Guy's Battle with Gallstones
A Patient's View of a Laparoscopic Cholecystectomy
The purpose of this article is to offer reassurance to those who are reticent about having their gallbladder removed. The medical name for this procedure is a laparoscopic cholecystectomy.
Topics for Guy's Gallbladder Operation
Firstly, I want help others who face my predicament. I want to explain why an operation to remove the gallbladder is the best option for those who suffer regular abdominal pain caused by gallstones. (Also known as cholecystitis, choledocholithiasis or bile duct stones.) The reason that I maybe able to convince those who are wavering, is because I was the biggest doubter before I had my successful keyhole operation.
I am not big on disclaimers - but I will say that naturally you would seek guidance from a doctor on your suitability for this laparoscopic cholecystectomy operation. My advice is aimed at people who broadly match my clinical history for gallstones.
Secondly, I want to thank my doctor* who persevered with this pig-headed patient, and used logic to convince Guy Thomas to go ahead with the operation.
Last, but by no means least, I would like to thank Mr Lake and his team at Worcester Royal Hospital (England), for removing my gallbladder via keyhole surgery so skilfully.
* My doctor would prefer to remain anonymous.
The root of my problem was that I have inherited a susceptibility to gallstones. My father also had his gallbladder removed by a laparoscopic cholecystectomy. Moreover, his father, my grandfather, had severe gallbladder pain and associated pancreatitis complications.
At the age of 53 I had my first gallbladder attack. 7 more episodes followed in the next 2 years. While a low-fat diet from ages 55 to 59 reduced the frequency of attacks considerably, the bouts of gallstones did not stop entirely. Furthermore, I often experienced a low-level 'grumbling' in my abdomen; I could feel activity in the region of my gallbladder, particularly when I lay in bed at night.
I will always believe that you can win a skirmish with gallstones by eating a regular diet and by avoiding as many fatty foods as possible. Indeed, I fended off choledocholithiasis attacks for 4 years with a virtually fat free diet. However, my doctor persuaded me that I could not win the gallbladder war. They floated the idea that eventually I might have a nasty gallstone attack, which could have debilitating consequences. At the very least further gallstone attacks would cause me more pain and discomfort. Her clinching argument was the benefit of an operation when I was relatively young and fit, rather than waiting for the inevitable operation when I was older and probably in reduced health.
Gradually, I took on-board the idea that two days in hospital when I am healthy is preferable to weeks in hospital recovering from a perforated gallbladder, or suffering the excruciating complication where the pancreas becomes inflamed. As I computed this mental balance sheet, I also debited a day here, two days there, for minor choledocholithiasis attacks of pain in the upper right abdomen and in the kidney area.
I was nearly ready to commit to an operation to remove my gallbladder. Yet there were still a few demons to overcome before I went ahead with my cholecystectomy. In truth there was a fear of an operation, especially as I had not previously experienced general anaesthetic or any sort of intrusive surgery. Other factors holding me back included the feeling of indestructibility, especially as I am rarely ill.
I say again, without my doctor's firm persistence with logical arguments, I would have continued to find irrational reasons not to have the keyhole surgery. However, in May 2008 I committed to the Laparoscopic Cholecystectomy procedure at Worcester Royal Hospital, England. After a 5 month wait, the hospital scheduled my operation for October 2008.
Incidentally, my operation was on a Saturday morning, I was thankful for the relative peace and quiet of the timing, and I appreciate the hospital laying on extra operations outside the normal working week.
The night before my gallbladder operation I ate very little. The hardest part was not being able to drink on the morning of the operation. I coped by washing my mouth with water, I confess to swallowing just one drop of water on three occasions, just to ease the parched feeling.
I arrived at the hospital at 8 o'clock in the morning. The ward sister took me to my bed in the Surgical Short-Stay Unit, where I was fitted with a pair of surgical socks which would keep my feet warm. An hour or so later I was wheeled to the pre-operating theatre on a trolley. They put a needle into the back of my hand.
The next thing I remember was waking up two hours later - my operation was over and the surgeon had successfully removed my gallbladder. I was pleasantly surprised that I had no headache. Others experience nausea with this operation, but I was lucky and felt fine. I attribute my digestive well-being to not eating for 12hrs before-hand, plus my anaesthetist's skill.
General stiffness coupled with the sensation of a wound in my abdomen severely restricted every attempt at movement. I would describe my situation as experiencing a significant amount of discomfort, but no pain. I also felt elation, some say this was the effect of the anaesthetics and the pain killers; my own view was the euphoria was mainly because the operation was over and I was not only alive, but 'OK'.
Day 1 Post Laparoscopic Cholecystectomy
I noticed that I was wearing an oxygen mask. The nurse told me this was to help recover from the affects of the anaesthetic. The combination of the air stream from the mask and the intrusion of the anaesthetic tube gave me a sore throat. I remember thinking, 'If my worst problem is a tender throat, then I know I am OK'. Next, I noticed that I had a tube coming out of my abdomen with a bottle at the end to collect blood or serum. There were only about 3 drops or purple fluid in my tube. [Some other patients did not have such a tube].
After about an hour I decided I was going to get up from my bed. I admit it was a titanic struggle; it reminded me of getting out of bed after various sports related injuries. It took me ages to perform each stage: sit up, legs on the floor, bend forward, stand. Somehow I got into my dressing gown, one of the many thoughtful touches provided by my beloved wife Pauline.
I had previously checked that walking would do me no harm post gallbladder operation, therefore I was determined to move under my own steam. My mind wandered to marathon runners, and the thought that it's too fast a pace that cripples runners, not distance, thus if I take my time, I will reach my goal, which in this case was the toilet. Pleased to note that my bladder and associated tubing was working fine.
On returning to my cubicle in the ward I sat on a chair next to my bed. Taking little sips, I drank as much water as I could; once again I was thrilled that there was no nausea. A nurse came with coffee - lovely. Then another nurse or nursing assistant came with lunch. To my way of thinking, fresh sandwiches were a brilliant choice of food for patients, I selected the tuna and mayonnaise on brown bread. There was even a choice of luxury yogurts for desert. Naturally I ate slowly. I had a strange desire to test that all my limbs and organs were working normally after the operation.
As anticipated, my abdomen was swollen, but again I was fortunate because I had none of the disagreeable gas build-up in the colon as reported by other patients. During the course of the day I had just two minor episodes of coughing, presumably as a result of the anaesthetic. Actually, laughing caused the most pain, and it's very hard to stop laughing once you start.
One unexpected symptom of gallbladder keyhole surgery is pain in the shoulders caused by the carbon dioxide, which is needed to extend the abdomen for the keyhole instruments. I experienced this classic sensation, but it caused me almost no discomfort, Guy is lucky - again. However, I will always attribute my 'lucky streak' with this operation to the skill of the surgeon and the anaesthetist.
I have always believed that the only good part of being ill is the feeling of getting better. And I was beginning to feel better and better. Clearly the anaesthetist and surgical staff had given me pain killers for my operation, but at this time I refused all offers of more pain killers, believing that the pain and discomfort was controlling how much I SHOULD do. Judging by the reaction of the nurses, my guess was that even without extra pain killers, I was moving around significantly more than other patients who had this operation.
Supper arrived; more lovely sandwiches, with pears and ice cream for dessert. This suited me, moreover there was a choice for those patients who preferred other food. After eating, I was happy to have a jab of a heparin like drug, which was designed to prevent my blood clotting.
Problem in sleeping after a gallbladder operation
The only time I felt crippling pain was at midnight. I was ready to sleep, so I moved from the chair into bed and lay down in the foetal position. At this point the pain was unbearable and I called for the nurse who gave me 2 Paracetamol (Tylenol, acetaminophen). These tablets soon relieved the pain and enabled me to sleep fitfully for 6 hours.
Presumably it's to prevent this situation that other patients are given, and take, their pain killers immediately after the operation. Incidentally, I have developed a pet theory that for this particular cholecystectomy operation, sitting in an upright chair, or even walking causes less pain than lying in a bed.
When I awoke on the first morning after the gallbladder removal, I tried to get out of bed. At first I though that I had suffered a relapse. It was 3 times more difficult to get out bed the following morning after it was an hour after the operation. But I did it. Thereafter I just gingerly moved around, loosened up, and never looked back. I had muesli for breakfast, other patients had toast which smelt wonderful. Again I take my hat off to hospital catering - simple fare, but perfect for we patients.
During my frequent walks around the ward I saw a report on the notice board about patient satisfaction. My attention was drawn to the question: 'Did the nurses answer all your questions?' I want to proclaim that I appreciated the way that every nurse answered fully each and every question that I asked. I would like to add that following my treatment, the resulting satisfaction survey should be now be nearer 100% than the 86% figure that I saw, especially if the compiler takes into account the number of questions that I asked.
Part of me was restless to go home even 2, 4, or 6 hours after my operation. Part of me knew it was a sensible decision to stay long enough for the nursing team to be sure there were no complications. I trusted that this tube, with its bottle was inserted for a good medical reason, and I accepted that I could not leave until the doctor was satisfied that it was no longer needed. For me this was 24 hrs after my operation.
Part of me wanted to drive myself home, but the three women in my life, wife, mother and sister, persuaded me in a pincer movement to leave my car at home, and I think the other road users were grateful that I was driven home in a taxi.
One unexpected side-effect was reflux, or food repeating. However, I believe that this was due to my poor posture caused by bending too far forward while eating my first meal at home. Subsequent meals eaten with a straight back have caused no further problems.
I read the notes for patients, and was interested by the paragraph which said that pain-killers helped get patients ambulant, but as mentioned earlier, I was moving more than most. However, it did occur to me that the slight pain was stopping me walking and sitting correctly, but then I remembered the advice of an eminent physiotherapist who said, 'Always walk as though you are attached to the ceiling by an invisible string'. Posture sorted.
My mind turned to the idea that I had now won the war with my laparoscopic cholecystectomy, but now I had to win the peace and make sure that my scars healed without infection. Consequently, I phoned the hospital ward and asked about removing the dressings. The nurse told me that it was OK to remove the 4 patches. This I did in the bath, where I also gingerly peeled-off the associated steristrips. There was no sign of the self-dissolving stitches, but neither was there any bleeding so I just let nature take its course and heal the scars. See photo to the right, taken after I removed the 4 patches.
In truth, this procedure for removing the dressings is just what the nurses had told me on three separate occasions back in the hospital, I just could not believe that treatment for the wounds could be so simple.
Feeling good now. I can do everything I normally do, just a little bit slower. Yes I have a few twinges, but they are the sort of aches and pains that you get when you are mending after a sports injury or a fall.
My abdomen has been feeling a little 'prickly' for a few days, I think it's where they shaved off the hair before they made the incision for the laparoscopic instruments. I phoned the hospital to ask about care of my wounds and the nurse said, 'Don't, repeat, don't put any cr�me on the cuts'.
Nature takes its course and the scars continue to heal without any intervention from me. I did suffer two minor episodes, which I could best described as phantom gallstone attacks. I put it down to the after-effects of the operations, perhaps internal scars healing, or organs settling into their new positions - really I am guessing. The result was a few unpleasant few hours feeling a pain under the right breast.
No more attacks of any sort. All clear.
What spurred me to make this entry is because one person who had had a laparoscopic cholecystectomy wrote to report that they are suffering from Post Gallstone Syndrome. I feel sorry for them, and am slightly apologetic to report that I am fine. My weight has remained constant and my health is good. I have had no problem with any aspect of my digestive system. This is probably down to good fortune. However, I have helped lady luck by continuing with a low-fat diet. I am not a vegetarian, but I don't eat much meat, and I do seem to eat smaller portions than other people.
Guy's Awe of the Surgeon and the Anaesthetist
One can appreciate why doctors seek simple explanations to encourage and to reassure patients about their up-coming operations. However, these simple diagrams don't do the surgeon's skill justice. As someone with just a little scientific knowledge, I am in total awe of the surgeon who carried out my cholecystectomy. In a nutshell, I have nothing but admiration for his skill in using keyhole surgery to find the pear-sized gallbladder, snipping it, and removing it from my body carefully.
Then there is the anaesthetist. You could dismiss them as someone who just puts you under for the operation. But I got to wondering; how does he know just the right dose I needed, how does he fix it so I feel nothing? How does he manage to play his part without chipping my crowns or scratching my windpipe? I guess he knows because he is an expert; again, I admire and appreciate his skill.
While I am grateful to all the nurses who attended me during my 24-hr stay on
the ward, I realize there is a whole theatre team of nurses whom I never met.
I take this opportunity to thank them too.
Conclusion: Gallstones. Post Laparoscopic Cholecystectomy
If you suffer from gallstone attacks, and your doctor recommends a laparoscopic cholecystectomy to remove your gallbladder via keyhole surgery - take their advice.
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