How does gallbladder removal affect alcohol tolerance. What are the long-term consequences of laparoscopic cholecystectomy. Can gallbladder surgery lead to unexpected digestive issues. Why do some patients experience false positives on gallstone ultrasounds. Are there potential risks associated with excess bile acid post-surgery.

The Unexpected Impact of Gallbladder Removal on Alcohol Tolerance

Gallbladder surgery, medically known as cholecystectomy, is often presented as a routine and low-risk procedure. However, many patients find themselves grappling with unexpected challenges in the aftermath. One of the most surprising and frustrating issues for some is a dramatic change in alcohol tolerance, particularly when it comes to beer consumption.

In the author’s personal account, he describes how his ability to tolerate alcohol has significantly deteriorated since his gallbladder removal. What was once a casual enjoyment of a few beers has turned into a potentially distressing experience:

• Even small amounts of beer (330ml of 5% lager) can trigger severe nausea and vomiting
• Tolerance for other types of alcohol has decreased, limiting consumption to about one unit
• The connection between these symptoms and the gallbladder surgery seems apparent, though not medically confirmed

This drastic change in alcohol tolerance raises important questions about the long-term effects of gallbladder removal on the body’s ability to process certain substances. Is this a common side effect that patients should be warned about before undergoing the procedure?

Post-Cholecystectomy Syndrome: More Than Just Digestive Discomfort

While the medical community often portrays gallbladder removal as a straightforward solution to gallstone problems, many patients report experiencing a range of ongoing issues following the surgery. These collective symptoms are sometimes referred to as post-cholecystectomy syndrome.

Common complaints among patients who have undergone gallbladder removal include:

1. Persistent digestive difficulties
2. Intolerance to certain foods, especially fatty or greasy items
3. Unexpected reactions to alcohol
4. Chronic diarrhea or other bowel irregularities
5. Abdominal pain or discomfort

These issues can significantly impact a person’s quality of life, leading to frustration and even depression as they struggle to adapt to their new digestive reality. Are healthcare providers adequately preparing patients for these potential long-term consequences?

The Prevalence of Bile Reflux After Gallbladder Removal

One of the most common and potentially problematic issues following gallbladder removal is bile reflux. This occurs when bile, which is normally stored in the gallbladder and released in controlled amounts, flows back into the stomach or esophagus.

Research indicates that 80-90% of patients experience some degree of bile reflux into the stomach after cholecystectomy. This high prevalence raises several important questions:

• How does chronic bile reflux affect overall digestive health?
• Are there long-term consequences of increased bile exposure to the stomach lining?
• What can be done to mitigate the effects of bile reflux in post-cholecystectomy patients?

Understanding the implications of this common side effect is crucial for both patients and healthcare providers in managing post-surgical care and expectations.

The Physiological Role of the Gallbladder: More Than Just a Storage Organ

The gallbladder is often dismissed as a non-essential organ, with many medical professionals describing it as “useless” once it develops stones or other issues. However, this perspective overlooks the important physiological role the gallbladder plays in digestion and overall health.

Key functions of the gallbladder include:

• Storing and concentrating bile produced by the liver
• Releasing bile in controlled amounts to aid in fat digestion
• Regulating bile acid metabolism
• Potentially influencing gut microbiota composition

Given these functions, it’s clear that removing the gallbladder is not without consequences. How does the body adapt to the absence of this organ, and what are the long-term implications for digestive health and overall well-being?

False Positives and Unnecessary Surgeries: A Concerning Trend

One of the most alarming aspects of the gallbladder surgery story is the apparent frequency of false positives in diagnostic imaging. The author mentions encountering numerous individuals who, after having their gallbladders removed, discovered that the organ either contained no stones or only had sludge – a condition that doesn’t always require surgical intervention.

This trend raises several critical questions:

• How accurate are current diagnostic methods for detecting gallstones?
• Are patients being adequately informed about the possibility of false positives?
• What are the criteria for recommending gallbladder removal, and are they stringent enough?
• How can we reduce the incidence of unnecessary surgeries?

The implications of unnecessary gallbladder removals are significant, both for individual patients and for the healthcare system as a whole. It’s crucial to examine current practices and consider ways to improve diagnostic accuracy and patient education.

The Potential Risks of Excess Bile Acid: Beyond Digestive Discomfort

While the immediate effects of excess bile in the stomach, such as reflux and gastritis, are well-documented, there may be more far-reaching consequences that deserve attention. Recent research has begun to explore the potential systemic effects of chronic bile acid exposure.

One particularly concerning area of study involves the link between excess bile acid and cardiomyopathy. Animal studies have suggested that the accumulation of bile acid in the stomach may have distal effects on heart health. This raises important questions about the long-term cardiovascular risks for patients who have undergone gallbladder removal.

Other potential risks associated with chronic bile acid exposure include:

• Increased risk of gastric and esophageal cancer
• Alterations in gut microbiome composition
• Potential metabolic disturbances
• Impacts on the liver and pancreas function

As research in this area continues to evolve, it’s crucial for healthcare providers to consider these potential long-term risks when discussing gallbladder removal with patients. How can we better monitor and manage these risks in post-cholecystectomy patients?

The Power of Patient Communities: Shared Experiences and Crowdsourced Solutions

In the face of unexpected health challenges following gallbladder removal, many patients have turned to online communities for support, information, and potential solutions. These virtual gatherings of individuals with shared experiences serve several important functions:

1. Providing emotional support and validation for those struggling with post-surgical complications
2. Sharing practical tips and strategies for managing symptoms
3. Crowdsourcing information on alternative treatments and lifestyle modifications
4. Raising awareness about the potential long-term effects of gallbladder removal
5. Advocating for better patient education and follow-up care

The sheer number of individuals participating in these communities underscores the prevalence of post-cholecystectomy issues. It also highlights the need for more comprehensive research and medical attention to these long-term effects.

How can healthcare providers better integrate the insights and experiences of these patient communities into their treatment approaches? What role can crowdsourced information play in improving patient outcomes and developing new strategies for managing post-cholecystectomy syndrome?

Navigating Life Without a Gallbladder: Dietary Adaptations and Lifestyle Changes

For many patients, adjusting to life without a gallbladder involves significant dietary and lifestyle modifications. While these changes can be challenging, they are often necessary to manage symptoms and improve quality of life. Some common adaptations include:

• Reducing intake of fatty and greasy foods
• Eating smaller, more frequent meals
• Incorporating digestive enzymes or bile acid supplements
• Avoiding trigger foods, which may include dairy, caffeine, or alcohol
• Increasing fiber intake to help regulate bowel movements
• Staying well-hydrated to support digestion

While these strategies can be helpful, it’s important to note that individual responses vary greatly. What works for one person may not be effective for another, highlighting the need for personalized approaches to post-cholecystectomy care.

Are healthcare providers offering sufficient guidance on these lifestyle adjustments? How can we develop more tailored recommendations for patients struggling with post-surgical complications?

The Psychological Impact of Unexpected Health Changes

Beyond the physical symptoms, many patients grapple with significant psychological challenges following gallbladder removal. The author’s personal account touches on feelings of self-pity, depression, and a sense of loss – emotions that are likely shared by many others in similar situations.

Common psychological impacts may include:

• Frustration and anger over unexpected health complications
• Anxiety about future health issues or dietary restrictions
• Grief over the loss of certain foods or activities (like enjoying a beer with friends)
• Depression related to chronic symptoms and lifestyle changes
• Feelings of isolation or being misunderstood by others who haven’t experienced similar issues

Addressing these psychological aspects is crucial for overall patient well-being. How can healthcare providers better support the mental health of patients dealing with unexpected post-surgical complications? What role can support groups or counseling play in helping individuals navigate these challenges?

The Need for Improved Patient Education and Informed Consent

One recurring theme in many patient stories is a sense of being unprepared for the potential long-term consequences of gallbladder removal. This raises important questions about the quality and comprehensiveness of patient education and the informed consent process.

Key areas for improvement might include:

1. More detailed discussions about potential long-term side effects and lifestyle changes
2. Better explanation of the gallbladder’s role in digestion and overall health
3. Information about alternative treatments or management strategies for gallbladder issues
4. Clear communication about the possibility of false positives in diagnostic imaging
5. Resources for post-surgical support and management of potential complications

By providing more comprehensive information, healthcare providers can empower patients to make truly informed decisions about their treatment options. How can we improve the informed consent process to ensure patients fully understand the potential risks and benefits of gallbladder removal?

The Future of Gallbladder Treatment: Exploring Alternatives to Removal

Given the potential long-term complications associated with gallbladder removal, there is growing interest in exploring alternative treatments for gallbladder issues. Some promising areas of research and development include:

• Non-surgical methods for dissolving or removing gallstones
• Improved diagnostic techniques to reduce false positives and unnecessary surgeries
• Targeted medications to improve gallbladder function and prevent stone formation
• Dietary and lifestyle interventions to manage gallbladder health
• Minimally invasive procedures that preserve gallbladder function

As our understanding of gallbladder function and the long-term effects of its removal continues to evolve, it’s likely that treatment approaches will become more nuanced and personalized. What role can patient experiences and outcomes play in driving this research and development?

The Importance of Long-Term Follow-Up and Monitoring

For many patients, the challenges of living without a gallbladder extend far beyond the initial recovery period. This underscores the need for long-term follow-up and monitoring of post-cholecystectomy patients. Key aspects of ongoing care might include:

1. Regular check-ups to assess digestive function and overall health
2. Monitoring for potential complications such as bile reflux or nutritional deficiencies
3. Periodic assessments of liver and pancreatic function
4. Screening for potential long-term risks, such as increased cancer risk in the digestive tract
5. Ongoing support for dietary and lifestyle management

Implementing more comprehensive long-term care protocols could help identify and address issues earlier, improving outcomes for patients. How can healthcare systems better integrate long-term follow-up into standard post-cholecystectomy care?

The Role of Research in Improving Outcomes

As more patients share their experiences with post-cholecystectomy complications, it becomes clear that there is a need for more extensive research in this area. Key areas for investigation might include:

• Long-term health outcomes for patients who have undergone gallbladder removal
• The physiological adaptations that occur in the body following cholecystectomy
• The impact of bile acid dysregulation on various body systems
• Development of more effective treatments for post-cholecystectomy syndrome
• Improved diagnostic methods to reduce unnecessary surgeries

By investing in this research, we can hope to develop better treatment protocols, improve patient outcomes, and potentially reduce the need for gallbladder removal in some cases. How can patient experiences and crowdsourced data contribute to these research efforts?

Empowering Patients: The Importance of Self-Advocacy

Given the complexity of post-cholecystectomy issues and the varying experiences of patients, self-advocacy becomes a crucial skill. Patients who are well-informed and proactive in their care often report better outcomes and quality of life. Key aspects of patient self-advocacy include:

1. Educating oneself about gallbladder function and potential post-surgical complications
2. Keeping detailed records of symptoms, dietary triggers, and responses to treatments
3. Seeking second opinions when necessary, especially before agreeing to surgery
4. Actively participating in treatment decisions and asking questions
5. Connecting with support groups and patient communities for shared experiences and advice

By empowering patients to take an active role in their healthcare journey, we can improve individual outcomes and contribute to a better understanding of post-cholecystectomy challenges. How can healthcare providers better support and encourage patient self-advocacy?

As we continue to explore the complexities of gallbladder health and the long-term effects of cholecystectomy, it’s clear that a more nuanced and patient-centered approach is needed. By combining medical expertise with patient experiences and ongoing research, we can hope to improve outcomes and quality of life for those facing gallbladder issues. The journey towards better understanding and management of these challenges is ongoing, but with collaboration between patients, healthcare providers, and researchers, progress is possible.

My Gallbladder Surgery Story. And: The Water Party Project | by Daniel Rosehill

My beer-drinking days: on temporary hiatus

Unfortunately, since the surgery, my ability to tolerate any alcohol whatsoever has only gotten worse rather than better — although perhaps I’m just drinking so little of it that my system reacts more forcefully to the periodic ingestion — and my tolerance has undoubtedly plummeted.

When lockdown started my usual Thursday night pub expeditions went out the window. As they did, work, paradoxically, picked up — in a dramatic and life-consuming sort of way. And I gradually, perhaps instinctively, began avoiding alcohol at all.

For the past month or two my alcohol consumption has essentially been limited to a glass of wine to initiate the weekend. And a glass or two on the odd Zoom call with friends in Ireland.

However:

For reasons that are as of yet unknown any time I drink beer — specifically — I become violently ill. And I mean violently.

This week, Jerusalem started to re-open.

To mark the occasion we headed out to one of the first bars to resume operations to some extent and basked in one of the first manifestations of relative normality — something we would have taken entirely for granted in The Olden Days.

Two “ shlish “ (330ml) beers of 5% lager were enough, to my disappointment, to kick off another marathon nausea and vomiting spree — the first I had had in about four months.

Right now, other than knowing that something is definitely amiss, I’m not terribly sure what is going on with my health. Blood-work has eliminated any obvious causes — but has not provided an answer. Yet the connection to the surgery, to me, again seems obvious.

What I do know is that I can’t tolerate beer for whatever reason. And that my ability to drink any other alcohol seems to be capped at about one unit.

I hold out a little bit of hope that, as I move through the diagnostic process and put pieces of the puzzle together, I will one day be able to enjoy a pint of Guinness again without knowing that it will probably trigger a dramatic expunging of my stomach contents several hours later.

But there has been a sort of unhealthy self-pitying grieving process to work through in the meantime.

Why me? And why me at the start of my thirties? These are the sort of questions that I have been grappling with internally and which, at times since the operation, have pinned me down into a sort of temporary depression.

I’ve mostly moved through that necessary journey. Right now my best bet is probably to play it safe.

And thankfully, I’m not facing the battle alone. At least virtually.

These problems might, at first glance, seem unexpected or even dramatic.

But in my quest to find answers online, trawling through Facebook Groups and other online communities, I have encountered countless scores of individuals — of both genders, of all age brackets, occupations,and prior health states — who have been left with these exact problems, and sadly, sometimes much worse ones.

The sheer numbers, to my mind, are staggering: I would estimate that tens of thousands of people around the world are suffering through protracted digestive difficulties brought about solely through laparoscopic gallbladder removal — an operation we are repeatedly told is a “harmless” way to extract a “useless” organ.

More incredibly, perhaps, I have also met plenty of individuals who appear to have similarly experienced false positives on ultrasound and who, after parting ways with the organ, learned that it either contained no stones — or only contained sludge, a condition which can be relatively benign but which might, on the other hand, also foreshadow the development of stones themselves.

So for a lot of us it’s very murky business. But a few things, at least to me, are clear.

Such as that in my opinion, and that of many, and as the simple 80–90% incidence of post-cholecystectomy bile reflux into the stomach makes clear, extracting the gallbladder is not a “nothing” medical procedure that can be dismissed as having no effect on patients’ lives after the acute recovery period is complete.

It is an indisputable fact that humans digest better, physiologically, when their bile can be stored in a reservoir. And, to resort to a truism, we probably wouldn’t have been engineered with a gallbladder if one didn’t serve a purpose.

But the effects might be more far-reaching than bringing up bile unless we can find a way to keep it away from our stomachs.

There is evidence that excess bile acid is far from innocuous even when it doesn’t result in clinically apparent gastritis — cardiomyopathy has been linked to the pooling of bile acid in animal studies, an apparent distal effect of the acid accumulation in the stomach.

On the positive side, where there are many other patients there is solace in numbers and the potential power of crowdsourced brainstorming to help find, if not cures, natural or medical treatments which might alleviate some of the unfortunate consequences of this very common surgery.

I recently went on an iHerb trawl and have begun exploring what natural supplements might provide relief instead of pharmaceuticals: psyllium husk replaces the bile binder and other natural compounds aim to mitigate other parts of the picture, such as nausea. Whether it will work, for me, I haven’t gotten around to investigating yet.

The best I can do is try. And see what works. And hope that in time, as medicine advances, we will find a way to treat gallbladder disease without excising the organ at all.

And that when that happens the ranks of those suffering with bile reflux gastritis, post-cholecystectomy syndrome, and the other countless labels and conditions tied to this “routine” operation will therefore empty.

(The list of long-term complications of gallbladder removal I have mentioned here is not in any way exclusive. Besides bile reflux gastritis, bile salt diarrhea, and postcholecystectomy syndrome — a mixture of symptoms — are common.)

The Unusual Tale of the Roaming Gallstones

“You have a mass in your chest, near your lung,” the voice on the phone said. The 71-year-old woman listened quietly as her doctor explained what the CT scan showed. The doctor suggested that she see a chest surgeon to figure out what it was and what they should do about it.

The woman wasn’t surprised to hear that she had a mass. That’s why she went to see her doctor in the first place. Weeks earlier, when she was rubbing her chronically aching back, she noticed that there was a subtle bulge between the next-to-last rib on her right side and the rib just above it. The mass felt hard, almost as if she was growing a new rib. And then it just kept growing. She went to see her doctor when the bulge was the size of an apricot.

[Watch ‘Diagnosis,’ a new show from The Times and Netflix.]

Her doctor ordered a chest X-ray. The woman was puzzled when her doctor called to tell her that the X-ray was completely normal. But when a physician assistant she had been seeing about dietary supplements looked at the film, he noticed that the scan hadn’t gone low enough to capture the mass. When the woman called her doctor back with that news, the doctor ordered a CT scan of the chest with contrast. That would show them what was there, the doctor assured her. It had, and now she needed a surgeon.

Finding a Doctor

When the woman told her daughter about the results of the CT scan and the doctor’s recommendations, her daughter immediately started searching for a surgeon. She found one at Memorial Sloan Kettering Cancer Center in New York. The woman called the surgeon’s office and sent over the imaging. The office said it would call with an appointment if the surgeon thought he could help. Four hours later, the office called back with an appointment — actually, two. The surgeon thought she should also see one of his colleagues. They were each surgeons specializing in sarcomas — the kind of tumors that grow in muscle and bone. But this second doctor operated on tumors in the abdomen and other areas. Although the mass was clearly in the back of the chest wall, it was located below the diaphragm, and so it was outside the area of the first surgeon’s expertise.

Most Likely Cancer

The woman took her daughter when she went to see the surgeons. She was, the patient told the first doctor, very healthy and active. She exercised regularly and didn’t smoke and never drank. Her only medical problem was hypothyroidism. Also, her gallbladder had been removed nearly two years before. The cardiothoracic surgeon examined the woman and then the mass on her ribs. He reviewed the imaging of her chest and back.

This was probably a cancer, the doctor told the two women, most likely a sarcoma of the bone. It seemed clear that it had invaded the surrounding soft tissue. She was probably going to need that part of her ribs removed. And maybe radiation. But first she’d need a biopsy; his colleague Dr. Sam Yoon would perform the biopsy and do any additional surgery that was necessary.

How It All Began

Yoon’s office was in the same building. Yoon asked the woman about the pain in her back. It began a couple of years earlier with her gallbladder, she replied. Back then, she got what she thought was a really bad stomach bug. She had a crampy pain on the right side. When it didn’t let up after a couple of days, she decided to go to the hospital. Her daughter was visiting but didn’t drive, so the woman drove herself. It was perhaps the longest 10 minutes she had ever lived through.

In the emergency room, she had been given Maalox and started to feel better. When she suggested that she was ready to go home, the nurse hurried to her bedside and told her that her gallbladder was infected and needed to come out.

She’d had the surgery the next day and went home the day after that. They told her that she would feel fine in no time. And over the next few weeks, she started to feel better. But she was far from fine. Then, a month after the surgery, she got this incredible pain up and down the right side of her back — from her shoulder blade down to her buttocks. She called her doctor, who ordered her first CT scan. There was no infection, no kidney stone, no abnormality. She was given a painkiller and sent home. Whatever it was that was causing this pain would get better with time.

It didn’t, though. She still couldn’t sleep on that side, and even sitting could be painful. When her car lease ended, she had to test nearly a dozen models before she found one that she could drive without pain. And even then she had to put a small pillow on her left side to keep her right side away from the seat. She went to an acupuncturist; she tried physical therapy. Nothing helped. And then this goose egg started to emerge on her back.

Roving Gallstones

After hearing this story, Yoon examined the patient and her hard, tender lump. He reviewed the two CT scans she had sent, then sat down at his desk and smiled. “I’ll bet my friend, the chest surgeon, a game of golf that this is not cancer.”

The painful mass in her back was not a tumor, he explained. It was a result of her body’s effort to get rid of some gallstones, spilled when her gallbladder was removed two years earlier.

It used to be that gallbladder surgery was done through an enormous incision in the upper-right side of the abdomen. Using this surgical technique, it was easy to take out even an inflamed gallbladder without spilling a single gallstone. About 30 years ago, surgeons started using little cameras inserted into the body to guide the operation. This newer surgery was called a laparoscopic cholecystectomy — laparoscopic meaning an examination of the loin (lapar in Greek) with an endoscope, and cholecystectomy meaning the removal (ectomy) of the gallbladder (cholecyst). The operation could be performed through three small incisions using cameras and special instruments. Because the incisions are tiny, sometimes gallstones fall out of the gallbladder as it’s being removed and end up roaming free in the abdomen. It’s not an uncommon event — estimates are that stones are spilled in up to 30 percent of all lap choles (as the surgery is called for short). Yoon could see in the first CT scan that gallstones were left behind during her surgery.

Bad Luck

Most of the time, nothing happens to the stones. But in a handful of cases (up to 0.03 percent of them), the gallstones cause pain and inflammation as the body tries to get rid of them. And that, Yoon said, is what happened to her. In the second CT scan, Yoon could still see the stones. But in the intervening months, the woman’s body had wrapped them in inflammatory tissue and was trying to force them out through the chest wall.

Let’s get the biopsy to make sure there’s nothing else going on, Yoon suggested. And then he would take out the stones. The biopsy showed nothing but inflammation — no sign of any type of cancer. Two weeks later, Yoon cut into the mass and scooped out the stones that got away the first time.

It took the woman a few months, but two years after that gallbladder surgery, she finally felt fine.

I asked Yoon how he was able to make this diagnosis when his colleagues hadn’t. Before he specialized in cancer surgery, he told me, he trained as a general surgeon. During that training, he saw his share of spilled gallstones — both in the body and on CT scans. And while he never had a patient with this kind of rare complication, he had certainly read and heard about it from those who had. “For me,” he said, “this wasn’t a difficult diagnosis.” He happened to have the perfect training for it. Any surgeon would have figured it out before taking the patient to the operating room, Yoon told me. He just got there a lot faster.

My gall bladder and how I lost it

My gallbladder – a personal account

Why this account?

I decided to write this account of how my gallbladder came to be removed after the searches I performed seemed to reveal far more horror stories than “Happily ever after” ones. I guess it’s only human nature that people who consider they have a good case to moan about should do so, and that people whose cases clanked quietly through the system just shut up and get on with living. I thought I would try to redress the balance.

About us

First, a little background information. I am 65 and retired two years early to coincide with a move from Buckinghamshire to east Hampshire in order to be nearer to our daughter and her family. I have always enjoyed good health, and an overnight stay in hospital in 2007, following ear surgery, was my first such since 1967. My wife and I have been married since the dawn of civilisation, and we celebrate our ruby wedding next year. She is disabled by rheumatoid arthritis and has considerably more experience than I of hospitals, having had two joints replaced and a few other bone repairs.

How it all started

My story started in the middle of August, 2009. One Friday morning I noticed my urine was rather darker than usual. In view of the season I thought I had maybe let myself get a bit dehydrated, so resolved to drink more in compensation. Later in the day I went to my weekly Pétanque session, but a backache developed and I did not play for long. In the evening a pain developed immediately below my breastbone. It was constant, dull but powerful. I tried a couple of doses of Gaviscon but to no avail, and finally I rang the doctors’ deputising service.

A doctor called me back in about 20 minutes. After listening to my list of symptoms she declared “In view of your age and sex I am sending an ambulance.” I have been a first aider for some years, and the pain did not match the criteria for a heart attack, but by now it was getting me down, so I put a few essentials into a flight bag and waited for the ambulance.

We live in a village, eight miles from the nearest (not very large) town. The ambulance turned up in about 15 minutes. I was conducted aboard and immediately wired up to a multi-purpose cardiac device which appeared to be an electrocardiograph and defibrillator combined. The ECG produced was good, so no worries about the heart. The paramedic did several more tests and inserted a cannula into the back of my hand before we started off for the Royal Surrey County Hospital at Guildford. I remember little of the journey, as by now I was breathing gas and air and the pain was dulled. The small boy which resides inside every middle-aged man would love to know if “blues and twos” were used. I do not recall any sound, but judging from our progress up the A3, including through the notorious Hindhead roadworks, something must have been suggesting to other road users that they should move over, for one abiding memory was observing, through a small tinted-glass window, a constant stream of overtaken vehicles.

Friday night in A&E

We arrived at the Royal Surrey at 10.20 pm. I was wheeled into A&E, and the paramedic took the multi-purpose cardiac device, which obviously worked with its own battery, off to show the triage nurse. Five minutes later I was lying on a trolley in an A&E cubicle. First, another ECG. Next a series of blood tests and X-rays before, after about two hours, I was ‘seen’. The seeing was done by the A&E doctor, who pronounced his opinion that I had suffered an obstruction of the bile duct, no doubt from a gallstone. Before being taken to a ward for the night I was wheeled to the surgical assessment unit, next door to A&E, where (as soon as he had finished his latest operation) the duty surgeon came to see me. He expressed his agreement with the opinion of his medical colleague, and cleared the way for me to spend the rest of the night on a bed which, after my A&E trolley, felt the epitome of luxury and comfort.

This was my first contact with A&E on my own account since, I believe, 1960, when the cut hand resulting from contact with a model aero engine propeller was rapidly stitched up. I was hugely impressed with everything I saw of the department. It all appeared spotlessly clean, and the staff were superb. I came into contact with staff from at least three continents and I know not how many nationalities, and every one of them dealt with me in a totally professional, friendly manner. Two things remain in my memory: in the adjoining cubicle was a very old gentleman who had quite forgotten why he was there or who had brought him. The patience of the staff trying to tease bits of information from him was beyond praise. And an overheard telephone call (I cannot call it a conversation, all I heard was very one-sided): “Sir, your son is here, he is 14 years old and very drunk. He is not fit to go home alone and he certainly cannot stay here. You will please come and collect him”. (The time was around midnight.) I am reminded of a few lines of Kipling’s:

Yet, patient, faithful, firm, persistent, just

Towards all that gross, indifferent, facile dust,

The angels laboured to discharge their trust

By the next morning the pain had subsided. Presumably the blocking gallstone had moved on to pastures new. Around mid-day I was seen by the duty consultant, a general surgeon who specialised in laparoscopy. He offered me another day in hospital, but for home reasons I preferred to get away. He ordered further tests – gastroscopy and ultrasound – before deciding on a course of action.

Further tests

A few days after returning home I suffered a high temperature and the most amazing night sweat. My GP was called and diagnosed cholangitis, an infection in the bile duct. It responded quickly to some industrial-strength antibiotics, but was exciting while it lasted! It certainly stiffened my resolve to get rid of the gallbladder as soon as I could, as did learning that Andy Warhol died of a gallbladder-based infection.

Now came a period of waiting. The first test turned out to be an ultrasound scan of my abdomen. This proved to be the only occasion on which the practitioner was not communicative. He seemed anxious to ensure that I could see nothing of the scan results. In the end I asked him directly if there were gallstones; I assumed the resultant grunt to mean “Yes”.

Three days later, on 21 September, I went for endoscopy. My wife has had a couple of these procedures and finds them distressing, so she suggested I elect for a sedative. In retrospect this was not a good decision: it meant a £30 taxi ride to the hospital and collection by a ‘responsible adult’. As things turned out the sedative was a waste of time and effort. The practitioner was very thorough in numbing my throat, then he administered the sedative and set to work. I was compos mentis all through the procedure which I did not find too unpleasant. Only afterwards was a little light shed on things. Sitting in the patients’ room (television, free coffee and sandwiches) I got into conversation with my neighbour, a very slightly-built man. He told me he had slept throughout the procedure, having received 10 ml of the sedative. On looking at my notes it became apparent that to sedate me, weighing probably a stone more than my new acquaintance, I was given just 2 ml! It would seem to me that the thoroughness of the throat deadening was the key to an easy procedure. Anyway, the gastroscopy turned up no ‘nasties’ beyond a mild inflammation of the duodenum. All clients of the procedure are now given a test for the presence of helicobacter pylori, the precursor to stomach ulcers, and that result was fortunately negative.

During the next six weeks I tried on two occasions to contact the consultant’s secretary, in an attempt to find when my follow-up appointment would be. On both occasions I left voicemail messages, but neither call was returned. I was beginning to wonder if I had run up against an age barrier, but with hindsight I think it was just simple incompetence, the only instance of it I experienced in the whole of my gallbladder saga. In desperation (I was keen to get a resolution by Christmas if possible – I could visualise a malevolent gallstone deciding to disrupt Christmas day!) I rang my GP surgery and asked if they could chase things up. They had more success and spoke to the secretary. The follow-up appointment was set for 19 November.

I arrived at Guildford bright and early for my 8.30 appointment. By 9 am I was giving a blood sample, having agreed to the proposed laparoscopic cholecystectomy. By 9.30 I was being pre-surgery assessed. The staff nurse carrying out this task was superb: patient and thorough with a good sense of humour. All pre-op patients are tested for MRSA. A positive result, the information leaflet assured me, did not mean that surgery would be cancelled, but special care (a private room perhaps, or last of the day’s operating list) would be taken to minimize the chances of cross infection. By 10.15 I was tucking into a light breakfast in the staff/visitors’ restaurant.

On 25 November came a telephone call from a lady in the admissions department: would I be available for surgery on 23rd December? I actually cried off that day, as I had an audiology appointment at Basingstoke. (I am hard of hearing, or as my wife would say, deaf as a post.) The following day she called again: how about 4th December? I jumped at that appointment, and spent the next week jumping around equipping the house for an expected week of car-free convalescence.

Surgery at last

I presented myself at the SSSU (short-stay surgery unit) by 7.30 am on the 4th. By 8 I was lying on my bed in a gown, having my details checked. By 8.30 I had seen the anaesthetist. By 9 I was drifting off to sleep – such a change from my 1967 operation, when sleep came unpleasantly like becoming paralysingly drunk in about half a second. By 10.30 I was in recovery, by 11 I was in the ward drinking a welcome cup of tea and talking to the surgeon. The gallbladder was thickened and inflamed, and I was better off without it. Thirty minutes later I was dressed and eating a light lunch. My daughter once again obliged, and I was home by 3.30.

Aftermath

I make no apology in going into detail here. Knowledge is strength, and forewarned is forearmed. The NHS information leaflet tends to gloss over anything its writers consider at all unpleasant, but life isn’t like that. I hope the points I make here will be of use to a future patient.

The hospital supplied some Co-Codamol tablets, a high-strength painkiller, sufficient for four days. The first evening was not very pleasant: the left-over gas which had not been purged from the abdomen tends to collect around the shoulders, and no amount of rubbing does any good. I had provided myself with a couple of tubes of Trebor extra-strong mints. Just how they work I do not know, but at least they take one’s mind off it! Walking about seemed to help, too. The drug administered to dry the mouth was very effective, and for most of Friday my mouth felt like the inside of a sandpaper factory. But the mints helped. Going to bed was a trial, as the diaphragm and stomach muscles were decidedly out of sorts, and punished me for flopping down on the bed by making it feel as if I were breaking in two! I finally got comfortable, but only on my back. I did not get much (or any) sleep.

From Saturday onwards was just steady positive progress. By Wednesday I was free of pain everywhere except directly over the highest incision. I celebrated by taking my dog for a walk, the first time (by me) since Thursday. Later that day we went shopping. I was careful to ensure that the bags were only very lightly filled. The old advice – back straight, lift with your knees, hold the load close to your body – is useful here.

Aftercare

What aftercare? In my experience there isn’t any. The old leaflet I had been given referred to a morning-after visit from the district nurse, and a follow-up appointment at hospital, but they are long gone. The incisions are closed and sealed with adhesive which can be washed after a few days, though I intend to keep mine dry for ten. This method has at least the advantage of making the entry of germs very difficult, but infection can, of course, start up internally. Following my mega-temperature episode in the Summer I bought an accurate, reliable digital thermometer. I recorded my temperature twice daily for a few days before the operation, and of course carried on afterwards. There is no simpler and quicker way of spotting an infection than temperature rise. More than 1 degC. rise means an immediate call to the doctor. Antibiotics can then knock it over quickly.

The only other point I want to mention here is bowels (did someone say ugh?) Disturbed eating patterns, plus heavy-duty painkillers, can result in constipation at a time when lots of straining in the lavatory is very unpleasant. A call to our friendly pharmacist confirmed I could ‘borrow’ some of my wife’s Lactulose solution. It is actually palatable! And about six hours after taking a dose I was relieved that normal service was resumed and the problem was behind me. The other point, of course, involves the very opposite. Without the gallbladder to provide a ‘boost’ in bile availability, a fatty meal can escape being fully digested. While this can have advantages for those (including me) who find it a trial to maintain their chosen weight, the sudden arrival of a lot of fatty food at the body’s back door can result in diarrhoea. I started to reduce my intake of fatty food at the time of the Summer crisis, but after the surgery, as I did not wish to end up depriving myself of some well-liked dishes, I decided to follow the modern trend and keep a Blog. No, not one of them, this one is a bog log! It simply allows me to co-relate any sudden outputs with what was previously input. So far (eight days post-op) I have had no problems in this regard.

Finally

I wrote this for fun. If any pre-surgery patients find any of it of interest I shall be delighted.

December 2009

6 Gallstone Symptoms You Should Know About ​​​

Compared to the rest of the digestive system, the gallbladder doesn’t receive a ton of airplay.

The pear-shaped organ that hangs out with the liver and pancreas, acts as a storage facility for bile, releasing it into the intestines on the regular to help the body digest fats. Its job might seem like no biggie, but a faulty gallbladder can cause serious drama—usually, in the form of gallstones.

Here’s the deal: The bile your gallbladder stores (and later ships to your intestines) is made up of fatty substances, like cholesterol. When excessive amounts of fat are present, crystals form, explains Georgia-based ER doctor Darria Long Gillespie, M.D. Over time, these crystals can clump together and morph into stones that vary in size—anywhere from a single grain of sand to the size of a golf ball. (Yikes.)

Gallstones occur in up to 20 percent of American women by the age of 60, and women between 20 and 60 years old are three times more likely to develop gallstones than men, according to the American College of Gastroenterology. This is likely due to pregnancy and oral contraception, says Gillespie, as fluctuations in sex hormones (think: estrogen and progesterone) may trigger an uptick in gallstone production.

The tricky thing is that most people with gallstones have “silent stones,” meaning they simply don’t experience any gallstone symptoms. “Since silent gallstones don’t cause symptoms, they don’t need to be treated,” says Gillespie, noting that these gallstones are typically found on a CT scan or ultrasound that was done for other reasons.

However, some people who have gallstones experience very real symptoms. Gallstone symptoms can vary in frequency and severity, and since, if you do experience symptoms, they are likely to keep happening, surgery to remove the gallbladder is the most common treatment. If you’re not a candidate for surgery, other treatments—such as bile acid pills to dissolve the gallstones or shock wave lithotripsy to break them up—may be recommended, she says.

If you experience any combination of the below gallstone symptoms, it’s time to check in with your doc for a consult:

Abdominal Pain

The biggest tipoff that you might have gallstones? Abdominal pain that comes and goes (especially after fatty meals). “Gallstone pain is described as an intense, dull discomfort located in the right upper quadrant of the belly,” says Matthew Mintz, M.D., board-certified internist in Bethesda, Maryland. “It can also radiate to the back and right shoulder.” When the gallbladder contracts in response to eating or other normal stimuli, it tries to force the stone out of the gallbladder in the process, causing pesky pain that can last anywhere from five minutes to a few hours.

“Imagine you have a gallstone the size of a golfball trying to pass through an opening the size of a straw,” says Robby Holland, M.D., emergency physician and medical director at The Colony ER Hospital in Texas. “You would definitely be in pain.”

Many people can have gallstones and just experience abdominal pain, which often goes away on its own. “If it doesn’t occur too frequently and isn’t particularly disruptive, many patients elect to not have surgery,” says Gillespie. However, frequent episodes of abdominal pain, severe pain, or pain in addition to other symptoms calls for a checkup.

Related: The Symptoms Of Colon Cancer That Every Young Woman Should Know

Nausea and Vomiting

If the stone gets stuck in one of the ducts that keep your digestive enzymes flowing—causing inflammation, swelling, and worsening pain—nausea and vomiting are likely to make an appearance, says Mintz.

If you experience unexplained nausea and vomiting, or frequently find yourself sick after eating, it’s worth talking to your doc.

Dealing with diarrhea? Try these remedies:

​

​

Heartburn

Because many gallstone symptoms mimic that of indigestion—heartburn, acid reflux, cramping—it’s easy to ignore the signs, says Holland.

But if these symptoms strike repeatedly after meals (and things like movement, rest, passing gas, or going number two don’t relieve the discomfort), it could be a sign that a gallstone is blocking the exit of your gallbladder.

Jaundice

If a gallstone blocks the bile duct, which is the pathway the gallbladder uses to send bile to the small intestines, the entire system backs up. This buildup increases the concentration of bilirubin in the gallbladder—a yellowish substance that’s normally processed by the liver and turned into bile.

“As bilirubin concentrations increase in the bloodstream, it starts to deposit in the skin, turning it yellow,” says Jonathan Zipkin, M.D., urgent care specialist at Northwell Health-GoHealth Urgent Care in New York. With jaundice, the whites eyes often also turn a yellowish hue.

Related: 5 Body Odors You Should Never Ignore

Dark Pee, Light Poop

The breakdown of bilirubin during the digestive process is also what makes your pee yellow and your poop brown, says Zipkin. If you experience dark urine (despite being hydrated) and light-colored stools when you’re on the throne, it could be a sign of a bile duct blockage.

Related: Scary! This STD Is Becoming Impossible To Treat

Fever, Chills, and Rapid Heartbeat

A fever, chills, and rapid heartbeat—especially combined with abdominal pain that just won’t quit—could mean the gallbladder outflow is completely blocked and has caused an infection, says Gillespie. Infections can become life-threatening if ignored, so it’s uber-important to seek immediate medical attention if you suspect your gallbladder’s the culprit.

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Gallstones and earlier death linked

By Leigh Krietsch Boerner, Reuters Health

NEW YORK (Reuters Health) – People who have gallstones are more likely to die within 20 years of diagnosis than people without the disease, a new study says.

Gallstones sufferers are also more likely to die from heart disease or cancer, said the study published in the journal Gastroenterology.

The findings don’t mean that one condition causes the other. Instead, gallstone disease and heart disease may have the same root cause, Dr. Philip Barie, professor of surgery and public health at Weill Cornell Medical College in New York, told Reuters Health.

“People with gallstones may have an abnormal balance of fats in their body, including cholesterol, although there’s no clear relationship between gallstone disease per se and high cholesterol,” said Barie, who was not involved in the study.

More than 25 million people in the US have gallstone disease, and almost one million new cases are diagnosed every year, according to the American Gastroenterological Association.

Gallstones happen when material in the bile hardens and sticks in the ducts leading from the gall bladder, where bile is stored, to the small intestine. Because bile can still get from the liver, where it is made, to where it needs to go, the gallbladder isn’t necessary and can be removed.

The researchers looked at the medical records of more than 14,000 people between 20 and 74 years old. About one in 14 had gallstones, and one in 20 had their gallbladders removed between 1988 and 1994.

About one in three people who had gallstones or their gallbladders removed died from any cause during the follow-up time, compared to about one in seven similarly aged people without the disease.

Heart disease claimed the lives of slightly less than one in five gallstone sufferers, compared to one in 20 people without. Death from cancer was also more likely, with one in ten people with gallstones falling victim, compared to one in 25 people without the disease.

The researchers followed all patients until 2006, and recorded all causes of death from the patients’ death certificates.

One of the authors on the paper, from Social and Scientific Systems Inc., did not respond by deadline, and the other, at the National Institutes of Health, declined to comment.

Severe gallstones are usually treated by cutting out the gallbladder, said Barie, who does such operations. The risk of dying from an emergency gallbladder surgery is about one in fifty, depending on the age of the patient. But if the gallbladder is removed before it becomes an emergency, the risk of dying is only about one in 500, he said.

Barie suggests that people with gallstones keep on a low fat diet to reduce the risks of heart disease or stroke.

“Just a good healthy diet,” he said.

SOURCE: bit.ly/i4Rkdw Gastroenterology, online November 15, 2010.

How Gallbladder Surgery Gave Me My Life Back

Richard Brown recalls the first sign that something was wrong: He had intense abdominal pressure and pain. “I was passing blood in my bowel and throwing up,” he says. In February 2015, Brown was diagnosed with gallstones  — one of the leading causes of gastrointestinal-related hospital admissions, according to the Society of Gastrointestinal and Endoscopic Surgeons.

As many as 25 million Americans have or will develop gallstones, a disease of the gallbladder. The gallbladder is a small organ that stores bile produced by the liver to help break down fat during digestion. Gallstones form when particles in the bile clump together into hard stones. They can cause inflammation of the gallbladder (cholecystitis) or bile duct (cholangitis).

Certain factors — such as being a woman, obesity, and family history  — can raise your chances of developing gallstones, but anyone can get them. While gallstones are common, their severity and treatment vary.

“Gallbladder disease lies on a spectrum,” says Todd Baron, MD, director of advanced therapeutic endoscopy at the University of North Carolina School of Medicine. “At one end, there are no symptoms. At the other end of the spectrum is life-threatening cholecystitis. In between are patients with intermittent biliary [gallbladder or bile duct] pain.”

Gallstone symptoms usually follow a predictable pattern, with pain below the sternum or rib cage, says Julie Yang, MD, a gastroenterologist at Montefiore Health System in New York. The pain can be steady, lasting four to six hours, and may radiate into the back and right shoulder, sometimes accompanied by nausea or vomiting.

The good news is that only 2 to 3 percent of people with gallstones require treatment. In such cases, the gallbladder is often surgically removed — known as a cholecystectomy. Using laparoscopic technology through several small incisions in the abdomen, the surgery is minimally invasive and recovery is generally quick. Cholecystectomy is the most common elective abdominal surgery performed in this country, with over 750,000 performed each year.

Open gallbladder surgery, in which the organ is removed through a single, large incision, is reserved for patients who had complications during laparoscopic surgery, such as gallbladder inflammation or infection. A relatively new procedure known as NOTES (natural orifice transluminal endoscopic surgery) involves incision-free surgery using a natural orifice such as the patient’s mouth or vagina to remove the gallbladder.

RELATED: 10 Essential Facts About Your Gallbladder

Brown, a patient of Dr. Baron’s, was not a candidate for gallbladder removal because of a co-existing health condition  — cirrhosis, or scarring of the liver. Large blood vessels around Brown’s liver made the surgery too high risk. As a temporary treatment, Baron installed a tube in the side of Brown’s abdomen to drain the bile externally, a procedure called percutaneous cholecystostomy.

“Percutaneous cholecystostomy is not a good long-term strategy,” Baron says. “It’s a bridge to something else.”

That “something else” for Brown was transmural endoscopic drainage, in which a small mesh tube, or a stent, is implanted to allow bile to flow directly from the gallbladder into the small intestine. The procedure allows future stones to pass through the stent without causing complications.

For Brown, 58, who lives in Jackson, North Carolina, it has been a life-changer. After the surgery, he was able to return to favorite outdoor activities such a working in his yard and fishing. “I can work in my yard for six or seven hours,” Brown says. “I can do more than people half my age.”

Baron and Yang note that there is still no long-term data about gallbladder stents; and, like NOTES, the procedure is not widely performed at many medical institutions. “We must be careful not to oversell these treatments,” Baron stresses.

Baron recently led a team of experts in a review of gallbladder surgery options.  “Whether the approach to the management of gallbladder disease is surgical, endoscopic…or percutaneous,” they wrote in last month’s New England Journal of Medicine, “the most important considerations in selecting an approach are the patient’s overall medical condition and the local and systemic consequences of the disease.”

If your doctor is recommending gallbladder surgery, Baron suggests that you “ask your physician how many procedures he or she has done, and what their complication rate is. Ask about other treatment options.”

Gallstones: Should I Have Gallbladder Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor’s recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Gallstones: Should I Have Gallbladder Surgery?

Get the facts

Your options

• Have surgery to remove your gallbladder.
• Don’t have surgery. Wait and see if you have another attack.

Key points to remember

• If you feel comfortable managing mild and infrequent gallstone attacks, and if your doctor thinks that you aren’t likely to have serious complications, it’s okay not to have surgery.
• Most doctors recommend surgery if you have had repeated attacks. If you have had one attack of gallstone pain, you may want to wait to see whether you have more.
• Surgery is the best way to prevent gallstone attacks. The surgery is very common, so doctors have a lot of experience with it.
• Your body will work fine without a gallbladder. There may be small changes in how you digest food, but you probably won’t notice them.

FAQs

Gallstones are stones made of cholesterol and other things found in bile. They form in the gallbladder or bile duct. They may be as small as a grain of sand or as large as a golf ball.

Most people with gallstones have no symptoms and don’t need treatment. Those who do have symptoms often have surgery to remove the gallbladder.

In people who do have symptoms, the most common one is pain in the upper right area of your belly. Other symptoms include nausea and vomiting.

Symptoms usually don’t come back after the gallbladder has been removed.

If gallstones block a duct, you may get jaundice. Jaundice makes your skin and the whites of your eyes yellow. It can also cause dark urine and light-coloured stools.

Laparoscopic gallbladder surgery is the most common surgery done to remove the gallbladder. The doctor inserts a lighted viewing instrument called a laparoscope and surgical tools into your belly through several small cuts. This type of surgery is very safe. People who have it usually recover enough in 7 to 10 days to go back to work or to their normal routine.

Open gallbladder surgery involves taking the gallbladder out through one larger incision in your belly. Open surgery may be done if laparoscopic surgery is not an option or when problems are found during laparoscopic surgery. The hospital stay is longer with open surgery.

Stones in the bile duct

If gallstones are found in the common bile duct before or during surgery to remove the gallbladder, a doctor may do a procedure called an ERCP (endoscopic retrograde cholangiopancreatogram). This involves putting a tube called an endoscope down your throat to your small intestine. The doctor uses the scope to look for stones in the duct and remove them.

The overall risk from laparoscopic gallbladder surgery is very low. The most serious risks include:

• Infection.
• Bleeding.
• Injury to the common bile duct.
• Injury to the small intestine by one of the tools used during surgery.

Risks from open gallbladder surgery include:

• Injury to the common bile duct.
• Bleeding.
• Infection.
• Injuries to the liver, intestines, or major blood vessels in the belly.
• Blood clots or pneumonia related to the longer recovery period after open surgery.

Both surgeries have the risks of general anesthesia.

Post-cholecystectomy syndrome

After gallbladder surgery (cholecystectomy), a few people have ongoing symptoms, such as belly pain, bloating, gas, or diarrhea. This is called post-cholecystectomy syndrome. These symptoms can be treated with medicines.

There is little risk in not having surgery if you have only one mild attack. But if you have more than one painful attack, you’re likely to have more in the future.

The risks of not treating gallstones may include:

• Unpredictable attacks of gallstone pain.
• Episodes of inflammation or serious infection of the gallbladder, bile ducts, or pancreas.
• Jaundice and other symptoms caused by blockage of the common bile duct. Jaundice makes your skin and the whites of your eyes yellow. It can also cause dark urine and light-coloured stools.

About 1 out of 3 people with gallstones who have a single attack of pain or other symptoms do not have symptoms again.^{footnote 1} That means that 2 out of 3 people do have another attack.

You may be able to prevent gallstone attacks if you:

• Stay close to a healthy weight by eating a balanced diet and getting regular exercise.
• Avoid rapid weight loss. When you lose weight by dieting and then you gain weight back again, you increase your risk of gallstones, especially if you are a woman. If you need to lose weight, do it slowly and sensibly.

Your doctor may recommend surgery if:

• You have repeated gallstone attacks.
• The pain from the attacks is severe.
• You have complications, such as inflammation of the gallbladder or the pancreas.
• You have an impaired immune system.

Compare your options

Compare Option 1Have gallbladder surgeryDon’t have surgery

Compare Option 2Have gallbladder surgeryDon’t have surgery

Have gallbladder surgery Have gallbladder surgery

• You are asleep during surgery.
• You may go home the same day, or you may stay in the hospital for a day or two. If you have open surgery, your hospital stay will be longer.
• You can return to your normal activities within a week to 10 days. If you have open surgery, it will take 4 to 6 weeks.

• Surgery gets rid of the gallstones and usually keeps them from coming back.
• The surgery is safe and is very common.

• All surgery has risks, including bleeding and infection. Your age and your health also can affect your risk.
• Risk from laparoscopic surgery is very low. Possible problems include injury to the common bile duct or the small intestine.
• After surgery, a few people have ongoing symptoms, called post-cholecystectomy syndrome.

Don’t have surgery Don’t have surgery

• You try to prevent another attack by eating a balanced diet and getting regular exercise to stay close to a healthy weight.
• You avoid losing weight too quickly.

• You avoid the risks of surgery.

• You may have more gallstone attacks.
• You may have episodes of inflammation or infection of the gallbladder, bile ducts, or pancreas.
• You may have jaundice and other symptoms caused by blockage of the common bile duct.

I have had a couple of gallbladder attacks over the past few years. They weren’t too bad, but I did take a sick day or two each time. Because I travel several times a month for work, I have decided to have my gallbladder removed. That way I won’t have to worry about having an attack while I am away on business, possibly even out of the country.

When I was pregnant, my doctor discovered that I have gallstones. We talked it over, and it turns out that it’s possible that the stomach pain I had a couple of years ago might have been related to my gallstones. I haven’t had any problems since then, so we agreed to wait and see if I have another attack. If I do, we can do some tests and find out if the pain is caused by the gallstones. I don’t want to have surgery if there is no need.

My first gallstone attack was pretty painful. I know I could handle another attack if it happens, but I would just as soon have surgery and know that I won’t have another one.

My gallbladder attacks have been pretty mild so far, and I’ve only had two in the past 5 years. I’m not too concerned about it. My doctor told me the signs of a more serious problem, so I feel well-prepared for another one, if it happens. We agree that I don’t need surgery now.

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have gallbladder surgery

Reasons not to have gallbladder surgery

The pain from my gallstone attacks is very bad.

I have had one or more gallstone attacks, but they don’t hurt much.

More important

Equally important

More important

The thought of having more attacks is worse than the thought of having surgery.

I want to avoid surgery if I possibly can.

More important

Equally important

More important

I do a lot of travelling to places where I may not be able to get help if I have a serious attack.

I’m never too far away from medical treatment.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you’ve thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having gallbladder surgery

NOT having gallbladder surgery

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

1.1, It’s all right not to choose surgery if I’ve only had one mild gallstone attack.2.2, Having surgery is the best way to get rid of my gallstones.3.3, I could be putting my future health in danger if I have my gallbladder removed.1.1,Do you understand the options available to you?2.2,Are you clear about which benefits and side effects matter most to you?3.3,Do you have enough support and advice from others to make a choice?

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2.2, Check what you need to do before you make this decision.

3. Use the following space to list questions, concerns, and next steps.

Your Summary

Here’s a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Next steps

Which way you’re leaning

How sure you are

Your comments

Key concepts that you understood

Key concepts that may need review

Credits

References

Citations

1. Wang DQH, Afdhal NH (2010). Gallstone disease. In M Feldman et al., eds., Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 9th ed., vol. 1 , pp. 1089–1120. Philadelphia: Saunders.

You may want to have a say in this decision, or you may simply want to follow your doctor’s recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Gallstones: Should I Have Gallbladder Surgery?

Here’s a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

1. Get the facts
2. Compare your options
3. What matters most to you?
4. Where are you leaning now?
5. What else do you need to make your decision?

1. Get the Facts

Your options

• Have surgery to remove your gallbladder.
• Don’t have surgery. Wait and see if you have another attack.

Key points to remember

• If you feel comfortable managing mild and infrequent gallstone attacks, and if your doctor thinks that you aren’t likely to have serious complications, it’s okay not to have surgery.
• Most doctors recommend surgery if you have had repeated attacks. If you have had one attack of gallstone pain, you may want to wait to see whether you have more.
• Surgery is the best way to prevent gallstone attacks. The surgery is very common, so doctors have a lot of experience with it.
• Your body will work fine without a gallbladder. There may be small changes in how you digest food, but you probably won’t notice them.

FAQs

What are gallstones?

Gallstones are stones made of cholesterol and other things found in bile. They form in the gallbladder or bile duct. They may be as small as a grain of sand or as large as a golf ball.

Most people with gallstones have no symptoms and don’t need treatment. Those who do have symptoms often have surgery to remove the gallbladder.

In people who do have symptoms, the most common one is pain in the upper right area of your belly. Other symptoms include nausea and vomiting.

Symptoms usually don’t come back after the gallbladder has been removed.

If gallstones block a duct, you may get jaundice. Jaundice makes your skin and the whites of your eyes yellow. It can also cause dark urine and light-coloured stools.

What is the surgery to remove the gallbladder?

Laparoscopic gallbladder surgery is the most common surgery done to remove the gallbladder. The doctor inserts a lighted viewing instrument called a laparoscope and surgical tools into your belly through several small cuts. This type of surgery is very safe. People who have it usually recover enough in 7 to 10 days to go back to work or to their normal routine.

Open gallbladder surgery involves taking the gallbladder out through one larger incision in your belly. Open surgery may be done if laparoscopic surgery is not an option or when problems are found during laparoscopic surgery. The hospital stay is longer with open surgery.

Stones in the bile duct

If gallstones are found in the common bile duct before or during surgery to remove the gallbladder, a doctor may do a procedure called an ERCP (endoscopic retrograde cholangiopancreatogram). This involves putting a tube called an endoscope down your throat to your small intestine. The doctor uses the scope to look for stones in the duct and remove them.

What are the risks of gallbladder surgery?

The overall risk from laparoscopic gallbladder surgery is very low. The most serious risks include:

• Infection.
• Bleeding.
• Injury to the common bile duct.
• Injury to the small intestine by one of the tools used during surgery.

Risks from open gallbladder surgery include:

• Injury to the common bile duct.
• Bleeding.
• Infection.
• Injuries to the liver, intestines, or major blood vessels in the belly.
• Blood clots or pneumonia related to the longer recovery period after open surgery.

Both surgeries have the risks of general anesthesia.

Post-cholecystectomy syndrome

After gallbladder surgery (cholecystectomy), a few people have ongoing symptoms, such as belly pain, bloating, gas, or diarrhea. This is called post-cholecystectomy syndrome. These symptoms can be treated with medicines.

What are the risks of NOT having the gallbladder removed?

There is little risk in not having surgery if you have only one mild attack. But if you have more than one painful attack, you’re likely to have more in the future.

The risks of not treating gallstones may include:

• Unpredictable attacks of gallstone pain.
• Episodes of inflammation or serious infection of the gallbladder, bile ducts, or pancreas.
• Jaundice and other symptoms caused by blockage of the common bile duct. Jaundice makes your skin and the whites of your eyes yellow. It can also cause dark urine and light-coloured stools.

About 1 out of 3 people with gallstones who have a single attack of pain or other symptoms do not have symptoms again.¹ That means that 2 out of 3 people do have another attack.

If you decide against surgery, what can you do to prevent another attack?

You may be able to prevent gallstone attacks if you:

• Stay close to a healthy weight by eating a balanced diet and getting regular exercise.
• Avoid rapid weight loss. When you lose weight by dieting and then you gain weight back again, you increase your risk of gallstones, especially if you are a woman. If you need to lose weight, do it slowly and sensibly.

Why might your doctor recommend gallbladder surgery?

Your doctor may recommend surgery if:

• You have repeated gallstone attacks.
• The pain from the attacks is severe.
• You have complications, such as inflammation of the gallbladder or the pancreas.
• You have an impaired immune system.

2. Compare your options

Personal stories

Personal stories about gallbladder surgery for gallstones

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

“I have had a couple of gallbladder attacks over the past few years. They weren’t too bad, but I did take a sick day or two each time. Because I travel several times a month for work, I have decided to have my gallbladder removed. That way I won’t have to worry about having an attack while I am away on business, possibly even out of the country.”

“When I was pregnant, my doctor discovered that I have gallstones. We talked it over, and it turns out that it’s possible that the stomach pain I had a couple of years ago might have been related to my gallstones. I haven’t had any problems since then, so we agreed to wait and see if I have another attack. If I do, we can do some tests and find out if the pain is caused by the gallstones. I don’t want to have surgery if there is no need.”

“My first gallstone attack was pretty painful. I know I could handle another attack if it happens, but I would just as soon have surgery and know that I won’t have another one.”

“My gallbladder attacks have been pretty mild so far, and I’ve only had two in the past 5 years. I’m not too concerned about it. My doctor told me the signs of a more serious problem, so I feel well-prepared for another one, if it happens. We agree that I don’t need surgery now.”

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have gallbladder surgery

Reasons not to have gallbladder surgery

The pain from my gallstone attacks is very bad.

I have had one or more gallstone attacks, but they don’t hurt much.

More important

Equally important

More important

The thought of having more attacks is worse than the thought of having surgery.

I want to avoid surgery if I possibly can.

More important

Equally important

More important

I do a lot of travelling to places where I may not be able to get help if I have a serious attack.

I’m never too far away from medical treatment.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you’ve thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having gallbladder surgery

NOT having gallbladder surgery

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1. It’s all right not to choose surgery if I’ve only had one mild gallstone attack.

You’re right. It’s okay not to have surgery if you feel you can manage mild and infrequent attacks and if your doctor thinks you’re not likely to have serious problems.

2. Having surgery is the best way to get rid of my gallstones.

That’s right. Surgery gets rid of the gallstones and usually keeps them from coming back. The surgery is safe and widely done.

3. I could be putting my future health in danger if I have my gallbladder removed.

Correct. Your body will work fine without a gallbladder. There may be small changes in how you digest food, but you probably won’t notice them.

Decide what’s next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

3. Use the following space to list questions, concerns, and next steps.

Credits

References

Citations

1. Wang DQH, Afdhal NH (2010). Gallstone disease. In M Feldman et al., eds., Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 9th ed., vol. 1 , pp. 1089–1120. Philadelphia: Saunders.

Note: The “printer friendly” document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Current as of: February 10, 2021

Author: Healthwise Staff

Medical Review:E. Gregory Thompson MD – Internal Medicine & Brian D. O’Brien MD – Internal Medicine & Adam Husney MD – Family Medicine & Arvydas D. Vanagunas MD – Gastroenterology & Kenneth Bark MD – General Surgery, Colon and Rectal Surgery

Wang DQH, Afdhal NH (2010). Gallstone disease. In M Feldman et al., eds., Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 9th ed., vol. 1 , pp. 1089-1120. Philadelphia: Saunders.

The Stone Guest – Moskovsky Komsomolets

Gallstone disease, which will be discussed today, has an ancient history. Mentions of her and methods of treatment have been found since the time of Hippocrates. The number of people suffering from this disease has always been great, and for many centuries, doctors have been looking for ways to get rid of the “yellow disease”.

Today in the arsenal of doctors there are many different methods of treating gallstone disease. It is extremely difficult for a person who does not have medical education to understand this diversity.The wrong approach threatens with big trouble – for the sick first of all. What does the right decision mean? And how do you find it? What can modern medicine do in this regard? All these and many other questions are answered by the Head of the Department of Surgery of the Center for Endosurgery and Lithotripsy, Candidate of Medical Sciences Sergey Alexandrovich Gordeev.

A bit of history Gallstone disease has suffered throughout the history of mankind. In one of the Egyptian mummies, for example, gallstones were found during research.Such an interesting fact is also known: in ancient times, gallstones were used for fortune telling and as decorations. Mentions of gallstone disease are found in the writings of doctors from about the XIV century AD. In 1341 in Padua, while embalming the corpse of a noble woman, Gentile da Foligno described a “large green stone” found in the gall bladder of a deceased woman.
Later, already in the 17th century, Albrecht Haller first proposed a classification in which all stones were divided into large egg-shaped ones, consisting of “a tasteless yellowish substance that melts when heated, like sealing wax, and can burn”, and smaller, dark-colored.So, “having tasted it,” Haller proposed a simplified classification, which is still used today, distinguishing stones by their composition: cholesterol and pigmented. … and some statistics In our time, gallstone disease is one of the most common diseases. It is no coincidence that it is called “the disease of the century”. Stones in the gallbladder and ducts are detected on average in 10-20% of the adult population. Almost every fifth of us is susceptible to this disease. By the way, women on average get sick five times more often than men.Perhaps, you will hardly find in our country a family in which at least one of its members did not have a “bilious” problem.
The incidence of cholelithiasis, as statistics show, increases with the development of civilization. According to clinical observations, in post-war Russia, the incidence almost doubles every ten years.
This is the trend in almost all developed countries of the world. Causes? Unhealthy diet, excessive consumption of fatty high-calorie foods, unfavorable ecological environment, stress factors and much more, which gives us a rapidly developing civilized society.An aggravating factor is the growing number of people with obesity and other diseases of “civilization”. In these people, gallstone disease occurs much more often. Imagine that the lowest incidence of this disease is found on the African continent among the aborigines and it is only 1%, and in some tribes it is absent altogether. Why are stones formed? God, creating the first man, in all likelihood, still counted on the fact that his creation would live in the Garden of Eden and eat organic food.What came of this – we know very well. In what ecological environment we live, what we eat and what we drink, it is unnecessary to comment. There are more than enough factors that create conditions for the occurrence of gallstone disease. After all, the bile produced by the liver has a rather complex composition. Cholesterol, phospholipids and bile acids are in it in the form of complex molecules called “micelles”. Any violation of the composition of bile leads to the loss of its insoluble components in the form of stones. This bile is called “lithogenic” (prone to stone formation).
Predispose to it – stagnation of bile in the bladder as a result of its atony, inflammatory changes in its wall, excessive consumption of fatty foods. Add here a genetic predisposition, diseases of the gastrointestinal tract, immune disorders, etc.
Therefore, it is important to timely monitor and eliminate risk factors for the appearance of stones in the gallbladder. Today there are all conditions for this: diagnostic methods, such as ultrasound examination, laboratory studies and much more, have been improved.Doctors recommend starting with an ultrasound of the liver and biliary tract. This study is the most informative today and in the hands of a specialist has one hundred percent diagnostic value. Can you do nothing with stones? This question worries every patient who is faced with a problem. Alas, nothing can be done. The fact is that not the stones themselves, but the complications associated with their presence, are the main danger. Long-term presence of stones in the gallbladder causes chronic inflammation of its wall: thickening and scarring.Such an organ is no longer able to adequately contract, it actually becomes a stone collector and a source of infection. Hence the unpleasant prospects. The most common complication is acute cholecystitis, which becomes phlegmonous (purulent) in 40% of patients. Inflammatory changes in the wall often lead to its perforation, the spread of infection outside the bladder and the development of peritonitis.
It is even worse if the gallbladder manages to “push” the stones into the bile duct. Most often, choledocholithiasis – this is the name of this complication – occurs with multiple small stones of the gallbladder.Even a small stone that gets into the common bile duct can completely block its lumen. The subsequent increase in bile pressure in the duct leads to damage to liver cells and the occurrence of obstructive jaundice.
Large stones can cause pressure ulcers of the bladder, followed by the formation of fistulas with adjacent organs. With age, the number of complications increases. And where the planned removal of the gallbladder could in due time solve the problem of “illness and health”, a situation arises when the question is about “life and death”.
The idea of ​​dispensing with surgery is certainly very tempting for both the patient and the doctor. In the late 1930s, an attempt was made to dissolve gallstones with a mixture containing a mixture of bile acids. However, the technique did not meet the expectations of the researchers. Most of the stones do not lend themselves to drug dissolution, the prescription of drugs has a lot of contraindications and requires long-term use.
Lithotripsy – stone crushing is another method of conservative treatment of gallstone disease.The Center for Endosurgery and Lithotripsy is one of the first institutions in our country where this method of treatment was applied. However, the frequent recurrence of stones made the procedure practically abandoned. Thus, removal of the gallbladder (cholecystectomy) remains the only radical treatment for gallstone disease. If a person wants to get rid of stones, he must get used to the idea of ​​the need to remove them together with a diseased gallbladder. How to live without a gallbladder? The gallbladder has an important function in the body: it is a kind of reservoir that “pumps up” bile and creates its portioned flow into the duodenum.But imagine that this tank is clogged with stones and sand. What kind of work could there be? After removal of the gallbladder, bile is constantly flowing into the intestine through the common bile duct. At the same time, the physiology of the process is not disturbed, and the lack of portioning is compensated by the body without any problems. In this case, the flow of bile through a narrow duct does not create conditions for stone formation.
Doctors of the Center for Endosurgery and Lithotripsy have gone through almost all the historical stages of treatment of gallstone disease, starting to do this back in 1991.For more than ten years, various methods of treatment have been tested: from crushing stones to the treatment of the most complex forms of choledocholithiasis using laparoscopic techniques. Professionalism and experience are the ingredients of success. At the very beginning, the only correct direction of treatment was chosen – radical deliverance of the patient from the problem using the least traumatic techniques. To operate not for the sake of an operation, but for the sake of the patient has become the main and humane ideology of the surgeons of our center.
The first laparoscopic cholecystectomy performed at the CELT in 1991 lasted more than two hours, squeezed out a lot of sweat and energy from the team, but the result exceeded all expectations.The woman walked around the ward the very next day after the intervention, and the funniest thing is that she refused to believe that her bladder had been removed through small holes in her stomach. Today it is already history. Today, in many clinics, laparoscopic cholecystectomy is performed, it has entered the category of proven techniques.
Along with regular operations, the Endosurgery Center is constantly improving new methods of treatment. The priority area at present is the treatment of complicated forms of gallstone disease – of course, by minimally traumatic methods.A frequent client in these conditions was a “refusenik” – a patient who was refused laparoscopic surgery in other hospitals. Today, extensive experience has been accumulated in the treatment of acute, phlegmonous and even gangrenous forms of cholecystitis.
In choledocholithiasis (stones in the bile ducts), CELT surgeons have developed algorithms for surgical tactics, including low-traumatic techniques for the gradual removal of stones from the ducts with subsequent removal of the gallbladder. To facilitate the extraction of “difficult” stones stuck in the common bile duct, specialists of the CELT Department of Surgery were among the first in the country to use lithotripsy.Fortunately, there are opportunities for this. Almost all patients who came to the Center with stones left without them. The process of improving treatment methods is ongoing. Today CELT is a leader in the treatment of various forms of gallstone disease with low-trauma methods. Believe me, these are not empty words. Behind them is one of the best surgical teams in Russia, which has worked in a single team for almost 15 years, and has more than 10,000 successful operations.

For more information on the work of the department of surgery CELT you can get a single multi-line phone 788-33-88 or on the clinic’s website at www.celt.ru.
License of the Moscow City Health Department, MDKZ 17517/8976 series. Valid until February 1, 2009

May 28, 2004

About the operation to remove the gallbladder

This guide will help you prepare for your gallbladder surgery at Memorial Sloan Kettering (MSK). They will also help you understand what to expect as you recover.

Read this manual at least once before your surgery and use it as a reference as you prepare for the day of your surgery.

Take this guide with you to all visits to MSK, including the day of your surgery. You and your healthcare team will guide you through your treatment.

to come back to the beginning

Transaction Information

Gallbladder

The gallbladder is a small, tear-shaped organ located under the liver (see Figure 1). Its main function is to store bile. Bile is a substance produced in the liver and helps the body to digest fat.The gallbladder secretes bile when food, especially fatty food, enters the digestive tract. After removal of the gallbladder, the liver will begin to perform this function.

Figure 1. Gallbladder

Operation to remove the gallbladder

Cholecystectomy is an operation to remove the gallbladder. The gallbladder can be removed in one of two ways – by laparoscopy or through an open incision (surgical incision).Your surgeon will discuss with you which option is best for you.

Operation laparoscopy

When removing the gallbladder by laparoscopy, your surgeon will make 4 very small incisions (see Figure 2). Each one will be approximately ½ inch (1.27 cm) long.

Figure 2. Incisions during laparoscopic cholecystectomy

One of the incisions is made in or near the navel. Your surgeon will insert an instrument called a laparoscope through this incision.A laparoscope is a thin tube with a video camera at the end. Carbon dioxide is pumped into the abdomen (belly) to expand it. The result is a space that allows the surgeon to see your organs and tissues freely. Through the remaining holes, other instruments are inserted to remove the gallbladder. The gallbladder is then removed through an incision in the navel.

Laparoscopic gallbladder removal takes about 1–2 hours. In some cases, patients are able to return home on the day of surgery.

Open Transaction

In about 10% of cases, the gallbladder must be removed through a larger incision made from top to bottom in the center of the abdomen. This operation takes about 2 hours.

to come back to the beginning

Before surgery

The information in this section will help you prepare for your surgery. Read this section after you have assigned your surgery and refer to it as the date of your surgery approaches. It contains important information about what you need to do before your surgery.

As you read this section, write down the questions you want to ask your healthcare provider.

Preparation for surgery

You and your healthcare team will prepare for your surgery together.

Help us make your transaction as secure as possible: Tell us if any of the statements below match your situation, even if you’re not entirely sure.

• I am taking blood thinning medication, for example:
  • aspirin;
  • Heparin
  • Warfarin (Jantoven ^® or Coumadin ^® )
  • Clopidogrel (Plavix ^® )
  • Enoxaparin (Lovenox ^® )
  • Dabigatran (Pradaxa ^® )
  • Apixaban (Eliquis ^® )
  • Rivaroxaban (Xarelto ^® )

  There are other similar medications, so be sure to tell your healthcare provider about any medications you are taking.

• I am taking prescription drugs (prescribed by my healthcare provider), including patches and ointments.
• I take over-the-counter medicines (which I buy without a prescription), including patches and ointments.
• I am taking nutritional supplements such as herbs, vitamins, minerals, and natural or home remedies.
• I have a pacemaker, automatic implantable cardioverter defibrillator (AICD), or other cardiac pacemaker.
• I have sleep apnea attacks.
• I used to have problems with anesthesia (with a medication that makes me fall asleep during surgery).
• I am allergic to some drugs or materials such as latex.
• I don’t want to have a blood transfusion.
• I drink alcohol.
• I smoke or use electronic smoking devices (eg disposable e-cigarettes, vape, Juul ^® ).
• I am taking soft drugs.

On alcohol use

The amount of alcohol you drink may affect your condition during and after surgery. It is very important to tell healthcare providers how much alcohol you are drinking. This will help us plan your treatment.

• If you stop drinking abruptly, it can cause seizures, alcoholic delirium and death.
  If we know that you are at risk for these complications, we can prescribe medications for you to avoid them.
• If you drink alcohol regularly, there is a risk of other complications during and after surgery. These include bleeding, infections, heart problems, and longer hospital care.

To prevent possible problems, before the operation, you can:

• Be honest with healthcare providers how much alcohol you drink.
• After the appointment of the operation, try to stop drinking alcoholic beverages.If, after stopping alcoholic beverages, you experience headaches, nausea (vomiting sensation), increased anxiety, or have trouble sleeping, tell your healthcare provider right away. These are early signs of alcohol withdrawal that can be treated.
• Tell your healthcare provider if you are unable to stop drinking.
• Ask your healthcare provider questions about how drinking alcohol might affect your body in connection with surgery.As always, we will ensure the confidentiality of all your medical information.

About smoking

During surgery, smokers may experience breathing problems. Quitting smoking even a few days before surgery will help prevent these problems. If you smoke, your healthcare provider will refer you to the Tobacco Treatment Program. You can also contact this program by calling 212-610-0507.

Sleep Apnea Information

Sleep apnea is a common breathing disorder that causes a person to stop breathing for a short period during sleep.The most common type is obstructive sleep apnea (OSA). In OSA, the airway is completely blocked during sleep. OSA can cause serious complications during and after surgery.

Let us know if you have sleep apnea attacks, or if you think you may have such attacks. If you are using a breathing apparatus (such as a CPAP machine) to prevent sleep apnea, take it with you on the day of surgery.

Within 30 days prior to surgery

Preoperative study

Before your surgery, you will be assigned a presurgical testing (PST). The date, time and location will be indicated in the appointment reminder that you receive at the surgeon’s office. You will help us if you take with you to the preoperative examination:

• A list of all the medicines you take, including prescription and over-the-counter medicines, patches, and creams.

90,083 Results of any tests you did outside of MSK, such as exercise ECG, echocardiogram, or carotid Doppler

90,083 names and phone numbers of the medical staff treating you.

On the day of your appointment, you can take your food and medicine as usual.

During the preoperative examination, you will meet a highly qualified nurse. This is a medical professional who works with anesthesiologists (medical personnel who have received special training who will perform anesthesia during surgery). A senior nurse / nurse will review your medical record and your surgical history with you. You will need to undergo a number of tests, including an electrocardiogram (EKG) to check your heart rate, chest x-rays, blood tests, and other tests needed to plan your treatment.In addition, a trained nurse can refer you to other specialists.

The Nurse will also advise you on what medications you will need to take on the morning of your surgery.

Decide who will look after you

Your caregiver plays an important role in your treatment. Before your surgery, your healthcare team will tell you and your caregiver about the surgery. In addition, the person will need to take you home after your surgery and discharge from the hospital.Also, this person will help you at home.

Information for caregivers

Existing materials and support are available to help you meet the many responsibilities that come with caring for someone undergoing cancer treatment. For support resources and information, visit www.mskcc.org/caregivers or read the resource Guide for Caregivers
…

Complete the Health Care Proxy Form

If you have not yet completed the Health Care Proxy, we recommend that you do so now.If you have already completed this form or have other advance directives, please take them with you to your next appointment.

The Power of Attorney for Health Care Decisions is a legal document that specifies the person who will represent you in the event that you are unable to do so on your own. The person listed there will be your health care agent.

Talk to your healthcare provider if you are interested in completing a power of attorney to make healthcare decisions.You can also read the resources Advance Care Planning and How to Be a Care Representative for information about health care proxies, other advance directives, and acting as a health care agent.

Perform breathing and coughing exercises

Take deep breaths and clear your throat before surgery. Your healthcare provider will give you a stimulation spirometer to help expand your lungs.For more information, see the resource How to use your incentive spirometer. If you have any questions, ask your healthcare provider.

Stick to a healthy diet

Aim to eat a well-balanced, healthy diet prior to surgery. If you need help with diet planning, ask your healthcare provider to refer you to a dietitian nutritionist.

Buy a 4% chlorhexidine gluconate (CHG) antiseptic cleanser (such as Hibiclens®).

4% CHG solution is a skin cleanser that kills various microorganisms and prevents their appearance within 24 hours after use. Showering with this solution before surgery will reduce your risk of infection after surgery. You can purchase a 4% CHG antiseptic skin cleanser at your local pharmacy without a prescription.

7 days before surgery

Follow your healthcare provider’s instructions when taking aspirin

If you are taking aspirin and any medicines containing aspirin, you may need to change your dose or not take them within 7 days of your surgery.Aspirin can cause bleeding.

Follow your healthcare provider’s instructions. Do not stop taking aspirin unless directed to do so. Read the resource Common Medicines Containing Aspirin and Other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) or Vitamin E for more information.

Stop taking vitamin E, multivitamins, herbal remedies and other dietary supplements

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before surgery.These medicines can cause bleeding. For more information, read the resource Herbal Remedies and Cancer Treatments.

2 days before surgery

Stop taking nonsteroidal anti-inflammatory drugs [NSAIDs].

Stop taking NSAIDs such as ibuprofen (Advil ^® and Motrin ^® ) and naproxen (Aleve ^® ) 2 days before surgery. These medicines can cause bleeding.For more information, read the resource Common Medicines Containing Aspirin and Other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) or Vitamin E.

1 day before surgery

Record the time at which the operation is scheduled

An admissions officer will call you after 2:00 pm the day before your surgery. If your surgery is scheduled for a Monday, you will receive a call the previous Friday. If no one contacts you by 19:00, please call 212-639-5014.

A staff member will tell you when you should come to the hospital for your surgery. You will also be reminded how to get to the ward.

The operation will be performed at one of the following addresses:

Presurgical Center,
^{located at 1275 York Avenue (between East 67 th Street and East 68 th Street),
New York, NY 10065
2nd Floor Elevator M}

Presurgical Center,
^{located at 1275 York Avenue (between East 67 th Street and East 68 th Street)
New York, NY 10065
6th Floor , Elevator B}

Shower with a 4% CHG antiseptic cleanser (e.g. Hibiclens®)

The evening before the day of surgery, shower with a 4% CHG antiseptic cleanser.

1. Wash hair with regular shampoo. Rinse your hair thoroughly.
2. Wash your face and genital area with your regular soap. Rinse your body thoroughly with warm water.
3. Open the 4% CHG solution. Pour a small amount into your hand or onto a clean washcloth.
4. Move away from the water jet. Massage the 4% CHG solution lightly into the body from neck to feet. Do not apply it to your face or genital area.
5. Return under tap water and rinse with 4% CHG solution.Use warm water.
6. After showering, dry yourself with a clean towel.
7. Do not use any type of lotion, cream, deodorant, makeup, powder, perfume or cologne after showering.

Sleep

Go to bed early and try to get a good night’s sleep.

Instructions for eating before surgery

Do not eat after midnight before your surgery. This also applies to candy and chewing gum.

Morning before surgery

Instructions for drinking drinks before surgery

• If your healthcare provider has prescribed CF (Preop) ^® , drink it two hours before your scheduled arrival time at the hospital. After midnight before your surgery, do not drink anything else, this also applies to water.
• Unless your healthcare provider has prescribed you CF (Preop), you may not drink more than 12 ounces (350 ml) of water between midnight and two hours before your scheduled hospital arrival time. Don’t drink anything else.

Do not drink any more fluids 2 hours before your scheduled arrival time at the hospital. This also applies to water.

Take medication as directed

If your healthcare provider tells you to take some medicines in the morning before your surgery, take only those medicines with a small sip of water. Depending on the medications, this may be all or some of the medications you usually take in the morning, or you may not need to take them at all.

Shower with a 4% CHG antiseptic cleanser (e.g. Hibiclens®)

Shower with 4% CHG antiseptic skin cleanser before leaving the hospital.Use the same remedy you used the night before.

Do not apply any lotion, cream, deodorant, makeup, powder, perfume or cologne after a shower.

Points to Remember

• Wear comfortable, loose-fitting clothing.
• If you wear contact lenses, remove them and put on glasses. During surgery, contact lenses can injure your eyes.
• Do not wear metal objects. Remove all jewelry, including body piercings.The equipment used during the operation may cause burns if it comes into contact with metal.
• Do not use any lotion, cream, deodorant, makeup, powder, perfume, or cologne.
• Leave valuables at home (such as credit cards, jewelry, and a checkbook).
• If your period (period) starts, use a sanitary towel, not a tampon. You will be given disposable underwear and a pad if needed.

What to take with you

• Loose trousers, such as training pants.
• Sneakers with laces. Your legs may become swollen. The lace-up sneakers can even be worn on swollen feet.
• Own breathing apparatus for the prevention of sleep apnea (eg CPAP apparatus), if available.
• Incentive spirometer, if you have one.
• A Health Care Proxy Form, if you have completed it.
• Mobile phone and charger.
• A small amount of money that you may need for small purchases (for example, to buy a newspaper).
• A bag for storing personal items (such as glasses, hearing aids, dentures, dentures, wig, and religious items), if you have them.
• These are recommendations. Using these guidelines, your healthcare team will guide you on how to take care of yourself after your surgery.

Where to park

MSK Garage is located at East 66 ^th Street between York Avenue and First Avenue. For parking prices, call 212-639-2338.

To enter the garage, turn East 66 ^th Street from York Avenue. The garage is located approximately a quarter block from York Avenue, on the right (north) side of the street. A pedestrian tunnel leads from the garage to the hospital.

There are other garages located at East 69 ^th Street between First Avenue and Second Avenue, East 67 ^th Street between York Avenue and First Avenue, and East 65 ^th Street between First Avenue and Second Avenue.

Upon arrival at the hospital

You will be asked to state and spell your first and last name several times, as well as indicate your date of birth. This is for your safety. People with the same or similar names can be operated on on the same day.

Change for operation

When it’s time to change for your surgery, you will be given a hospital gown, gown, and non-slip socks.

Nurse appointment

You will meet with the nurse before your surgery.Tell her / him the doses of all medications you took after midnight and when you took them (including all prescription and over-the-counter medications, patches, creams, and ointments).

The nurse may place an intravenous (IV) line into one of the veins, usually in the arm or hand. If your nurse does not give an IV, your anesthesiologist will do it when you are in the operating room.

Meeting with anesthesiologist

You will also meet with your anesthesiologist before your surgery.This specialist:

• will review the medical record with you;
• will ask if you have had any problems with anesthesia in the past, including nausea or pain.
• will talk about your comfort and safety during the operation;
• will tell you about the type of anesthesia you will receive;
• will answer your questions about anesthesia.

Preparing for surgery

Before surgery, you will need to remove your hearing aid, dentures, dentures, wig, and religious paraphernalia (if you have any of the above).

You will go to the operating room yourself, or a staff member will take you there on a gurney. A member of the operating team will help you lie down on the operating table and put compression boots on your shins. They will inflate and deflate smoothly to improve blood flow in your legs.

When you are comfortable on the table, the anesthesiologist will administer anesthesia through an IV line and you will fall asleep. Your IV line will also give you fluids during and after your surgery.

During operation

When you fall asleep, a breathing tube will be inserted through your mouth into your windpipe to help you breathe. You will also have a urinary catheter (Foley) placed to drain urine from your bladder.

After surgery is complete, surgical staples or stitches will be placed on your incision. In addition, Steri-Strips ^™ (thin strips of surgical tape) or Dermabond ^® (surgical adhesive) will be applied to your incisions. The incision site may be covered with a bandage.The breathing tube is usually removed while you are still in the operating room.

to come back to the beginning

Post-operation

The information in this section will let you know what to expect after surgery, while you are in the hospital, and when you leave home. You will learn how to safely recover from surgery.

As you read this section, write down the questions you want to ask your healthcare provider.

What to expect

After your surgery, you will wake up in the Post Anesthesia Care Unit (PACU).

You will receive oxygen through a thin tube under your nose called a nasal cannula. The nurse will monitor your body temperature, heart rate, blood pressure, and oxygen levels.

You may have a catheter inserted into your bladder to monitor the amount of urine you are making. In addition, compression boots will be worn to improve circulation.

You may be given a pump called patient-controlled analgesia (PCA).For more information, read the resource Patient-Controlled Analgesia (PCA). Pain medication will be given through an IV line.

Generally, about 90 minutes after you are transferred to the recovery room, you will be able to receive visitors. Some of the nurses / nurses will explain the rules of conduct to them.

After your stay in the recovery room, you will be transferred to the hospital room.Shortly after you are brought into the room, you will be helped out of bed and into a chair.

A nurse will tell you how to recover from surgery. Below are some guidelines to help make this process safer.

• It is recommended that you walk with the support of a nurse or physiotherapist. We will give you medicine to relieve your pain. Walking helps reduce the risk of blood clots and pneumonia. It also helps to stimulate and restore bowel function.
• Use an incentive spirometer. This will help expand the lungs, which will prevent pneumonia from developing. While awake, do breathing exercises and coughing exercises every 1–2 hours. Your nurse will teach you how to fix the incision. This is to help the stomach muscles move less and reduce pain when doing exercises that stimulate coughing. For more information, read the resource How to Use Your Incentive Spirometer.

Frequently Asked Questions: Hospital Stay

Will I have pain after surgery?

The doctor and nurse will often ask you about your pain and give you medication as needed. If pain persists, tell your doctor or nurse. You will be prescribed pain medication before leaving the hospital.

Pain medications can cause constipation (less bowel movements than usual).

Why is walking important?

Walking will help prevent blood clots in your legs. It also reduces the risk of other complications, such as pneumonia.

Will I be able to eat?

Your doctor will tell you when you can start eating and drinking. This will depend on the timing of your surgery and how you feel afterwards. Some patients can drink a little in the evening after the operation. Most people can start eating the day after surgery.When you are able to eat, you should do so, gradually returning to your normal diet, taking into account the tolerance of certain foods.

Eating a balanced, high-protein diet will help you recover from surgery. Your diet should include a source of healthy protein with every meal, as well as fruits, vegetables, and whole grains. For additional tips on increasing the amount of calories and protein in your diet, ask your nurse for the resource Eating Well During Cancer Treatment.If you have questions about your diet, ask for a referral to a dietitian.

How long will I stay in the hospital?

If you have had laparoscopic gallbladder removal, you will most likely be discharged after 24 hours. If you have undergone open surgery to remove your gallbladder, your hospital stay will last 2-3 days.

Frequently Asked Questions: After Checkout

Will I feel pain when I get home?

The duration of the presence of pain and discomfort is different for each person.You may feel pain when you return home, and you may be taking pain medication. Follow the guidelines below.

• Take your medicine as directed and as needed.
• Call your doctor if the prescribed medication does not relieve pain.
• Do not drive or drink alcohol while taking prescription pain medication.
• As the incision heals, the pain will decrease and you will need less pain medication.Mild pain relievers such as acetaminophen (Tylenol ^® ) or ibuprofen (Advil ^® ) may help relieve pain and discomfort. However, taking large amounts of acetaminophen can damage the liver. Do not take more acetaminophen than what is listed on the bottle, or as directed by your doctor or nurse.
• Pain medications should help you get back on track.Take enough medication so you can exercise comfortably. Pain medications are most effective 30 to 45 minutes after you take them.
• Monitor the timing of your pain medication. It is better to take the medicine when the pain first appears and not wait for it to intensify.

Can I take a shower?

Yes. A warm shower relaxes and helps relieve muscle pain. When showering, use soap and gently wash your incision. After showering, pat these areas dry with a towel and do not bandage the incision (if there is no discharge).Call your doctor if you notice redness or discharge from your incision.

Do not take a bath until you discuss it with your doctor at your first visit after surgery.

Is it normal not to feel hungry after surgery?

Yes, not feeling hungry after surgery is common, also known as decreased appetite.
Try to eat several times smaller portions, eating each food group (fruits / vegetables, meat / poultry / fish, bread / cereals, dairy products).This will speed up the healing process.

How can I prevent constipation?

• Go to the toilet at the same time every day. Your body will get used to emptying your bowels during this time.
• If you feel like using the toilet, don’t put it off. Try going to the bathroom 5-15 minutes after meals.
• We recommend emptying your bowels after breakfast. During this time, reflexes in the large intestine are strongest.
• Exercise if you can.Hiking is great exercise.
• If you can, drink 8 glasses (8 ounces (240 ml) each, 2 L total) of liquid daily. Drink water, juices, soups, milkshakes, and other decaffeinated drinks. Caffeinated beverages such as coffee and soda remove fluid from the body.
• Gradually increase your dietary fiber content to 25-35 grams per day. Fiber is found in fruits, vegetables, whole grains, and cereals. If you have a stoma or recently had bowel surgery, check with your doctor or nurse before making any dietary changes.
• Prescription and non-prescription drugs are used to treat constipation. Start with one of the following over-the-counter medicines:
  • Docusate sodium (Colace ^® ) 100 mg. Take _____ capsules _____ times daily. This remedy softens stools and has few side effects. Do not take it with mineral oil.
  • Polyethylene glycol (MiraLAX ^® ) 17 grams daily.
  • Senna (Senokot ^® ), 2 tablets at bedtime.It is a stimulant laxative that can cause cramping.
• If you have not had a bowel movement in 2 days, call your doctor or nurse.

Can I drink alcohol after surgery?

Do not drink alcoholic beverages if you are taking pain medication.

How do I care for my incision?

The location of the incision will depend on the type of surgery performed. If the skin under the incision is numb, this is normal, because some of the nerve endings were cut off during the operation.After a while, the numbness will disappear.

• By the time you are discharged from the hospital, your surgical incision will begin to heal.
• You and your caregiver should work with your nurse to examine your incision before you leave to see what it looks like.
• If there is any discharge from the incision, record the amount and color. Call your doctor’s office and talk to your nurse about incision discharge.

Change the dressing at least once a day, and more often if it gets wet from discharge.If the cut has stopped flowing, you can leave it open.

If Steri-Strips are applied to your incision at discharge, they will come off and fall off on their own. If they do not fall off after 10 days, you can take them off.

If you go home with glue on the seam, it will also come off and peel off on its own, much like Steri-Strips.

Is it normal to feel tired after surgery?

Yes, feeling tired (weak) is an expected side effect.It usually takes 3 weeks to fully recover.

Can I return to business as usual?

It is very important that you return to your normal business after the operation.
Spread them out throughout the day. You can do light housework. Try to wash the dishes, prepare light meals, and do other things as much as you can.

You can return to your normal sex life as soon as your incisions heal without pain or weakness.

Your body will tell you when you are overworked. Increasing the intensity of the loads, monitor the reaction of the body. You may notice that you have more energy in the morning or afternoon. Plan your activities for the times of the day when you feel energized.

When is it safe for me to drive?

You can drive again 3 weeks after surgery if you are not taking pain relievers – they can cause drowsiness.

When can I return to work?

The timing of returning to work depends on what kind of job you have, what kind of surgery you have undergone, and how quickly your body recovers. In most cases, patients can return to work 1–2 weeks after laparoscopic surgery and 3–4 weeks after open surgery.

What exercises can I do?

Exercise will help you gain strength and improve your well-being. Hiking and climbing stairs are excellent physical activity.Gradually increase the walking distance. Climb the stairs slowly, resting and stopping as needed.
Check with your doctor or nurse before proceeding to more vigorous exercise.

When can I lift weights?

Consult your doctor before lifting weights. In most cases, you should not lift anything heavier than 5 pounds (2.3 kg) for at least 6 weeks.Ask your doctor how long you should refrain from lifting weights.

How can I deal with my feelings?

After surgery for a serious illness, you may experience a new feeling of depression. Many people say that at some point they felt like crying, had to experience sadness, anxiety, nervousness, irritation and anger. You may find that you are unable to contain some of these feelings. If this happens, try to find emotional support.

The first step on this path is to share your feelings. Friends and family can help you. A nurse, doctor, and social worker can give you comfort and support and advice. Always tell these professionals about your own emotional state and about the emotional state of your friends and loved ones. Numerous materials are available for patients and their families. Whether you are in the hospital or at home, nurses, doctors and social workers are ready to help you, your friends and loved ones deal with the emotional aspects of your illness.

When will my first visit to the doctor after surgery take place?

Your first postoperative visit will take place 1-3 weeks after you leave the hospital.
The nurse will give you directions on how to make an appointment, including the phone number to call. During this visit, your doctor will discuss the laboratory results with you in detail.

What if I have other questions?

If you have any questions or concerns, talk to your doctor or nurse.You can reach them Monday through Friday, 9:00 am to 5:00 pm.

After 5:00 pm and on weekends and holidays, call 212-639-2000 and ask the doctor who is on duty in your place.

When to contact your healthcare provider

Tell your healthcare provider if you have:

• Temperature 101 ° F (38.3 ° C) or higher
• pain that does not go away after taking pain medication;

• there is discharge from the incision that has an unpleasant odor or looks like pus;

• increased redness around the incision;

• there is or increased swelling around the incision.

• new symptoms or physical changes appeared.

• have any questions or concerns.

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Support Services

This section provides a list of support services that can help you prepare for and recover from surgery.

As you read this section, write down the questions you want to ask your healthcare provider.

Auxiliary Services MSK

Admitting Office
212-639-7606
Call if you have questions about hospitalization, including requesting a single room.

Anesthesia Department
212-639-6840
Call if you have questions about anesthesia.

Blood Donor Room
212-639-7643
Call for more information if you would like to become a blood or platelet donor.

Bobst International Center
888-675-7722
MSK accepts patients from all over the world. If you are from another country, call for help arranging your treatment.

Chaplaincy Service
212-639-5982
At MSK, chaplains are ready to listen, support family members, pray, reach out to local clergy or religious groups, or simply provide comfort and a helping hand.Anyone can apply for spiritual support, regardless of their formal religious affiliation. The Interfaith Chapel is located next to Memorial Hospital’s main lobby and is open 24 hours a day. If you have an emergency, call the hospital operator and ask to speak to the duty chaplain.

Counseling Center
646-888-0200
Psychological counseling helps many people.We provide counseling to individuals, couples, families and groups of individuals, and we provide medications to help you cope with anxiety or depression. To make an appointment, ask your healthcare provider for a referral or call the phone number above.

Food Pantry Program
646-888-8055
The Food Pantry Program provides food to low-income patients during cancer treatment.For more information, contact your healthcare provider or call the phone number above.

Integrative Medicine Service
646-888-0800
The Integrative Medicine Service offers a variety of services in addition to traditional health care. These services include music therapy, mind / body therapy, dance and movement therapy, yoga and tactile therapy.

MSK Library
library.mskcc.org
212-639-7439
You can visit our library website or contact library staff for more information on a particular cancer. Alternatively, you can check out the LibGuides section on the MSK library website at libguides.mskcc.org.

Patient and Caregiver Education
www.mskcc.org/pe
Visit the Patient and Caregiver Education website to find educational materials in our virtual library.You can find learning resources, videos, and online programs.

Patient and Caregiver Peer Support Program
212-639-5007
You may be encouraged to talk to someone who has received treatment like yours. Through our Patient and Caregiver Peer Support Program, you can talk to a former MSK patient or caregiver.Such conversations are confidential. You can communicate in person or by phone.

Patient Billing
646-227-3378
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.

Patient Representative Office
212-639-7202
Call if you have questions about a health care power of attorney or concerns about caring for you.

Perioperative Nurse Liaison
212-639-5935
Call if you have questions about who MSK will share your information with during surgery.

Private Duty Nursing Office
212-639-6892
You can request the assistance of a Private Duty Nursing Office or Companions. Call for more information.

Resources for Life After Cancer [RLAC] Program
646-888-8106
At MSK, patient care does not end after active treatment is completed. The Resources for Life After Cancer (RLAC) program is designed for patients who have completed their treatment and for their families. This program offers a variety of services such as workshops, workshops, support groups, and post-treatment counseling.She also helps with health insurance and employment issues.

Sexual Health Programs
Cancer and cancer treatments can affect your sexual health. MSK’s Sexual Health Program can help you get started and address sexual health issues before, during, and after treatment.

• Our Women’s Sexual and Reproductive Medicine Program can help you if you have cancer-related sexual health problems such as premature menopause or reduced fertility.For more information or to make an appointment, call 646-888-5076.
• Our Sexual and Reproductive Medicine Program for Men can help you if you have a cancer-related sexual health problem such as erectile dysfunction (ED). For more information and to make an appointment, call 646-888-6024.

Social Work
212-639-7020
Social workers help patients, their families and friends cope with the challenges of cancer.They provide one-on-one counseling and support groups during your treatment and can help you connect with your children and other family members. Our social workers can also refer you to local agencies and programs, and provide information on additional financial resources if you are eligible.

Tobacco Treatment Program
212-610-0507
If you want to quit smoking, MSK has specialists who can help.Call for more information.

Virtual Programs
www.mskcc.org/vp
MSK Virtual Programs offer online training and support for patients and caregivers, even if you cannot come to MSK in person. Through interactive activities, you can learn more about your diagnosis and what to expect during treatment and how to prepare for the different stages of cancer treatment. Classes are held confidentially, free of charge and with the involvement of highly qualified medical professionals.If you would like to join a virtual training program, visit our website at www.mskcc.org/vp for more information.

For more information online, see the Cancer Types section of www.mskcc.org.

External Support Services

Access-A-Ride Organization
web.mta.info/nyct/paratran/guide.htm
877-337-2017
MTA New York offers ridesharing and escort services for people with disabilities who are not can take the bus or metro.

Air Charity Network
www.aircharitynetwork.org
877-621-7177
Provides travel to treatment centers.

American Cancer Society (ACS)
www.cancer.org
800-ACS-2345 (800-227-2345)
Offers a variety of information and services, including Shelter of Hope ( Hope Lodge) – a place for free accommodation for patients and their carers during cancer treatment.

Cancer and Careers Website
www.cancerandcareers.org
A resource for educational materials, tools and information on various activities for working people with cancer.

Cancer Organization Care
www.cancercare.org
800-813-4673
275 Seventh Avenue (between West 25 ^th Street and 26 ^th Street)
New York, NY 10001
Consulting, Groups support, educational workshops, publications and financial assistance.

Cancer Support Community
www.cancersupportcommunity.org
Provides support and educational materials for people facing cancer.

Caregiver Action Network
www.caregiveraction.org
800-896-3650
Provides educational materials and support for people caring for loved ones with chronic diseases or disabilities.

Organization Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Offers free travel for medical treatment around the country through available seats on corporate flights.

Gilda’s Club
www.gildasclubnyc.org
212-647-9700
A place where men, women and children with cancer receive social and emotional support through communication, workshops, lectures and social events.

Good Days Organization
www.mygooddays.org
877-968-7233
Offers financial assistance to cover copayments during treatment. Patients must have health insurance, they must meet a number of criteria, and they must be prescribed medications that are on the Good Days formulary.

Healthwell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover copayments, health insurance premiums, and deductibles for certain drugs and treatments.

Joe’s House
www.joeshouse.org
877-563-7468
Provides cancer patients and their families with a list of places to stay near treatment centers.

LGBT Cancer Project
http://lgbtcancer.com/
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT tolerant clinical trials.

LIVESTRONG Fertility Organization
www.livestrong.org/we-can-help/fertility-services
855-744-7777
Provides information on fertility and support for cancer patients whose treatment involves fertility risks and cancer survivors.

Look Good Feel Better Program
www.lookgoodfeelbetter.org
800-395-LOOK (800-395-5665)
This program offers workshops to help you learn more positively perceive your appearance.For more information or to sign up for a workshop, call the above phone number or visit the program website.

National Cancer Institute
www.cancer.gov
800-4-CANCER (800-422-6237)

National Cancer Legal Services Network
www.nclsn.org
Free Cancer Legal Advocacy Program.

National LGBT Cancer Network
www.cancer-network.org
Provides educational materials, training courses and advocacy for LGBT patients who have had cancer and are at risk.

Needy Meds Resource
www.needymeds.org
Provides a list of programs that support patients in obtaining generic and registered brand drugs.

NYRx Organization
www.nyrxplan.com
Provides prescription drug benefits to eligible current and former New York State public sector employees.

Partnership for Prescription Assistance
www.pparx.org
888-477-2669
Helps eligible patients who do not have prescription drug coverage get drugs for free or purchase them at a low cost.

Patient Access Network Foundation
www.panfoundation.org
866-316-7263
Provides co-pay assistance for insured patients.

Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to medical care, financial assistance, insurance assistance, job retention assistance and access to a national resource directory for people with insufficient health insurance.

Organization RxHope
www.rxhope.com
877-267-0517
Provides help with getting drugs that people may not have enough money for.

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Educational Resources

This section provides a list of the training materials that have been referenced in this manual. These materials will help you prepare for your surgery and recover safely from it.

As you read these resources, write down the questions you want to ask your healthcare provider.

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Good prognosis – clinic of German medicine in Kiev: prices, reviews

5.00

Added by Olesya 27-03-2021 10:10

“Good prognosis” – a class, yes a head start to the class “Feofaniya”! [“Theophania” of the servants of the state services, policy, to lay down to the sovereign administration on the right]

Friends, I will not repeat those who seem to be the patients about the chain itself – the price of all the daily management! I was gladdened by my sister, who should reconsider the diagnosis, and yet I do not like licenses / likuvatisya / visibility for an hour, but for me a folding operation was carried out, which is the first in my life.My sister was amazed at the performance of the program “I will ruin my tila”. The site was amazed – I found out the likars, read the guides …

I went for a consultation before Hanny Oleksandrivna Averinoi’s license and immediately (for the first time in my life!) And my friends, who know, passed me “according to the knowledge”, without koshtovno in the state class. There it may be strong, I received a message, but on the day of the operation I saw it …

I know, “Good forecast.” The operas were performed by Sergiy Ivanovich Anistratenko, Ganna Oleksandrivna Averina, Kostyantin Viktorovich Kotsubanov.Administrator Natalia everything was done without a hitch, everything was done on the same day, which is the best for me. Irina finished her hair in the intensive therapy ward. Oksana, Katerina, Tamara (Tamara is just a bdzhilka !, like the best nurse in the ward – a young nurse, I’ll take care of it more comfortably), all the medical and maintenance staff – you’re just namey! And yet here it seems that “MI is doable to you” – it is the same way to bring the good robots to the team, to form a specific command.

And now about macromanagement: friends, the concept of innovative medicine is real, high standards of service, culture and special awareness of the skin drug and personnel.Tsia klinika is an eye for other clients, the format of robotic advanced medicine and, I think, more – a small butt of a robotic medical system (a new cycle), as if we wanted to be in Ukraine! I naygolovnishhe: who gives a head start to “Feofaniya”? There is no need for “dyakuvati”, not vimagayut habari. And so I want to base our clinics and the entire medical system without corruption, with high standards of advanced medicine, reference value-based organizations, such as “Dobriy prognosis”.

Success Tobi, “Good forecast”, Ty – just super!

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