Lessons I've Learned from my Gallbladder

Three days before Christmas last year, I was sitting on the couch watching television after supper. Over the course of about an hour I developed what I took, at the time, to be the worst case of “heart burn” I’d ever had: a dull pain, very strong, centred under my rib cage. The pain was accompanied by tremendous gas that manifested in burps the likes I’d never knew myself capable of producing.

I figured the problem was simply related to something I’d eaten, and when it passed a few hours later, I forgot all about it.

Then, two days later, the same thing happened.

On and off for the next several weeks I developed a regular pattern of symptoms: about two or three hours after eating I would begin to feel a pain in my lower back, followed, over the next half hour, by increasing abdominal pain, the aforementioned burping and, at its worst, chills and irritability.

I had no idea what was happening to me, but it wasn’t pleasant.

The week after New Years, I made an appointment with my family doctor, and she diagnosed me as having a stomach ulcer. There are two types of peptic ulcers, those of the stomach and those of the duodenum. Mine was pegged a stomach ulcer because of the time of day, and because eating more, which sometimes makes duodenal ulcers feel better, made me feel worse.

Because I’d appeared to have some relief from Pepcid Complete, my doctor prescribed me Ranitidine 150, which is a genericized version of Zantac.

I dutifully took the Ranitidine twice daily for 30 days. It had no effect whatsoever, and my symptoms only got worse.

Starting from the first time I noticed the symptoms, I started to modify my diet to try and reduce them. I continued this, and broadened the foods I limited or eliminated, once the problem was diagnosed as a stomach ulcer. Following the sort of guidelines you can find many places, I eliminated citrus fruits, caffeine, chocolate, fried foods, milk, tomatoes and spicy foods. While I could easily identify foods I could say for certain would cause me problems, I had a more difficult time finding foods guaranteed not to cause problems.

About three weeks into this experience, in late January, I’d managed to stay symptom free for a week, and naively thought I was “cured.” Catherine and I went out to dinner at The Pilot House, and I had what, in an earlier time, would be considered a pretty non-spicy, innocuous meal. We went out to the movies afterwards, and when we got home I was descended on with the wraths of hell, and was up, with the worst symptoms to that point, until 6:00 a.m. It wasn’t fun.

With neither the Ranitidine nor my dramatic change in diet offering any reliable relief, I made another appointment with my family doctor for late January. At that appointment she did two things: schedule me for an ultrasound, and change my prescription to Nexium.

An interesting sidenote: I was sent to Summerside to the Prince County Hospital for my ultrasound because they could see me right away whereas my doctor characterized the wait at the Queen Elizabeth Hospital in Charlottetown for an ultrasound to be “several months.” Thank goodness for Summerside!

I was on the Nexium for a week, and, like the Ranitidine, it offered no more relief than taking nothing offered.

I had the ultrasound the following Tuesday, and three days later I was in the office of a surgeon in Charlottetown talking about gallbladders.

The gallbladder, an organ I’d given no thought to before, ever, is a small organ located near the liver. Its function is to assist in the storage and pumping of bile (“A yellow, or greenish, viscid fluid, usually alkaline in reaction, secreted by the liver.”) from the liver, where it’s made, into the intestines, where it assists with digestion.

Gallstones are formed when “when liquid stored in the gallbladder hardens into pieces of stone-like material.” When gallstones form, they can block the normal flow of bile from the gallbladder to the intestines, and when this happens, the result can be a “gallbladder attack.”

I learned all of this from the surgeon I was referred to because my ultrasound showed that I had something in my gallbladder that was causing problems.

When I read about the usual symptoms of a gallbladder attack, it was a pretty spot-on description of what I’d been going through.

The “cure” for gallbladder problems is to remove the gallbladder. There are other approaches that have been tried that involve trying to remove or dissolve the gallstones, but my surgeon advised that the reoccurrence of gallstones, assuming these methods are even successful, is high.

Fortunately, we mostly don’t need our gallbladders. I get the impression that it’s “mostly” because it seems that the gallbladder, while we can live happily and healthfully without it, hasn’t quite reached the stage that the appendix has reached in terms of being totally useless. The best description I’ve read says this:

Once the gallbladder is removed, bile flows out of the liver through the hepatic ducts into the common bile duct and goes directly into the small intestine, instead of being stored in the gallbladder. However, because the bile isn’t stored in the gallbladder, it flows into the small intestine more frequently, causing diarrhea in about 1 percent of people.

With things getting steadily worse — the frequency and severity of my attacks was increasing from “once or twice a week” to “once every couple of days” — I had to do something, and it was pretty clear that the gallbladder was the source of my problems. So I agreed with my surgeon that we should schedule its removal.

Easier said than done.

It’s all very well and good to listen to reports about the “health care crisis” and think of it as an abstract problem. In my case the problem was very concrete and clear: the wait for a “cholecystectomy” (aka gallbladder removal) in Charlottetown was six weeks.

Now, granted, I could live through the pain, and I wasn’t in imminent risk of more serious injury (gallbladders, it seems, don’t “rupture” like appendixes do). So I can understand more serious operations going ahead of me. But I’ll tell you, back on February 28th when my appointment was made, the first week in April seemed pretty close to “the end of time.”

But here we are: I’m scheduled for a laparoscopic cholecystectomy tomorrow morning at the Queen Elizabeth Hospital. The “laparoscopic” part means that the operation is done with a video camera and some lower-impact incisions; this in contrast to an “open cholecystectomy,” which, from descriptions I’ve read, sounds like what you see the surgeons doing on M*A*S*H every night. Laparoscopic cholecystectomy is day surgery — you can leave the same day as the surgery — while an open cholecystectomy requires a week-long recovery in hospital.

What have I learned from this three month odyssey?

First is patience. I’ve basically been unable to eat a normal diet for three months. I’ve been subsisting on oatmeal, apple juice, rice, and toast. I’ve been able to function — not thrive, but at least function. I watched as “the end of time” receded into 5 weeks, 4 weeks, next week, and now it’s tomorrow. That’s been a good lesson in patience.

Second, I learned a lot about my diet. When you have to think seriously about whether or not to put something into your body, lest it cause you to hunch over in pain three hours later, you tend to take eating more seriously. I’ve gotten good at reading labels. I finally figured out the difference between protein, fat and carbohydrates. I know a lot about the relationship between what I eat and how I feel. I’ve learned a lot about the kind of foods I was used to eating, and how easy it is, relatively speaking, to do without them. I’ve shaken off an addiction to (or at least a predilection for) sugar, fat and fast food. My diet for the past three months has been abysmal, but at least I’ve been thinking. These are all lessons I hope will last.

Third, I’ve learned that one way to lose weight is to eat less. There’s nothing like threat of gallbladder attack to motivate, and because I’ve been averaging about 700 calories a day for three months, I’ve lost almost 40 pounds in the process as a pleasant side-effect. This fact alone has gone a long way to keeping my spirits up, as it’s just plain easier to live without an additional 40 pounds to carry around all the time.

Finally, I’ve had to come to grips, if not with my own mortality at least with my own fragility. Up until this point in my life, I’ve been pretty ignorant of any connection between my actions (or lack thereof) and my well-being. The “cheeseburger to body connection” has been an abstract ill, with effects in some nebulous future. I consider it a great gift from my body to alert me to this in such a determined but non-life-threatening way.

I’ve also learned the following very practical techniques for reducing the pain of a gallbladder attack; your mileage, obviously, may vary:

• Take a hot bath. This is like wearing a hot water bottle. It’s a great pain reliever, and also takes the stress off the lower back, where gallbladder pain lasts longest.
• Take Tylenol 3’s. This only worked some of the time for me, and only during the last couple of weeks. My surgeon prescribed these after the attacks increased to the point where they were going on for 6 or 7 hours. Rather than eliminating the symptoms, the Tylenols appear to shorten the attacks and make them easier to take. At least sometimes.
• Go on a liquid diet. My surgeon recommended going on a liquid diet for 24 hours after an attack. When he initially suggested this, I thought he was insane, and I ignored his advice. When things got really bad, I followed his advice, and it helped. Often I found myself symptom free for 4 or 5 days after 24 to 48 hours of clear liquids alone.
• Relax. I’ve found that if, at first sign of symptoms, I go upstairs and lie down, listen to the radio, and trying and just lie still, I can shorten attacks considerably. On the other hand, if I try and push through, or stay downstairs in the hubbub of family life, it’s amazing how the little stresses of everyday life can make things worse.

I’ve not written about any of this earlier because, frankly, writing about it would have made things worse by making it all appear more real and concrete. I was happier pretending it was all a sort of private dietary fantasy. But I thought it important to at least say a few words now, if only so that my experiences can go on the record and perhaps be of assistance to others.

I’ll be away from this space for the rest of the week. Talk to you all on the other side of the anaesthetic!