Two years ago, I had my gallbladder removed — a procedure known medically as a laparoscopic cholecystectomy (well, technically just a cholecystectomy, but most are these days performed laprascopically.)
I went to my doctor for what was felt like a muscle ache that kept returning to the same place on my right side. An ultrasound was ordered that showed no evidence of stones and thus the ache remained a mystery or potentially evidence of nothing more than a recurring muscle strain.
One year later, the ache returned. Same ultrasound referral, different result. This time, it declared, my gallbladder had a collection of stones ranging in size from 1mm to 4mm. And once that happens, current medical consensus is that the tenant has to be evicted.
As many post-cholecystectomy patients probably know—or may, in retrospect, have learned—the threshold of proof that doctors look for in order to excise gallbladders these days is worryingly low.
Sludge? Stones? Yank it out!
Personally, my money’s on the prediction that this approach will, in time, come to be regarded as horribly misguided (much as we look back on the era of lobotomies today and wonder what on earth doctors were thinking).
The Frenetic Lead-Up To My Gallbladder Surgery
The lead up to the surgery itself happened dizzingly fast —and I caution anybody going through the same thing to take their time (if their doctor says that they have it, that is) and to ask for a second opinion or to demand it if one isn’t forthcoming.
At the very least, ask for something better than a single ultrasound scan which was the entire evidentiary basis upon which I lost this important digestive organ.
My process felt extremely rushed from start to finish. When the hospital (Hadassah Ein Karem) called to ask whether I could slot in for surgery in two weeks and I asked whether I could have the day to think about it, my request was abruptly denied with quintessential Israeli brusqueness. This isn’t the way patients should be treated when trying to weigh up an enormously serious decision that may have lifelong consequences.
My family doctor wisely advised me to defer the operation until after my wedding. But once that was out of the way the surgeon to which I was referred laid on the pro-surgery spiel thick and heavy. With the confidence and bravado that only Israeli doctors can quite muster, he assured me that the gallbladder was a “useless” organ; that I could be at work the “very next day” if I so wanted; and that I could continue eating just the way I had before the surgery.
In my best attempt at an Israeli accent, if I were to be told the same thing now, I would respond: bull-sheet.
The Unholy Duo Of Bile Reflux Gastritis And Postprandial Functional Dyspepsia (FD)
For the month following my surgery, I came down with a pretty classical case of bile reflux gastritis.
In normal person language: bile was refluxing up into my stomach causing a chemical gastritis and all that that involves, and I was throwing up bile into a toilet for the best part of a month. Fun times.
Thankfully — with the help of a medicine called cholestyramine, a bile binder, which is basically a repurposed old cholesterol-lowering drug — that phase passed over (which gives me hope for future further improvement; the body can and does adapt even to something as dramatic as the loss of a digestive organ).
However, the bile reflux phase was only to prove the start of my problems.
For any men reading this: Did you ever secretly laugh as the women in your life complained about feeling bloated and wondered what, on earth, that actually meant?
If you did, you owe them an apology.
Bloating is miserable. I’ve had it almost around the clock for two years now. Although I am hopeful that with this diet I’ve turned a tide that will herald better digestive days.
The diagnosis for the feeling of being bloated and full after anything I eat is postprandial functional dyspepsia (FD). It’s hard to describe using words. If I drink a glass of water, it feels like it sits there sloshing around rather than … you know .. moving in the direction of gravity towards wherever it goes after the stomach. It’s a strange feeling. Unlike anything I can remember before the surgery.
Recently, in light of the fact that things didn’t seem to be getting much better on their own (my gastroenterologist seemed to be banking on the passage of time as having magical curative properties), I decided to begin trying to find scientific papers on this perplexing condition. Did doctors know what caused FD?
Doing so, I kept coming across a guy called Laureate Professor Nick Talley who has, it seems, conducted a disproportionate amount of research into this area and other manifestations of general mishaps in the gut-brain axis. I noticed that he had done a few YouTube interviews which always indicates to me that somebody is open-minded and eager to share their research. My intuition was accurate. I shot Prof. Talley an email inviting him to appear on my obscure YouTube channel (current subscriber count: about 370) and he graciously agreed.
Thus, I had the privilege of talking about scientific advances in treating this condition with Professor Nicholas Talley, one of the world’s leading research gastroenterologists, only a couple of weeks ago (no, really; check out the interview below!)
Unfortunately, unlike bile reflux gastritis, getting dyspepsia under control isn’t so easy.
Doctors use a variety of methods ranging from PPIs to prokinetics to old-school antidepressants, but patients’ response to treatment can sometimes only be partial.
My situation was complicated by the fact that—about a year into my recovery—I developed depression, as in the clinical kind.
I was putting on weight (thank you, prokinetic number one); felt bloated and full after just about anything that passed my lips; had developed random nutritional deficiencies; and attempting to exercise just made the gastritis worse. I felt like I was stuck in a catch-22 from which there was no escape.
To make things work, even alcohol had turned on me: more than a beer or two and I would spend the next day feeling like I had been run over by a truck. Ergo, self-medication with alcohol (thankfully) wasn’t an option. Everybody has their breaking point at which life’s occasional miseries just exceeds their capacity to deal with it. And this was mine.
Wellbutrin Doesn’t Help With Bloating, But It Keeps You Motivated Enough To Find Strategies To Make You Feel Less Bloated…
Things took a turn for the better a couple of months ago when I began treatment with a drug called Wellbutrin (bupropion).
So far it’s been everything I could ask for in a medicine, or at least most things.
Because I enjoy geeking out on science—and more recently have begun finding psychiatry and what humans know about the brain truly fascinating—I’ve been reading a little bit about its mechanism.
Unlike first-line antidepressants (today, the SSRIs; to a lesser extent the SNRIs), it’s a norepinephrine and dopamine reuptake inhibitor (NDRI). I like to think of it as treating depression via the back door (in this analogy, the front door, the neurotransmitter system classically modulated to treat depression, is serotonin).
If you’re motivated enough to keep going with this tricky business called life (⬆dopamine), you’re motivated enough to go run errands and meet friends and take exercise and these things all end up making us happier (⬆ serotonin). Scientifically-minded readers of this blog can correct me if I’m misunderstanding the science. If I butchered it — sorry!
Most importantly, it keeps me energized and optimistic enough to keep pushing for answers and trying new things and generally moving forward with my life instead of wallowing in self-pity and grumpiness about being bloated during most of my waking hours. In the two months I’ve been on this medicine, I’ve made more progress in improving my digestion than in …. the entirety of the time before I started it. Which is kinda a big deal.
Unlike Vyvanse, it doesn’t make me feel like a crazed drug abuser (the best of times, the worst of times). And it’s even, somehow, managed to get me on the best sleep schedule of my life. I’m out most nights by 23:00 and up before 07:00. I just feel like myself. It’s like self-medicating with coffee, my hitherto go-to. Only a lot better.
Phase Two Of The Post-Cholecystectomy Era: The Fat Reduction Kick
To add to the growing feeling that I’m slowly morphing into a Jewish version of Ned Flanders — a clean-living puritan residing in the world’s religious epicenter — I’ve even been overhauling my diet to try reduce my symptoms.
I now shrivel in disdain at not only copious indulgence in alcohol. But even the thought of eating my hitherto favorite foods — falafel, shawarma, olives; note the commonality here is fat — has me recoiling in horror. I will promise to be the driest and cheapest guest at whatever barbecue parties I am in the future invited to.
Lest I never get an opportunity to say this again, please let me affirm my strong belief in the following: every single patient who goes through a cholecystectomy should meet with a dietitian as part of their standard post-operative care.
The outcome could be nothing more than knowing that if you develop problems that they are out there and these are likely to be their recommendations. But many patients wouldn’t be left feeling high and dry when — or rather if — things take a turn southward digestively.
Too often, the sum total of the dietary advice proferred is .. nothing .. or a bizarre insistence that you (the patient) will absolutely not develop any dietary issues. The sum total of my post-op care —minus a cursory meeting with the surgeon — was a one page handout that looked like it had been drafted some time in the 1970s and told you what to do in the days following your surgery.
Affirmation two: no doctor should (ever) make the generalization that every patient who has their gallbladder removed will have no digestive symptoms.
If for no better reason than that evidence-based medicine contradicts this position.
Prospective studies of patients show that 5-40% of patients who have their gallbladder removed go on to develop postcholecystectomy syndrome (PCS) which is a sometimes debilitating triad of misery whose constituent element include things like the aforementioned bloating, IBS, and general digestive distress.
Evidence-based medicine believes in the power of diet. Alternative practitioners often don’t return the favor.
Something that stood out to me from my conversation with Prof. Talley last week: gastroenterologists, and doctors generally, are very open to the idea that dietary changes can help realize significant clinical improvement for patients particularly when the issues are digestive in nature. Prof. Talley asserted that he sends all his functional dyspepsia patients to a dietitian for evaluation and dietary modification.
Here, I can’t help but notice, and point out, a stark inequality between doctors and the ranks of the anti-medicine crusaders for whom I generally have very little time.
Those who seem to make it their life’s work to rail against “conventional” medicine seem to start from the flawed promise that doctors are against all remedies—such as supplements or herbal concoctions—that don’t involve administering either pharmaceutical drugs or surgeries.
They tend to then cite this as evidence to support various “big pharma” conspiracy theories asserting that doctors, and the drug companies, are forever bound to one another in bed.
This is not the case.
Evidence-based medicine supports any medicinal intervention for which there is an evidentiary basis.
Ironically, therefore, practicioners of conventional medicine are much more open-minded to alternative approaches than many exponents of alternative approaches are to conventional treatments.
But alas, I digress.
***
TL;DR: I had my gallbladder removed and have spent the best part of the last two years looking and feeling like a pregnant lady. After recovering from a bout of depression induced by feeling too gassy and gross to move, thereby making the general malaise worse, I am now doing better. With this renewed energy, I am currently in the process of cleaning up my diet. Increasingly, I find myself remembering a clean-living Jewish version of Ned Flanders who balks at things like excess alcohol consumption, fatty foods, and …. hopefully not also fun.
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Daniel Rosehill is a technology writer and marketing communications (MarCom) professional based in Jerusalem. Originally from Cork, in Ireland, Daniel’s diverse set of interests include Linux and open source technology; backups and disaster recovery (and naturally, digital prepping); and language-learning and travelling.