Thalassemia & Gall Stones + doctors

[chiang mai]

Mrs chiang mai had been suffering from abdominal pains and diarrhea in the early mornings, initially thought to be a food based problem she changed her diet but without resolving the problem. Antacids seemed to be work for a while, after I realized the extent of the problem she tried Miracid which also seemed to work, for a while - later, the old Thai standby of Tiger Balm was deployed.

Today I dragged her kicking and screaming to a local hospital to see a well respected Gastroenterologist, fifteen minutes later she had an ultrasound and blood tests, grain sized gall stones were observed during the ultrasound. One hour later she met with a surgeon who wanted to operate to remove the gall bladder, when quizzed about the certainty of the diagnosis he became evasive, the possibility of a Peptic Ulcer was mentioned.

I asked whether a gastroscopy exam would not be better, in order to rule out ulcers and confirm gallstones, he replied, "it may be symptomatic and not conclusive", in the meantime, he's ready to operate and Mrs cm who is Thai, is compliant, I am less so, I am appalled.

Some where in the midst of all of this, Mrs cm casually tells me that she has hereditary Thalassemia, a blood disorder that promotes gall stones. Mrs cm will undergo a gastroscope exam in the morning, I've already said that regardless of what the results are, a second opinion will be sought.

I'm posting this account for a couple of reasons, primarily to highlight the willingness of doctors to operate without doing proper diagnosis, I was amazed and shocked. The second reason is to highlight how Thai wives/partners tend to cover up medical problems, not wanting to spend money on doctors and hospitals and thinking that all things can be cured by pharmacies and Tiger Balm, they can't, sometimes they are quite serious. Thirdly, they say a little knowledge can be dangerous and I agree, but having no knowledge of the human anatomy or its workings and no idea about medical diagnostics, is even more dangerous.

[uptheos]

Grain sized gallstones, if they were like dice I could understand it.

Have a similar problem with someone and boy is she getting the runaround!

Good luck, it can't be pleasant for her.

[h90]

Take at least 2 opinions.....don't trust a single dr..

Operations are good business.....

[Sheryl]

Given the small size of the gallstones it makes good sense to invest in more diagnostic investigations.Gallstones of that size do not require surgery unless the patient is symptomatic, and from the sounds of things it is unclear whether your wife's symptoms are due to the stones or something altogether else such as peptic ulcer disease.

[Sheryl]

P.S. should also get a stool tests. The diarrhea doesn't really fit with either gall stones or peptic ulcer/gastritis.

[chiang mai]

P.S. should also get a stool tests. The diarrhea doesn't really fit with either gall stones or peptic ulcer/gastritis.

I was thinking the same thing this morning and the doctor seems to have skipped that one!

The gastroscope came back negative, no peptic ulcers so it's all believed to be down to the gallstones and the thickened DB wall.

Oddly, the doctor also skipped advice on medication to help dissolve the stones so that's our next step, do you have any thoughts on this?

As always, extremely grateful for your input.

[uptheos]

OP - initially thought to be a food based problem she changed her diet but without resolving the problem.

I can relate to a certain extent, but can/do you watch what she eats 24/7?

A person not too far from me also changed her diet, but when the opportunity arose she couldn't avoid the sticky rice and super hot dips she was brought up with, especially when with friends.

"I can't help it, aroi maak".........I feel like saying 'well suffer', but I don't.

[Sheryl]

P.S. should also get a stool tests. The diarrhea doesn't really fit with either gall stones or peptic ulcer/gastritis.

I was thinking the same thing this morning and the doctor seems to have skipped that one!

The gastroscope came back negative, no peptic ulcers so it's all believed to be down to the gallstones and the thickened DB wall.

Oddly, the doctor also skipped advice on medication to help dissolve the stones so that's our next step, do you have any thoughts on this?

As always, extremely grateful for your input.

Meds (1) don't work very well (2) take a very long time when they do - sometimes years and (3) have potentially nasty side effects. For these reasons, reserved for situations where surgery is nto possible.

Before thinking of either meds or surgery, I think need to be surer of the diagnosis. "Grain sized" gall stones would usually not cause this and may be an incidental finding. You now mention another finding- "thickened DB wall". Do you mean GB, gallbladder? As that would increase the likelihood that her pain is due to the GB. However I remain puzzled by the fact that it accompanies diarrhea, and by the smallness of the reported stones.

Suggest you get a second opinion.

[chiang mai]

P.S. should also get a stool tests. The diarrhea doesn't really fit with either gall stones or peptic ulcer/gastritis.

I was thinking the same thing this morning and the doctor seems to have skipped that one!

The gastroscope came back negative, no peptic ulcers so it's all believed to be down to the gallstones and the thickened DB wall.

Oddly, the doctor also skipped advice on medication to help dissolve the stones so that's our next step, do you have any thoughts on this?

As always, extremely grateful for your input.

Meds (1) don't work very well (2) take a very long time when they do - sometimes years and (3) have potentially nasty side effects. For these reasons, reserved for situations where surgery is nto possible.

Before thinking of either meds or surgery, I think need to be surer of the diagnosis. "Grain sized" gall stones would usually not cause this and may be an incidental finding. You now mention another finding- "thickened DB wall". Do you mean GB, gallbladder? As that would increase the likelihood that her pain is due to the GB. However I remain puzzled by the fact that it accompanies diarrhea, and by the smallness of the reported stones.

Suggest you get a second opinion.

Sorry yes, that should have read, 1. multiple small gallstones, 2. "Thick GB fundus wall without tender, focal adenomyomatosis.

Everything else is unremarkable including gastroscope and liver panel (globulin is high at 3.8).

Any thoughts as to whether an MRI might be useful?

Thanks for your input Sheryl, we will seeks a second opinion.

[Sheryl]

"multiple small" is not quite the same as "grain sized". Tiogether with the other findings, increases the likelihood her pain is due to gall stones, but should still get another opinion and possibly more tests.

MRI can help determine whether stones are causing blockage, which is what in turn causes spasmodic pain. Another test that can be useful is endoscopic retrograde cholangiopancreatography (ERCP), a type of endoscopy combined with Xray which can not only visualize gallstones directly but also often remove them, avoiding the need for surgery.

See if you can see one of these docs at Sripat:

Apinya Leerapun

Pises Pisespongsa

Satawat Thongsawat

BTW is the stones are the cause of the pain, the pain should niotiecably worse after eating fried or other fatty food, and be much better when she eats no fat. Is this the case? And is the pain always accompanied by diarrhea? It is the diarrhea that I find confusing.

[chiang mai]

I understand the confusion regarding granular vs multiple small stones, the former came verbally, direct from the radiologist, following the U/S, the latter came via the radiology report which I saw this afternoon for the first time.

I've explained to my wife the need to better understand the relationship between food, pain and diarrhea and she has committed to be more specific about this over the next week, daily diet will also be recorded, Mrs CM is mostly vegetarian and fried food is not a staple part of her diet.

The pain occurs currently around 3:00am, although during the daytime exam an area in the region of the gall bladder is pressure sensitive to a lesser degree.

I will pursue the following and many many thanks for the lead:

"MRI can help determine whether stones are causing blockage, which is what in turn causes spasmodic pain. Another test that can be useful is endoscopic retrograde cholangiopancreatography (ERCP), a type of endoscopy combined with Xray which can not only visualize gallstones directly but also often remove them, avoiding the need for surgery".

[Sheryl]

May be a little unpleasant but might be worth a try to have a "challenge" of fried food (there are plenty of vegetarian dishes that are fried.) Do it at a time that she is pain free and see what happens.