Gallstones & Surgery

I’ve been debating for weeks about whether to blog about this.  I’ve decided to tell part of the story: the less personal part.  Starting in early September, I was experiencing pretty severe pain in the right upper quadrant of my abdomen.  It was about the severity of broken bones, and was enough to make me feel nauseous.  Given the location of the pain, I was fairly sure it was in my gall bladder.

The gall bladder normally stores bile, which is produced by the liver.  Bile is what helps to emulsify fats from the diet so that you can digest and absorb them.  The liver also produces cholesterol.  Sometimes this process and the bile-cholesterol balance becomes imbalanced, which can cause the bile to start to become really concentrated and then it precipitates, forming gallstones.

Those things can HURT.   But why the pain?  After a meal (about 30 minutes later), the gall bladder contracts and squeezes some bile into the digestive system.  If you have a gallstone, it squeezes that, too.  That tends to hurt.  If the gallstones are small enough, they may be squeezed into the bile duct, which can be dangerous and very painful.  If the bile duct becomes blocked, the gall bladder can become inflamed and swollen.  This inflammation can spread to the nearby liver and pancreas, which can become life-threatening.

My gallstone was diagnosed by ultrasound.   Fortunately (or unfortunately), it isn’t that small.  It’s big.  It’s actually an inch in size, and that is  8 times larger than the duct–so it’s physically impossible for this thing to pass on its own.  Therefore, surgery is required.  Because it is physically too big to get lodged in the bile duct, my stone isn’t life threatening and won’t become life threatening, so my surgery is considered “elective.”

This has meant some fairly significant delays in getting treatment.  I’ve been in nearly continuous pain for about 2 months now, and that is only partially managed by my prescription for Norco.  Now for fun drug talk: Norco is a combination of hydrocodone and acetaminophen (Tylenol).  Vicodin is also a combination of the same two drugs, but the ratio of hydrocodone to acetaminophen differs a bit (same amount of hydrocodone, more acetaminophen in Vicodin).  The TV show House made popping Vicodin look almost normal.  House is an idiot.  Vicodin/Norco isn’t particularly effective as a painkiller for me (Darvocet, propoxyphene + acetaminophen, was better, but the FDA took it away).  On top of that, Vicodin/Norco isn’t particularly psychoactive for me: I don’t get any warm fuzzies, or high, or anything out of it except moderate pain relief.  I don’t think I’d ever become addicted to the stuff.  Again, House is an idiot.

My surgery is  a laparoscopic cholecystectomy (removal of the gall bladder).  One of the most common questions I get is whether there are other treatments.  For gall stones, not really.  You can’t blast them with ultrasound and break them up (well, you probably could, but you might also damage other nearby tissues like your liver and pancreas).  Even if you do break them up into small enough pieces to pass, that’s going to mean more (excruciating) pain, and they’re almost guaranteed to come back.  There are drugs that can dissolve smaller ones, but mine is far too large for the drugs to be effective.  They can also take years, and once you stop taking the drugs, the stones return.  The only viable treatment option is removal of the whole offending organ.  As it turns out, it’s more of an accessory organ; it’s not critical for life or functioning.

To prepare for my surgery, I’m trying to get my weight into the normal BMI range, assiduously taking my vitamins, and keeping my skin moisturizes (this should reduce scarring).  I’m trying to keep my bowels running smoothly because it seems to reduce the pain I have, but a side effect of Norco (or any narcotic) is constipation.  I’ve watched a video of the procedure so I know what will be happening while I’m out.  I’ve met with my surgeon, and I fully understand what to expect and what will be happening… and I’m still very apprehensive.  I have a fear of hospitals (nosocomephobia), which is surprisingly common: according to a recent report by Women’s Health magazine, it’s one of the top ten fears, and 15% of people have trouble with hospitals.  I’m not sure how accurate that statistic is, but they cite the NIH, so that gives me some confidence.  In the meantime, I’m trying to prepare for my class absences and other anticipated issues and trying to keep my mind off the issue.  It’s getting harder.  My surgery is set for November 6.

WARNING: The video below contains blood and body organs.  It’s not for everyone.  Feel free to skip it.



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