High ejection fraction with debilitating symptoms but docs say okay....

[Skygirl321]

Hello, I'm a 46 year old female. I am physically fit, eat very healthy, don't smoke, only drink alcohol occasionally and have no health issues other than I have had debilitating nausea/queasiness off and on for about 7 years. At first it seemed as though it was cyclic, however it then presented itself at other times during the month as well. It has in the last few years gotten worse. In May I was sick for 19 days straight. When I'm sick, I feel like I've been poisoned. It's like the worse case of morning sickness in the world however I don't vomit. I am starting to have pain in my URQ area that radiates towards my back. I also am starting to notice that I have shortness of breath after I eat as well as pain, the nausea is not always present at the same time, sometimes it comes out of nowhere and sometimes it is after a meal. I have had so many tests and everything comes back normal.  I do have 6 hemangiomas on my liver.  They are all about 2 cms. Again they say these don't cause symptoms. I did however recently have a HIDA scan and it showed that my ejection fraction was at 90%. I saw my GI doctor and he said that high ejection fractions are rare but normal however with my long history of symptoms he referred me to a surgeon whom I saw today and he said that 90% was normal also. He said that they only consider gallbladder issues if it's below 35%. I am so frustrated!  
Thanks for taking the time to read my post.
Leesa

[Skygirl321]

I look forward to it!  (:  See you in a couple weeks!  

[Christopher R Watters, MD]

We will roll out the red carpet.

[Skygirl321]

Thank you Dr. Watters.  I did call your office and I'm coming in to see you!  (:  

[Christopher R Watters, MD]

With the additional info I would agree with you that the gallbladder is the most likely culprit. Feel free to give my office a call (919-431-9911). You can look me up on www.dukehealth.org

[Skygirl321]

Also, one more note.  I have taken Reglan in the past and it has not helped my symptoms,  it's only made me very tired.  I do take zofran and it seems to take the edge off my queasiness/nausea however dealing with nausea for 7 years has to make me wonder if my body and mind have just accepted this condition as the norm and that I don't even know what feeling good feels like anymore.  I have not been prescribed the other medication you mentioned sucralfate.  I'm surprised none of my doctors have prescribed it for me.  
Thanks again  

[Skygirl321]

Dear Dr. Watters,
Thank you for your reply and so quickly!   My symptoms were not replicated when they injected the CCK.  It was infused over the course of an hour. I did have a lot of cramping however no queasiness or nausea.  I'm not sure how important this is or if it's even an issue but it took 65 minutes for my gallbladder to show up. The technician told me that they were going to give me a shot of morphine or that I could go home and come back in 3 hours but right then she saw a spec that was my gallbladder.   I did had diarrhea immediately following the test.  That is a symptom that I left out.  I typically always have loose/runny stools after I eat.  I also left out that in April I had a endoscopy (my second one) which showed my stomach was red and irritated but they could not explain why.  They treated me with xifaxan even though my tests for H pylori were negative.  

When this all began, I was certain that it was hormonal and related to my cycle.  I would be sick for about a week straight and it came at about the same time each month.  It felt exactly like what I experienced in my pregnancies.   In 2008 I had a partial hysterectomy only removing my uterus, hoping that may help as I had very heavy periods and several large fibroids but no endometriosis.  At that time neither I or any of my doctors related any of my symptoms to gallbladder issues.  In  2005 I had a sonogram and it showed no stones  and a CT that said it was normal and from that point forward my gallbladder was never spoken of again until recently.   I began having URQ pain and shortness of breath  along with my other symptoms so they recommended a HIDA scan.  My pain is always lurking, however worse after I eat, sometimes radiating towards my back.  One other thing, in May I  had a lupron shot to see if once and for all my hormones were playing a roll in this and I have not seen any decline in my symptoms.

The surgeon yesterday recommended an MRI of my brain.  They are supposed to call me to schedule that today.  I am willing to do whatever tests they recommend in hopes that they will find an answer however I'm pretty certain that it's my gallbladder.  The amount of time I have invested into researching this makes me believe that it is.  I am really at my tolerance level though.  The last bout of nausea was enough to send me to the ER.  I'm not even sure why I went, they sent me home with antibiotics.  After 7 + years of searching for help and answers and getting no where, even being told that I needed a distraction in my life by one of my doctors, (even though I have four children, a husband and a full time career)  I am approaching what I would say is my wits end!    I would be very interested in your clinic.  When do you plan to open it?  I am willing to travel wherever I need to go to get a proper diagnosis and treatment.   Thank you so much for your time!  
Leesa

[Christopher R Watters, MD]

Leesa,
I am sorry you have had such a long ordeal. One question - what happened when they infused the CCK during the HIDA? Were your symptoms replicated? If your look around this forum and the gallbladder forum you will find several others that have been frustrated by what is increasingly recognized as misinterpreted HIDA scans. You fall into a very small subset of patients. It is very likely that removing your gallbladder would solve your problems. However, as you mention, an earlier relationship with menses makes endometriosis remains a possibility. It is also likely that your course started with alkaline reflux gastritis. This happens because if inappropriate contraction of the gallbladder when the stomach and duodenum are empty. Some of this refluxes back into the stomach where it is extremely noxious. Classically, these symptoms are worse in the early morning because there is no food remaining in the stomach to buffer the alkaline bile. In patients such as yourself, I will typically give them a trial of sucralfate and metaclopramide for a month before recommending cholecystectomy. These medications coat the stomach and make it empty more rapidly to allow it to heal. Infind that approximately one third respond to this regimen. Of the remaining, 90% have resolution of symptoms after laparoscopic cholecystectomy. Several recent studies have demonstrated that the measured ejection fraction is highly unreliable and not as good as reproduction of symptoms in predicting who will benefit from cholecystectomy. There is a lot of data showing that up to 30% of normal patients will have an abnormal ejection fraction when the CCK is given over 3 minutes instead of 45-60 minutes yet this is how the vast majority of radiology departments do the study. Unfortunately, this is an area where there is very little understanding by the mmajority of physicians, surgeons, and radiologists evaluating these patients. We are in the process of establishing a clinic specifically aimed at managing biliary dyskinesia patients. The inconsistency and frequent mismanagement of these patients leads to an extremely frustrated population.