Dear Dr. Roach: My husband鈥檚 doctor is telling him to have his gallbladder removed because sometimes he has pain in his right side. They did all kind of tests, but he has pain when he drives long hours or when he eats salads, not fried or fatty foods. Can you tell me more about the surgery, and what it might be like for him after the surgery?
A.M.
Almost every time a gallbladder needs to be removed, it is because of gallstones. Gallstones are common. Six per cent of men and nine per cent of women have them, but most of the time, people have no symptoms. It isn鈥檛 always clear whether the symptoms people have are due to the gallstones that are found on imaging studies, such as CT or ultrasound, but there are some clues to help decide whether a gallbladder that contains stones needs to be removed.
The classic symptoms are pain in the right upper abdomen, especially after eating a fatty meal, such as fried food (some people eat salads with lots of fatty dressing).
Sometimes gallbladder pain is not food-associated. Symptoms at nighttime are not uncommon. Nausea, bloating, lower chest pain, belching and burning pain are all well-described with gallbladder disease, and the proof comes when surgery relieves the symptoms.
Sometimes, the imaging test can give clues. Thickening of the gallbladder wall or pain with pressure on the gallbladder (Murphy鈥檚 sign) are suggestive of acute gallbladder inflammation.
Unfortunately, doctors aren鈥檛 always right. Occasionally a person鈥檚 gallbladder is removed, and it doesn鈥檛 help the symptoms at all. Then, a new search needs to be done to discover the true cause of the symptoms.
Most people do very well after gallbladder surgery. The liver itself takes over the job of storing bile, in the ducts of the liver, and bile is released into the intestines appropriately after eating. However, it takes time for the system to get adjusted to not having a gallbladder, and only 60 per cent of people are completely back to normal after three months. A few people have persistent symptoms for years. Thus, it鈥檚 wise to be as sure as possible that symptoms are due to gallbladder disease before undergoing surgery.
Dear Dr. Roach: I鈥檓 85 years old. I have numbness in my hands 鈥� sometimes the right, sometimes the left; sometimes both hands or not at all. It lasts only a while. My doctor feels that it鈥檚 a pinched nerve in my neck. Can you give me any advice?
J.B.
A pinched nerve in the neck becomes more prevalent as people age. The nerve can be compressed by bony structures in people with osteoarthritis in the neck (this is spinal stenosis), or by disk material in someone with a herniated disk. Having symptoms on both sides is less common than having symptoms consistently on one side only. A careful physical exam can give clues that this is the case, but an MRI or other imaging study is the best way to be sure of the diagnosis.
Hand numbness also may be caused by the nerve being 鈥減inched鈥� in other locations: in the carpal tunnel in the wrist or in the cubital tunnel in the elbow. An EMG test can help sort out where this is coming from.
It鈥檚 certainly possible to have carpal tunnel syndrome on both sides.
My best advice is not to rush into surgery at any age, but especially not at age 85. Physical therapy can prevent many people from needing surgery. However, if numbness progresses to weakness, it鈥檚 time to reconsider.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
