Suggestions/advice on where to have an endoscopy and gall bladder surgery?

[Mobi]

I have been in the UK on a 3 week break to visit my family and just after I arrived, I started to experience severe pains in my upper abdomen that lasted for 4 – 5 hours.

The pains were so severe that I was rushed to hospital twice. The first time they were more concerned with my heart (which turned out to be fine) and I was eventually sent home with some tabs for acid indigestion.

I was back at the hospital 2 days later with more intolerable chest pains and this time the doc realised it was not heart related. He pushed down on my abdomen on the right side, just below my rib cage and I nearly jumped through the roof in agony, He told me that he thought it was gallstones and I needed to have an endoscopy to confirm it, but he couldn’t order one for me as I haven’t got a UK GP.

I explained that I was travelling back to Thailand in 1 week and he has given me a load of high dosage meds to hopefully stabilise my pain attacks until I get back home. So far so good, but I am becoming increasingly fatigued and even a short stroll leaves me exhausted.

I have read up on gall stones and my symptoms match the condition to a tee so I have little doubt that the doc’s diagnosis is correct. However I do need to confirm with an endoscopy and then have the surgery which nowadays is usually a keyhole procedure.

To say the least, I’m not very flush these days and dread to think what they may charge at BPH.

So has anyone else had this particular problem and can anyone suggest a good, not too expensive place to have the endoscopy and the operation.

Thanks for any info or advice.

Mobi

[jrtmedic]

Others may suggest a doctor/hospital.

Sorry to learn you may have gallstones causing biliary colic.

Be aware that an invasive procedure (endoscopy) is not usually the first line of investigation. A plain abdominal x-ray followed, if necessary by an ultrasound scan or CT would be more usual means of securing the diagnosis.

You may find the information in this link helpful.

http://www.mayoclinic.com/health/gallstones/DS00165

[Sheryl]

Mobi,

1. Laparoscopic surgery will be at least double the cost of an open procedure wherever you go so if funds are really tight, may want to reconsider on that point.

2. Suggest this general surgeon at St Louis Hospital:

Name : DR. NARONGSAK JONGSIRI Type : Staff Clinic : Surgery Department Specialty : General Surgery / Endoscopic Surgery Available Languages: Thai , English Education : 1987 MD. FACULTY OF RAMATHIBODI HOSPITAL MAHIDOL
UNIVERSITY.

1991 CERTIFICATE IN CLINICAL MEDICAL SCIENCES(GENERAL SURGERY) AT MAHIDOL UNIVERSITY.

1990-1992 RESIDENCY PROGRAM OF GENERAL SURGERY. THAI ROYAL MILITARY HOSPITAL. (PRAMONGKUTKLAO HOSPITAL)

1996 CLINICAL FELLOWSHIP IN LAPAROSCOPIC SURGERY AT THE ROYAL BRISBANE HOSPITAL. BRISBANE, STATE OF AUSTRALIA.

1999 CLINICAL FELLOWSHIP IN LAPAROSCOPIC SURGERY AT THE ALFRED HOSPITAL. MELBOURNE, STATE OF VICTORIA AUSTRALIA. (DUNLOP-BOONPONG SCHOLARSHIP UNDER THE ROYAL COLLEGE OF SURGEON OF THAILAND AND AUSTRALIA)

2006 CERTIFICATE OF THE HOSPITAL ADMINISTRATION AT THE FACULTY OF RAMATHIBODI HOSPITAL. Training : 1996 Training Laparoscopic surgery at the Royal Brisbane
Hospital Brisbane, State of Queensland Australia
2006 Certificate of the Hospital Administration at the faculty
of Ramathibodi Hospital Work Date :

Monday :: 08:00 AM - 05:00 PM
Tuesday :: 08:00 AM - 05:00 PM
Wednesday :: 08:00 AM - 05:00 PM
Thursday :: 08:00 AM - 12:00 PM
Friday :: 08:00 AM - 05:00 PM
Saturday :: 09:00 AM - 04:00 PM

I've met him, he did a hernia repair on my nephew. I found him pleasant, competent and staightforward, and as you can see above, he did a fellowship in laporascopy in Australia.

If you are admitted there, be warned that the admitting dept sometimes tries to pitch expensive VIP rooms, especially to foreigners. Hold firm against same. It is worth the added cost of private as opposed to semi-private room but nothing more than that, at least IMO.

[Thanyaburi Mac]

Gall stones found via ultrasound, included in packaged annual physical exam. Decided to have them out. Checked in mid-morning, op noonish, two nites in the room "just to be sure," and out the door.

FYI, Dr Tanes also plays the guitar, if that makes a difference.

Mac

26 June 2007 Vibhavadi Laparoscopic cholecystectomy (gall bladder) b109,550 $3,341.49

Doctor Name: Tanes Puapornpongse, M.D.

Department: Surgical Clinics

Details:

Doctor of Medicine, Siriraj Hospital, Mahidol University

Diplomate, Thai Board of General Surgery

Master of Business Administration (MBA), Chulalongkorn University

Diplomate, Thai Board of Family Medicine

Certificate Clinical Fellowship in Laparoscopic and Endoscopic Surgery (Imperial College University of London, UK)

Certificate Clinical Fellowship in Breast Surgery (Imperial College University of London, UK)

Clinical Attachment Course on Hepatobiliary and Pancreatic Surgery (Imperial College University of London, UK)

Present : General Surgeon

[Mobi]

The long silence in this thread is because I decided to correspond via PM to Sheryl, and over the past few weeks, she has given me very good advice which I have been following in an effort to try and solve my problems.

However, I have now reached an impasse and frankly I have no idea where to go from here, so I thought I'd put it back in public forum in the hope that someone out there has had a similar experience or can advise a plan of action.

To bring you up to date, back in September, I took Sheryl’s advice and went to Q Sirikit hospital in Sattahip to see if I could arrange to have an ultrasound to confirm the UK doctor’s suspected diagnosis of gallstones.

This was duly carried out and although I don’t have a copy, it basically said that my organs (liver, kidneys etc) are fine and the gall bladder is full of sludge but no sign of any stones. It also said that there was no cholecystitis. In other words, according to the doc, the gallbladder seems to be in good shape. The ultra sound couldn’t check out my pancreas, as there was too much gas.

I was then referred to another specialist who arranged for me to be admitted to have a gastroscopy and an endoscopy. (Cameras down my throat and up my backside). This was carried out last Monday, and was complicated by the fact that I had to be weaned off warfarin, (which I take because of my artificial heart valve), before the procedures and it involved a 3 night stay in hospital.

The results of both procedures show absolutely no abnormalities – everything is normal. I have copies of both reports, and I was a surpised to read that the endoscopy report had the comment ‘poor bowel prep’. This was despite the fact that I hadn’t eaten anything from midday on Sunday – and even before then, very little , just boiled rice soup for the previous 24 hours - up until around 1 pm on the Monday when the procedure was carried out. I had followed all the pre- op guidelines to the letter. (I spent the entire Sunday afternoon/evening in the loo after taking the enema in the early afternoon and was still passing liquid from my bowel barely 2 hours before the procedure). I tried to tell them that my bowel did not appear to be completely empty but nobody was listening. I am not sure if the ‘poor bowel prep’ had any serious effect on the camera's ability to discern any problems in the bowel.

Anyway, on Tuesday morning a young junior doctor came to see me and told me that there there's nothing wrong with me and I can go home.

I asked her about my severe abdominal pains and on-going diarrhoea and she said it is ‘nothing surgical’ and probably just ibs. (irritable bowel syndrome).

I asked if ibs can cause such severe pains and she just said ‘it’s not surgical and go see the medical department’.

I asked if my pancreas could be the cause and she said they haven't examined it but my symptoms do not fit pancreatitis.

(I should add that I have independently taken a blood test for the enzyme amylase in my blood which came back ‘normal’ so I think I can rule out pancreatic problems)

So I am back to square one and I don’t even know if I should continue taking the meds that the doc prescribed for me back in the UK to alleviate the symptoms. I did try stopping them some weeks ago and had a bad pain attack the same night. I have even had pain attacks while taking the meds, and when that happens, I double up on the dosage and take Tramadol and paracetamol to deaden the pain. Even with all this, the pain rarely subsides for at least 4 hours and I am zonked out for the following 24 hours from the tramadol.

So I came home yesterday, and decided to ‘soldier on’ without the meds which I stopped when I was admitted to hospital.

Last night I woke up at 1.30 a.m. with a very bad abdominal pain attack and was up most of the night, despite taking the meds and Tramadol to try and relieve the pains. I eventually fell asleep exhausted just before 6 am, and even then the pain was still present, although it had reduced in intensity.

I have to say that I feel very put out that I had no opportunity to see the specialist prior to the operation, and afterwards I was fobbed off with a junior who told me, ‘Nothing wrong – go home!’ I don’t want to turn into a ‘whinger’ and have to say that on the whole I was treated very well, both as an outpatient and in-patient.

But surely, this can’t be right. I went there with a very serious, ‘life-changing’ acute pain problem in my upper abdomen, along with chronic diarrhoea, and now, almost 2 months later, I’ve been effectively told there’s nothing wrong with me.

I can live with the diarrhoea, but the pains are almost unbearable, and I have no wish to spend the rest of my life becoming addicted to opiates to relieve the pain.

For those out there who may have some knowledge on this, the meds I was prescribed in the UK are Omeprazole 20mg (twice a day) and Buscopan 10mg twice a day. I double up on the Omeprazole when I feel a pain attack coming on.

So if anyone has any suggestions on where to go from here, maybe a really good specialist that they can personally recommend and who will take the time to listen to me carefully and not suggest expensive tests or procedures unless they are really necessary, as these days my funds are very limited.

Thanks guys, and if I have missed anything that may be relevant, please ask away.

Mobi

[Sheryl]

Mobi,

"It’s not surgical, go see the medical department" is NOT the same as "nothing wrong with you, go home".

What they were saying is that within their area of specialization, no problem could be identified. I'd suggest you take their advice and see a GI specialist in the internal medicine dept, whether at Queen S. or elsewhere.

[Mobi]

Mobi,

"It’s not surgical, go see the medical department" is NOT the same as "nothing wrong with you, go home".

What they were saying is that within their area of specialization, no problem could be identified. I'd suggest you take their advice and see a GI specialist in the internal medicine dept, whether at Queen S. or elsewhere.

Probably my fault for not making it clear what happened.

The doctor came to see me and said 'nothing wrong - go home.' and she started to leave the room

It was only after I pressed her at some length that she she somewhat reluctantly said words to the effect that if I was not happy, I should go back the the 'medical dept'.

There was no referral, (like there was when I started the process, from medical to surgical etc), and It was like extracting blood out of a stone, and believe me, as far as she was concerned my 'treatment' was at an end. Again, I pressed her as to the causes and she said 'probably ibs'.

Before leaving, we checked with the ward nurse in charge and she said that if I wanted to go back to 'medical' I would have to start all over again and make my own appointments.

I have to say IMHO that it was less than I could reasonably expect after 2 months of treatment,including many outpatient visits and 3 days in hospital and I do not think it is right that I had no opportunity to discuss anything with the specialist who recommended and carried out the procedures, especially as I am still continuing to suffer from the original symptoms. and am in considerable distress.

Am I wrong?.....or have I missed something?

[thaiexpat21]

Clearly , from your point of view, the "discharge" and provision of futher advice could have been handled better.

What is positive is that nothing of a "surgical" nature was discovered following what appears to have been a pretty comprehensive investigative process.

I do not believe complaining will improve your situation.

What is needed now is for you to return to your gastroenterologist for futher advise/investigation. Retaining the same hospital has the advantage of your records being easily accessed. Seeking advise elsewhere would almost mandate you asking for copies of your records so as to avoid the need for unnecessary repetition of investigations.

[Mobi]

Yes you are correct and that is what I intend to do.

I never saw s GI specialist in the first place as I was referred directly from the GP to surgical.

As I have said elswhere the "complaint" was more in the nature of an assessment of where do I go from here?

The last thing I want to do is start all over somewhere else. Been there done that and it could well be a case of "out of the frying pan ..."

Sent from my GT-N7100 using Thaivisa Connect Thailand mobile app

[FBN]

"Sludge" in the gallbladder does exactly what a stone does; it obstructs the flow of bile causing the colic as well. Bile is necessary to digest fats in the diet and an absence of that may cause diarrhea.

The only treatment really is to remove the gallbladder. Your body does not need to keep a reservoir of bile to deal with a three meals a day diet; it was part of human development when we went from hunting gathering and eating huge amounts of meat and fat in one sitting which required large amount of bile to eating the way we do now.

[thaiexpat21]

"Sludge" in the gallbladder does exactly what a stone does; it obstructs the flow of bile causing the colic as well. Bile is necessary to digest fats in the diet and an absence of that may cause diarrhea.

The only treatment really is to remove the gallbladder. Your body does not need to keep a reservoir of bile to deal with a three meals a day diet; it was part of human development when we went from hunting gathering and eating huge amounts of meat and fat in one sitting which required large amount of bile to eating the way we do now.

Chronic diarrhea can also be a problem post-cholecystectomy!

Best ensure a positive diagnosis before committing to a "cure"

It maybe that a more positive imaging technique is required in your case.

[Mobi]

"Sludge" in the gallbladder does exactly what a stone does; it obstructs the flow of bile causing the colic as well. Bile is necessary to digest fats in the diet and an absence of that may cause diarrhea.

The only treatment really is to remove the gallbladder. Your body does not need to keep a reservoir of bile to deal with a three meals a day diet; it was part of human development when we went from hunting gathering and eating huge amounts of meat and fat in one sitting which required large amount of bile to eating the way we do now.

Thank you for that.

Yes, when I read on the ultrasound report that my gallbladder was ‘full of sludge’ I ‘Googled’ it while waiting to see the specialist and read that sludge could indeed be the cause of my symptoms.

But when I saw the specialist he said that as there was no inflammation (cholecystitis) in the gallbladder it was unlikely that sludge was the cause and recommended that I have more tests.

I told him that I had just read that sludge can be the cause, and he said that he could take out the gallbladder if I wanted him to, but I would complain if it didn't solve the problem.

I was then passed onto another surgeon who performed the endoscopy and gastroscopy and nothing more was said of the sludge.

My symptoms match those of gallbladder problems, with the pain attacks manifesting in the upper right/middle part of the abdomen, just under the rib cage and are so painful that I can hardly bare it.

But the pain doesn't gravitate to my upper shoulder and back, which apparently is fairly common and I have no fever. Even right now, when I have no pain, if I tap my upper abdomen, it is quite tender.

Your post has made me wonder yet again what I should do for the best.

I have just read that a drug called Ursodiol can be taken to dissolve the sludge and/or gallstones. Maybe I should try this, or am just tinkering with things that I shouldn’t?

[Thai at Heart]

I have been in the UK on a 3 week break to visit my family and just after I arrived, I started to experience severe pains in my upper abdomen that lasted for 4 5 hours.

The pains were so severe that I was rushed to hospital twice. The first time they were more concerned with my heart (which turned out to be fine) and I was eventually sent home with some tabs for acid indigestion.

I was back at the hospital 2 days later with more intolerable chest pains and this time the doc realised it was not heart related. He pushed down on my abdomen on the right side, just below my rib cage and I nearly jumped through the roof in agony, He told me that he thought it was gallstones and I needed to have an endoscopy to confirm it, but he couldnt order one for me as I havent got a UK GP.

I explained that I was travelling back to Thailand in 1 week and he has given me a load of high dosage meds to hopefully stabilise my pain attacks until I get back home. So far so good, but I am becoming increasingly fatigued and even a short stroll leaves me exhausted.

I have read up on gall stones and my symptoms match the condition to a tee so I have little doubt that the docs diagnosis is correct. However I do need to confirm with an endoscopy and then have the surgery which nowadays is usually a keyhole procedure.

To say the least, Im not very flush these days and dread to think what they may charge at BPH.

So has anyone else had this particular problem and can anyone suggest a good, not too expensive place to have the endoscopy and the operation.

Thanks for any info or advice.

Mobi

Went through it 10 years ago. At the time there were few doctors in Thailand handling this endo scopically. I went home to the UK. Luckily I had company private insurance at the time.

I would go to your local private hospital and see how experienced the doctor is with endoscopes. The operation isn't that bad if done with endoscopes. Maybe 2 hours maximum and I was up and about a day later.

If it's down though incision that is much longer recovery time. Whether they can do it endoscopically is determined by a blood test. Get the test done asap. Not every doctor you will come across in Thailand will perform this endoscopiclly.

The pain is excruciating, 2nd only to child birth.

The pain comes on when you lie down because the stones will move to block the duct. Sleep sitting up. Lay off the pizza and milk.

I was completely misduagnosed in Thailand. Called my father's mate who did the operation in the end. After that pain, I would have offered my left hand to make it go away.

Edited October 31, 2013 by Thai at Heart

[Thai at Heart]

"Sludge" in the gallbladder does exactly what a stone does; it obstructs the flow of bile causing the colic as well. Bile is necessary to digest fats in the diet and an absence of that may cause diarrhea.

The only treatment really is to remove the gallbladder. Your body does not need to keep a reservoir of bile to deal with a three meals a day diet; it was part of human development when we went from hunting gathering and eating huge amounts of meat and fat in one sitting which required large amount of bile to eating the way we do now.

Thank you for that.

Yes, when I read on the ultrasound report that my gallbladder was full of sludge I Googled it while waiting to see the specialist and read that sludge could indeed be the cause of my symptoms.

But when I saw the specialist he said that as there was no inflammation (cholecystitis) in the gallbladder it was unlikely that sludge was the cause and recommended that I have more tests.

I told him that I had just read that sludge can be the cause, and he said that he could take out the gallbladder if I wanted him to, but I would complain if it didn't solve the problem.

I was then passed onto another surgeon who performed the endoscopy and gastroscopy and nothing more was said of the sludge.

My symptoms match those of gallbladder problems, with the pain attacks manifesting in the upper right/middle part of the abdomen, just under the rib cage and are so painful that I can hardly bare it.

But the pain doesn't gravitate to my upper shoulder and back, which apparently is fairly common and I have no fever. Even right now, when I have no pain, if I tap my upper abdomen, it is quite tender.

Your post has made me wonder yet again what I should do for the best.

I have just read that a drug called Ursodiol can be taken to dissolve the sludge and/or gallstones. Maybe I should try this, or am just tinkering with things that I shouldnt?

It has to go. It can get chronically infected and then you will have a massive problem.

[Mobi]

Went through it 10 years ago. At the time there were few doctors in Thailand handling this endo scopically. I went home to the UK. Luckily I had company private insurance at the time.

I would go to your local private hospital and see how experienced the doctor is with endoscopes. The operation isn't that bad if done with endoscopes. Maybe 2 hours maximum and I was up and about a day later.

If it's down though incision that is much longer recovery time. Whether they can do it endoscopically is determined by a blood test. Get the test done asap. Not every doctor you will come across in Thailand will perform this endoscopiclly.

The pain is excruciating, 2nd only to child birth.

The pain comes on when you lie down because the stones will move to block the duct. Sleep sitting up. Lay off the pizza and milk.

I was completely misduagnosed in Thailand. Called my father's mate who did the operation in the end. After that pain, I would have offered my left hand to make it go away.

You're not wrong about the pain - the worst I've experienced bar none - even worse than when I first woke up after open heart surgery, and according to my GF, on that occasion, I asked to be killed off to put me out of my misery....

[Mobi]

"Sludge" in the gallbladder does exactly what a stone does; it obstructs the flow of bile causing the colic as well. Bile is necessary to digest fats in the diet and an absence of that may cause diarrhea.

The only treatment really is to remove the gallbladder. Your body does not need to keep a reservoir of bile to deal with a three meals a day diet; it was part of human development when we went from hunting gathering and eating huge amounts of meat and fat in one sitting which required large amount of bile to eating the way we do now.

Thank you for that.

Yes, when I read on the ultrasound report that my gallbladder was full of sludge I Googled it while waiting to see the specialist and read that sludge could indeed be the cause of my symptoms.

But when I saw the specialist he said that as there was no inflammation (cholecystitis) in the gallbladder it was unlikely that sludge was the cause and recommended that I have more tests.

I told him that I had just read that sludge can be the cause, and he said that he could take out the gallbladder if I wanted him to, but I would complain if it didn't solve the problem.

I was then passed onto another surgeon who performed the endoscopy and gastroscopy and nothing more was said of the sludge.

My symptoms match those of gallbladder problems, with the pain attacks manifesting in the upper right/middle part of the abdomen, just under the rib cage and are so painful that I can hardly bare it.

But the pain doesn't gravitate to my upper shoulder and back, which apparently is fairly common and I have no fever. Even right now, when I have no pain, if I tap my upper abdomen, it is quite tender.

Your post has made me wonder yet again what I should do for the best.

I have just read that a drug called Ursodiol can be taken to dissolve the sludge and/or gallstones. Maybe I should try this, or am just tinkering with things that I shouldnt?

It has to go. It can get chronically infected and then you will have a massive problem.

Yes, but don't I first need a positive medical diagnosis? it still could be something else that is causing the problem... or not?

Edited October 31, 2013 by Mobi

[Sheryl]

The problem is that tests have failed to show any indication of inflammation in the gallbladder and the specialist he consulted does not believe the gallbladder to be the cause of the problem.

On the other hand, no alternative cause has been found. The doctor who did the work-up suggests IBS, but then that is a catch-all for people with abdominal paid for now determined cause. Onthe other hand, OP does report chronic diarrhea which would fit with IBS.

The OP has several options:

- seek a second opinion on the gallbladder issue from another doctor.

- insist on gallbladder removal, which the doctor indicated he would do if the patient insisted but did not think would resolve the symptoms. The OP is an insulin-dependent diabetic with cardiac problems so surgery is higher risk for him than would normally be the case and not to be undertaken lightly,

- accept the diagnosis of IBS and go under the care of a (non-surgeon) GI specialist for it

Mobi, if you want to pursue #1, it may be hard to do at Queen Sirikit. I'd suggest getting all your records and going elsewhere. Suggest you email [email protected] (Phyathai Sri Racha Intl dept) and explain that you have persistent upper right abdominal pain that a doctor in the UK though was due to gallstones, but ultrasound showed no stones or inflamation, only sludge and the doctor who performed the tests was doubtful that this was the cause. however, extensive other tests have failed to find an alternate explanation and you would like a second opinion about the advisability of proceeding with a cholecystectomy, and could he suggest a doctor. Gavin is quite accomodating and will direct you to someone for a consult. See what that doc says and then take it from there.

Note that he will probably not be able to give you definitive answers but you can ask for percentages i.e. in his opinion what are the odds that gallbladder removal will resolve the symptoms.

P.S. if the attacks seem related to ingestion of food containing fat/oil that would tend to strengthen the case for the pain being due to biliary colic. Does eating fried food etc seem to bring it on?

[Mobi]

Thank you Sheryl, that is great advice and I will follow up accordingly.

For the sake of clarity, it was specialist No. 1 who told me that it was unlikely to be a gallbladder problem and then referred me to specialist No. 2 who took over the new tests. Maybe the gallbladder has been forgotten about in the handover from one to the other. Who knows? It was one of the questions I had after the endoscopy results but didn't have any chance to ask.

Yes, the pain attacks do tend to occur after I have eaten fried/fatty/oily food. The first ever attack occurred after a bacon sandwich, the second, in the UK was after a very rich Indian meal, the third, in the UK was after a fish and chip dinner, and so on, although since then I have tried to be careful what I eat. The last one which occurred a couple of days ago was after a salad, but the salad was somewhat flooded with locally made oily salad cream by my well meaning GF.

So if I understand you correctly, the biliary colic seems to indicate gallbladder problems,.Is that right?

[FiftyTwo]

P.S. if the attacks seem related to ingestion of food containing fat/oil that would tend to strengthen the case for the pain being due to biliary colic. Does eating fried food etc seem to bring it on?

I had unbelievable pain due to gallstones last year, taken to hospital and in for 3 nights on intravenous anti biotics and pain killers, after being diagnosed, realised the 'acid indigestion' I had suffered for the last 10 years was also gallstone induced.

I didn't want my gallbladder removed, so decided to try an alternative approach.

No fatty foods at all, no crisps, no chips, no fried food, no fizzy drinks, no alcohol, a little bit of chicken sometimes.

No highly processed foods, no white bread, no cakes, no biscuits, no sugar, only wholemeal bread.

No coffee, but tea was OK.

Exercise for at least 1 hour every day, strict control over meal size and frequency. No food after 6pm.

So far it's worked, only two very minor attacks in the last year.

I've been able to resume more normal eating and drinking.

But I have lost nearly 10Kg and continue to hike nearly 40Km a week in the mountains.

Not sure this could work for you with your other medical problems.

Edited October 31, 2013 by FiftyTwo

[Sheryl]

Thank you Sheryl, that is great advice and I will follow up accordingly.

For the sake of clarity, it was specialist No. 1 who told me that it was unlikely to be a gallbladder problem and then referred me to specialist No. 2 who took over the new tests. Maybe the gallbladder has been forgotten about in the handover from one to the other. Who knows? It was one of the questions I had after the endoscopy results but didn't have any chance to ask.

Yes, the pain attacks do tend to occur after I have eaten fried/fatty/oily food. The first ever attack occurred after a bacon sandwich, the second, in the UK was after a very rich Indian meal, the third, in the UK was after a fish and chip dinner, and so on, although since then I have tried to be careful what I eat. The last one which occurred a couple of days ago was after a salad, but the salad was somewhat flooded with locally made oily salad cream by my well meaning GF.

So if I understand you correctly, the biliary colic seems to indicate gallbladder problems,.Is that right?

Biliary colic is a gallbladder problem. It is spasmodic pain (can be quite severe) that occurs when the gallbladder encounters obstruction in trying to dicharge bile into the intenstine, which it is triggered to do upon ingestion of fat. Usually the obstruction is from stones but 'sludge" can have this effect too. Usually inflammation will develop in the GB but that, apparently, has not occurred in your case from what you say of the report of specialist #1 (2nd specialist did not, as far as I can tell, do any tests that would have shown this -- sounds like what he did was upper & lower endoscopies which would rule out gastritis/ulcer disease and tumors of the stomach or lower intestine).

If the pain is provioked by consuming fat, and does not occur when you do not consume fat, that is highly suggestive of biliary colic.

If you don't want to get a new doc's opinion, you could go back to specilaits #1 and say look, additional tests were all negative, there's nothing in the upper or lower GI tract, the only positive test finding has been the sludge in the GB and I still have the pains and they come on after eating fatty foods, what do you think are the odds that taking out the GB will relieve this? (make clear you understand that there is no 100% guarantee).

[Mobi]

Thank you so much for all that information, Sheryl, it really is appreciated.

I sent an email to Gavin at Sri Racha hospital, very much along the lines you suggested, even used most of your wording, and he replied, recommending that I see a Dr Dr. Jitlada who is a gastrointestinal specialist.

I was under the impression that you were suggesting that I see a surgeon, to obtain a second opinion on gallbalder removal, so would seeing a gastrointestinal specialist.be the right way to go?

Thanks

Mobi

P.S. I've just looked up what GI specialist does, and I guess it is the right doc to see. Have you ever heard of Dr Jitlada?

Edited November 1, 2013 by Mobi

[Sheryl]

What you really need is an opinion as to how likely your pain is to be due to the GB. For that, not so important whether the doc is a surgeon, easy enough to find a surgeon to take out the GB, issue is making an informed decision as to whether to do so.

I don't know anything about Dr. Jitlada other than that she is a GI specialist.

[impulse]

I know this can be controversial, but are there any non-surgical methods to clean up sludge in a gall bladder, or to prevent the sludge from building up in the first place?

I have read with some skepticism about cleansing with large quantities of olive oil and Epsom salts. But the rather graphic pictures of the "stones" that were excreted looked a lot more like hardened olive oil than any kind of crystal stone.

Still, the idea that adding something like olive oil to my diet over the long haul would be preferable to surgery in the end. But I'd want something more authoritative than the wing nut conspiracy websites (yes, I'm a fan) to suggest it.

What does the peer reviewed medical literature say?

Edited November 1, 2013 by impulse

[FiftyTwo]

I know this can be controversial, but are there any non-surgical methods to clean up sludge in a gall bladder, or to prevent the sludge from building up in the first place?

I have read with some skepticism about cleansing with large quantities of olive oil and Epsom salts. But the rather graphic pictures of the "stones" that were excreted looked a lot more like hardened olive oil than any kind of crystal stone.

Still, the idea that adding something like olive oil to my diet over the long haul would be preferable to surgery in the end. But I'd want something more authoritative than the wing nut conspiracy websites (yes, I'm a fan) to suggest it.

What does the peer reviewed medical literature say?

As I already said, diet and exercise, no short cuts.

Gall bladder problems are related mainly to lifestyle problems.

[Mobi]

What you really need is an opinion as to how likely your pain is to be due to the GB. For that, not so important whether the doc is a surgeon, easy enough to find a surgeon to take out the GB, issue is making an informed decision as to whether to do so.

I don't know anything about Dr. Jitlada other than that she is a GI specialist.

I have an appointment to see her on Sunday, so lets see how it goes.

We called the naval hospital this morning to find out how to get a copy of my ultrasound report (I already have my Colonoscopy and EGD reports). I was told I must make an appointment to see the specialist and explain why I needed it and get his permission.That would almost certainly entail a 4 - 5 hour wait to see him, after all he didn't even have time to see me after the operation.

Considering that I paid for the report, and they have already given me the other reports without me asking for them, I found this information.... somewhat irritating.....

Fortunately, I pretty much remember what the report said, so I have written it down and will give it to the new doc. If they think the gallbladder needs to come out they will probably end up doing another one anyway, so I'll just write it off to yet more experience.

Once again, many thanks for the advice, and I'll report back.

[bunnydrops]

I'm not giving advice, I'm not a doc. I had mine taken out about 3 weeks ago at Suranarii hospital (military hospital) in Korat. Cost for Laparoscopic surgery, 3 days in the hospital and the meds 22000baht. I was having the pain almost everyday, sometimes for 8 hrs---Yes, I said the same thing "just kill me already" then when the pain would finally go away, it was like nothing happen, felt normal.

I'm good with pain, but when you feel it coming on and not knowing when it will end does take it out of you. Good Luck

[impulse]

I know this can be controversial, but are there any non-surgical methods to clean up sludge in a gall bladder, or to prevent the sludge from building up in the first place?

I have read with some skepticism about cleansing with large quantities of olive oil and Epsom salts. But the rather graphic pictures of the "stones" that were excreted looked a lot more like hardened olive oil than any kind of crystal stone.

Still, the idea that adding something like olive oil to my diet over the long haul would be preferable to surgery in the end. But I'd want something more authoritative than the wing nut conspiracy websites (yes, I'm a fan) to suggest it.

What does the peer reviewed medical literature say?

As I already said, diet and exercise, no short cuts.

Gall bladder problems are related mainly to lifestyle problems.

Can you reference some peer reviewed medical literature stating that's the case?

[TallGuyJohninBKK]

For the OP, it doesn't sound like the main hospital you've been dealing with has been treating you very well...

The medical records for your tests are YOURs, and they shouldn't be putting you through the ringer in order to obtain a copy of them, including having to revisit one of the specialists in order to make the request.

Also, the way you described your treatment by the junior doctor sounds pretty shoddy.... Even if they didn't find any surgical issue needing resolution, you might have hoped that she or the others there would have been more focused on diagnosing and treating/healing their patient, vs. simply shuttling you off to a different part of the hospital.

Part of the issue there, as was addressed above, is that you were dealing with surgeons as opposed to GI specialists. You hopefully need to get an educated, informed and correct diagnosis before venturing into the surgical arena.

I never saw s GI specialist in the first place as I was referred directly from the GP to surgical.

Edited November 1, 2013 by TallGuyJohninBKK

[bunnydrops]

For the OP, it doesn't sound like the main hospital you've been dealing with has been treating you very well...

The medical records for your tests are YOURs, and they shouldn't be putting you through the ringer in order to obtain a copy of them, including having to revisit one of the specialists in order to make the request.

Also, the way you described your treatment by the junior doctor sounds pretty shoddy.... Even if they didn't find any surgical issue needing resolution, you might have hoped that she or the others there would have been more focused on diagnosing and treating/healing their patient, vs. simply shuttling you off to a different part of the hospital.

Part of the issue there, as was addressed above, is that you were dealing with surgeons as opposed to GI specialists. You hopefully need to get an educated, informed and correct diagnosis before venturing into the surgical arena.

I never saw s GI specialist in the first place as I was referred directly from the GP to surgical.

True-- I had an MRI at at S. Marys. When I changed to another hospital, I just went in and asked for the prints. They just gave them to me, didn't have to see doc.

[Mobi]

For the OP, it doesn't sound like the main hospital you've been dealing with has been treating you very well...

The medical records for your tests are YOURs, and they shouldn't be putting you through the ringer in order to obtain a copy of them, including having to revisit one of the specialists in order to make the request.

Also, the way you described your treatment by the junior doctor sounds pretty shoddy.... Even if they didn't find any surgical issue needing resolution, you might have hoped that she or the others there would have been more focused on diagnosing and treating/healing their patient, vs. simply shuttling you off to a different part of the hospital.

Part of the issue there, as was addressed above, is that you were dealing with surgeons as opposed to GI specialists. You hopefully need to get an educated, informed and correct diagnosis before venturing into the surgical arena.

I never saw s GI specialist in the first place as I was referred directly from the GP to surgical.

True-- I had an MRI at at S. Marys. When I changed to another hospital, I just went in and asked for the prints. They just gave them to me, didn't have to see doc.

The more I think about it the more I realise that it was probably a case of the 'ball being dropped' between specialist 1 and spec 2.

Spec 1, quite rightly wanted to do further tests to ensure the cause of the symptoms wasn't something other than gallbladder, as the ultrasound was inconclusive, and referred me to spec 2.

Spec No. 2 did the further tests, and when they came up negative, he probably didn't even bother to read my file notes properly to check the reason for the tests in the first place. Maybe he thought I was just having the test as a matter of routine health check - give my age etc. That would explain why he told the junior doc to tell me 'nothing wrong, go home'.

As for having to get the spec's permission to get a copy of the ultrasound report - well the least said about that the better. I was given my own copy of the colonscopy and EGD reports without even asking for them.....

Ah well, I am where I am, and lets' see what the GI spec at Phyathai says tomorrow.....