Gall bladder – Diary of a Disabled Person.

You Are What You Eat.

Given my passion for my chosen field of academic study (nutrition, if you didn’t know) you should probably be relieved that up until this point I have managed to resist to urge to write about what I eat. Today that all comes crumbling down (ooh, crumble).

The complexity of the relationship between diet and health cannot be overstated, but is only made more complicated once disease has to be considered. Throw in multiple diseases and suddenly you need a degree to figure it all out. Fortunately, I just so happen to have one.

My primary consideration when it comes to food is actually fat intake, due to the fact that all the way back in February 2017 someone stole my gall bladder. The gall bladder stores bile and pours it into the small intestine when food is detected in the gut. Fat absorption is increased as a result. Without a gall bladder bile simply drips into the gut continuously, regardless of the presence or absence of food. When it comes to meals the bile excretion doesn’t change and the ability to absorb fats from meals therefore reduces. Simply and grossly put, if the fat isn’t absorbed it leaves the intestines via another route in something called steatorrhoea. If you are in any way squeamish, for the love of god DO NOT GOOGLE WHAT THAT IS.

After this I need to assess my fibre intake. Colorectal cancer runs in the family, and the constant dripping of bile into the intestine after the gall bladder is removed irritates the gut wall, increasing the risk of developing the cancer even more. CFS can also result in constipation which is alleviated by fibre, as the use of painkillers and decreased exercise levels both demote bathroom business.

My next consideration is maintaining energy levels throughout the day. Consuming complex carbohydrates like bread, pasta, oats, rice etc. provides energy over a longer time period, and caffeine and sugar can be used to give me instant boosts when my energy levels drop. I also don’t want to consume too many calories as without exercise extra calories simply get stored as fat, causing a gain in weight.

Minor considerations include vitamin and mineral intakes as these are all involved in the normal energy metabolism and immune responses, and also the consumption of isoflavones from soya which may reduce the risk of breast cancer, a disease which also runs in the family.

This all sounds very complicated to create a diet that meets all of these needs, so to demonstrate what this looks like, I’ve recorded what I eat on an average day.

6 am: caffeinated coffee and cereal with skimmed milk (to keep fat intake low).

7 am: another coffee with a little skimmed milk in.

9 am: either coffee or tea, again with skimmed milk.

11 am: either coffee or tea, skimmed milk.

12.30 pm: lunchtime! Coffee with skimmed milk, a sandwich on white bread (white flour is fortified with additional nutrients, whereas wholemeal bread has more fibre, but compounds in the fibre reduce the absorption of nutrients), an apple, a handful of grapes, and a low fat yogurt.

2 pm: tea or coffee with skimmed milk, a couple of biscuits.

4 pm: tea or coffee with skimmed milk.

5.30 pm: tea or coffee with skimmed milk.

7 pm: decaffeinated tea with skimmed milk.

9 pm: carbonated water, main meal (example: Stir fty with instant noodles, sauce, poultry, a red onion, pepper, courgette, and frozen sweetcorn. The soy sauce contains isoflavones, and the frozen sweetcorn is richer in nutrients than fresh sweetcorn as nutrients are “locked in” when frozen), dessert (cake, sometimes with ice cream or custard).

10 pm: decaffeinated tea with skimmed milk.

Without access to some of the resources I used on my degree it’s difficult to give a precise calorie count but this comes to between 1,600 and 1,800 kcal per day. The occasional glasses of wine would bump this up to 2,000 kcal. Before you panic and say I eat too little, please remember that I have extremely low levels of activity and therefore simply don’t need the calories!

The management of my diet enables me to maintain relatively steady energy levels throughout the day, which is particularly important at work, and also keeps me from developing the very unpleasant side effects that come from gall bladder removal. At the same time my diet is by no means bland, is interesting and varied, and includes some typically unhealthy foods. Consumption of unhealthy foods in moderation can be part of a healthy diet, and I don’t spend my entire life eating what looks like next doors hedge.

And now that I’ve written this, I’m hungry…

Galled.

That very night at approximately 4 am, the pains started up again. The area just below my diaphragm gave the sensation of intense cramping, and the pain spread upwards around the entire rib cage and shoulders. I was denied the pain relief that I had been prescribed the week before and offered one that I was allergic too, which was stated clearly on my medical notes. The pain continued to build up and the nurses on the ward repeatedly rang the doctors in charge of my case, trying to get one of them to come and see me. However, despite the fact that you could hear my screams half way down the corridor, I was deemed to be attention-seeking and unimportant.

At 7 am I rung Jarred. I don’t think I even said a word, just screamed, but he knew what was wrong and dropped everything to rush over to the hospital. When he arrived one of the nurses was sat with me, holding my hand. Jarred said he had never seen anyone look so worried and upset before in his life; the nurses believed me and my supposed attention-seeking antics. Jarred sat by the bed and held my hand while the nurses continued to fight my corner against the doctors. At 9 am the pains began to fade, and by 10 am they had virtually gone. I apologised to those on the same ward as me for waking them up, but not one of them held it against me.

It was evening before the registrar showed up again, clearly unconcerned about that morning’s episode, his response being that “it had gone now, anyway”. He then informed that I had a 3 mm gall stone wedged in the lower region of my common bile duct blocking pancreatic secretions, and that I would be having an endoscopy to get a closer look at it the next day. I had never been so angry with anyone before; had the surgeons checked for further gall stones after removing my gall bladder, which takes only a simple test, this would have been spotted and I wouldn’t have gone through all the pains afterwards.

To numb the back of your throat prior an endoscopy, inhibiting the gag reflex, a numbing solution is sprayed into your mouth which tastes like rotting bananas. After some sedation the camera was passed down my throat and through my stomach into the top part of the intestine, while I lay on my front on the table. The screens above me showed pictures of the gall stone well and truly wedged at the end of the pancreatic duct. After a few attempts to dislodge it the doctors decided that they would need to open the duct to pull the stone out. They sedated me to the point of unconsciousness and removed the stone, finding that the stone was in fact 5 mm wide.

A few days after the endoscopy I was released from hospital, although this time I was less confident that the pains would not return. Thankfully, the passing months proved me wrong, and I was finally discharged from the surgical outpatients clinic the following July. While I find the first surgery somewhat comedic and can laugh at the awkward experience, I still find it difficult to smile when I remember its aftermath.

Utterly Galling.

5 days after returning home from hospital the pains returned, but this time they were much more intense and lasted longer. I ended up in accident and emergency, and within five minutes of arriving I was being treated because of my breathing difficulties. 10 ml of intravenous morphine later I was feeling a lot better; it’s difficult to tell whether this was because of the pain relief or the fact that I was as high as a kite. It was difficult for Jarred to tell too, because apparently my speech was an incomprehensible slurring murmur.

I was transferred back to the care of the surgeons who had removed my gall bladder, who this time were far less welcoming and seemed to consider me a waste of time. However, having had more than enough pain and vomiting for one year crammed into a matter of days I refused to go home without some form of medical help, and Jarred thankfully backed me up on this because it gave him a few days where he could leave the toilet seat up without being nagged.

First of all I had a chest x-ray. Being a somewhat busty woman, this was actually quite difficult, because when I was told to press my chest against the flat surface of the x-ray machine, my stomach couldn’t touch the surface, and perhaps this is why the x-ray showed nothing.

Next, they tried a CT scan, which is like being passed through the hole in the centre of a large polo mint. I was quite happy to watch the cameras spinning around me; it was strangely hypnotic. They took one scan without any dye injected, and then another with the dye which would highlight my blood vessels to spot any problems occurring in the cardiovascular system. The only thing wrong with this dye is, because of its ability to produce a sensation of warmth in the thighs, it quite honestly felt like I had wet myself. Apparently this sensation is perfectly normal, I was assured by the radiographer, and I was relieved to find that I hadn’t wet myself at all.

The CT scan showed nothing so then I had to have an MRI scan. Of all the tests I had had this was the one that made me feel deeply uncomfortable. My face was less than a foot away from the white roof of the tunnel, and I imagine that for anyone with full-blown claustrophobia it is a daunting experience. I managed to keep calm, although I couldn’t help being annoyed that the grey stripe painted along the roof of the tunnel was off-centre and wonky.

The night after having the MRI scan a registrar came to visit me while my parents and Jarred were there. He told us that he had seen nothing on the scan, despite him not having the special training on interpreting MRI scan results, and when I pointed out where the pains were the most intense, he told me that it wasn’t the liver that was hurting. This was despite the fact that the liver spans the abdomen just below the diaphragm, which was exactly where I was pointing. My mum, who is a nutritionist herself, looked like she wanted to rugby tackle the registrar to the ground, and both my dad and Jarred who have no medical background at all knew where the liver was. The registrar tried to discharge me but I refused until the pains had been dealt with properly. Little did I realise at the time that my stubbornness would prove to be such a wise decision…

A Galling Experience.

As a 20 year old woman with a healthy body weight and balanced diet, even the radiographer was surprised when, during an ultrasound scan at the local hospital, my gall bladder took on the appearance of the asteroid field scene in Star Wars Episode 5: The Empire Strikes Back. I had been suffering periods of intense pain just below my diaphragm for about a week making it difficult to breathe, and blood tests revealed that one of my liver enzymes was at almost ten times the concentration it should have been. Anyone with medical knowledge will now be shouting at the screen “gall stones” and they are not incorrect. My gall bladder was crammed full of the blighters, and was so inflamed that they were worried it would burst.

Image description: a diagram showing where the gall bladder is found in the abdomen. The gall bladder is highlighted in green, and rests beneath the liver, above the stomach and small intestine.

24 hours after the ultrasound scan, which I suppose I ought to be grateful found gall stones and not a baby, I was being prepared for emergency surgery. The surgeon visited me on the ward shortly before my operation and she perched on the bed to explain what was wrong with me, and what the procedure was. As a nutritionist with a lecturer who specialised in liver and gall bladder disease, I was well aware that the gall bladder “was a bag of bile that helped digest lipids”, and what exactly was entailed in an emergency laparoscopic cholecystectomy (emergency key-hole gall bladder removal), and took great delight in informing the surgeon as much. Fortunately she saw the funny side of this, as I only realised after I had said this that it probably wasn’t sensible to annoy someone who would shortly be digging around inside my abdomen while I was unconscious.

I was wheeled down to theatre on a rickety trolley and was surprised at how calm I was feeling considering that this was the first time I had ever had surgery. In the preparation room the surgeon asked me how I was feeling, and in response I did perhaps the most British thing anyone has ever done, and said;

“I’m good,” while giving a thumbs up.

I woke up just under two hours later very dazed and confused, particularly because the cannula had moved from my right elbow to my left hand. I was also rather disconcerted to find that I was still in theatre; thankfully the operation had been completed, and they were simply injecting the last lot of morphine prior to transferring me to the recovery room, but it scared me nonetheless. The morphine must have knocked me out again because I woke up about an hour after this in recovery, and after a few minutes a porter came to return me to the ward.

A few hours after coming out of surgery I realised that I needed to pee. There was, however, one small issue. Trying to get to a toilet while attached to a drip and oxygen tube, with a drain hanging out of my right side and still feeling woozy from the anaesthetic, is like trying to ride a bicycle backwards up Mount Everest in a blizzard. I resorted to the use of a commode, which was made far more awkward by the presence of my parents who sat outside the cubicle. Perhaps most embarrassingly of all, I had to get Jarred, who was also visiting me, to pull my kickers down for me, as I was so tangled and confused that it was simply impossible on my own. Fortunately, the effects of the anaesthetic seemed to wear off overnight while I slept, and by the morning I was feeling significantly better.

I was discharged later that afternoon, with some strong pain killers and anti-sickness tablets to help me cope with the after-effects of someone repeatedly prodding me with metal sticks. I was only sad that I wasn’t allowed to keep my gall stones, which I still hold would have made a very interesting artefact to display on my shelf of interesting things. However, my galling experience was far from over…