lb only meat per meal. use a good amount of pure olive oil in fry pan.
eat 3 or 4 small meals per day, not 2 large ones.

you dont want a no fat diet but one rich in EFA's. eat high quality bread, peperidge
farm or arnold brand. b4 bed , place slice of bread in bowl, and saturate with
olive oil, maybe 2 or 3 tablespooons. after eating , wash down with strong lemon
water, maybe 1/2  glass. olive oil is very, very good for folks w/gb problems.
there is a book  -- BETTER HEALTH through NATURAL HEALING by dr Ross
Trattler, 2nd edition, it is an old book, but available on e-bay for a few dollars.
it has another author also , adrian jones. has info about gb problems.

urinary problems. have psa test done and pcp can check prostate , might have
BPH. is there any burning when you urinate ??

one hour b4 meals take one Pepogest cap, by nature`s way. available online.
very good for gb problems.
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No burning when urinating, just finding that I'm going much more frequently.  I'm also urinating regular amounts, not just a little at a time.  The color does seem a little bit brighter yellow, but does not seem so unusual to me.  When I saw the first GI doc, I believed that he checked my prostate (actually pretty sure, you know when these things happen and don't forget the experience) and said all was fine.  But I'll also check with my PCP and discuss the urine test with him.  I actually don't drink any coffee, alcohol, or soda, I do drink herbal teas, like chamomile, water, natural/organic juices, etc., don't smoke, no drugs, try to exercise daily, so I'm pretty good from this perspective.  Theoretically I should be the poster child for good health and practice.  I'll keep in mind your food suggestions and see how things develop.
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Thanks for the suggestions.  I'll go try the Pepogest as I had not heard of this, and I've heard that peppermint oil is good for Gerd folks.  Have you heard of Aloe Vera AMP?  It's pretty expensive stuff but supposedly most folks have found that it helps with digestive issues.

Looked up DGL also, licorice is also supposed to be good for stomach.  I'll try this out as well.  Thanks again for suggestion.

Also looked up PSA and BPH as I'm not too familiar with all these acronyms, but good to get to know these.  I'll ask my PCP about this as well.  Thanks again for the food and book suggestions, I'm currently reading some Dr. Weil books on healthy eating and will make my way to yours.
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Misha, you are providing good info - I just found out you're a man :) .

You see, we enjoy bombing you with our diet ideas, please take it as a pure help in the consideration. When you're off from Prilosec, acid and proteins (which trigger acid secretion) may touch you more than before. And sugars cause bloating. I just want to be "technically" correct. Fruit juices are source of acid (pain) and sugars (gas), I don't want to spoil your day, but if you'll engage into proposed diet, maybe try with vegetable juices, or something with less sugar.

Then, I was thinking you're not bloated, but you said you're, if I get you right. Would you mind considering having a BREATH test for H. pylori again? Tests made during the biopsy maybe cought only some parts of gastric mucosa and not others. Blood tests show also previous infections, so they are useless.

Your age - still a mystery.
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have not tried ALoe AMP but aloe is  good for burns, wound healing. DR Weil
has some good books on general health.

here is an excellent website:
lef.org........go to health concerns, then drop down to disease prevention, then
you will see the topic of gastrointestinal. read the various protocols. this organzation
has been around for about 25 yrs. very reputable. they alos provide a list of innovative
doctors, maybe there is one close by if you dont like  your pcp.

Have a nice 4th of July, post test results next week and we`ll go from there.

TOM
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In early 40's.  I'm game for the breath test.  The GI did the biopsy and said it was "definitive" that I did not have HP, he seemed kind of bothered that I was asking him questions and has not returned a phone call from last week.  I believe I was very polite and professional with him, but I understand that there are cases like mine where the answers are not obvious and docs may not want to be bothered, at least that's my impression.
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I would be sorry, if I would contribute to your fights with a doctor. I can't say from here H.pylori yes or no. So, what speaks for H. pylori: inflammation of stomach (pain after eating) OR duodenum (pain on empty stomach), bloating of UPPER abdomen (uncomfortable felling under the ribs and in the chest), BURPING (more than usual). (Biopsy of both gastric and duodenal mucosa from several places would bec needed, now I don't know what was done, but a breath test can't miss H. pylori).

Low-sugar diet would surely reduce some bloating, but this is more like a test and not an end solution. If you think, I'm getting you wrong about bloating, tell straight. I have no interest to say you have H. pylori or not. Maybe you can set a day when you will try with a diet experiment - this can bring some answers.
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one more thing...... if you do try the bread with olive oil before bed.....skip
the lemon water for now. Since you are off the Prilosec, dont want acidy lemon
to aggravate your stomach. IF you have some stomach distress, that gnawing
feeling, try tums.
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Tried the Pepogest, seems fine so far.  Easy enough to find at Whole Foods Markets.  

The DGL licorice I tried was nasty, it was a plain flavor one so that could be why.  The other flavor was chocolate, which had sugar and other stuff in it so didn't want to try it.  I'll see how the Pepogest works out first and perhaps work my way up to DGL as it's chewable and no way to avoid the taste.

On 6th day without Prilosec and not too bad so far.  Went away for the day yesterday and ate out at a restaurant: had a lobster roll, which came with fries and chips.  Also had some carrot cake, avoiding the icing.  Had chomomile tea after this.  All in all well tolerated.  As Dr. Weil explains, sometimes we are in situations where the food doesn't match our usual eating plans, but the custom calls for it and as food is a social custom to be enjoyed, we should simply join in.  Back to the regular eating plan today and all seems fine so far.  Otherwise, the dull aches and pains are still there in the rib cage and right chest muscle, but they come and go, mostly coming when I lie down.
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Just received my medical records.  The Hida scan results are as follows:
4.85 mCi of technetium 99m Cholotec were injected and a HIDA scan was performed.
There is a normal concentration of radiotracer within the gallbladder and patency is demonstrated of the common bile duct with free spill into the small bowel.  0.3 micrograms of Kinevac were administered using a slow infusion method in order to calculate the ejection fraction.  The calculated ejection fraction is 62% at 30 minutes, which is within normal limits.

Looks like I have a pretty healthy gb in terms of structural function.
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Please stick w/ the DGL, I know the taste is ugly, but this is very important to begin
the healing process in your stomach. No doubt w/black stools in the past, you have
most likely a Peptic Ulcer. From time to time, there is some bleeding. THis will take
time to heal.

Since you are reading Weil, you know he is a big fan of stress reduction, deep
breathing etc. THere is evidence to suggest that anxiety, stress, nervousness
contribute to excess production of stomach acid. I know this from personal
experience.I worry about everything, just ask my wife. My stress is down
somewhat since retiring. I now take a long walk every day. Watch a funny movie
and turn off the TV w/24 hr bad news about economy etc.

Sweets will agravate stomach.  So  will caffeine and salt. I would tell you to
try soups, but most are loaded with salt. By the way, send some of that
Lobster Roll my way!!.

TELL me what is in GAS defense formula. Also, are you taking any digestive
enzymes such as Pancreatin ?? let me know please.

if you read the lef.org protocol "DigestiveDisorders" you will note the function of the
Pancreas and Bile from the liver in digesting food. An imbalance there will cause gas,
bloating etc. You may want to start taking digestive enzyme supplement with meal
unless of course you already are .

I buy the large container of Stonyfield Farms fat free plain yogurt then add fresh
fruit such as strawberries, peaches or whatever you like for a midday snack. This
can be made in advance and taken to work. Most commercial yogurt is junk, far
too sweet with added sugars etc. this is why i specify this brand.

Cooking with olive oil and stir frys - just a note- start slowly cooking w/this method.
Consuming large amounts of olive oil whn your system has not has a chance to
adjust might cause diarrhea.
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gb seems ok on this particular test.

another question about pain. if you lay on your back, then extend a straight line
downward from your right chest nipple to the point where your last rib ends. then
move your 1st 2 fingers from left to right about an inch either way , does it hurt
when you press in this location ??
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Just finished a review of my records, it also says hiatal hernia and colitis from 2004.  I really don't remember anyone mentioning these words to me, what I do remember is acid reflux and slow motility.  Looks like you definitely need all this information as a patient.
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Tom, I was reading that peppermint oil, licorice and potentially ginger are not good to take for folks with gb stones or gb disease as these products stimulate bile acid production.  Of course, I don't have stone or disease according to the tests, but this is what I was reading about these various herbs/supplements.  Thoughts?

Otherwise, www.disgestiveadvantage.com lists the various products, with the incredient GanedenBC as their patented probiotic.  Seems to still help me out a lot.  Although ... apparently this past weekend did produce some turbulence in my stomach, especially last night.  Must've been the lobster roll, fries, potato chips, carrot cake (no icing) from July 4.  I'm back on the wagon today in recovery mode, the morning was a little queasy, but the afternoon is a bit better.  I noticed that the rib discomfort occurred more noticeably about 1 hour after eating all meals this past weekend.  Also going to sleep and waking up with this discomfort was more noticeable.

One switch I've made is from Soy milk to Rice Dream milk, as the brand of Soy milk I was using has carageenan, which should be avoided by gi troubled folks.  At first the rice milk was odd tasting, but I'm used to it now.

In terms of squeezing the ribs, I would say that it doesn't hurt, but it is a little tender.  The pain/discomfort is like the ribs are being squeezed from inside and there's no way to relieve it.  If this could be taken care of, other than with narcotics, then I'd be a new man.

Also, the website you referred me to mentions Digest RC as a digestive aid, as Europeans have been using it for decades.  Folks without a gb should not take it, but wanted to know your thoughts on this aid.
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the pain about one hr after eating, exactly where is this pain ??

I did not mean to press into the right rib, but just under the bottom rib  on the
right where the rib cage ends. DOES the pain radiate from this area or is
it felt about midway btwn the right nipple and the last rib ?

Duodenal pain comes on 2-4 hrs after meals and is relieved by food.

Gastric ulcer pain 20- 30 min after eating.


Explored digestiveadvantage. contains probiotics but no digestive enzymes.

DIGEST Rc should be ok if no stones. i would switch to this after PEPOGEST
used up as itcontains several vital ingredients not just pepprmint. I forgot about
this product or  would have mentioned it sooner.


Se this article about hiatal hernia:
http://www.joyfullivingservices.com/hiatalhernia.html

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Hiatal hernia is protruding of one part of your stomach through the opening in diaphragm muscle, so upwards along with esophagus. This may (or not) cause acid reflux, wht you'd fell like a heartburn. This can explain your upper central abdominal issues, but not the right under-rib issues.

Right under-rib pain - is this like a prolong cramp, which grabs you, holds you and then ceases after some time, and then again...

What you think would happen after a decent fatty meal?
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Right under-rib pain - this is like a prolonged cramp, which grabs me, holds me, and then ceases after a time.  It tends to happen after most meals, but less severe on a low fat diet.  It also happens in the morning, waking me up, and at night when trying to go to sleep.  After a fatty meal it definitely will happen.  Although I'm afraid to eat a decent fatty meal because of the future pain that it will cause.
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I can't imagine anything other than gallbladder/biliary tree disorder with your symptoms. Now this pain may force you into using your intuition.
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...about what to take...
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Pain is just under right rib, not midway between rib and nipple.  Hiatal hernia article was interesting.  Will discuss with my GI and PCP.
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Ejection fraction of 62% from HIDA, no visible stones/sludge from US, CT, blood tests, etc.  Symptoms are classic gb issues.  Seems like gb is working fine, very puzzling, which must be why my PCP really prefers to remove gb.  Well, still have colonoscopy next week, and then can insist on mrcp afterwards if still no resolution.
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I don't think colonoscopy will show anything. MRCP is surely one to try.
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Finally had my colonoscopy today, all went fine ... although the prep for this is always the trying part.  The doc wrote me a script for Bentyl to take every 4-6 hrs for pain and cramps as needed; recommended taking metamucil/benefiber/citrucel 1x/day; drink 2 qts water/day; use natural laxative of senna or senoket at night if needed; exercise 4x/week for 45 min.

Not sure if my RUQ pain and other stuff is gone yet, but obviously way too soon to tell.  I also bought some Equilatrin at CVS while I was at it.  Will post results as time goes on.
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The GI doc said that there were spasms in my stomach/intestinal tract and that it was inflamed.  
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What was inflammed? Stomach? Colon? Be sure to get an exact diagnosis.
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The info sheet I was sent home with just says "inflammation".  I'm pretty sure the GI doc said in the colon and that it showed evidence of spasms.  I'll clarify next time I see him.

I've been taking my probiotics and back on Prilosec.  Stools have been soft to semi-bulky at best, but traditionally with Prilosec this has been better.  I'm also taking Benefiber and after a morning BM, the rest of the day seems fine.  However, I still have RUQ or right chest muscle discomfort about an hour after eating, which happens no matter what I eat - I also become extremely fatigued along with the pain.  I eat a low fat diet, drink plenty of water, and exercise, so I'm doing all the right things.  

The GI doc also mentioned a laxative at night, what are your thoughts on this?  I'll be seeing my PCP in a day or two to gather his thoughts.  My PCP still wants to remove the gb, however even if there is sludge or small stones in the bile ducts, wouldn't removal of the gb be the recommended next step anyway?
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1. This fatigue - any other symptoms, like hunger, dizzines, nausea, excitement...?
2. Laxatives - if you already have soft stools, and you have bms once a day, I don't see a reason for laxatives.
3. My thought from beginning - before any surgery, get the exact diagnosis. After all your tests, biliary duct motility tests has not yet been done, and from here the problems may appear. In this case it may happen, that gallbladder removal just won't help you, since you keep biliary duct after the surgery.
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1. Re: Fatigue - also become a little dizzy and dry mouth sets in.  No nausea or excitement.
2. Thanks, makes sense.
3. Will check with doc on biliary duct motility test - is this basically the MRCP or something else?
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Fatigue: I was thinking on dumping syndrome - rapid gastric emtying. Diagnosis is with gastric emptying test. Other: "postprandial hypoglycemia", diagnosis with glucose blood test after a meal.

MRCP is more for structural, organic causes like stones and strictures. It is ERCP, which can show dismotility of biliary duct, and manometry of sphincter of Oddi, which can show increased pressure of the sphincter.
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If biliary duct dismotility is found with ERCP, wouldn't removal of gb be done anyway as sludge or stones are likely to be found?
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Biliary dysmotility (biliary dyskinesia or sphincter of Oddi) may be an isolated issue, so without gallbladder dysmotillity or stones or sludge. So, the chances are, that you keep your gallbladder, even if a biliary duct problem will be found.

I believe you want to make one step further in solving this issue.    
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My PCP gave me Levsin to try to see if it helps, and it has a little bit as it's supposed to help with stomach aches/spasms I think.  But the side effects are that it makes me sleepy, so it's tough to take it during the day.  The dry mouth side effect is no big deal to me.  Otherwise BM's are back up to 2-3 times/day, usually within a few hours, so I'm trying a laxative to see if it can help make me more regular.

I'm seeing another GI doc next week, what argument should I present to him to have him do an MRCP and, if needed, an ERCP, as my other docs say that insurance won't want to pay for an MRCP?  What I've been told is that the combo of the US, CT, HIDA, Endo, Colo, blood and stool tests would've picked up any additional stones or sludge.  But also how does one tell if there's a problem with the SOD unless one tests it, and I'm not sure how this is done?
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With 2-3 bms a day you obviously don't need laxatives - these would trigger even more bms.

I was suggesting MRCP, since you were reluctant to have ERCP, which, by my opinion can detect motility problems in biliary tree. ERCP is done during esophago-gastro-duodenoscopy, and a contrast is injected through the duodenal bile duct opening into biliary tree. During the same procedure, manometry of sphincter of Oddi (measuring of pressures) can be done to evaluate SOD. And if some obstruction is found, it can be sometimes removed right away.

None of investigations you listed can determine dysmotility of biliary ducts. You are searching for dysmotility now, not for stones. HIDA would show some gross duct motility disorder, but HIDA is basically done for gallbladder function, and to determine patency of biliary ducts, but not really for dysmotility. Experienced gastroenterologist can give you more reliable information though.

ERCP sometimes causes mild transitional pancreatitis, but this should not distract you from the procedure itself. It is eventual cutting of sphincter of Oddi (in order to releave increased pressure), which has more complications, so speak with GI about that.
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I've been following these posts with interest. I know that you've said that your PCP would like you to have your gallbladder removed, but the surgeon will have the final say. Based on your HIDA scan results and other gallbladder tests, I think that the surgeon would not recommend that your gallbladder be removed. I've been having similar RUQ pain but I've had an abdominal sonigram, CT scan, MRI and Hida and they all said that the gallbladder was fine. The surgeon told me that based on my results, he can't remove the GB just because of pain. I should say that my original HIDA scan was not done with stimulation so I don't know what the ejection fraction was. But I've had another HIDA done but this time with stimulation so I should be getting the results back any day now. Unless I get a really low ejection fraction, I know that the surgeon will not recommend removing it. The surgeon told me that a good functioning GB has an ejection fraction of about 70% max, so your value of 62% looks really good. Hope this helps.


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My PCP talked to my surgeon, and the surgeon agreed to do the surgery if I want.  That's probably what will need to happen in your case as well.  My surgeon says that about 50% of cases such as mine feel better after surgery, so they're trying to keep me realistic about any success of such surgery.

The question is: with all this pain that you're having, what other options are they suggesting.  They've been telling me to live with the pain, sometimes it goes away, and eat a high fiber diet.  However this has gone on for ~9 months now, and it's a daily occurrence to have discomfort/pain, so I don't find their suggestions helpful since I'm doing everything by the book.  Let me know what your ejection fraction % is.
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I've been following this as well and I'm curious: what will you do if after having surgery you still have symptoms?  Of course this is my case and many others.  I did not have stones but a non-functioning GB.  My symptoms were way worse after surgery and now are back to the same as before.  Now that the doctors have removed my GB and they don't know the source of my pain, they seem to just want to ignore me... and I'm still paying for the GB removal (financially).
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It seems to me that next steps are ERCP in your case.  I asked my surgeon about this and this is one of the possibilities.  Fortunately I have insurance to help with the financial part.
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I have insurance, there is a deductible which is very high.

An ERCP would be OK although I did not have any stones, so it's not likely to have anything stuck.  Maybe some strictures, but this isn't something that had time to develop after surgery - it was obviously present beforehand.  A recent MRCP came back clear.  I am convinced I had my GB removed unnecessarily, even though the EF was 0.  I wonder too if painkillers or whatever other meds I was on at the time gave it the result and if having a HIDA scan med free would have shown a functioning GB.
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ERCP also used for detecting/relieveing pressure in the biliary ducts I believe.  So stones is one potential issue, as well as sludge, but pressure is another issue.
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Just received my HIDA scan results: 36% ejection fraction. The report said that anything anything above 33% is considered to be normal.
The bottom line with me is that my current Gastro Doc (he's the 2nd one I've been to) thinks that what I have is Non-ulcer dyspepsia (essentially indigestion with no known cause). Tomorrow I'm getting a capsule endoscopy to rule out any blockages in the intestinal tract followed by a normal endoscopy as a follow up to the one I had a year ago. My main problem right now is general bloating with slight nausea. To give you some background:
Last summer I started to experience stomach pain and bloating. Never had had any abdominal/gastro problems before that (I was 57, now I'm 58). Went to first gastro doc in Aug 07. He put me on Prilosec, then performed endoscopy in Sep 07. I was found to have mild gastritis and also Barrett's esophagus. Negative for H. Pylori. He then upped the Prilosec to 2x daily. By Oct, stomach still hurt, Zegerid was then added. Still no help. In Nov 07, had sonigram of abdomen (no stones found, all organs looked good) and in Dec 07 had barium swallow test (showed reflux still occurring). Reglan was then added to the meds. During that time, I was switched from Prilosec to Prevacid. My PCP thought I had IBS. He gave me Donnatal for bloating. In November 07, the RUQ started. It was about 1-2x a week. Usually if I laid down, it would go away after a few hours. If I took the Donnatal, the bloating would decrease, but the RUQ seemed to be enhanced. In Jan-Feb 08, the RUQ increased in intensity. It would come and go during the day. It didn't appear to be related to any type of food that I ate. I should mention, that I am very regular as to bowel movements. No diarrhea or constipation. In March after still complaining about RUQ, I had a CT scan (without contrast) and the first HIDA scan (without stimulation). Both results said GB was fine. Also had blood work done (liver enzymes fine, Sed rate good, no abnormalities). Was given Bentyl, Levsin, and Levbid to use for bloating. Found that If I took any of these for a few days that my ankles and calves would swell up, so I stopped. By the end of Mar 08, first Gastro doc said that he was stumped and that I should go seek help at a teaching hospital. First gastro doc had reduced my meds to just 1 Prevacid daily at the beginning of Mar. Made appt with new Gastro guy for end of May. Before that I met with Surgeon at same teaching hospital in mid May 07. He told me that he wouldn't remove GB based on CT and Sonigram results. Suggested that I ask new Gastro doc to order new HIDA scan with CCK stimulation. At beginning of April 07, noticed that bloating was becoming more prevalent and that RUQ pain was changing into a more general stiffness. Sometimes feels as though someone has placed a piece of cardboard around right side. Also noted that sometimes while swimming felt as though skin over right ribcage was tearing as I swam. Would usually stop after I finished swimming. Also noted that area above right hip felt as though I was wearing a weight. Also noted that right front RUQ would start when I started eating and would stop after I was done. Seems to be related to act of eating rather than what I ate.
When I met Gastro Doc No. 2, we reviewed past 10 months of data. He ordered a celiac  disease test (came back negative). MRI with contrast ( came back and said GB was fine as were other organs) and a breath test for bacteria overgrowth. (came back slightly positive, was given 1200 mg daily of Xifaxan for 10 days). This didn't seem to stop the bloating. Was still getting the RUQ pain. Saw Gastro doc again on July 16th. He ordered new HIDA scan with CCK stimulation (came back at 36% EF), capsule endoscopy (having it done tomorrow) and follow up endoscopy for early Sept. (To check up on Barrett's diagnosis from last year). He also told me to take Probiotics till I see him and he wants me to see a dietician/nutritionist in August. He did not address the RUQ. I think that he wants to see what the HIDA results would be. He said that he wouldn't want to see my gallbladder be removed and for me to still have the RUQ pain. At the end of the visit was when he thought that I might have non-ulcer dyspepsia. In the last few weeks, the RUQ pain has diminished slightly. I've noted that if I'm sitting in a chair and bend my right leg towards my body, that I sometimes get the right front RUQ and if I lie on my bed at a 45 degree angle, I sometimes start to feel the RUQ on my back. I also noted that when I lie on my stomach while sleeping, I sometimes feel as though I have a muscle pull in my right groin and I sometimes get a slight throbbing on my lower right side near where the appendix is located. I was reading about bloating and gas on the internet, and one article mentioned that sometimes gas that is trapped in the ascending colon on the right side can mimic gallbladder and appendix symptoms. I thought that was very interesting. Looks as though I'll have to wait till mid September when I see the Gastro doc again to discuss all the new tests results and dietician visit results. I'm starting to wonder as to whether my RUQ pain is related to the GB or rather to gas and bloating. Hope you get something out of this. Be careful about extended use of Bentyl, Levsin or Levbid.
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Thanks for all the detail Jim.  35% EF seems to be borderline from what I've read.  The GI journals usually look to include in their sample size those with EF less than 35% for GB removal studies to test for improvement.

My docs keep telling me that maybe the RUQ pain will go away, and it seems to be what is happening to you more or less.  They want me to wait out the pain as they think it's related to something else.  The right chest muscle pain they believe is musculo-skeletal, however this pain alternates with the RUQ pain, so I don't know what to think.

Keep us informed with your progress.
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Saw another GI today.  He said that biliary pressure would've been detected with elevated liver results from my blood work (I believe I have this correctly paraphrased), thus he strongly did not recommend an ERCP.  He said that he has done many of these and that's his opinion.  He said that GB removal has 20% of improving my symptoms, 20% of making things worse (as I already have a problem with fatty foods), 60% of keeping things as they are.  He also said that biopsy was done on the left side for my colonoscopy, while he would've preferred my right side (I suppose I could have another Colo, not fun.).  This GI also said that in cases like mine, the RUQ pain is much more severe for those where he was Ok with GB surgery.

He suggested a blood test (Prometheus Testing: IBS Diagnostics), a breath test (not for HP, but for bacteria [don't remember if this is overgrowth or what type of bacteria to test for]), and a barium study with x-rays.  I'll do all of these starting tomorrow.  He was thinking of an antibiotic (I believe for the bloating and gas).  Thought that JimK3145 above was saying that he read that gas/bloating might cause RUQ pain.

Question: I feel bad for my surgeon as I already cancelled 1 appt. for the gb surgery.  I currently have it scheduled for Sept. 10, how do I nicely have it cancelled again if need be?  Perhaps I just postpone it for a couple of months.
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This another GI seems to be very cooperative. Indeed, liver enzyme GGT is obviously increased in bile duct obstruction. But, you may have biliary dyskinesia, which is a motility disorder, which not necessary causes any obstruction. Colic, cramping pain comes from hollow abdominal organs with smooth-muscular wall (gallbladder, bile duct, pancreatic duct, the whole gut from esophagus to anus, and urethers.

I believe that the following discusion with your new GI can help
1. Is this what you're experiencing a cramp?
2. Is it possible that "cramps after the fatty meal"  would originate from any other organ, beside gb or bile duct?

About HIDA. As mentioned above, and as I know, ejection fraction (EF) of 30-35% is considered abnormal, 35-50% is debatable, and > 50% is normal. On the other hand, normal EF only means that gallbladder ejected contrast substances normally, what can be interpreted as "no stones", but...it still doesn't exclude gb motility disorders. Many patients with gb disease reported strong pain during CCK stimulation in HIDA.

There's only one thing in life which can't be canceled. Surgeon is your servant, he may become mad when you cancel 23th time, but hey...what harm can "one operation less today" do to him.

Gas in the colon, yes, it could cause pain. Breath tests are: for fructose or lactose intolerance, and for small intestinal bacterial overgrowth (SIBO), and of course for H. pylori in the stomach.

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I like this last gastro Doc. Pesonally, I would avoid taking
antibiotics for your RUQ pain. Wont do any good plus will
wipe out friendly bacteria in colon. Since you have a sensitive
colon anyway, this may cause loose bowels.

Boron-dumb question-say liver or pancreas were enlarged, would
this put pressure on GB possibly causing pain ?

TOm
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Boron, I'll bring up the biliary dyskinesia with the GI.  I did a google on this, and the below looks like it's telling me that a low EF % and post-GB surgery are common for coming up with this diagnosis.  


Biliary Dyskinesia

James Toouli, MBBS, PhD, FRAS  

Current Treatment Options in Gastroenterology 2002, 5:285-291
Current Medicine Group LLC ISSN 1092-8472
Copyright © 2008 by Current Medicine Group LLC


Opinion Statement
Biliary dyskinesia is a motility disorder that affects the gallbladder and sphincter of Oddi.
The motility disorder of the gallbladder is called gallbladder dyskinesia. Patients with this condition present with biliary-type pain, and investigations show no evidence of gallstones in the gallbladder. The diagnosis is made by performing a gallbladder ejection fraction, which is a radionuclide investigation. An abnormal gallbladder ejection fraction has a value less than 40%. Patients with an abnormal gallbladder ejection fraction should undergo cholecystectomy. This procedure has been shown to be effective in curing the symptoms in over 90% of patients.
Motility disorder of the sphincter of Oddi is called sphincter of Oddi dysfunction. This disorder is categorized as two distinct types--biliary sphincter of Oddi dysfunction and pancreatic sphincter of Oddi dysfunction.
Typically, patients with biliary sphincter of Oddi dysfunction present with biliary-type pain on average 4 to 5 years after having undergone cholecystectomy. Sphincter of Oddi manometry is essential in making a diagnosis of abnormal motility of the sphincter. On manometry, diagnosis of a sphincter of Oddi stenosis should lead to division of the sphincter. Sphincterotomy results in long-term relief of symptoms in more than 80% of patients.
Pancreatic sphincter of Oddi dysfunction clinically presents with recurrent episodes of pancreatitis of unknown cause. Having ruled out all of the common causes of pancreatitis, sphincter of Oddi manometry of the pancreatic duct sphincter should be performed. When manometric stenosis is diagnosed, these patients should undergo division of both the biliary and pancreatic duct sphincter. This treatment results in relief of symptoms in more than 80% of patients.

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It's not a dumb question, and I can only answer by using a logic, not experience...

When liver enlarges, it extends up and down, left and right...and the gallbladder is... behind, or if you want under the liver. There is soft intestine below the liver and gallbladder, and it moves away easily with liver enlargement.

Enlarged liver can put some pressure on the gallbladder, but the pain comes from  gallbladder/biliary duct muscle spasm, not pressure from outside. Abdominal tumor, pressing on the bile duct from the outside, or adhesions (after surgery or in endometriosis) could press on bile duct and block bile flow though...

Enlarged pancreas should not touch gallbladder or biliary duct.

Images:
http://images.search.yahoo.com/search/images;_ylt=A0WTbx__y5FIfTQB70GLuLkF?ei=utf-8&fr=sfp&p=gallbladder+pancreas&iscqry=
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Yes, it's good to have some research to be prepared for discussion with GI...

Questions for GI:
- are liver (GGT) OR pancreatic (amylase, lipase) enzymes increased in ALL cases of biliary dyskinesia, or only in some people, or only during pain attack?
- the same for increased pressures detected during manometry: are high pressures always detected or only during pain attack?

With other words: what is possibility of false negative results of manometry?

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A litle more precise answer:

Pressing with fingers on a gallbladder with stones, can (not necessary) cause pain.
Enlarged liver could cause pain in gallbladder with stones, bot not likely in healthy gallbladder.
Enlarged liver is often painfull by itself, or by pressing on it...
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Actually you opened an interesting question: can gas in the colon press on the gallbladder and cause typical gallbladder pain? Hm, hm.
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Do not have your GB removed.  Try visceral manipulation to have it drained.  If it is functioning okay-you probably have SOD.   The only way to find out if you have SOD is with ERCP w/manometry.  Do not believe any GI/or other doctor that tells you differently.  I had my GB removed last year for the same exact sxs as you describe.  What I ended up with is severe gastroparesis (I did not have this before) living on TPN for the past year.  I belive I had SOD-no I know I had SOD to begin with and when the GB was removed the SOD became worse.  AS for the gastroparesis-I'm not sure if the surgeon cut my vagus nerve but that is my suspicion.  Had I had an ERCP in the first place I would not now be waiting to die on tpn complications.   Most doctors don't have a clue about SOD and many don't even think it's a real condition.  If your GB is functioning on a HIDA then there is nothing wrong with your GB.   Go to a biliary expert and have an ERCP.  
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I had posted earlier to Misha50 and had mentioned the possibility gas in the colon causing pain. Below is an excerpt from the brochure "Gas, Bloating and Belching".

"Gas and Abdominal Pain:

Abnormalities of motility are thought to be associated with abnormal
sensitivity. This increased sensitivity to normal volumes of gas may
result in pain. For some who suffer with (pain that has no known cause), it is believed that abnormal motility and sensitivity may be the source of pain.
Splenic Flexure syndrome is a chronic abdominal pain disorder triggered by trapped gas at the left flexure (bend) of the large colon. This flexure is located where the large colon runs horizontally then bends downwards towards the rectum. This bend occurs near the spleen--hence the name ‘splenic flexure.’ Trapped gas in this location can cause pain to be felt in the chest region. Called ‘referred pain,’ since the pain is felt in a region distant from the source, it can mimic heart disease. Gas trapped in the right flexure can mimic pain of gallbladder disease or appendicitis".
This was from the website: www.digestivedistress.com
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Here's an article that Calgal had sent me some months ago concerning Proton Pump Inhibitors. I had mentioned that I've recently gotten my HIDA scan results (EF was 36%) and I've been on PPI's for about 11 months. My RUQ pain started about 2 months after starting the PPI's. I have sent a letter to my Gastro doc asking to whether I could stop the PPI's for about a month to see if that makes any difference, before I sit down with him to discuss the HIDA results. Thought you might find this interesting. I am also experiencing a lot of bloating also so I'm not sure if gas is not the cause of the RUQ pain.

"Proton Pump Inhibitor May Reduce Gallbladder Function

April 21, 2005 — A short course of proton pump inhibitor (PPI) therapy may result in a significant reduction in gallbladder motility and new-onset biliary symptoms, according to the results of a preliminary prospective study presented at the 2005 annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons in Fort Lauderdale, Florida.

A previous study has shown that discontinuation of PPI therapy after fundoplication for reflux disease results in normalization of preoperative biliary dyskinesia in a significant number of patients, coauthor Mitchell A. Cahan, MD, told Medscape. "Our study looked at the converse of that — what the effects of PPI therapy would be on gallbladder function in healthy volunteers." Dr. Cahan is a clinical instructor of surgery at the University of North Carolina School of Medicine in Chapel Hill.

In the study, gallbladder ejection fraction (GBEF) was assessed by cholecystokinin (CCK)-stimulated hepatobiliary (HIDA) scan at baseline and after one month of omeprazole therapy (40 mg/day) in 19 volunteers with no history of gastroesophageal reflux disease, biliary disease, or chronic abdominal pain.

Results at 30 days showed that omeprazole therapy was associated with a decrease in gallbladder motility in 79% of patients; overall, mean GBEF decreased by 13.6% compared with baseline (42.8% ± 32.3% vs 56.4% ± 30.0%; P < .01).

"Even more telling is the fact that before they started on omeprazole, five individuals had ejection fractions of less than 35% (biliary dyskinesia) — and at the end of the month, that number had doubled to 10," Dr. Cahan pointed out. "Moreover, of 15 patients who completed a symptom survey at the end of 30 days, four had symptoms that were compatible with biliary pathology such as nausea and vomiting, increased flatus, and right upper quadrant pain."

Although these findings are preliminary and larger studies are needed to determine clinical implications, Dr. Cahan recommends that healthcare providers seek objective evidence of reflux prior to initiation of PPI therapy and that they remain aware of evolving data regarding the effects of such therapy on biliary function.

"Given the fact that PPIs constitute the eighth most prescribed class of drugs, providers need to be cognizant of these potentially adverse findings leading to abnormal gallbladder function that could promote cholelithiasis or biliary dyskinesia," Dr. Cahan said. "Patients receiving escalated or long-term PPI therapy are potentially subject to these adverse effects."

The investigators report no pertinent financial conflicts of interest.

SAGES 2005 Annual Meeting: Abstract S120. Presented April 15, 2005.

Reviewed by Gary D. Vogin, MD"

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Thanks for the info on PPI`s. If you read my earlier posts, I suggested that Misha
go off Prilosec. I still maintain a course of 6-8 weeks max is best . It is a
terrific drug, but in recent years has become overused. I believe the key is
weening off it very slowly. While on prilosec, I felt nauseated and weak. My
research led me to DGL. Once again, thanks for this important info.
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Thanks for the info on the DGL. Not sure if you read my post to Misha 50 on 30 July. That explains my current medical situation. My post about the PPI's is the reason I would like to get off of them for awhile to see if it makes any difference. The reason that I've been on PPI's since last August 07 is that I was diagnosed with Barrett's esophagus by my first Gastro doc. I'm now on my Gastro Doc No.2 and am scheduled for a follow up endoscopy for Sep 2. Now that I have my HIDA results back (36% EF), I need to discuss this result with him also since I get intermittent RUQ pain.
One last item: Do you have any recommendations for anything to treat low level nausea? Thanks!
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read "alternatives to medications and surgery" in this Mayo Clinic link:
http://www.mayoclinic.com/health/barretts-esophagus/HQ00312/DSECTION=treatments%2Dand%2Ddrugs

Discuss w/Gastro Doc. You cant go on w/PPi`s the rest of your life.

Avoid all soda type drinks, Coke etc + coffee.

ARe you still on the PPI`s right now ??

Seek out a dietician or nutritionist w/certicifaction and Masters Degree.

EXplore the lef.org site.
from health concerns, drag cursor to disease prevention , then under gastrointestinal.
, click on Gerd. read about Baclofen.

dont lie down after eating. wait one hour, this causes reflux.
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I went off Prilosec for about 3 weeks and noticed that heartburn started bothering me, not killing me, but annoying enough.  I had no change in my RUQ symptoms.  I've been back on Prilosec for a couple of weeks and things are a little bit better.  Since I've taken Levsin, the RUQ pain seems to have dissipated a little bit so that it no longer really bothers me too much.  The biggest change is at night as it's not an overwhelming sensation.  There is still some RUQ discomfort that I notice, but so far seems manageable, not worthy of surgery as of this moment.  But the RUQ has dissipated in the past and came back with a sharp vengeance, so I'm hopeful that it really is going away.

The other products, such as pepogest and DGL so far have had no impact for me as I've tried them for a few weeks.  Not to say that they don't help others as I can only speak for my own experience.  I'm still taking my probiotics, which I find to help, even though all my docs seems to scoff at this motion.

JimK3145 - Water with a lemon always helps nausea.  You'll find it to be a natural wonder drug.  
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Re PPI's: There are folks who have been on Prilosec for over a decade and report no problems,  There are no long-term studies that I'm aware of, so my info is from docs and other folks I know who take Prilosec.  In regards to your comment that one can't be on PPI's for the rest of their lives, while I agree with your sentiment, reality is sometimes different, so we all need to do what works for us.
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To answer your questions: yes, I'm still on PPI's (Prevacid, 1x daily 30 mg since last Aug. 07 because of the Barrett's). The Barrett's will be re-discussed after my upcoming follow up endoscopy in early Sept, 08. The first endoscopy was performed in Sept, 07. I gave up carbonated drinks and soda last Sept '07. Also gave up caffeine at that time. I don't smoke or drink either. Now I drink decaffeinated iced tea. Also raised my bed's headboard about 9 inches. Usually don't lie down for at least 2 hours after eating. I have an upcoming appt with a dietician/nutritionist at the urging of my new Gastro doc. He also told me to start taking probiotics. My quest is to find out what is causing my bloating/nausea besides just treating the symptoms.

Misha 50: About the lemon: I was told that lemon bitters sometimes helps.
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I meant Swedish Bitters, not lemon bitters. Have either of you any experience with digestive enzyme supplements? Thanks!
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I`ve had good success w/digestive enzymes. I dont use on a constant basis.
I take w/meals,not 1/2 hr before or after, usually just w/main meal of the day.
THe theory is that they are useless because the enzymes will be destroyed
by the stomach b4 entering the small intestine. There are many brands
avaialable, I use Pancreatin., item # sw285 from Swanson. this is Enteric
coated which seems to help better than if not coated. Helps a lot w/gas
after meals. Try different formulations and brands and you`ll find that some
work betrer than others.

Misha-glad your feeling  a little better. I`ll have to do some research on Levsin.

Jim- let me do some research on nausea-I`ll try the Swedish Bitters if I can
find it, do youn have a brand?
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I don't have any particular brand for the Swedish Bitters. Thanks for the info on the enzymes. My experience with Bentyl, Levsin and Levbid have been that if I use them for a period of over 3 days, my ankles and calves start to swell. My PCP said that he could give me water pills to reduce the swelling but that in addition, I'd have to take potassium pills to replenish the potassium that I would lose from the water pills. I figured that that was too much aggravation so I've tried the herb fennel which I make as a tea. I've gotten my fennel from: www.helpforibs.com It works in reducing bloating about 80% of the time and there are no side effects that I've experienced.
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Many drugs carry with them serious side effects.Supplements offer risks too.
People reading this should always be aware and do the necessary research.
Also, folks reading these posts should not think I`m hell bent on vitamins-herbs
etc. I try to keep an open mind but do seek out alternatives to prescription
Meds where possible.

THe Chinese have ben using herbs for thousands of years. Now their
population explosion has caused terrible pollution which no medication
can cure. The Chinese have a high rate of liver cancer. I`m also noticing
increased cases of Bronchitis in the U.S during the winter.
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Wow - everyone has an opinion!  I had severe pain for quite some time before being DX with gall bladder and stones (many years ago).  Felt alot better after the surgery.  Going against what others are saying, I would have done anything to get rid of the excrutiating pain of stones passing out of gall bladder.  I was never so happy to have surgery!

Assess your pain,and YOU decide.  
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If I had stones it would be an easy decision.  But I have no stones and no sludge, so it's difficult to make a decision.  Of course the poor gb gets blamed for everything that can go wrong.  My latest GI says there's 20% of getting better, 20% of getting worse, 60% chance of no change ... so what to do, what to do.  I'll keep getting more tests, eat well, see how things go, and drive my poor docs crazy :-)
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Misha, if you'll still see your new GI, ask him, if gastric biopsy excludes H. pylori infection, or breath test is more reliable (as I think). I think it's possible that H. pylori doesn't occupy the whole mucosa (gastric + duodenal), so it can be false negative.
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Just had a quick talk with my latest GI.  The results of the breath test for bacterial overgrowth were positive.  I believe he said that this was in the lower colon/bowels (not too sure as I didn't write it down).  I have a barium x-ray test next week, and with results from this he'll be able to advise how to treat me.  I also had a blood test done last week, I believe it was called the IBS Kit on the lab sheet.  Looks like there's some rays of hope here after all.  To me the bacteria overgrowth makes sense: about 10 years ago I had a couple of bouts with H.Pylori and successfully treated them.  Then I had symptoms making me believe that I had a similar infection, but the antibiotics I was given only worked a short time.  All my blood and stool tests since then have been negative, but if it walks like a duck and quacks like a duck, then I'm inclined to believe that this is a duck.  I've basically been on Prilosec since five years ago.

Otherwise, my PCP wants me to try to trigger the RUQ to prove or disprove that my pain is GB related.  Well today I had a strawberry ice cream to test this out, with a couple of lactaid pills as I'm lactose intolerant.  So far no problem with RUQ pain or right chest muscle pain ... there was a little discomfort under the surface, but very mild and had already been there throughout the day, so I should say that the ice cream resulted in no additional discomfort.  Perhaps later there'll be some diarhea (diarrhea), but we all have to live a little and suffer the results of eating ice cream.  My PCP recommends something greasy and fatty to eat in order to really test out the gb, which I can do, but as I have been diagnosed with colitis, IBS, I know that this will cause other problems, but I'm game for this.  My RUQ discomfort/pain has been more manageable the past couple of weeks, although this morning it was a little more uncomfortable, which I attribute to eating chicken last night ... may not make sense but this is a pattern that I've noticed.

Anyways, will report on what this GI says after my x-ray next week.

Otherwise, I have an appt. with another GI tomorrow who's the chief of GI at his hospital.  I figure one can never have enough second opinions.  At this point I'm not sure what to ask him, other than inquiring about what I've done so far and what his thoughts are on the next area of investigation, such as biliary dyskinesia.
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Misha,
What antibiotic are they going to give you for the bacterial overgrowth? I had this test done in June, was tested positive and was given Xifaxan, 200 mg tablets, 6x daily for 10 days. Xifaxan is a synthetic antibiotic which doesn't dissolve in the stomach but rather goes to the small intestine where it can do its thing. After the 10 days, I was still getting bloating and a queasy stomach so it really didn't work for me. I've attached a weblink to the use of Xifaxan for the treatment of IBS. The Doctor who is pioneering this drug also has a book out on IBS which I bought on Amazon. The book is pretty interesting. Here's the link about Xifaxan: http://www.cbsnews.com/stories/2006/10/16/health/webmd/main2096522.shtml
My current GI was familiar with this Doc's work. Hope this helps.
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Jim, won't know which antibiotic till the x-ray results are in, which will be next week.  However, I go on vacation for a week a couple days after my x-ray, which leaves only 1 business day to get the results to my doc and to see him.  So realistically I'll have to wait till after my vaca.  Thanks for the info on your experience, I'll look it up and take a read.
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Misha,
Since your gallbladder is okay so far by the testing test on it and since your ejection fraction is very good (in the 60's), I'm wondering if that would qualify as biliary dyskinesia. I'm under the impression that if there was sludge in the common bile duct that it would be really hard to get a high ejection fraction like yours. I'll be interested in what this new GI chief has to say.
I had a capsule endoscopy done last week. (the one where you swallow the camera capsule). It takes 8 eight hours to complete. I got the results back today. My GI doc says that everything was okay, nothing out of the ordinary. So now, there's only 1 test remaining which will be a 1 year follow up endoscopy which I will have on Sep 2.  Even though my ejection fraction is 36%, my Doc says that my GB is okay. (I think it's borderline biliary dyskinesia) and I still don't have a good explanation for the bloating/slight nausea and intermittent RUQ that I still experience. Since my earlier post about the use of PPI's on ejection fraction and possible, RUQ pain, I convinced my GI doc to let me stop taking the Prevacid that I've be on for 11 months until the endoscopy. (that'll be about 4 weeks) to see if it makes any difference with the RUQ and possibly stomach pain. Hopefully between the 2 of us, we'll get some answers about the RUQ. Keep me posted.
P.S. Could you ask this new Chief GI the following question: Could biliary dyskinesia cause stomach bloating and or nausea/general queasiness and the RUQ and if one doesn't have dyskinesia, then what causes the bloating, RUQ, if all tests say the GB and other organs are all fine. Thanks. I'm looking forward to see what his answer will be.
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Jim, my last GI says that liver enzymes would be elevated if blocked bile ducts.  Will let you know what GI tomorrow says.  Misha
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I'm not sure how a biliary pain could be triggered with food, since fat causes contraction of gallbladder, but opens a sphincter of Oddi, not contracts it. So, this is one question for GI: With which food trigger biliary pain (not gallbladder pain).

Gb/biliary disorders can cause: nausea, RUQ pain, biliary reflux (from duodenum into stomach) - what can trigger or aggravate GERD.

Bloating in gb disease would occur only, if a stone was preventing a bile flow into intestine, so fats weren't absorbed in the small intestine, reach the colon, where bacteria would ferment them and produce gas.

So, bloating ( lower abdominal bloating) obviously is from bacterial overgrowth. I personally don't recommend treatment with antibiotics, since these can lead to more problems (Clostridium difficile...).

Misha, since you're lactose intolerant, it's posible you're also FRUCTOSE intolerant. Treatment is with a diet. You can try to exclude some fruits (appleas, pears, mango, prunes), all fruit juices, honey, foods with sorbitol and high fructose corn syrup (HFCS) for few days to see if it helps. I think you should temporarily exclude sucrose also, just to starve those bacteria. I think this is safer approach than with antibiotics. So, this is another thing to discuss with your GI.
More about fructose malabsorption and low fructose diet:
http://www.allhealthsite.com/212/low-fructose-and-fructose-free-diet/
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Boron, saw my GI today, who has as one of his special interests IBS.  He was very very nice, understanding, and helpful.  Talked to him about my whole history, as well as biliary dismotility and fructose intolerance.  For the time being he recommended staying on Levsin a few times/week, or as needed if I have a severe inflammation.  He also recommended thinking about some chronic medications,which are older depressant meds, for the future if I find that I have severe attacks.  He also provided a sample of Align probiotics to try, which contain Bifidobacterium infantis, also suggesting that I can try Florestor (sp?) probiotics.  He definitely does NOT think that GB surgery is a good idea, and thinks that it may make matters worse.  He didn't think that I have a biliary motility issue nor a fructose issue, partly because my symptoms appear to be getting better, but he was very open to revisiting these topics.

I shared with him my eating ice cream yesterday and he doesn't believe I need to try eating any fried, greasy, fatty food to try to trigger RUQ pain.  So far no probs from eating the ice cream from yesterday.  He believe that my right chest muscle pain is probably musculo-skeletal, which I've heard before, and that this can be looked at separately.  My only notion with this is that the RUQ pain started at the same time as the right chest muscle pain, these two pain/discomfort points usually have alternated with one another, but seem to coexist with each other at this point.  Anyways, that's the update for now, will let you know how the Align stuff works.
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Muscle or rib pain (costochondritis) get worse by pressing on the spot. This spot is on the chest (over the lowest rib or higher).

Align and other probiotics help ONLY in intestinal infection (food poisoning) and in antibiotic-associated-diarrhea. Not in IBS, Crohn's, or whatever. This is my opinion after thorough research of probiotics.

The only food to provoke gb issue, would be a high-fat food, like chocolate, cheese. Pain would appear within an hour after a meal.  

30% of persons diagnosed with IBS have one of food intolerances.
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My GI doc had given me some samples of Align to take when I saw him in July. I've just finished my 3rd week of them. I haven't really felt any change however.
As to IBS, one theory as to the cause: it's either bacteria, parasites or food allergies. Here's a link: http://www.ibstreatmentcenter.com/
Since you've been on PPI's for about five years, do you take any vitamin supplements to offset any deficiencies in calcium, B12, etc which can be caused by the PPI's? I've noticed that even though I've only been on the PPI's for 11 months, I can definitely hear the difference in my bones, especially in my legs when I get out of bed in the morning or when I get out of a chair and even when I'm swimming. (by the way, I'm 58). I had never heard some of these sounds before.
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Jim,

On my 3rd day of Align, not sure if I have any improvement or not at this point in time.

For the website you mention, it looks like a promising and hopeful medical center for IBS.  I always find it interesting that a lot of these websites sell related products, which of course makes sense in many ways, but it does make you wonder about their intentions.  But anyways, I've had tests for bacteria, parasites, food allergies and so far very little 'positive' test results, so far only the SIBO test has resulted in positive.   I'm wondering if there are other tests for other types of bacteria and parasites.

I've taken B vitamin supplements for awhile, but my sense is that it made me want to urinate frequently and urgently: my experience is this when I took it, since I've been off of it this problem has diminished greatly.  I do detect a slight issue in my hip bone, but part of what we're experiencing is age related as well, so it's difficult to truly distinguish what's what.  I think that also what we experience, as my GI doc that I saw this week explained to me, is that IBS people tend to be more sensitive especially in the gut area, meaning that we're probably more sensitive in general, such as to cold and heat.  We can choose to accept this as normal for us or not, but ultimately if all the tests come back negative, it proves that we're healthy and have an issue that we need to manage, for example if we wake up on the wrong side of the bed and have a muscle ache, then that's just what that is and we just need to accept that that's what we have and need to adjust accordingly, which in this case would be stretching the muscle or whatever helps to deal with the ache.  If the gut is sensitive, we can't truly feel it until we eat something, so it's hard to deal with and accept this.

I admit that it's frustrating to not have an 'answer', but medical science in many cases does not have any answers.  I find the ibs website that you mentioned providing a ray of hope, but I'm also very skeptical of it.  If there really were solutions out there, I believe that these would have been propagated throughout already.  I suppose it depends on what we define as a solution.  Ultimately our experiences are valid for each of us and we each need to find the answers that work best for us.
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Misha,
I'm curious after the barium x-ray test that you have coming up as to whether your doc will give you the Xifaxan med to take. If you like I could send you a couple of the chapters in a PDF format from the book that I bought from Amazon about the use of Xifaxan for treating IBS. Maybe you could show this to your doctor. If you're interested, I'd need an email address. Thanks!
My Gastro doc has let me go off of the PPI's that I've been on for the past 11 months to see if that makes a difference as to my RUQ pain. I just stopped them on Monday. I have the upcoming endoscopy on Sep 2, 08.
I just started to take a general multi-vitamin plus an additional one for calcium and vitamin D.
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Re: Muscle or rib pain getting worse by pressing on the spot - this is not the case with me.  I've tried it and docs have tried it.

Re: Align and other probiotics help ONLY in intestinal infection and in antibiotic-associated-diarrhea. Not in IBS, Crohn's, or whatever: I can only tell you what my and other people's experiences are, which is that taking these probiotics does help many people, including myself.  So maybe I have an infection of some sort, can't medically say for sure.

Re: The only food to provoke gb issue, would be a high-fat food, like chocolate, cheese: my GI from yesterday said not to try to invoke pain with problem eating foods, but to use my reasonable judgement to determine what should be Ok to eat, based on various factors, such as stress level, latest experience with certain foods, etc.

Hopefully I'll know more after I take that barium uptake x-rays next week.
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Misha, I have checked ingredients of Gas defense on digestiveadvantage.com

Beside bacteria Geneden BC30, it includes endo-Cellulase, exo-Cellulase, Hemicellulase, Invertase, which are ENZYMES, which break down dietary fibers. The point of this drug is that it breaks down fibers instead of bacteria. When bacteria break them down, they produce gas, and when the drug break them down, it doesn't produce gas. They are enzymes in this drug and NOT probiotic which help you. So, I think other probiotics also won't help you.

But now you have the proven cause of the gas - SIBO. It is small intestinal bacterial overgrowth. If you can get rid of these bacteria, you will no longer need Gas defense.

Now, you can go with antibiotics, but before doing this, ask how long this would take. Antibiotics can kill one type of bacteria and cause overgrowth of others (Clostridium difficile)...sometimes. Then you have deal with that...with another antibiotics.

I'm not against using antibiotics in your case, just providing some info.

The other possibility is diet, which should be low-fiber (low celullose, which would need exclusion of legumes - beans, peas, soy, lentils...), and low-sugar (low sucrose, fructose, lactose). This is diet treatment, not long-life diet.
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Misha,
When you start your treatment for SIBO, let me know which antibiotic is prescribed and how long you will have to be on it. Also, when you are finished with the antibiotic, will there be any follow up testing to see if the antibiotic effectively killed the SIBO or will you have to undergo a second round of treatment and if so what will be the antibiotic and for how long? Is there any protocol that your Doc will be following? Thanks!
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Jim,

My GI gave me Xifaxan, 1200 mg day for 2 weeks.  Then in 4 weeks he'll give me something else to try to provide further assistance, not sure if this will be something different or more of the same, but it sounded like something different to try.

I did the x-ray barium uptake test about 2 weeks ago, and it was painful to drink the stuff, and it also caused pain in my stomach, also causing a little flare up in my side.  The radiologist doc said I had a lot of reflux, which of course is nothing new, but that this might explain why I have discomfort at night when laying down, again this is nothing new.  A few days after the x-ray my symptoms calmed down a bit, but never completely.

Anyway, I've read some on the antibiotic and will see what happens.  My GI also recommended probiotics, which I take, and also yogurt.  However as I'm lactose intolerant I have to avoid the yogurt, and I've tried the soy yogurts and they are nasty.  If anyone has any good suggestions, such as goat's mile yogurt if there is such a thing, then that would be greatly appreciated.

Also if anyone has any suggestions on how to stop burping, which I do after I eat or drink anything, then that would be very very helpful too!  They can be a little on the loud side and it doesn't feel healthy to suppress them.  

Misha
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Misha,
Thanks for the update. My first round (10 days at 1200 mg/day) with Xifaxan didn't do much for me. I'm on a second 10 day Xifaxan round but so far I haven't noticed any real improvement. I'm still getting a lot of bloating. Next week I get an endoscopy.  Do you have the headboard of your bed elevated? I put blocks under the headboard feet on my bed and I was able to raise the headboard about 8 inches. It definitely puts you on an angle. I think that you can get blocks or even a wedge to sleep on at Bed Bath and Beyond or other places similar to that. It might be worth a try!

Jim
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Finished the Xifaxan treatment, not sure if it helped or not, but don't feel any worse for it, so worth trying it.  The GI that I finally like, as he tells me that there are many options, wants to do another Enodoscopy as he does a little extra looking and takes a biopsy that he says most other GI's don't do.  He explained it to me and I don't really know the difference, but these are easy procedures after you've had everything else done including these.  He says that he's found things that other GI's haven't found, so worth going for it.

He also mentioned Lotronex if I have severe diarhea (diarrhea) and cramping.  This is a very interesting and powerful drug per my research and fortunately I don't think that I'm that bad off enough to take it.  I still have dull aches in URQ and muscle tension/pain in upper right chest muscle, but perhaps I'm just used to these by now.  Interestingly enough, I get cramps when I eat chicken, which is easily solved - I don't eat chicken anymore.  I've been able to eat most other foods, while taking it easy on meat for dinner, as it tends to cause some inflammation.  

I think I've been to about 4 GI's at this point, and it is very frustrating to hear, "Sometimes these things go away on their own", "These things go in cycles", "Try yoga and other techniques to reduce your stress", "You're a sensitive Type A personality so you're prone to extra pain", etc.  Well of course all things in life go in cycles, stress is a part of our life, personally and career-wise, and we all need to work, so I'm not sure that these statements actually do me any good.  I truly believe that I've researched IBS and other related issues pertaining to me extensively and have actively tried to modify my life to improve symptoms, so it feels frustrating to hear some of these things.  All we're looking for are options, which luckily I've found 1 GI who believes in trying different things, such as a SIBO test, which the other GI's didn't find any value in, and other tests.

Anyways, I'll let you know how the next Endo goes.
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