Doctor unsympathetic to pain

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DEAR DR. GOTT: Five years ago, I complained to my doctor about serious pain in the area of my gallbladder. The pain also extended around to my back. A sonogram was taken and the report came back normal.
I went back to the same doctor two weeks ago to prepare for a colonoscopy. I complained about the same pain. He thrust his hand into that area; I screamed and my legs flew up. Another sonogram was taken and came back normal.

Well, there is nothing normal to me about having this endless pain and discomfort. Is there a more in-depth examination? Can a gallbladder really hurt this long and still be normal?

DEAR READER: It shouldn’t, but apparently it can if a physician is unable to get to the bottom of this or any other issue. If surgery is performed and the gallbladder is not removed, there is a probability that additional stones will form.

The gallbladder is a small muscular sac located under the liver and near the upper portion of the small intestine. The liver produces bile, a substance that aids digestion. The bile is then sent through to the gallbladder, which contracts when food enters the digestive tract. Unfortunately, some of the components of bile crystallize to form stones, a condition known as cholelithiasis. These stones may flow along with the bile but can become trapped in the duct, causing severe pain. When the stones pass through the duct or fall back into the gallbladder, the pain subsides. When blockage occurs, surgery may be necessary to prevent serious damage to the liver and other organs.

Symptoms present with intermittent nausea, vomiting and pain in the upper right abdomen near the rib cage; radiation to the upper back is common. Acute cholecystitis presents with severe upper right abdominal pain, fever, chills, nausea and vomiting. Pain may radiate to the back or under the shoulder blades or appear on the left side of the body. Chronic cholecystitis can present with gas, nausea and abdominal pain following meals.

Diagnosis might be made with the assistance of liver function tests, amylase or lipase levels and a complete blood count blood. Abdominal X-rays, ultrasound, CT and MRI may also be helpful. An oral cholecystogram can help determine whether the gallbladder anatomy is normal, allowing it to function properly. A HIDA scan can help determine how well the gallbladder is functioning. Testing is painless and should not add to your stress level.

There are alternatives to surgery, including lithotripsy and dissolution therapy. ERCP (endoscopic retrograde cholangio-pancreatography) can be used if stones are suspected. Surgeons have routinely performed laparoscopic surgery when blockage occurs. There are two methods of removing the gallbladder — laparoscopically or through open (traditional) surgery. However, a newer — albeit experimental — procedure is available that allows removal of the gallbladder without external incisions. It is known as natural orifice translumenal endoscopic surgery (NOTES). This advancement substantially reduces both pain levels and recovery time; however; further testing and documentation is necessary before adequate data can be documented.

Measures to reduce the possibility of developing stones include the avoidance of alcohol, large meals, fatty foods and crash diets. Obesity and yo-yo dieting contribute to gallstones. Therefore, a careful weight reduction plan is appropriate.

To give you related information, I am sending you a copy of my Health Report “Gallbladder Disease.” Other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and forwarded to PO Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print out an order form from my website www.AskDrGottMD.com.

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