No insights either but I think a second opinion is in order. I’m a big Duke fan (I’ll be there on the 30th) but MUSC is a good place too if it’s closer.

I'm so sorry to hear this. Put me in the 2nd opinion corner as well. Personally, I think it's well worth the trip to Duke to buy peace of mind. It sounds like Mr. SK's situation isn't urgent, so there's no panic--but sooner rather than later, for sure. Does anyone know why his gall bladder is malfunctioning? I know it is responding to dietary changes, but is that just delaying the inevitable?

In my experience (both personal and with friends), the new laproscopic/minimally invasive surgical techniques are incredible and, my opinion, worth getting the surgery done early to increase the odds that laproscopy is an option.

Good luck.

I was also about to suggest MUSC.

If you decide on surgery, consider the anesthesiologist as well. Otherwise you show up day of to discover you have 'contracted' this person of whom you have never heard. You may have limited choice, but should be able to get names and check credentials etc.

Niece had hers removed years ago.

Still doing well.

You mentioned that he's seen an NP and a PA. Absolutely nothing against those folks, but they don't have the same level of experience and training that the MDs have.

Since there isn't an emergency requiring an immediate decision, I think a second opinion is the way to go.

Hope it goes well.

quote:

Originally posted by Nina:
It sounds like Mr. SK's situation isn't urgent, so there's no panic--but sooner rather than later, for sure. Does anyone know why his gall bladder is malfunctioning? I know it is responding to dietary changes, but is that just delaying the inevitable?

In my experience (both personal and with friends), the new laproscopic/minimally invasive surgical techniques are incredible and, my opinion, worth getting the surgery done early to increase the odds that laproscopy is an option.

All of this... so, we haven't really had someone talk us through the results of the HIDA scan, hopefully that will happen tomorrow, but if not, we'll keep searching till we find someone who can do that.

But yes, although it's not urgent or acute, sooner is probably better in terms of the surgery....

As to why it's malfunctioning, I don't know if there will ever be an answer for that, and certainly not a definitive one.

A fatty diet is supposed to be bad for the galbladder, but I have also read that refined grains are bad, including white rice. I don't get the connection, based on my understanding of the gallbladder, but although Mr. SK doesn't hav a highly fatty diet, he does eat a *lot* of white rice. And he has (presumably genetic) high cholesterol, so that may be connected as well.

Piqaboo, thanks for mentioning the anesthesiologist, I'll ask about that.

WTG,

quote:

You mentioned that he's seen an NP and a PA. Absolutely nothing against those folks, but they don't have the same level of experience and training that the MDs have.

Exactly. I think the medical professionals who've seen Mr. SK are all good, but I'm ready to meet with a doctor.

This whole not having a PCP thing is a real drag.

In the "good news" department, I spoke with the admin person in my dept today, and she's from this area and lives in the town where the big hospital that we're going to tomorrow is. She had very good things to say about the hospital, so I feel good about that.

In the "bad news" dept, Mr. SK had a few pretty good days, but yesterday and today have not been very good, so I feel like we probably don't want to dilly dally too long here.

Thank you everyone, for the advice, comments and words of encouragement!

I can't think of anything to add to Quirt's story, other than that I remember, as he does, that the surgery was less of an issue for him that the pre- and post-surgery discomfort, which passed fairly quickly.

My story is horrifying, so I will say in advance that most of it doesn't apply to Mr. SK at all, but I'm sharing it because a few details might be pertinent.

Some of you may remember my 11-day stay in a Reston, VA hospital in 2006. I had my gall bladder removed after twelve hours of very severe pain on a transatlantic flight. In retrospect (and by "in retrospect," I mean after obsessing over my records and digging up as much information as a non-medical person can get her hands on), I'm not sure my gall bladder needed to come out, which is the main reason why I say that much of this doesn't apply to Mr. SK. My symptoms were more representative of an intestinal obstruction that was very fortunately self-limiting, given that it happened while I was over the Atlantic. I was taken to the hospital by ambulance, where my gall bladder function tests were inconclusive. Mr. SK's test results seem more indicative of a gall bladder problem, so I think it's far less likely that he's being misdiagnosed. Still, if it's not an emergency, a second opinion seems perfectly reasonable to me.

In my case, the first and second opinions went the other way. They initially wanted to discharge me without treatment, so that I could find my own way back to Florida when I eventually became able to do things like sit up or eat. Before that happened, my doctor got an opinion from a GI specialist who recommended that he take the gall bladder out laparoscopically based on my description of my symptoms, despite the fact that the tests didn't show it to be a problem. During surgery, they found that the gall bladder itself looked good but there were a few tiny stones inside. (I doubt they were large enough to prompt a removal if I hadn't presented with such severe pain that they decided they needed to do something, which is one reason I think an obstruction was more likely my problem.) During the removal, one of the tiny stones slipped into the duct leading out of the gall bladder, lodging there.

Laparoscopic surgery wasn't appropriate for a stone in the duct, so they completed the gall bladder removal but left the stone. Two days later, they did a procedure where they went in through my mouth and fetched out the stone, which I thought was the end of it.

That night, the excruciating pain was back. Sometime before midnight, my surgeon was called. He prescribed painkillers and told the nurse not to call him back until morning. The painkillers did not work. This was the worst night of my life, pain-wise. When the doctor showed up the next morning, he diagnosed me with pancreatitis, which is a known risk with the stone-fetching procedure. (They claimed to have warned me about that, but this is untrue. I have known people who had pancreatitis and I would have remembered. Also, if they were giving any thought to the possibility that my pancreas was digesting itself, don't you think waiting until morning would have seemed like a poor idea?)

It took several days to recover from the pancreatitis and from very high white cell counts that were never explained. (The white cells are another reason I think that an obstruction is a more likely explanation for what happened to me.) They eventually released me and told me to go home and tell my doctor about the white cells because they didn't know what the heck was causing them to be elevated, even after consulting with an infectious disease specialist. The white cell count went back to normal a few weeks after I escaped the bozos in Reston. I eventually recovered and gained back the twenty-five pounds the ordeal had cost me.

The takeaway for you is that none of this is likely to happen to Mr. SK. If you get a second opinion that says to take out his gall bladder, I would follow it. I would find somebody who does a whole lot of the surgery that he is having. It's a common enough surgery that I don't necessarily think you need to go all the way to Duke, but I'd consider going to a teaching hospital like USC or Wake Forest if I was unsure about the local doctors.

It's my understanding that the laparoscopic surgery is very safe when you don't have the weirdo complications that I had, and I understand that the recovery is much easier than open surgery. I hardly noticed the recovery from the laparoscopic surgery itself. There was very little pain and the scars are very small. They were so minimal that I was able to wear a bikini, (which I don't think that Mr. SK intends to do. ) Unless his doctors are firm that the open surgery is more appropriate, I'd be inclined to go with the laparoscopic option.

If I were you, I would listen very closely when they talk about what his recovery should be like. Ask them about potential complications and get detailed descriptions of their symptoms. I did not have an effective advocate who would demand that someone pay attention to my pain, but Mr. SK has you and I know that you'll make sure he gets the best care. If you know what to expect, you'll recognize any sign that things aren't going according to plan and you'll be able to make his doctors listen to you.

I'll say it again: This is a very common and safe procedure. He should go home feeling much better than he does now. You are a scholarly person, so do some reading about what to expect, but don't let yourself worry too much. He is going to be fine.

One thing I would suggest is to ask any and all medically trained friends that you have to give you names of surgeons. Call those surgeons. If they don't do that surgery, they will know of someone who does it and does it well. Medical professionals know who in their business is good and who is someone they could not recommend.

Whenever I need a medical professional, I ask my tennis teammates (an ER doc, two gynecologists), and they ask around and get me a great referral.

Interestingly, I have been underwhelmed by some of the referrals I have received from my own primary care docs (who are old). I don't know why this is. Maybe they get used to referring patients to a certain practice and lose touch with whether that practice is actually providing the best care? Maybe they are old and just aren't as familiar with the younger docs? But my medical friends actually seem to ask around on my behalf and seem to find referrals to docs who are tops in their field.

Funny thing. I too am biased against older docs; I think younger docs know the latest techniques and also exhibit less burn-out and don't give off a vibe of "heard it all before."

I think in law the opposite is true. Older lawyers know immediately how to get to the bottom of the issue and resolve things efficiently, whereas younger lawyers haven't developed that judgment yet.

But I digress . . . good luck, SK. I hope everything goes well.

Following along on Cindy's digression, my new PCP in Oklahoma is older. Older than me, which means he's pretty old, but not Doug-old.

I found him through pure dumb luck. I did a lot of research and called several highly-rated PCPs, none of whom were taking new patients. However, at one practice, they mentioned that one of their other doctors was taking new patients. I figured I could always change later, if I needed to.

Anyway, the guy is pretty good. He's attentive, he's smart, and he's pro-active. And, he doesn't pretend to know everything. There's a new mole under my eye, and he said that he couldn't be sure, so I'd better see the dermatologist about it.

I've also uniformly liked the specialists he's referred me to, so much so that Mary Anna is now seeing one of them, and so much so that I rely on his recommendations without researching them to death extensively.

All of which is to say, I don't think a bias against older doctors is always warranted.

Again, thank you everyone for your kind words and for all the advice and comments. It's comforting just to be able to talk about all of this instead of trying to figure it all out inside my own head!

MA, I think I remember some of those details, but reading them again, oh my! How horrible that must have been! I'm so glad you are past that!

So we had our appt with the surgeon today, and remember this is the first time we've actually seen a doctor rather than a PA or nurse practitioner etc. Here's the upshot: Mr. SK won't do surgery right now. (Oh and I asked, the doc mainly does this kind of laparoscopy and does a lot of gallbladder surgeries specifically. If we get to the point of scheduling surgery, I will ask more specific questions then.)

Now for the details.

First of all, the doctor was quite different from (IOW much better than!) the PA we saw at the GI specialist's office. He paid close attention to Mr. SK's medical history and took all those details into account in ways no one else has. Then he talked through the results of the HIDA scan with us, which was one of the things I was hoping for. Importantly, he said it's not the case that Mr. SK's gallbladder is obstructed, and as per the ultra sound, he doesn't have stones, his GB isn't enlarged etc. So it's not a clear cut case that Mr. SK needs to have the GB removed. The doc spoken several times about "treating the patient" rather than just making decisions based on isolated numbers (which, I think, is what the PA was doing.) The doc also explained various details about the gallbladder, GERD and other GI processes and problems, and it was really helpful to have all of that explained in the context of Mr. SK's situation.

Basically, he said that it's not clear that all of Mr. SK's symptoms/pain are from the gallbladder, and he said that the kind of pain Mr. SK has isn't consistent with an urgent need for gallbladder removal. And given Mr. SK's history with GI problems, and also with upper GI and HIDA scan diagnostics in the past (which always were negative/normal until this most recent round of testing), there might be something else causing the pain, like GERD/acid problems. In which case, they could take the gallbladder out but the pain/symptoms would remain. He said something like "we can always do surgery at a later point, but once we take the gallbladder out, we can't put it back" (obviously, but it's good to hear that from the surgeon himself!) and he really stressed that if the gallbladder isn't the source of the pain that Mr. SK has, then the surgery would be unnecessary.

He also said that if the pain doesn't resolve, he would recommend a repeat of the HIDA scan, because Mr. SK has had only one bad scan (but a good one a few years back), and two HIDA scans with the same kind of low/abnormal numbers would be a stronger indicator that the gallbladder needed to come out.

Because Mr. SK has had some good days and has only been taking meds for about 2-3 weeks, the doc advised that Mr. SK keep doing the meds and the dietary modifications he's doing, and that we return to him for follow up in a few months, and also that Mr. SK see the GI specialist and consider doing an upper GI, but he said unless the pain/symptoms get worse, then there's no hurry and it might make sense to wait and see if the medication is going to continue making improvements.

So his rec was to do follow up w/ GI doc and upper GI in a month or so. Of course, he also said if anything changes then to come back right away or go to an ER if there are extreme symptoms (and we got all the details about what to watch for etc.) But he said he doesn't think that it's likely that there will be a sudden change based on Mr. SK's condition right now.

So I think we both feel pretty good about this. I ade Mr. SK an appt with the GI specialist for next month, and then a follow-up with today's doc after that, at which point he'll advise us on whether Mr. SK should have another HIDA scan done etc.

So that's the update, Mr. SK and I will talk more tonight, but I think he really liked this doctor and feel like what he was saying made sense. And he (Mr. SK) said "if a surgeon, who makes his living performing surgeries, is telling you you don't need surgery, it seems pretty reasonable to believe that"

On the topic of the age of doctors and Cindy's and Quirt's comments... I kind of feel like when it comes to a PCP or general practitioner, an older doc could be good because he/she will have the experience and insights of all those years. But with a surgical procedure I want a younger doc who has the most recent training etc. Ultimately it depends a lot on how much the doctor actively tries to keep up with the latest info, techniques, and guidelines.

That's great news, SK! The kind of comprehensive analysis that you described is what I was very much hoping you would receive.

Just as an aside, I'm not sure there's much new technology that an older practitioner might be missing out on, especially when it comes to treating gallbladder disease. Laparoscopy was kind of the last big thing, I think, and it's been around for decades. Otherwise, you just want a doc who knows how to sort through test results and symptoms to come up with the best recommendations.

Here's hoping Mr SK feels better soon!

SK, that sounds like the kind of doctor I would like, and trust, a lot.

That's really reassuring, and I think Mr. SK is spot-on that it makes sense to trust someone who is arguing against something that would put money in his pocket.

I think you're in good hands.

Yep!

Thanks y'all!