Friday, 22 November 2013

In, out, shake the gallbladder about.

Oooh, what a hokey cokey time it's been. Two hospital admissions in the last ten days. Both for this rancid, gravel filled, cess pit of bacteria and bile that is nestling under my ribs.  My gallbladder and I have officially fallen out. It has a strop every time I eat and it threw a completely psycho wobbler at me eating pineapple the other day. PINEAPPLE!!! Oh ffs, I knew it had a problem with fat- so have been super low fat (which is more difficult that I anticipated) but the pineapple wasn't battered or anything! grrrr. so yeah, twenty minutes after eating it, I was reaching for the tramadol, which was about as effective as Boris Johnson. 

John arrives home (phew!). Pain continues, chuck down some paracetamol and codeine for good measure (Opiate- tastic). Pain level escalates from a 7 to a 10, cue me writhing about on the floor trying not to upset kiddo (who fortunately is watching the ipad and ignoring mummy squeeling and swearing). NHS 24 say they can't send anyone out - John rings them with me screaming "I just want morphine!!" in the background!

So we ring the childminder who is an absolute star and comes over to look after kiddo whilst we race off to A and E, jumping red lights and tooting people. I'm in absolute agony, unable to keep still, a nurse opens a door, looks at me and I plead to her for morphine. The lovely doctor is pretty quick with the drugs, but despite the full dose, I can still feel the pain. Good stuff though that smack, I can see why junkies find it a bit moreish (sorry, bad taste humour...  I am NOT advocating drug abuse!).

Doing a Zammo
I get carted off to the general incompetancy ward (I think it was actually general surgery). All night they are slamming doors, shouting, wheeling spectacularly noisy trolleys and ignoring me. The doctor eventually shows up 4 hours after I get admitted and I get my long overdue morphine top up.  They decide to take my gallbladder out but not until it gets less inflammed. Then they change their minds. They decide to do a repeat ultrasound (the last one was about 10 months ago) and then change their minds. The surgeon is trying to find every excuse he can not to put me on his waiting list. "but I doubt removing your gallbladder will address the pain" he says. Why? "because this started with a bike ride"- no it didn't! It happens after eating, I had told them about the bike ride because I was trying to explain how variable my Lyme can be. "well, you have a history of backache". yeah, years ago, because I was hunched over a microscope at work- nothing to do with this!. "well, you have generalised pain problems" he says. Actually, I reply, pain has always been a minor feature of my Lyme disease, I'm quite lucky that way. For goodness sake!

Apparently it has to go to a multidisciplinary panel to decide my fate because I am complex (I have Lyme). So when it suits them I have Lyme, when it suits them to say I don't, I don't! ach!!!. Also, he wants a report off the cardiologist. This is fair enough but he could have asked for this weeks ago when I saw him in clinic and told him of my heart problems. He says they can't use Lyme as part of the decision as to whether to operate, for medico-legal reasons. Well, it sounds like they are using it as a reason NOT to operate, but can't use it as a reason to operate- despite the letter explaning why it's an issue for Lyme patients from my LLMD. 

So, what's the evidence for a connection between gallbladder problems and Lyme? Nothing concrete as far as I can ascertain from pubmed and google scholar.  There is an association between ceftriaxone use and biliary sludging (sludge in the gallbladder) but I've not had ceftriaxone since 2008 and I had no gallbladder type pain then. A well respected Lyme doctor in the states, writes in  his excellent blog :

"This an area of Lyme medicine which deserves more attention. Many Lyme patients end up with removal of the gallbladder. Lyme can infect the wall of the gallbladder and cause chronic inflammation. This appears to happen with increased frequency when there is also evidence of Salmonella infection. In the past most gallbladder disease was related to gall stones. There has been a change. Most patients with gallbladder disease no longer have stones; they have chronic inflammation of the gallbladder. Patients with gallbladder disease have recurrent bouts of abdominal pain which starts out mild but gradually builds up to severe pain. The pain may be located in the right upper abdomen or be generalized to the entire abdomen. Nausea and vomiting may occur. In the past doctors have ordered a sonogram to evaluated the gallbladder. When the problem is related to infection this test will be normal. The diagnosis is made with a nuclear medicine scan called a HIDA scan, with the administration of a hormone called CCK. The hormone injection will likely cause the symptoms to recur and the test will showed a low ejection fraction, indicating abnormal functioning of the gallbladder. Generally, successful treatment requires removal of the gallbladder which can be done with a minimally invasive laparoscope. The fact that intravenous Rocephin is known to cause gallbladder attacks may suggest that this is a sort of Herxheimer reaction involving a gallbladder which is already infected with Lyme bacteria."

I don't know if I have salmonella infection or not, I've never been tested. I have written to the main UK NHS testing laboratories asking if they would test my removed gallbladder- these are the Rare and Imported Pathogens lab at Porton Down and  the Scottish Lab at Raigmore, Inverness- which, sadly, is called the national Lyme's testing service on their website. (spot the mistake!).  Both have not replied to my very polite emails.

I am absolutely convinced that these episodes of pain are related to my gallbladder, They are typical of biliary colic - they happen after eating (apart from pineapple, previous episodes have been associated with eating some fat). They are localised in the right upper quadrant- i.e. just under my ribs on the right hand side. The pain radiates around to my back and often I get pain in my right shoulderblade. I always get intense nausea with it and sometimes vomitting. The attacks last for a number of hours- several to around 8hrs, but recently I've been constantly mildly sore in that area. 

They could be just gallstones- there is a medical mneumonic,  'fat, fair, female, fecund and forty'. well, I'm definately female, thin if anything, had one child, nearly forty and fair, so half right. I'm not one for munching on chips and pizza everynight, we have a fairly low fat, fibre rich diet as a rule, so I don't think it's diet induced. The ultrasound 10 months ago showed lots of 'gravel' in my gallbladder (which the sonographer said can cause a lot of pain).  I have to trust the experience of my Lyme doctor who says that his patients benefit from having the chronically inflammed  gallbladder removed, he has seen thousands of Lyme patients and I think he knows his stuff.. All I know is I want this vile little organ out - NOW!!!!

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