Dear Dr. Roach: I am a 75-year-old man in pretty decent health, as far as I know. I had an ultrasound due to some lower abdominal discomfort. The ultrasound did not show any reason for the pain, which actually subsided. But it did show that my gallbladder is full of stones. I am terribly concerned because in the past, I have not done well under anesthesia. With colonoscopies, doctors say they give you something to help with nausea, but it never helps me. I vomit and stay dizzy all day, even into the next day.
Should I be concerned about the surgery itself? I am beside myself, as surgery day is quickly coming up. What can you tell me about the terrible nausea I experience?
R.
As far as the surgery itself, removal of a gallbladder is usually well-tolerated. It is typically done using a laparoscope rather than a traditional open surgery. Laparoscopy makes recovery for the patient much faster. It is still a major surgery, and there are always risks with any surgery, but most people have a good recovery and outcome.
Post-operative nausea and vomiting is a significant concern. About 30% of adults will have this complication after undergoing general anesthesia. There are indeed many ways to prevent this complication, and your best friend in this regard is the anesthesiologist. You should tell the anesthesiologist as much as you can about the previous procedures you have had, as well as your symptoms of dizziness and vomiting. The anesthesiologist can adjust the type of anesthesia and use not just one, but potentially several different treatments to prevent this complication.
Dear Dr. Roach: I am an 86-year-old woman, and I’m quite active. I have a plantar fibroma on the arch of my foot.
Can you explain what this is, the treatment is for this condition and if surgery is needed? What is the recuperation like?
N.B.
A fibroma is a benign tumour of connective tissue. They can occur in any of a host of different tissues, from the skin to muscles, from blood vessels to bones. When they occur on the plantar surface of the foot (“plantar” is from the Latin word meaning “sole” of the foot), they occur within the thick band of connective tissue called the plantar fascia. Pain comes from pressure on the nodule by your shoes or by being barefoot on the floor, but symptoms are often worse when wearing shoes.
Foot experts do not rush to surgery. If you have no symptoms, then no treatment is needed. If you are experiencing pain, then stretching, shoe inserts or physical therapy is usually tried before treatment with a steroid injection. If symptoms aren’t relieved by conservative treatments, if the injection isn’t helpful, or if the symptoms return after initial relief, surgical treatment is sometimes done. But potential complications, including flattening of the arch of the foot, make surgery something to consider only after giving other therapies a good chance.
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]
