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Gall bladder and hepatitis
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Gall bladder and hepatitis

Hi, Medhelpers! I'm in Buenos Aires and we are having a heat wave. Man, is it hot! Whew!!!

I got to see the head hepatologist at one of the big public hospitals here last week. Very nice and knowledgable guy, quite different from the screwballs at my own hospital. Many people here have told me that the public hospitals are better than the private ones, and I am beginning to believe it.

This head honcho, Dr. Frider, told me among other things that I ought to have my gall bladder removed as I have stones. He says that the gall bladder is a danger for hepatitics because once you've got cirrhosis the operation to remove it can cause decompensation. So he says I should have it removed now rather than later, when it might be too late. He also said I can have another liver biopsy done at the same time.

This seems to make sense to me, but I wanted to check with people here in the forum about it. Anyone have knowledge or experience with gall bladder problems, or preventative gall bladder surgery?

Any helpful comments will be greatly appreciated.

Cheers!

Mike
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148588_tn?1412862268
Makes sense to me to have it done now along with the biopsy. It's my understanding that this type of bx can give a much more accurate picture of what's going on with your liver.
I had a stone get caught in my common bile duct shortly after my original HCV dx ('92) and aside from being excruciatingly painful, it also caused a flare up of pancreatitis. Chose to have it removed and have never missed it.
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233616_tn?1312790796
yep, if he says it needs doing better to do it probably.

I had mine done...it was stoneless, but had torn loose from my liver numerous times, (due to my long history of dieting without much success (no pituitary function) )

the tearing caused infection....the stones can too. If it gets bad enough, the thing can burst. Also, if a stone does get caught beneath the common duct it will back up the bile into your pancreas and digest it....rare...but not good.

you have to weigh the risk of that versus the risk of surgery though. Since you are stage 4 you should not have any surgeries that are not needful.
But a needful one is best done sooner rather than later.

I'm facing the same issue, only with my female parts. One must weigh the risks and it may help to talk to an anesthesiologist and find out what is most likely to clear to liver quickly, amongst the many drugs. Anything that circumvents the liver and rely's more on the kidneys would be preferable.

let me know what you decide to do. I'm curious.
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163305_tn?1333672171
I know there's a drug called ursidiol prescribed to dissolve stones.
Some doctors now prefer to put you on that rather than doing the operation.

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148588_tn?1412862268
http://www.drugs.com/pro/ursodiol.html
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Avatar_f_tn
Mike, I had my gallbladder removed about 9 years ago.  It was a fairly unremarkable surgery.  Home the next day.  It's usually done laparoscopically.  I wouldn't discourage anyone from having it done because I didn't have any adverse effects and there was no life style changes for me after the normal recovery period.

If you have stones, it would seem to me to be just a matter of time before symptoms pop up and those symptoms are not fun.
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895634_tn?1283992810
Mike,
Some thoughts on your GB.  Many people have asymptomatic stones and go for years with no problem.  I documented my GB stones in 2001 and had no symptoms until April of '09.  As my surgeon said "better to deal with it now on a semi emergent basis and get the first string team than wait for an acute problem and have it removed by the backup squad".

Acute cholecystitis is painful and makes surgery slightly more difficult than elective cholecysyectomy.  If you liver disease progresses you can develop pericholecystic varicies that make laproscopic removal my difficult.

Liver biopsy during lap cholecystectomy is easily done, if you haven't had one.

I understand your apprehension.  Many consider lap chole to be a minor procedure, but a "minor procedure" by definition is a procedure on somebody else.  I did not have mine out without much trepidation.   Spent 1 night in hospital due to coexisting medical problems, but quick recovery.

Best of luck,
Robo


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Avatar_m_tn
I would NOT have the gall bladder removed.  For every person that doesn't have any problems after removing it there are many more that do have problems. Do yourself a favor and research this real good before jumping to a decision.

Like one of the others said many people live with stones without any problems, including me. If it isn't bothering you leave it alone!
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213141_tn?1270665712
Hasn't anyone heard of Apples and Apple juice dissolving Gall Stones? Did you know that Apples or Apple juice actually dissolves Kidney Stones too?
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789911_tn?1368640383
I thought they determined you to be a stage 2.  Is there anything else going on with the gb other than the asymptomatic stones?  I like the idea of dissolving than removing.  Did the hep doc say you could do any treatment for the HCV?
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Avatar_f_tn
Hi there. I 2 am in stage 4 Hep-c w/gall stones. I seen my internal med. dr 1 st sent me 4 x-rays & a sonar gram. She then mentioned a Hyderscan which I never heard of. So I met w/a surgeon. She said I had plenty of stones, didn`t need to have my gall bladder or the stones removed & also said I needed a hyderscan ASAP.
A friend went w/me 2 write notes w/my memory scan being the size of a gnat since my brain sugery...So I called my GI dr to set an appt for the hydercan only to be told by my dr.s nure that they have a place for people like me up in the mountains w/rubberwalls.
I was abit confused, but she told me she thought I had a problem wanting to have a hyderscan done & that I was a hyperchondriac.
Excuse me, but prior to 2 of my drs telling me I needed to have 1 done (ASAP) I had never heard of it & still don`t know what it is!
From what I`ve researched re:gall stones w/Hep-C ttends to increase your viral load. I was scheduled in 2005 whille I was living in DE that it needed to be removed then & that a cathera would be inserted btwn both my liver & gall bladder as to ensure the bile duct wasn`t cut w/my liver being distended @ the time.
I`ve been having problems w/my gb since 1984 & feel that if it needs to come out, I`d rather it happen now then down the road & just be done w/it. I can cause bilary tract infections as well, which are difficult to pick up on a scan if you are taking pain meds. Well, they actually don`t allow you to take them for 6 hrs prior to the scan to be able to see whether there`s any spasms going on that are undetectable on meds as that area is relaxed.
I`m sorry, but I`m probably not helping you much, just sharing the little bit of info I have. I would like to start Infterferon soon. It`s been nearly 7 yrs since I was diagnosed. However until now I couldn`t find any1 to treat me. Prior to DE I lived in NJ & prior to that I lived in NY where I was born..
I still in shock that I finally found a dr who wants to treat me. Genotype 1A. I don`t know if it has anything to do w/treatments changing as I never bothered looking into them since I couldn`t find any1 willing 2 help me. Iwas told my chances were only 40%. I`ll take that!...Plus I`ve gotten pretty tight with The Big guy upstairs (heard we can`t really talk about religion in here).
Good luck to you & don`t be afraid to seek out a 2nd & even 3rd opinion. No disrespect 2 any1, but some of them aren`t called Quacks for no reason, lol!
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Avatar_f_tn
Hey again,
I just remembered reading in a medical book a friend gave me & I was suprised to read that 2,000 mgs. of vitamin c daily can eliminate gallstones...I had doubled up to that dose a few days b4 reading about it.
I guess the only way I`d know if it worked or not is 2 ask for the dreaded hyderscan. .Asking couldn`t hurt,  however in my case, I was told I would go on that  much needed "vacation" in the mountains the dr mentioned!...NOT!...lol
Pls. let me know how it goes for you.
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Avatar_m_tn
i think what you are talking about with a scan to evaluate the gall bladder function is a
"HIDA scan" not Hyderscan. good luck
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Avatar_f_tn
Stage 3-4, geno1a, svr for almost 4yrs.. I had one stone in my gallbladder,removed in may of 2009, iam 54 yrs old,surgeron said it had to go, gallbladder was very inflamed. It took 45min  for him to do the surgery, and i went home 2hrs. later.  I have felt so much better since the surgery....Good Luck to you...Leah
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233616_tn?1312790796
the reports of people with probs after GB removal are greatly exaggerated. It's less than 10% of folks that have issues and there's a reason that they do.
Namely, they eat too much crud. Fat to be precise is the usual culprit.
Fat is harder to digest, requires more bile, bile concentration is reduced my GB removal.
However, if you eat healthy you shouldn't have any issues.
I dip my bread in olive oil, and eat some rich dishes and have no issues.
(well except at Holidays and thats just too many calories)

The only people I know personally who have had issues after GB removal were those who binged on a pound of M & M's and such. Obviously one can't eat a pound of fat at a sitting and not have some issues.

Here's the issue, yes, you could use ubsodiol, and it's not liver toxic so it may seem like a good alternative, but you have to weigh what may happen.

What I mean is, stones are not all created equal. Some are small, mostly fatty, and will dissolve with the drug, some are harder, denser, contain minerals not just fat, and don't dissolve well.
If you have one large stone, as many do, it can block the bile duct on a regular basis, causing inflammation as stored bile becomes more and more concentrated while it cannot be released due to the blockage and eventually enough infection to burst the gall bladder.
A burst is life threatening, sepsis and so on, peritonitis can follow. also, dissolving the stone can, not will but can, cause them to be expressed.
Meaning as they become smaller they can escape the GB, head down the duct, and if they pass into the intestines you are fine but if they get caught in the common bile duct or at the sphincter of oddi (where bile enters the intestines) then you will have a back up and trouble.
This is why removal is still the preffered SOC.
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Avatar_m_tn
my GI at Univ of Penn told me it was more like 30% who have some sort of problem after removing GB. not all serious but something none the less. my point is if it isn't bothering you leave it alone. there is that possibility you could feel worse after. I know one person that can't even go out to eat because as soon as they finish eating they have to run to the bathroom. very embarassing.
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238010_tn?1293989260
I'm "at least" stage 3, far enough along for my doctor to want me to get the liver cancer screening annually.  Last summer my doctor (a gastro) said she found gallstones with the ultrasound, and said don't worry about them now.

I think I might try a gallbladder cleanse sometime before the next screening to see if it works.  There is no clinical evidence that it does anything.  

However, there are a number of people who absolutely believe it works.  And as far as I know, no harm done if it doesn't work.  

Just google "gall bladder cleanse," you will get a lot of relevant hits.  There are different cleanse recipes out there, I have no idea which one is best.  Maybe someone with experience can chime in.  

IMHO, I don't think organs should be removed unless they absolutely have to.

smaug
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475555_tn?1303617674
Hi, Merry! Thanks for the insights. Re my stage F3/F4 Fibroscan, that has now been superceded by a later F1/F2 scan, so I'm probably not even F3 yet. It's hard to tell, though, since all my fibrosis tests are in disagreement.

Thanks VERY much for reminding me that, if I do have the gall bladder surgery, I need to make sure the anesthetist knows I've got hepatitis C. You're right, it's important that they use the least-harmful drugs.

I'll keep you in touch.

Mike
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475555_tn?1303617674
Hi! Thanks for posting. I was wondering: what is the normal recovery period? How long will I have to stop doing gym and sports?

Thanks.

M.
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475555_tn?1303617674
Thanks for the insights, Robo. Your reasoning sounds good and it's more or less what Dr. Frider said: take it out while it's easy. And it'd be nice to have a really good liver biopsy instead of the bad one done in 2008. So I'll probably go for it, that is, if I can convince my hospital to do it.

Mike
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475555_tn?1303617674
It's always interesting to hear dissenting opinions like yours. What are the problems that people have after removing it?

It's true that I've had no problems with it so far, and my philosophy has always been "If it isn't broken, don't fix it", but Dr. Frider (and some of the other posts here) have me pretty well convinced to remove it. My fibrosis is advancing. I haven't done Tx yet, but seeing as I am geno 1b there's not much chance of it working. So, when my liver becomes cirrhotic, if I still have the gall bladder I'm in trouble. Isn't it better to get rid of the darn thing now?

Once again, though, I'd like very much to hear what the bad consequences of the gall bladder operation could be.

Thanks.

Mike
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475555_tn?1303617674
Hiya. You wrote:

} I thought they determined you to be a stage 2.  

Yeah, more or less. At least, that's the agreement between the biopsy and the last Fibroscan. But it's all kinda inaccurate.

} Is there anything else going on with the gb other than the asymptomatic stones?

Nope.

} I like the idea of dissolving than removing.

That's the first thing I'm gonna bring up when I see him again in March.

} Did the hep doc say you could do any treatment for the HCV?

Tx for me is a long and confused story. This Dr. Frider who brought up the gall bladder isn't my regular hep MD. He's the chief hepatologist at a big public hospital, and I just had a consult with him. My hep MD at my health plan hospital wants me to do SO, and I am resisting.

M.
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475555_tn?1303617674
Hi, babycham! Real sorry to hear about all your troubles with doctors, but frankly nothing about "the medical profession" surprises me any longer.

What the heck is a Hyderscan? Never heard of it. (Which doesn't mean much, as I have never heard of a lot of things.)

If you are F4 you probably don't want to wait for approval of the new meds and ought to try SOC, if your new MD is willing and your insurance covers it. That's my understanding of the situation, anyway. Even if Tx doesn't clear the virus, it will get your viral load down, slow down the fibrosis, give you a year of relief. That's nothing to sniff at.

My situation is somewhat different as I am probably not even F3 yet, and where I live (Argentina) the care on Tx is not so good as in the States. So I am not in any hurry to do it. If I can, I want to wait for beetter drugs.

But it's all a game of roulette. Especially for us gt 1s.

Good luck!

Mike
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475555_tn?1303617674
You had the stone removed, not the whole gall bladder?

And they did the surgery because the stone was causing trouble, not because you have hepatitis?

M.
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475555_tn?1303617674
Thanks for the biology and reasoning on removal vs dissolving. Sounds right. I am thin and am very careful what I eat (zero fat), so there shouldn't be any problem on that score.

Maybe I can talk my hospital into doing an ultrasound scan to see how hard those stones are. Maybe they can tell whether they are dissolvable or not.

I have long-time Irritable Bowel Syndrome and often have intestinal pain after eating, even after eating diet foods. I wonder how removing the gall bladder will affect my IBS?

Mike
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475555_tn?1303617674
I tend to agree with you about not messing around with things that aren't producing symptoms. The problem is that once I do start having trouble due to the gb stones, it might be too late to do anything about it. (I might have cirrhosis then.)

This Dr. Frider who brought up the matter told me that a number of his hep C patients died because of gb problems, so now he gets them all (that is, the ones with stones) to remove the gb before the problems start. He said it was particularly important for hep C patients like me who are geno 1, because we can't be sure of ever clearing the virus, at least not with the present therapy. And he doesn't belive the PIs and other new drugs are going to be approved soon. Too many epidemic/demographics issues, like creating resistant virus strains.

So he says, take out the gb now. Like an insurance policy. Then, if I do end up with cirrhosis, at least I won't die from gallstones or decompensation.

Mike
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1117750_tn?1307390169
could always just try tx!!!!!!!!!!! i recon its over 50 % chance these days
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Avatar_f_tn
"It's true that I've had no problems with it so far, and my philosophy has always been "If it isn't broken, don't fix it", but Dr. Frider (and some of the other posts here) have me pretty well convinced to remove it. My fibrosis is advancing. I haven't done Tx yet, but seeing as I am geno 1b there's not much chance of it working. So, when my liver becomes cirrhotic, if I still have the gall bladder I'm in trouble. Isn't it better to get rid of the darn thing now? "

What makes you think your fibrosis is advancing?  You're nearly 60 years old and you're at Stage 1/2.  I think you're doing pretty well.  It has the potential to advance but it's not advanced.  You're in pretty good shape overall.  Not much chance of it working?  You've got close to 50% odds.  

I have not had any gallbladder problems at all but I sure wouldn't be going and getting my gallbladder out without any symptoms at Stage 1/2 because the operation causes difficulty for cirrhotics.  That makes no logical sense to me.  What does make sense is all the more reason to get your treatment issues wrapped up and get on with it and arrest your fibrosis at THIS stage before it DOES advance and contributes to any further extra-hepatic illnesses or issues.  I wouldn't be putting all this energy into a gallbladder, I'd be putting it into getting the Hep C over and done with.  
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475555_tn?1303617674
I want to thank everyone who posted. I haven't replied to all, but I certainly appreciate all the comments and suggestions. As usual, I learn more from people here than from talking to doctors ("talking" being a figure of speech). I knew nothing about gall bladders and gallstones when I posted. Now at least I have a set of serious questions to ask before I let them start cutting.

Mike
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475555_tn?1303617674
Yes, well, that's what a lot of people keep telling me, but when you're geno 1b, over 65, and have a high viral load, the statistics are now 26% chance of SVR with SOC. That's not good enough for me, considering the side effects and that I am still asymptomatic. Sure, I could end up badly regretting this decision. But if I do Tx, have bad sides, lose my otherwise excellent health, and end up not clearing the virus, I'll have regrets then, too. And with my luck, I'd probably get run over by a car in downtown Buenos Aires the day after EOT.

M.
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475555_tn?1303617674
We're back to the same vicious circle about Tx, Trish. You may be right about not operating my gall bladder now, but on the Tx-or-not-to-Tx issue I stand firm. I do not want to, and will not get into the endless SOC thing. My chances are not 50%, they're more like 25%. Doing 18 months of harmful drugs and then having a relapse (as has happened to sooo many people) is not "getting the Hep C over and done with", it's just getting on the Pharma train without a return ticket. I don't even want to "test" the SOC drugs to see what sides they cause me, because I'd be creating resistances. If and when I go onto a therapy, I want it to be one that works. SOC does not work for 65-year-old geno 1s with high viral loads.

That said, and considering that I don't have any gallstone symptoms either, I'm not rushing over to the operating room and telling them to sharpen the scalpels. Everything in due course.

And by the way, no one knows how fast my fibrosis is progressing. To know that, I'd have to know when I got infected, and I don't know that. It could have been in 1962, it could have been in 2005, and it could have been anytime in between. So being F1/F2 now means zilch.

I appreciate your concern, Trish, but panicking into SOC is not the answer.

Luv ya!

Mike
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Avatar_f_tn
I had my gallbladder removed laproscopically, {stone included}, sorry abot the typo, I was back to work in 3wks full duty....Leah
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Avatar_f_tn
I wasn't suggesting you panic into SOC or even that you go for SOC at all.  I believe I used the word "treatment" - you were looking into trials most recently.  My suggestion to focus on getting your treatment options in order is because that seems to be what your many posts of late have been directed to and it's where you left off at.

"I do not want to, and will not get into the endless SOC thing."

I don't think anyone does.  Usually one round of SOC and then it's a matter of determining what needs to be done to increase one's odds the next time around.  I don't think I know anyone who does endless rounds of SOC.  Having said that, what I believe you're inferring is that you would like this to be a one-shot deal and hedge your odds accordingly.  I think you have some company there.

"To know that, I'd have to know when I got infected, and I don't know that. It could have been in 1962, it could have been in 2005, and it could have been anytime in between. So being F1/F2 now means zilch. "

I agree with you that being F1/F2 now means zilch other than that you have much to be thankful for being only F1/F2 at 60+ years of age.  Not even knowing when you got infected will tell you how fast your fibrosis will progress.  It's different for everyone.  I got infected somewhere back in late seventies, early 1980 I reckon and was still only Stage 1/Grade 1 when diagnosed in 2006.  Others are quite different than that.  What is important is ongoing monitoring and reducing and eliminating those things that can exacerbate the progression of fibrosis.  While fibrosis can advance very fast for some, the balancing thought is that many will die with Hep C rather than because of it.  Being overly alarmist is not helpful.  Being vigilant is what is required because advance of fibrosis is not predictable.

"Doing 18 months of harmful drugs and then having a relapse (as has happened to sooo many people) is not "getting the Hep C over and done with", it's just getting on the Pharma train without a return ticket."

First of all, it's 48 weeks for a Geno 1 and only 18 months if you are one of those who is still not UND at 12 weeks and if all your variables make sense for you to continue on to 72 weeks. That is NOT a given for every person.

Second of all, it's not getting on the Pharma train as if anyone opting for treatment is a no-mind sheep who's been duped into thinking that these drugs can actually cure you.  Well Mike, they actually CAN cure you as the numerous SVR posts attest to.  The drugs are difficult, chance of cure is lower for Geno 1's and yes, it might require a second or further round of treatment.  I respect those who choose not to treat.  I also understand very well those who consider 40% odds worth taking on and there are those with even lower odds who go for the "pharma" route as it's their only option, Mike and will continue to be our only option for some time to come when we're talking about cure.  Pharma is it, like it or not.  

"I don't even want to "test" the SOC drugs to see what sides they cause me, because I'd be creating resistances."

There are those who don't respond as well to interferon/ribavirin combo because their strain of HCV is intrinsically more resistant to interferon. This is NOT the same as developing resistance to interferon that didn't exist prior to injecting interferon on treatment and BECAUSE of taking interferon for treatment of HCV.  From the reading I've done on this, those who develop resistance are in the extreme minority. If I am incorrect, I hope others will post accordingly.

Deciding to hold out for as sure a thing as you can get, particularly at Stage1/2, makes alot of sense. Good luck with that and I hope all the pieces fall into place for you very nicely at an opportune time.

Trish

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233616_tn?1312790796
I know this will sound crazy but trust me it's true.
too little fat is as injurious to the gall bladder as too much.
In fact too little fat in the diet can actually cause inflammation and ruptures because the bile becomes so concentrated it's toxic. Bile is being secreted all the time, some, not all, ends up in the GB where it stores up for the times we eat fat and proteins. Since more bile, or rather concentrated bile helps us digest these hard to break down items, our body thusly provides the solution impeccably.
What will happen minus the GB is a little less breakdown will occur of fats and proteins, but not a lot less. You will still absorb plenty . (although by plenty, I mean around 5% is normal for an adult.)  (absorption is 15% as babies and goes downhill during life as our mucousa and cilli begin to degenerate.

I can't say how much with IBS you might be effected. Have you been tested/treated to see if you have BD or some other bug?  Do you do any probotic type regimes?
My best guess would be it should not end up giving you grief but there are exceptions.
There are people that swear that's what set theirs off...and so you would want to research and look into it.  
here's a link that has some info and also some myths busting dietary info.

http://www.helpforibs.com/news/newsletter/limemint072704.html

although, my experience with folks with bowel irregularities is that there are dietary ways to settle most stuff down, that's assuming that you aren't carrying a virulant bug causing it, or that your immune system hasn't gone into hyperdrive.

I cured myself of IBS years ago (when belladonna was the only cure, so long ago)...I did it by changing my diet and by changing my high stress profession as well.
In any case, IBS is pretty complicated and I don't think the GB surgery is probably the cause, although I suppose if something got botched or injured in the nerve matrix of the intestines then that could exascerbate things.
In any case, read the link, and remember we all need some daily fat, good lipids are essential to health.
Your liver makes a quart of bile a day, and it recirculates about 6 times, so you are drenched in bile anyway, with or without a GB. The oily diarrea (diarrhea) folks get after GB is because high fat meals can act like a good lube job, minus enough concentrated bile, but as I said, unless you eat a LOT of fat and protein, that is not usually an issue.  What do you do currently to control IBS?
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233616_tn?1312790796
I'm a little confused by your fibroscan reading when your MEld is at 10... that MELD is not indicative of stage 1/2.
You do remember I told you one lobe could be in worse shape than another, right?
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717272_tn?1277594380
See what you can find out about he possibility of dissolution of stones by some other method.  Personally, I am for leaving this earth with as many of my parts and pieces as possible.  On the other hand, I have had several in-laws who had gall bladders removed with no later problems whatsoever.  Makes you wonder why some parts are there if there removal doesn't change your life at all.
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Avatar_m_tn
just google gall bladder removal side effects for more info about it.

as for treating, how do you feel about treating with the new drugs in about a year? this would up your SVR % to around 80+ %. And most likely a shorter course of tx with telaprevir.
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338734_tn?1377163768
I would think that there might be a risk of gallstone getting into the cyctic duct of common bile duct. I would think that would cause some real problems with the liver. If they know you have the stones, then maybe they can watch them. By all accounts I have heard, you'll know it if the stones start to move or the gall bladder itself gets diseased. Maybe it is better not to remove it until that occurs, but listen to the doctor on that one because I have no idea how much or how fast a clogged duct could affect the liver.

They took my GB out with the liver during transplant. I can't say I have missed it in the least. Maybe I fart a little more! :-)

Good luck to ya, buddy!
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475555_tn?1303617674
Thank you, Trish, for all your good words and kind thoughts. It means a lot to me, more than you can imagine, that I now have such good friends as you and the other nice people in the forum who try to help me. I could not have made it this far in one piece if it weren't for you.

Michael
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I've gotten my IBS pretty much under control, by changing my diet and using Miopropan (don't know the U.S. name) once in a while. I changed my diet considerably, to good effect. I still have diarrhea attacks once or twice a month, but it's always because I didn't eat right or at the wrong time. I'm also a very stressed person and that makes it worse.

Yes, they did all the possible tests on me, and they all came back negative. The gastros decided it was due to nerves, improper diet, and diverticulos. Can't do much about the nerves or the diverticulos, but diet change has helped a lot.

I agree that the tests do not jibe. My MELD is high mostly because of my low platelets. But most of my other blood scores are normal (hgb a little high, and transaminases high and going higher). Maybe I've got onbe lobe F2 and the other F3. Seems pretty likely.

BTW, I saw a hematologist today to get an opinion on doing a phlebotomy to get my hgb down so I can get into that trial in New York in March, when they'll be opening it up again. Get this: the hematologist gave me an order for a bone marrow punction! She didn't explain exactly why she wanted it, but it has something to do with my high hgb (16 to 17). I'm kinda scared, as I know nothing about bone marrow punctions, except that they'll be giving me a general anesthetic, so it must be pretty painful. I guess it's some sort of biopsy. I wonder how long it takes to recuperate???

Have you got any info on this? All I know is that someone oin the forum told me to be careful about anesthesia because some of the drugs they use can dammage the liver. Frankly, the whole thing freaks me out. I didn't think my hgb was that high.

I'm going to try and get my GP at the hospital to enquire why they want this bone puncture done. I wish I'd never gone to see that hematologist [grin].

Mike
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Hi! How's life?

Yeah, I'm working on getting as much info as possible re the gall bladder thing. I don't even know if I could talk my hopsital into removing it, so there's plenty of time to see about other options. A friend told me just yesterday that some people have had their gall bladder stones removed my laser surgery. That sure sounds like the way to go.

Today my hospital sprung a new one on me: they want me to have a bone marrow punture, apparently to see why my hgb is so high. I don't like the sound of this at all. Like, are they just using me for practicing their procedures? From boredom or something?

Any way, do you know anything about bone marrow? I don't know diddly.

Mike
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Are you pretty confident they're going to approve Telaprevir soon? It would be worth waiting for. But I've read and heard the opinion expressed by several hepatologists that the USG isn't going to approve it, at least not right away. Too many demographic concerns, like creating more virulent escape variants in the population.

I'd sure like to have an inside man at the FDA. But then I guess so would all the folks with Vertex shares [grin].

M.
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Hey, Brent, how's it going? It's been a while. Hope you are copasetic. How's life on immuno-suppression? Must be a barrel of laughs, huh? (Just kidding of course. My usual perverse sense of humor.)

If farting is the worst consequence of having the GB removed, I'm safe. I fart so much already that no one would notice the difference.

As usual around here in B.A., there are gonna be as many different opinions between doctors on whether or not to remove my GB and when, as there are on when and how to do Tx. Which is the main reason I tend to do nothing: too many choices, not enough facts.

I sorta liked Dr. Frider's argument about not waiting until it's too late. I lean towards the preventive medicine side of things. But there's always that "Don't fix it if it isn't broken" refrain whispering to me from the past. It's one of those damned if you do, damned if you don't situations. I know I don't have to explain that one, right?

Anyway, it isn't happening tomorrow. And now I've got a more pressing worry: this bone marrow puncture they want to do on me. If it ain't one thing it's another. Never a dull moment. Isn't life weird?

M.
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I have seen honest-to-god guinea pigs that get fewer intrusive tests and procedures than you seem to be getting in BA. Are you the only test animal they have in SA? :-)

Best wishes on your decision. Hope it all comes out OK (no pun intended). Hang in there

Brent
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my best guess is it's to rule out the rare bone marrow disease that causes too many red cells to be made. Although, you are only 1 or 2 points out of normal range, so not sure what their thinking is.

It might be better to get your iron accessed...you don't want them to bleed you with your platelets being low, unless your iron is high...having a few too many HGB (red cells) is something most hcv'ers would envy.

anyway, if they are insisting, I'd consider it...they'll give you a fast acting sleeper like versed or something...you should throw it off fine...the fast acters wear off in minutes, and aren't as problematic as the stuff for long surgeries.

You said SOC won't work at 65 type 1??  You are slender, don't have to many other contraindicators, I'd say whoever told you that didn't know that many folks are successful at that age. Particularly those with good BMI index and no IR.  The other thing to consider is if you could SVR, you'd stop the slippery slope now.  How high are your Alt's?  What your iron at?
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It seems I am the hospital{s favorite guinea pig. Sometimes I wonder if it isn't a general policy used to scare me off and get rid of me. I'm not very popular there as I am always asking questions and generally being a pest. I think they unconsciously would like me to disappear, one way or an other. It's the "other" way that worries me.

M.
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Searching the web, I found one site that gives the normal hemoglobin ranges as:
Adult males: 14-18 gm/dl
Men after middle age: 12.4-14.9 gm/dl

According to this I am too high, with usually 16 to 17 gm/Dl.

I'm not at all happy with the idea of doing one or more phlebotomies in oreder to get into that trial, which reopens in March, but maybe I should try it if it's the only PI trial around. Like you say, dumping one or even two half-liters of blood maybe isn't a great idea with platelets down to around 125k.

I don't know what my iron is. The only thing I can find on my blood analyses is serum ferretin, which is very high (around 280 ng/mL in 2008). Saturation (whatever that means) was high, too.

Glad to hear that the anesthetic won't be heavy. I hear that anesthetics are bad for the liver.

Frankly, I hate the whole idea of it. But if it's really justified, I'll do it. What the hell, I'm already the prime guinea pig for the hospital. Might as well do 'em all.

Mike
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Hi Mike,
I noted on your other thread you said smoking can cause high Hgb. So there you go -- quit smoking and you might lower it to help you get into the trial, as well as adding substantially to your overall health. I know -- you LOVE that advice, right?  ;)
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I know I gotta quit this awful habit. The trouble is that I go berserk when I can't smoke. It's a real addiction, and one of the only ones I've ever had. I guess I have a heavy oral thing, because when I stop smoking for a few hours I start eating like I never saw food before, and I talk so much that people don't want to hang around with me. I figure smoking is the lesser evil.

Even if I could stop, don't you think it would take a long time, if ever, for the effects to work and my lungs get back into shape so that my hemoglobin went down? I don't think it's something that works right away, is it?

But maybe that's just making excuses, huh?

M.
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I read this:

"In 2-3 months your circulation will improve, walking will be easier, and lung function will increase by up to 30%."

I guess that would mean that in 2-3 months your blood might see some change, but I really don't know.

Good luck in any case!
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Thanks. Right now my head is spinning with all these unexpected developments.

M.
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I was told I have hep3 seems I got in after blood transfusion back in 1991 after I hemorrhaged from a hysterectomy. I'm seeing a GI next week. the Hep3 was found through a scan after being in hospital for a very low hemoglobin. I was also told I had 4 small stones .I've had pain from GB before but this attack is different and hurts in my back as well. I'm having a pill camera study done to see from where I'm bleeding . I've had  a colonoscopy and a scan to check out the top part of my body, that's  where they saw the stones and my liver, now the pill study will show the middle area. I haven't had my Geno (I think this is correct) stage yet. My brother has Hep C as well and has tired the interferon but was too much for him. I understand the pills are easier on the body then the shots he had to take. Any info on this would be welcomed.
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You need to post a new question (create a new thread). This thread ended in 2010 and is not being read any more.

Also, from what you say - Hep3(?), Geno stage (?) - I think you are not well informed about HCV. People will help you and give you information if you post a new question in the forum.

Good luck.

Mike
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