Should I get my gallbladder removed?

[erdovi]

It started about 6 months ago after I got back from a cruise (where I ate way more than I usually do at home).  I started to feel as if I had a tight belt (or corset) wrapped around my lower ribs.  In the beginning it would sometimes feel very tight and hard to ignore, and other times I could almost forget it was there.  At times it would wrap around below my right rib and around to my lower back, or centers on my breast bone, especially after I eat certain types of food.   I wouldn't describe it as pain, just discomfort.   I had an ultrasound and was told everything looked fine.  Blood work was fine.  I had a stomach scope and told all was fine (although I do have a small hiatal hernia, which I already knew).    I then had a HIDA scan done and had a 68% ejection rate, although I did experience discomfort during it.  I've also had a chest xray and was told all checks out fine.  My doctor put me on two months of a double dose of omeprazole.  It did help to lessen the degree of discomfort, but it still didn't take away the tight feeling completely.  As soon as I stopped taking the medicine, I went back to feeling like I did before, but now even more constant.  My doctor thinks it is still a good chance that it's my gallbladder and recommends getting it removed.  Even though I know you can live without a gallbladder, I still hesitate to get it removed.  Should I have a CT scan done first, to rule out anything else?  Can my gallbladder cause this constant tight feeling?

[erdovi]

Thank you.   My major complaint now is still getting little sleep because I can't find a position to sleep in where I don't keep waking up feeling like my shoulder down to my lower is back is a throbbing and burning pain.  My doctor tells me I am healing well, so what is causing this pain still at night?  

[Christopher R Watters, MD]

Your surgeon is correct. Remember that healing is actually an inflammatory reaction and low grade fevers are very common for a week or two following surgery. It is important to be up and moving as much as possible to reduce the chances that the fevers are due to collapse of small areas of the lung bases. Hang in there - it should start settling down pretty soon.

[erdovi]

I decided to have my gallbladder removed after another trip to the ER with pain to my right shoulder and whole right side.  It is now day 8 post-op and I still have a low grade fever (between 98 and 99) even though alternating Tylenol and ibuprofen.  I am getting very little sleep because whenever I sit for too long or start to recline my right side and right shoulder start throbbing and burning.   I talk to my surgeon every day and he always just tells me it is normal.   But I am worried I might have an infection or worse.  Usually I barely have a temperature that reaches normal.  I also discovered day 6 that I have thrush which I am on medicine for.

Should I be concerned or is my surgeon right and I just need to give it more time?  This has been a nightmare and I was so hesitate to have surgery in the first place.

Thanks

[Christopher R Watters, MD]

My philosophy has always been to wait if something can be done to make a procedure safer such as treat an existing infection or optimize cardiac function. If there is nothing else that needs to be addressed waiting only adds risk, allowing time for the very same complications that you are trying to prevent from occuring. I have learned that there is never a convenient time to step out of your usual routine and have surgery but sometimes you just need to make time.

[erdovi]

Thanks again.  Just one last question.  If it is my gallbladder, is this something I should get taken care of right away?  I am not in actual pain with this constant tightness, although discomfort at times.  And there has been no evidence of stones, however I don't want there to be a risk of serious damage or other complications if I give it time before coming to that decision.

[Christopher R Watters, MD]

Certainly not an unreasonable thought although low yield.

[erdovi]

Thank you for your quick reply.  What you just told me pretty much echos what my doctor said.  He feels that I might just be in the early stages and it will only get progressively worse.  Maybe I'm just being paranoid, but I keep thinking what if it isn't my gallbladder, but something else undetected.  I have always had a certain amount of bloating and belching, but this constant tight feeling is what bothers me the most.  
My doctor mentioned a CT scan in the beginning.  Would this pick up anything else that might be in the lower abdominal area, such as ovaries, etc?

Thank you again.

[Christopher R Watters, MD]

It is not an easy decision. It sounds like you have had a relatively thorough and thoughtful evaluation. You describe fairly typical biliary type symptoms and they are reproduced with CCK infusion. However, you have a normal gallbladder ejection fraction. In a large series of patients with reproduction of their symptoms with CCK, the Cleveland Clinic found that the measured ejection fraction was not as important as the symptom reproduction in predicting which patients would benefit from removal of the gallbladder. In my experience, I have also found this to be true with roughly 90% of patients in this category seeing resolution of their symptoms post op.