Appointment with General Surgeon for Gallstones tomorrow

[apetlover]

Dear Dr. Pho - My internist has set up an appointment tomorrow at the U of Wis Hospital with a general surgeon as a cat scan of my kidneys discovered 20-30 stones in my gallbladder. Per the urologist,  the kidneys were ok. I've been experiencing a lot of gastric problems for months plus a bad bout of vomiting a whole week-end after eating a fatty meal. I've lost over 20 pounds in 1 1/2 months through combined loss of appetite and gastric discomfort. I was put on a bland diet 2/12/09.

I also have GERD, and have taken a prescription drug for the condition for years, but it is no longer working.
The internist has also scheduled an endoscopy which I'll have on Friday, 2/27/09. The internist also ordered a 24 hour urine sample which I submitted 2/19/09.

I started reading your responses on this website on 2/15/09. I was most interested in your responses to a patient on 1/09/2009 regarding a possible carcinoid syndrome. The 24 hour urine was ordered after I told my doctor that I do have hot flushes and quite red cheeks. I also experience abdominal pain including extreme burning in that region after a bowel movement. I am forced to cool my abdomen off by placing ice packs on it. As I live in Wisconsin, I sometimes go out on my screened porch and sit there in the cold until my body cools off.

To get the most benefit from this appointment, I'd like you to advise me, what to expect from this consult. WHAT QUESTIONS  SHOULD I EXPECT THE DOCTOR TO ASK OF ME ?  All the doctors in the UW system have access to all my records no matter who orders what so, he, the surgeon, may know all that he needs to know medically to make the judgment to recommend surgery.  SECONDLY, WHAT QUESTIONS SHOULD I ASK HIM IN ORDER TO BE AN INFORMED PATIENT?  I've given you a lot of my symptoms above because my biggest fear I guess is that if I have my gallbladder removed  that it would only remedy a part of my puzzling symptoms.

[Kevin Pho, MD]

It would be unlikely that the general surgeon will address the potential carcinoid syndrome during the visit.  It will focus primarily on the gallstones, and with that number, along with the GI symptoms, removing the gallbladder will be a possible recommendation.

If the flushing leads to carcinoid syndrome to be suspected, a urine tests looking for the 5-HIAA level will be ordered.  This is normally done by your personal physician or gastroenterologist.

I agree with the upper endoscopy.  If the symptoms are associated with a bowel movement, a colonoscopy can also be considered.

These options can be discussed with your personal physician.

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

Kevin Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd

[apetlover]

My appointment is at 1:30pm CST 2/23/09. If I don't hear from you in time, please give recommendations for diagnostic tests due to my symptoms. Thank you.