So Mr. SK has been diagnosed with gallbladder disease (without gallstones) and it's been recommended that he have his gallbladder removed. We have an appointment with a surgeon on Friday. I am trying to prep for the appointment and figure out what kinds of questions we need to ask, and also figure out how to assess this surgeon.

The most common gallbladder removal is a laparoscopic procedure, but that is still considered major surgery, and sometimes patients end up needing to have the more traditional kind if the condition of the gallbladder prevents the laparoscopic procedure. So I am quite worried and want to make sure we choose the best surgeon etc.

Also, I feel like we need a lot more info...

Mr. SK doesn't have PCP, just a family nurse practitioner. Based on pain he was having,she recommended he have blood tests, urine etc., an ultra sound and a HIDA scan (which tests gallbladder and liver functioning). All the other tests come up normal/negative (and the ultra sound shows no gallstones).

But the HIDA scan showed his gallbladder is working at only 15%, normal/healthy functioning is above 50%, above 35% is a bit low but not considered something needing treatment. So by either of these numbers, his gallbladder is well below normal functioning, which could explain the pain he's been having. Since the results of this scan, he's been eating super carefully and that seems to be helping.

So after the scan and based on the radiologists reading of it, the FNP recommended Mr. SK to a GI specialist. He couldn't get in to see the doc, so he was seen by that office's physician's assistant. She said that gallbladders don't get better and that surgical removal is basically the only treatment. Her recommendation was that we meet with a surgeon (their office recommended us to a general surgeon not in that office, the GI doc doesn't do gallbladder surgery). So that's how we ended up with the appointment with this particular surgeon.

I have of course googled this surgeon and nothing comes up of concern, he performs laparoscopic surgeries but I note that he is not necessarily a specialist in gallbladder removal specifically. There is another practice which does specialize more specifically in laparoscopic gallbladder removal, but the doctor looks to be much older (his info says he's been in practice for 25-30 years) which I sort of worry about because I'd prefer someone more up to date on the latest procedures and thinking etc.

So how can I evaluate these surgeons? What can/should I ask the surgeon on Friday? I can't really say "so, how many medical malpractice lawsuits have you been involved in?" or "how many medical mistakes have you caused and what did you learn from them?"

But how can I do the best at making sure this is a skilled and reliable surgeon to entrust with my husband's life? That might sound over the top, but that's pretty much what we're talking about whenever there's a surgical procedure and general anesthesia involved.

I obviously have trust issues....

Also, if anyone has any other insights, things we should be thinking about or asking, please share.

I have been reading online ever since we got the results of the scan, and everything I'm reading, everything Mr. SK describes about how he feels, the details of the diagnostics etc., all these things are consistent across the websites and with what these medical professionals are telling me, so it's not like I think there's some possibility of an overlooked issue. But gallbladder disease in the absences of stones is a little more of a gray area I think, especially since he's currently not sick in an acute way. But it does seem clear that he has a poorly functioning gallbladder, and although the timeline for removal is not clear, the ultimate end point is likely removal (in order to avoid future complications which could be serious and which would ensure that the laparoscopic procedure wouldn't be an option).

Anyway, if you've read this far, thank you. Any advice, suggestions etc. about what kinds of questions to ask and what to take into consideration will be appreciated.

I cannot help you with evaluating the surgeon. Mine came out on an emergency basis, so I got the surgeon on duty. She was terrific.

I do understand that gall bladder surgery is one of the most common and least complicated surgeries.

As an aside, my GI had recommended getting it taken out. I stupidly took a wait and see approach, and thus wound up in the emergency room on a Friday night, getting wheeled straight up to an admit room.

I don't have anything useful to add, just want to with Mr.SK good luck with all this.

Have you thought about getting a second opinion from someone at an academic medical center ... Duke, for instance? You may need some help in interpreting the numbers and double checking to see that the recommendation you've gotten is really the only reasonable path.

If some simple changes to his diet have brought relief, that suggests you've got some time. I don't want to sound like a downer, but under our system's reimbursement rules surgery pays a lot and medical treatment doesn't pay nearly as much. For a relatively simple procedure, the incentives all push in a surgical direction.

Quirt, yikes!! Did you have gallstones? Did you have significant pain when your doc originally recommended the surgery? Had you had a HIDA scan etc?

Ax, thank you!

P*D, yes, that’s kind of where my mind is going re the fact that dietary changes have helped. Of course, reading Quirt’s comment is kind of scary!! But still, if you talk to a surgeon, you should pretty much expect them to recommend surgery. Besides the financial incentives (which are significant!), surgery is what they know and they’d likely lean toward that even without the financial incentives.

I don’t know that we can go to Duke but maybe there’s somewhere else we can go to get a better second opinion.....

I have no advice but hope for Mr. SK a complete and rapid recovery.

quote:

I don’t know that we can go to Duke but maybe there’s somewhere else we can go to get a better second opinion.....

Why, out of curiosity? I'm guessing your health plan permits some specialist care at a distance, and Duke (or any other academic hospital) likely participates in all the major health plans. They want the business too.

quote:

Originally posted by Piano*Dad:
Why,

Mainly because it’s 4+ hours one way. I mean I suppose we could go there. I don’t know if it would be treated as in-network or not.

But there should be other options, maybe in the town that’s only one hour away.

That’s the only drawback to where we live

We still use Duke for care on occasion. It's 3.5 hours for us. We just get a hotel room at a place that caters to the hospital. After the appointment we spend some time exploring the area (gardens, museums, the Lemur Center !!) and having a nice dinner out before heading home.

I suspect there are fine academic hospitals in SC or in Charlotte. But Duke has a pretty good reputation.

quote:

But Duke has a pretty good reputation.

That it does! I’ll see what Mr. SK thinks, thanks for the suggestion.

quote:

Originally posted by ShiroKuro:
Quirt, yikes!! Did you have gallstones? Did you have significant pain when your doc originally recommended the surgery? Had you had a HIDA scan etc?

Ax, thank you!

P*D, yes, that’s kind of where my mind is going re the fact that dietary changes have helped. Of course, reading Quirt’s comment is kind of scary!! But still, if you talk to a surgeon, you should pretty much expect them to recommend surgery. Besides the financial incentives (which are significant!), surgery is what they know and they’d likely lean toward that even without the financial incentives.

I don’t know that we can go to Duke but maybe there’s somewhere else we can go to get a better second opinion.....

Yeah, I had gallstones. I'd been having episodes ... very intermittent ... of intense pain for a day or two. I forget what testing we did, but my GI said I should consider surgery. (I really liked the guy, and he wouldn't have performed the surgery, so he had no financial incentive.) But I decided that if it was nothing more than intense pain every few months, I could live with it.

And then, one week, it was intense pain for three days. Mary Anna was in Massachusetts with me, so, on Friday morning, I made an appointment with the same-day on-call doctor at my doctor's office. I saw her at like 4:30 in the afternoon. She told me, "go get in your car, and go straight to the emergency room." I did that, and they did a battery of tests and then wheeled me upstairs for surgery. I went under the knife roughly eight hours after I was admitted.

The surgeon told me afterwards that my gall bladder was filled with sludge (that was the term she used), and that I wouldn't have made it to Monday morning. And the ER doctor made a point of telling me that it was good use of emergency services. I didn't have the heart to tell him that my GI had suggested getting it taken out on a non-emergency basis but I'd decided to tough it out for a while.

As far as the surgery went, it was easy as pie. The worst part wasn't post-surgical pain, it was the pain meds. They put me on Dilaudid, which made me horribly nauseated. I just sat there in bed, rocking back and forth in discomfort. The nurses, who were wonderful, called the surgeon on their own initiative and told her to get me off the Dilaudid. They put me on hydrocodone, and all was well after that. The surgeon came to check on me at like 8AM Sunday morning, and I was checked out of the hospital 24 hours after surgery, with zero complications.

Lucky Mr SK that he married you! I'd be doing the exact same thing. You certainly can ask the doctor how many times he has done this particular procedure. You should also ask other doctors in the community who they would want to go to for gallbladder surgery. Usually there's a consensus in a small city as to who the go-to doctor is for a particular type of surgery. Find out who that is.

Quirt that sounds like a rotten experience. Glad you didn't wait until Monday!

quote:

Originally posted by piqué:
Quirt that sounds like a rotten experience. Glad you didn't wait until Monday!

It was my own fault. I was hoping to avoid surgery, and wasn't being realistic.

The experience itself (aside from the nausea) was actually pretty good. The surgeon was great, the nurses were excellent and attentive, the ER treated me well, and Mary Anna was as wonderful as she always is. I really have no complaints and nobody to blame but myself.

Mr. Nanna had similar symptoms as Mr. SK. He would have random pain and diet helped, but didn’t solve the issue. His test results showed that his gall bladder wasn’t working at all (it’s been a while and I don’t recall the number, but it was low) and no gall stones. He scheduled the surgery. It was day surgery, laprascopic, with a general surgeon who does a lot of gall bladders.

He had no issues. Came home and by mid afternoon asked me to make Toll House cookies, which he happily and successfully ate. No problems since.

Good luck to Mr. SK. Second Opinions are a good idea, if only for peace of mind. I actually got 3 opinions for a surgery once. Medicare will pay for 3, so check with your insurance. You and Mr. SK should have confidence in your decision and the surgeon before you proceed with any surgery...but you already know that!