Gallstone- NHs won’t remove

[silverdarkness]

Anyone know anything about acute cholecystitis? I have had an awful time earlier this week and was in absolute agony in my stomach and back and unable to eat or sleep for 36 hours throwing up water even. I ended up in hospital on morphine and diagnosed with acute cholecystitis. My gallbladder is very inflamed and thickened and I have at least two gallstones the size of 50ps. I was sent home with codeine( didn’t work for his attack anyway)and told by the consultant to come back in 2 months for a check up and to never eat anything with fat in it again ( I am already a healthy weight). Unless it happens again and then I must go to a and e and then they MAY remove it. I had some awful pains just before Christmas but was not diagnosed yet so the Gp just said it was prob intigestion so this is the 3rd or fourth attack really but they won’t “ count” those ones just the ones that result in hospital admission. From what I have read online(NICE guidelines and nhs pathways)I should of been offered a gallbladder removal within a week and antibiotics as this is the standard treatment and this can be dangerous. Just wondered what others knew about this particular condition if they keep refusing to take it out what can I do??

Haha, I love how you think codeine or Oramorph (which contains so little morphine it's not even a controlled drug) deals with the pain. The only thing I've been discharged with that helps is Oxycodone.

And to be brutually honest. I would say less than 5% of people stick to a fat free diet (in my experience). 95% of people who are referred to us have gallstone pain following eating a fatty food

I do totally agree with this.

Thanks for your reply, Poinsetta, but I think I may have been a bit unclear in how I phrased my question. I was really asking if it is considered to be in a patient's best interests to be on a fat-free diet indefinitely, rather than have surgery? It's just that I find that very surprising (and worrying), given that a fat-free diet over a length of time will result in nutritional deficiencies, that then may cause other health problems/diseases.

And then, of course, there will be a mental health impact of being so restricted (and, no doubt, hungry), over a long period of time. My experience of the NHS is that it is extraordinarily poor at taking mental health impacts into account when deciding on what treatment to offer for physical health issues, but I would be interested to know if it is ever considered in this context?

"But it did make me laugh that you feel you are more worthy of the surgery quicker because you were in the paper"

that is NOT what i meant But considering i did what the NHS is always telling us to do and lost a lot of weight i didnt expect to come up against stalling tactics. Stalling is what it feels like to someone in this amount of pain.

Actually @Ponsietta100 , I'm curious to know how you deal with pts in my condition. Numerous biliary attacks post cholecystectomy over 18 months. Suspected choledocholithiasis. ?

Helena it always amazes me how patients in proper pain are fobbed off with paracetamol. It's well known to be the mildest of the mild, not even very effective painkiller, yet it's given in cases of severe pain, like gallstones, post-CS, labour, etc as if it will actually do anything. Madness.

Poinsetta you do realize that a lot of very low fat foods are high in sugar How do you square that circle?

ShovingLeopold I think you’re probably right. Not enough thought it put into long term effects of fat free dieting. Honestly, beyond the initial advice of fat free diet in my role I have no insight/experience of how this is dealt with later down the line because I only work in emergency assessment. Almost all of the patients I see as previously said don’t stick to the advice. So I don’t know how this is plays out for people in the long run. That I assume is discussed at outpatient appointments and followed up through their systems. But as someone previously said, even post op you’re advised to eat low fat. I think the NHS dietic approach as a whole is shocking and unhealthy, but that’s a WHOLE other thread.

One of my two gallstones - no wonder the pain was so bad. My gallbladder was on the point of bursting.

SimplySteve obviously I can’t speak for every case. But we’d usually do an ERCP. sometimes as a inpatient, sometimes as an outpatient.

HelenaDove we tell you to cook your meals from scratch and not buy convenience food. Also to be conscious of what you are buying and eating.

Well luckily i dont like ready meals

But here is one example Sainsburys medium fat Greek yoghurt 5g sugar per 100g

Sainsburys low fat Greek yoghurt 13g sugar per 100g

i had been doing SW for months when i had my first attack I was already eating low fat I could not take SOLID food I ended up living on small tins of tuna or slim a soups. i had to choose between being ravenously hungry or being in excrutiating pain.

@ShovingLeopard i dont get it either.

Thanks Poinsetta, it doesn't surprise me that not much thought appears to go into it. Like you, I find the whole NHS approach to dietetics excruciatingly old-hat. It's really worrying to think anybody may be encouraged to eat like this long-term, simply to save the NHS a few quid (upfront, that will then cost them more in the long-run when the other health problems show up after eating a poor diet).

Bluelady your photo made me wince....

Helena I'm not sure if it's money, or whether the fact a minority abuse opiates means that the vast majority are now expected to suffer, rather than be allowed to take them?

Thanks @Ponsietta100 for your replies, appreciated. I've had an endoscopic ultrasound suggested, or laparoscopic examination but need see the consultant first! I'm in a standoff with endoscopy as I will not have an EUS/ERCP done unless under GA. I had a DRE three weeks ago on my last "visit", I'm still having trauma from it now...

I did have an MRCP in March that indicated distended CBD and possibly SoOddi "issues". I'm rather worried I'm going to be stuck with these persistent attacks for life :(

I think you're getting some unfair heat too @Ponsietta100 just for expressing your units perspective. While I disagree with the stance, I thank you for your posts and time.

my gallstones were lots and lots of little ones They were put in a little plastic container after my op and given to me. My dad took them and threw them into the medical waste bin

Regarding fat intake btw, I've been on a very low fat fasting diet since 2016 (following appendicectomy) , it's not reduced my biliary attacks at all.

Thats a good point @ShovingLeopard. That Christmas when i couldnt stand up because my legs kept giving way couldnt stay concious and felt nauseous i remember mumbling to DH that i couldnt understand why people chose to do drugs if this is what it felt like.

This may be the elephant in room as regards treatment pathways for Gallstones:

Several risk factors for gallstone formation have been identified. One of the most important risk factors is female gender. Rates of gallstones are two to three times higher among women than men. But this is primarily a phenomenon of the childbearing age. Pregnancy is also a major risk factor for gallstone formation. The risk is related to the number of pregnancies. Sex hormones are most likely to be responsible for the increased risk. Estrogen increases biliary cholesterol secretion causing cholesterol supersaturation of bile. Thus, hormone replacement therapy in postmenopausal women and oral contraceptives have also been described to be associated with an increased risk for gallstone disease. However, the effect of estrogen is dose-dependent and new oral contraceptives with a low estrogen dose do not seem to increase the rate of gallstone formation.

Most references state being female is a big risk factor hence the 4 F's - Female, Forties, Fat, Fair (haired, no idea about that one!) I ticked all those boxes except Fat when I started having problems.

Sounds awful Helena. Totally shocking that they were prepared to leave you like that for months. In pain, unable to do much, presumably. Then the government and its tame media bleat on about the workday, benefit scroungers etc. But that's a whole other thread, I guess.

Workshy, I meant.

One word of caution, there can be long term debilitating side effects* from a cholecystectomy.

• read explosive diarrhea at short / no notice as a result of eating known or unknown trigger foods.

I did lose the job that i had at the time Ironically while i was recovering from the op Had the op on 28 April Job dismissed me in early May.

Heres something really weird I cannot eat bananas or take co codamol. They cause a gallstone like pain even though i no longer have a gall bladder i havent had a banana since 2009

Mine was triggered by pregnancy - when I definitely wasn't consuming much fat since I had hyperemesis! I agree running re elephant in the room. Whilst my later attacks were dealt with properly the initial one was a joke, including a twat of a paramedic saying "It's just indigestion hen "...I'm sure I don't need to tell anyone on this thread how much a gall bladder attack doesn't feel like indigestion.