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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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Avatar universal
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 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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Avatar universal
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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Avatar universal
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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Avatar universal
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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Avatar universal
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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Avatar universal
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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Avatar universal
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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Avatar universal
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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Avatar universal
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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Avatar universal
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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Avatar universal
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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Avatar universal
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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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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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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Avatar universal
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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Avatar universal
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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Avatar universal
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, 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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Avatar universal
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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Avatar universal
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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Avatar universal
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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Avatar universal
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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Avatar universal
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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Avatar universal
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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Avatar universal
I meant Swedish Bitters, not lemon bitters. Have either of you any experience with digestive enzyme supplements? Thanks!
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