(This is my personal account of life with gallbladder disease, acute cholecystitis, and the laporoscopic cholecystectomy performed on me on June 18, 2009. There is frank discussion about body functions, namely bowel movements.)

Originally written July 1, 2009.

The gallbladder is a non-vital organ that rests just below the liver, just below the protection of the ribcage. The liver produces bile, which is used in the breakup of fat in food. The bile is stored in the gallbladder, which contracts and injects bile into the intestine whenever it detects high enough fat content to warrant it. The gallbladder, affected by the western, American high fat diet, can develop symptoms in which gallstones are formed and stored, bile is produced too much or not enough, and the gallbladder itself can become diseased, nonfunctional, inflamed, and even ruptured if the inflammation is not treated. Removing the gallbladder is akin to having one’s appendix taken out–it is usually done as a last resort, if an acute attack of pain and fever inspires one to go to the hospital. Subtler, longer pains can denote that significant stones need to be removed. Surgery is elective and dependent upon an individual doctor’s estimation as to what is best for the patient. In my case, based on the frequency of pain symptoms, and history of it not functioning correctly, it was decided it was best removed.

I can pinpoint when my gallbladder started disfunctioning–I became abruptly lactose intolerant at age 16. When I paid attention to what I was eating, the abdominal cramps and subsequent diarrhea came strongly when I had a full cup of milk with dinner. I stopped consuming dairy products over my mother’s objections, and the cramps and diarrhea went away.

My mother joked that when it came to the visual consistency of my bowel movements, it was everything “from soup to nuts.” Not to be crass but that was precisely what I experienced. All in the same day, I could have a bout of loose diarrhea, a session of hard constipation, and a movement that looked relatively normal. My digestive system was always a fickle thing, hard to predict exactly what would make for unusual bowel movements, give me abdominal pains, and sometimes even fever. Because it was chronic, and relatively “normal” for me, I never went to the doctor for it. Because I successfully diagnosed my own lactose intolerance, and a single lactase enzyme pill taken during a meal dealt with the effects, I never sought medical attention for that either.

Over the years, I started avoiding spicy foods and oily/greasy foods along with those containing lactose, as those also gave me odd stomach aches and the resulting bowel movements were not pleasant. Sometimes the weird bowel movements would result from no discernable food sensitivities at all, and I would have bouts of bile salt diarrhea (euphemistically described as throwing potting soil into the toilet), or liquid bowel movements featuring a green, oily component I would later learn was copious amounts of bile. Sometimes my bowel movements were black as tar. Sometimes they were tinged with red. Again, I never sought medical attention with this, because it was something I was used to, it didn’t seem life-threatening, merely inconvenient and odd.

In April 2009, I experienced a particularly hurty bout of cramping in the upper right of my abdomen; I happened to be in the company of a CNA friend who works on the abdominal ward of a major hospital, who asked a few questions and indicated I ought to see a doctor about it. It didn’t seem that serious and so I procrastinated for several months. On June 17, 2009, I experienced my third bout in three weeks of this cramping, lasting over 12 hours. Early the next morning, I begged a friend to accompany me to the emergency room. They saw me during the height of one of these attacks, in extreme pain and discomfort, hyperventilating because it hurt to breathe, and making uncommonly loud noises.

Based on the area of pain, they took ultrasound pictures of my upper abdomen, and the technician zeroed in on my gallbladder. Usually the shape of a pear and twice as small, mine was showing up as a solid white mass, filled with stones, the shape of a hot dog, and enlarged. The ER doctor advocated surgery, I signed the waiver papers, and I was wheeled into surgery without much preamble.

This is what I experienced during the surgery itself–it is fairly straightforward, and lasted roughly 1.5 hours:

I woke up 1.5 hours later in the recovery room, before being carted to a private room to rest. They would keep me for observation the remainder of the day, into the evening, and the night. In all likelihood, when the doctor assessed me in the morning, he’d advise going home whenever I was ready. I woke up with oxygen nose prongs, a heart monitor/pulse-ox meter taped to my left finger, and an IV taped to my left elbow. Very soon after I was settled into my room, the nurse asked if I’d like to try some liquid food. I wasn’t particularly hungry but knew it’d make them happy to see me down food and not have it come back up, and so I was brought chicken broth, Jell-O, herbal tea, and another item I can’t remember. I downed most of the broth and all of the Jell-O, and waved the tray away, sufficiently full for the moment. A bit later in the evening, I’d request a plate of fruit and a dinner roll, which I’d nosh on for a few hours until the tray was clear.

The saline being dripped into my arm made me need to use the bathroom frequently, and because of all the gadgetry I was hooked up to, required a nurse’s attention in disconnecting me so that I could walk the short distance to the bathroom with my IV bag in tow. They kept tabs on how many CCs of urine I produced. Periodically they took blood pressure readings. The rest of the time, I rested, talked to the couple visitors who came, watched TV, and waited.

I slept perhaps three broken hours, woken up continually by nurses and assistants wanting more blood pressure readings, more blood samples for analysis, and by the commotion of the combative woman in the room next to me, who was continually ripping out her IVs, throwing items around, and unable to comprehend that she was in a hospital and that the people there were trying to help her. I watched TV, asked a nurse for a sandwich at 4am, used the restroom more, and managed another walk up and down the quiet corridor. With morning, came the followup visit by the doctor, the removal of the heart monitor, oxygen line, and even the IV, though the needle would remain in my arm until I left.

A gentle car ride home, and I spent the remainder of the day resting. My futon would prove too problematic for me to get in and out of, and so I made a temporary bed upon the old twin-on-platform I had out in the living room. The druid made me food whenever I asked, and helped me to a sitting position so that I could transport myself to the restroom.

My throat was oddly irritated, and two days later I’d visit the ER again to be diagnosed with strep, and given a bottle of antibiotics. I was prescribed Percoset for the pain as well, though I would take only Tylenol for much of my recovery. Because the swollen tonsils made it hard to swallow, I resorted to softer and softer foods, ending up on applesauce, fat-free frozen yogurt, and water when I could tolerate nothing else. Eventually I all but stopped eating, sipping water sporatically, taking my meds religiously, and watching my body temperature rise again and again with each check. After five days of this, I made the executive decision to call 911, request an ambulance, and seek medical attention at the ER again. They ended up emptying three full saline bags into me. For some reason, after that, I describe my system as having been rebooted. I had an appetite, I was conscious and responsive, and my fever finally leveled off and disappeared.

My liver quivered to life after being rehydrated, and I spent an extraordinary amount of time in the restroom between then and the following afternoon, experiencing extreme, explosive bile salt diarrhea. The frequency leveled off as my liver learned when to produce bile, and when not to, and at the time I write this, I have no lasting problems with too much or too little bile.

It was strongly advised that I stick to a high fiber, low-fat diet–I ate high fiber cereal for breakfast, snacked on a breast of chicken and applesauce for lunch, and had fruit or somesuch in the evening. My diet has progressed from there to pretty much what I was eating prior to my surgery–I was already sensitive to dairy, spicy, and oily foods, and so I’ve refrained from eating heavy amounts of that just yet.

My incision wounds consist of three inch-long scalpel lines, with a fourth inside my belly button. On my followup appointment with the doctor ten days after the surgery, the bandages were removed, I was given alcohol swabs to clean the surgical areas, and I remain unable to lift very heavy items, as my abdomen continues to heal. With the long bout of bile salt diarrhea, most of the remaining trapped gas in my abdomen was expressed, and the pain from that dropped off so much that I ceased taking any form of pain medication the day after I was rehydrated. Of course, I’m finishing up my antibiotic for the strep infection. The doctor detailed the report on the dissection they performed on my gallbladder: inflamed, with five stones measuring anywhere from .2cm to 2.5cm, which he reports is rather frikkin’ huge. He made the right decision in removing my gallbladder.

Life after gallbladder removal isn’t much different than it was before, now that I have sufficiently recovered. I couldn’t sit at the computer for 6 days after the surgery, though most of that was discomfort of not being able to have a bowel movement, and getting weaker as I could not eat. My bowel movements remain much different than they were before the surgery–the smell and the color are still way off, though, much of the time I am producing more or less solid lumps when I go. Some people report diarrhea after this kind of surgery, and though I have had my bouts, it does not happen often. I have a friend who always has diarrhea after eating, four years after his surgery, but then, his diet is full of high fats and alcohol, and I’m a bit smarter than that. Today for the first time in days, I had a bowel movement in which bile was present, a dark green oily substance accompanying the returning diarrhea. I cannot discern if that will be a frequent thing or not.

I can’t quite predict what my bowels will do after a given meal. I’m finding that whatever bowel movements I have are mild, for the most part. I have had cheese and french fries in a couple places with no adverse effects at all. I still take a Lactaid with each meal featuring dairy, though, I may experiment without such a pill, just to see what happens–the symptoms for my lactose intolerance were exactly the same as when I was having a gallbladder attack. Who knows, I may be able to get rid of the expensive pills altogether.

For those who are facing a cholecystectomy (removal of the gallbladder), or if you’d simply like more information on symptoms, preventative things you can do to avoid surgery, and what to do just after, I fully support browsing this website, which is full of easy-to-read information on how a gallbladder functions, how it misfunctions, and how to treat yourself post-op if it comes to that. In the days following my surgery, I was looking for an easy-to-browse list of foods that would hurt me least, and this worked nicely for me. Note the trend towards low-fat, high fiber items. If you need to stock your fridge with stuff that won’t hurt you for upwards of a week after surgery, use that list.

Some doctors advocate surgery with an acute attack of pain as I had; others would have chosen to bombard the stones with ultrasound waves to break them up and make them easier to pass. Mine was a case for which surgery was the best option; don’t be afraid to ask questions as to whether surgery is the best option for you, if you’re facing that choice. Be cautious, but also listen to what your body is telling you. I have a friend whose doctor waited seven months after the initial diagnosis to finally consent to allowing surgery. My friend, two years later, is still dealing with the consequences of being too cautious, his quality of life is impacted by having dealt with the symptoms for as long as he did.

I’m happy that mine was taken as soon as the pain and fever emerged. I’m not sorry I had it done, and I look forward to a life that is potentially better, with less pain and less adverse effects of a gallbladder that didn’t work correctly anyway.

Added to December 1, 2009.

It’s been a full six months since I updated this entry. In late August, low on Lactaid pills and seeing a prime opportunity to try a meal containing dairy without taking a pill to counteract the intolerance, I waited for the diarrhea, cramps, and fever to hit me, as it always did with the smallest amount of dairy. It never did. I think I did cartwheels around the house that day.

Flirting with disaster, I tried a little more. No effect. Throwing caution entirely to the wind, I consumed a large meal containing milk, cheese, the whole works. Nada. I’ve read that it’s common for people to develop sensitivities to certain foods like dairy. I’m amused that my body went the other way.

A full six months later, I can report that my health is perfectly normal. My bowel movements are normal. I still give dairy a sidelong look but I no longer carry lactase enzyme pills in my wallet. I eat high fat foods, consume alcohol (in moderation, of course, I never really liked that stuff), and I am confident in my body’s functions. Everything works brilliantly.

The druid still looks at me darkly when I refer back to that time, as it was a hairy ride for the first five days following surgery. I’ve been perfectly healthy since. I’m happy. I’m living life. It is good.