Episode Transcript
[00:00:00] Speaker A: From Riverside Health System. This is the Healthy youy podcast where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.
Have you ever finished a meal and thought, maybe I just ate too much only to feel that same pain the next time you eat? Our bodies have a way of telling us when something isn't right.
The challenge is that they usually whisper before they scream. So true. Gallbladder problems often begin with mild discomfort, nausea or pain after eating.
Symptoms that are easy to brush off until they start affecting your everyday life.
Today we're talking about what your gallbladder actually does, the warning signs you shouldn't ignore, and how today's minimally invasive treatments can help you get back to feeling your best.
I'm Frankie Myers and this is Healthy U. Where we break down everyday health topics and introduce you to the experts helping keep our communities well.
Joining me today is Dr. Whitlatch, a general surgeon with Riverside Surgical Specialists. Dr. Wischlass, welcome to Healthy youy.
[00:01:23] Speaker B: Thank you. Thank you for having me.
[00:01:26] Speaker A: Nice to have you.
To start us off, tell us a little bit about your role and why gallbladder disease is something you treat so often.
[00:01:35] Speaker B: Okay, so I am a community general surgeon out at Smithfield, the new hospital that Riverside just opened. Yes, we're really excited and we often see a lot of gallbladder disease coming through the ER as, even as an outpatient just because of our diets are so varied. And the western diet these days have a lot of trigger foods for that. So that's why it probably something we frequently treat.
[00:02:04] Speaker A: Yes, yes, I kind of hear. But we're going to talk more about that. It's the foods that we love. Like all those greasy, all the foods we love.
[00:02:10] Speaker B: Yeah.
[00:02:11] Speaker A: Good fried foods, but that's okay.
Most people know that they have a gallbladder. You know, we don't talk about it that often, but they're not exactly sure what it does, what it is. Can you explain it in more simple layman terms for us?
[00:02:28] Speaker B: Of course.
So the gallbladder, it lives in your abdomen in the right upper quadrant, right underneath your liver.
And its role is to help you digest food, mostly the fatty, the oily foods, so that your body can actually break it down within your small intestines so we can get that nutrients.
[00:02:49] Speaker A: Okay, very good.
So if Someone has their gallbladder removed, their body can still digest food normally. Or does it modify that in some way?
[00:03:00] Speaker B: It does. So, yes. So our body's, like, pretty resilient.
It will accommodate to not having a gallbladder anymore. So what happens is, after your gallbladder is removed, there is something called your common bile ducts. So this is the duct that drains your liver where your pancreas drains into and then meets up into your small bowel that will actually dilate up, and that becomes your new holding tank for bile.
[00:03:24] Speaker A: Oh, okay.
All right. That's reassuring to know.
[00:03:28] Speaker B: Yes.
[00:03:29] Speaker A: Before we talk about the symptoms people should watch for, let's tackle some of the biggest myths and misconceptions about gallbladder disease with a quick round of true or false. I love that. I'll read a statement, and you tell us whether it's true or false and explain why.
[00:03:49] Speaker B: Okay.
[00:03:50] Speaker A: Okay.
Number one, gallbladder attacks only happen after eating greasy foods.
[00:03:57] Speaker B: That's false.
[00:03:58] Speaker A: Okay.
[00:03:59] Speaker B: Everyone has different trigger foods.
Often. The most typical one is what you mentioned before. The pizza, the good foods that we love.
[00:04:07] Speaker A: Raw chicken.
[00:04:07] Speaker B: Raw chicken stuff. It is really good.
A lot of, like, the barbecue that we have in Smithfield, you know, that has a lot of fat in it often. So that will trigger it. But the most common thing I have is when people come in and they're like, I'm a healthy eater. Like, I don't eat all this fatty, greasy food that you're talking about. But everyone always forgets that. A lot of times it's the.
The salad dressings have oils. They'll make that. And so you're.
[00:04:35] Speaker A: That's.
[00:04:35] Speaker B: Also. Your gallbladder needs to help break that down.
[00:04:38] Speaker A: That's never thought about that.
You can live a healthy life without your gallbladder, Correct?
[00:04:46] Speaker B: That is true, yes. Okay.
[00:04:49] Speaker A: I was trying to trick you a little bit.
[00:04:52] Speaker B: You're good.
[00:04:54] Speaker A: All right, Number three, if the pain goes away, the problem is gone.
[00:05:00] Speaker B: False. So once you. You. You have gallstones, they don't just go away.
And so usually once you start becoming symptomatic from these gallstones, it's typically not a. Oh, it was one time 50 years ago, and then I never had any more issues ever again.
You may notice, oh, there was one time, and then it's like two months.
Then I have another issue, and then it starts to become more frequent. Is mostly the typical.
[00:05:32] Speaker A: Okay. And lastly, most gallbladder surgeries today are minimally invasive.
[00:05:37] Speaker B: True.
[00:05:38] Speaker A: That's true. Yes, that's true.
When is it not.
When is it not that approach. Not used.
[00:05:47] Speaker B: Oh, of course.
So I can count on my hand the number of times I've been forced to have to go open. They are typically patients with prior abdominal surgeries. They'll have what they call, like, a frozen abdomen, lots of scar tissue, where you're just like, hey, yes, it's just. It's easier just to make that incision over it. And so that makes it easier.
You can't get your critical view of safety to, you know, safely get the gallbladder out laparoscopic. And sometimes, as you know, a general surgeon, there's nothing better than our hands and do that typical finger dissection. The best tools we have. So usually it's very angry gallbladders. Okay. In this day and age where, you know, all of us coming through training have, you know, we're well versed in laparoscopic and now even robotic. And so the number of times that most of us have to go open, even for the nastiest of gallbladders, is pretty rare.
[00:06:40] Speaker A: Right. And that really helps with the recovery time, which is so important. When we. When we talk about minimally invasive, not making those deep incisions and cuts. Right. That take longer to heal.
[00:06:52] Speaker B: It is, yes. Yep. But as I tell people, if that's the safest way to get it out,
[00:06:55] Speaker A: then you have to do it.
[00:06:56] Speaker B: That's what we're going to do.
[00:06:57] Speaker A: Absolutely, Absolutely. Depending on your expertise.
[00:07:00] Speaker B: Yes, ma'.
[00:07:00] Speaker A: Am. What are the most common signs that someone's gallbladder may be causing problems?
[00:07:05] Speaker B: I think the most typical signs that people, you know, think of is, hey, I ate some pizza, fried chicken, you know, some, you know, barbecue, and then, you know, shortly thereafter, they get all this bloating and the typical right upper quadrant, you know, abdominal discomfort. A lot of times, people will also experience it.
And the fact that they, hey, I think, have a lot of reflux, a lot of gas pain. So people like, I've tried all this gas eggs, and they get no relief.
And so that's usually what brings them in.
[00:07:38] Speaker A: Okay.
All right. Are there certain groups of people who are more likely to develop gallbladder problems or gallstones than others?
[00:07:47] Speaker B: There's really no rhyme or reason who gets gallstones and who does not. You know, 15 to 20% of our population have gallstones just running around, have no idea, you know, who it. Who doesn't.
There are certain populations that have a higher propensity to develop them.
[00:08:07] Speaker A: Is it because of diet? Maybe some different ethnicities eat certain types of foods?
[00:08:14] Speaker B: It tends to.
If those are the trigger foods for it. If they're, if you're going to eat those more frequently, then of course you're going to become more symptomatic if you're the, you know, lucky 15 to 20% that have them. So that's why it tends to feel like, oh, my family members, everyone has gotten it out because you guys, most of people are eating the same foods.
A lot of times we see it also. It's in our bariatric community. They'll have rapid weight loss after their surgeries. And that change in your dynamics with your cholesterol will.
Because that's what gallstones are mostly made out of is cholesterols. And so you get that different ratio of them that you get more gallstones.
[00:09:00] Speaker A: That is good information.
[00:09:02] Speaker B: So they'll be like, hey, I thought I was eating healthy and I was doing well. And then obviously, oh, yeah, you're feeling great. And then, oh, now I have my gallstones.
[00:09:09] Speaker A: Okay.
[00:09:10] Speaker B: It's also women that are over 40 and then they're fertile. That's the kind of that over 40 thing. Everything happens just. It hits. It hits hard.
[00:09:20] Speaker A: Yes, it does.
Many people assume that it's just heartburn or something they ate. I'm not ready to go have my gallbladder checked here.
[00:09:28] Speaker B: Right.
[00:09:29] Speaker A: Why are gallbladder symptoms so easy to dismiss?
[00:09:34] Speaker B: Because they can mimic other things.
They often. Your abdominal discomfort is brief. Right.
It can last an hour to several hours. And when it lasts several hours is when people usually typically end up in the er.
But when it, you know, it's a brief, oh, I just don't feel good. I have gas.
You know, you go to bed, you get comfortable, you go to sleep. It's easy to be like, okay, well, that was just because I ate pizza. I ate something different.
[00:09:59] Speaker A: I ate latently down on it.
[00:10:01] Speaker B: I think we all justify. There's probably this.
[00:10:03] Speaker A: I need to sleep with my head up.
[00:10:04] Speaker B: Exactly. Exactly.
[00:10:06] Speaker A: Right, right. Okay. Okay. Good stuff. Before someone schedules an appointment, are there any clues they should look for at home that may suggest their symptoms are related to their gallbladder?
And you've mentioned a little bit.
[00:10:21] Speaker B: Right.
I think the biggest thing is noticing a trend.
So you're having. Every night I wake up at 2am after I've eaten a fatty meal and I have this abdominal discomfort. That's very typical. And so often I will have my patients come in that they're kind of unsure if they have gallstone pain or gallbladder issues. We keep food logs. Is the biggest thing to get that training Food diary. Yes, ma'.
[00:10:50] Speaker A: Am. Are there any changes with the bile elimination that would associate an issue with the gallbladder?
Like about bowel movements?
[00:11:01] Speaker B: Oh, bowel movements. Okay.
Yes, sometimes. Because if your gallbladder is not working efficiently, Right.
You're basically just eating that oil. You're not getting that coating to break it down.
So you will have actually looser bowel movements more frequently. So people are like, oh, my gosh, I ate that. And then immediately, I need to find a bathroom.
[00:11:22] Speaker A: Yes, yes, yes.
[00:11:23] Speaker B: That's very common.
[00:11:24] Speaker A: Really?
[00:11:25] Speaker B: Yes.
[00:11:26] Speaker A: Okay. Okay.
[00:11:27] Speaker B: With that said, on the other side, you know, that can also be one of the side effects of having your gallbladder out if you don't. We talked about that. Hey. Your body adjusts and you get that accommodation. You know, there is a handful of people that have looser bowel movements, you know, of kind of a long standing issue.
[00:11:45] Speaker A: Right, okay.
[00:11:46] Speaker B: But most people do just fine after that.
[00:11:47] Speaker A: Great information.
You can. As you can tell, I'm definitely interested. So if someone is noticing that those patterns, who should they make an appointment with first?
Should they start with their primary care provider or directly to a general surgeon?
[00:12:05] Speaker B: I always encourage people to go to their primary care of a doc first. I think they're the quarterbacks of medicine. And, you know, if you start with the specialists, you know, I know general surgery. Right. So I'm going to practice in my little box and everything you have is going to be gallbladder issues.
[00:12:21] Speaker A: Right.
[00:12:22] Speaker B: Whereas I think that our primary care docs do a wonderful job keeping a broad differential of like, hey, how can we tease this out so we can get you to someone that can help you, which may not be me.
[00:12:34] Speaker A: Right. May eliminate an unnecessary visit.
[00:12:37] Speaker B: Right.
[00:12:38] Speaker A: Exactly right.
All right.
Once symptoms begin, when should someone stop waiting and go and just make that appointment? I would think when the pain got so excruciating, that's enough to make you
[00:12:52] Speaker B: run somewhere, I think, when it's like disturbing your activities of daily living. And I say that in the fact that people will really start modifying their diets. They'll get kind of food aversions, if you will, because if I eat this, I'm definitely going to have abdominal discomfort. I'm going to have the looser bowel movements. I can't eat my pizza out leaving the house because I'm going to need the bathroom immediately. Right. I think when you start making those behavioral changes, certainly, you know, coming in to your primary care doc now, when the pain persists, I always tell people, you know, more than three or four Hours or it's just intolerable. You should absolutely come to the er.
[00:13:31] Speaker A: Okay, good stuff. What can happen if someone continues putting off treatment, Delaying fall, following up and seeing what's going on with them?
[00:13:44] Speaker B: I would say, you know, I tell this joke to all my patients. You know, your gallbladder is only going to act up when you're about to go on vacation. You have a important event to go to. You have family visiting.
And so when you keep on delaying it, that. That will absolutely be the time that you meet me in the er and then we're accommodating it. So. But also, you know, I mean, it doesn't.
I can definitely tell the people that have had their gallbladder issues for years, but, you know, usually people have the same outcomes. Your gallbladder comes out laparoscopically and just makes for a more challenging day for me. But that's okay.
[00:14:21] Speaker A: Sounds like it's better to be on top of it, because when they show up in your er, it's gonna be unpredictable, right?
[00:14:27] Speaker B: It is more unpredictable. So if you start having it's. Or at least just to start those conversations. Cause, you know, once you meet a surgeon, it's not like, okay, well, tomorrow we definitely have to get this thing out. At that point, we can schedule surgery on your time, you know, when those important events or people visiting aren't coming in, so.
[00:14:45] Speaker A: True.
So if someone comes to you with these symptoms, what can they expect during the first visit?
[00:14:53] Speaker B: Basically having the same discussion we're having right now, kind of teasing out their symptoms that they're having. A lot of times they've already had imaging and labs that we'll review. I'm a big proponent of looking at the images with the patient, so I can show you your gallstones and kind of decide if surgery is right for you.
[00:15:09] Speaker A: Okay.
All right.
When people hear they have gallstones, they often assume surgery is the only option.
Is that always the case?
[00:15:21] Speaker B: So just because you have gallstones does not mean you have to have your gallbladder out. So I don't think we kind of touched on that. You know, with 15 to 20% of the population and having gallstones, and then in this day and age where we do so much imaging, you know, during other evaluations, it's very common to have an incidental finding. So just because you have gallstones does not mean you need surgery. It's when you become symptomatic that you need surgery at that point. And usually only 20% of those 15 to 20% become symptomatic. So that means 80% of patients that have gallstones, they keep them. You can have them, you know, and just kind of monitor for symptoms.
[00:16:02] Speaker A: I've had friends and family members say
[00:16:04] Speaker B: they pass their stones for gallstones or kidney stones.
[00:16:08] Speaker A: Kidney stones or gallstones?
[00:16:09] Speaker B: Oh, I know all the stones. Yeah. Kidney, frequent. You can.
The gallstones, depending on the size, they can slip out.
That is something called cholidoglothiasis, and those we definitely want to take out. If you're, you know, passing gallstones out into your main duct system, you present the same way.
[00:16:31] Speaker A: Right.
[00:16:31] Speaker B: Usually it's abdominal pain, fevers, not feeling well.
But if those stones get stuck out of the gallbladder, they can make you very sick. So we like to make sure that the stones have been cleared, and then we take out the culprit, which is your gallbladder.
[00:16:48] Speaker A: Okay. Yeah. I always felt like it sounded like it would be very painful to be passing.
[00:16:53] Speaker B: Yes.
I think I've heard kidney stones are terrible.
[00:16:56] Speaker A: Yes.
[00:16:56] Speaker B: Even both gallbladder stones, I don't know, they're quite up to kidney stone passage, but certainly people come in very uncomfortable.
[00:17:03] Speaker A: Okay.
[00:17:04] Speaker B: Yeah.
[00:17:04] Speaker A: Okay. Good stuff.
For people who have symptoms being caused by their gallbladder, surgery is often the recommended treatment. We hear the phrase minimally invasive surgery, and we talked a little bit about that, but I'll let you expound on that. What does that actually mean?
[00:17:22] Speaker B: Right.
So usually that means a couple small incisions. Usually, depending on how big your gallbladder is, the biggest one is, you know, no bigger than two of your thumbs put together.
[00:17:34] Speaker A: Okay.
[00:17:35] Speaker B: And that's where we take your gallbladder out.
[00:17:37] Speaker A: Yep.
[00:17:38] Speaker B: Some are a little bit bigger, some you don't need to stretch out, and that's okay. And then usually, you know, the typical is a total of four incisions, plus or minus, just depends.
And so that's. Then we use just long instruments and a camera and take your gallbladder out.
[00:17:54] Speaker A: Okay. Good stuff.
What does recovery typically look like?
[00:17:59] Speaker B: If we are doing it as the outpatient and even some of the inpatient ones that come through the er, typically you can go home the same day. So it's the same day procedure.
Typically, you know, depending on, you know, what's, you know, how angry the gallbladder is, I guess is a good way to say it. Sorry.
You know, it typically takes about 45 minutes, plus or minus. Sometimes, you know, they're out in 20 minutes. You feel like an amazing surgeon. You're like. But some can be very humbling. And we're in there for you know, two plus hours. And so.
But yeah, you go home the same day, you can do activities of living the same day, you know, going up and down stairs, getting your food, going to the bathroom, walking around the neighborhood. The biggest limitation is probably no heavy lifting for about, you know, three or four weeks afterwards so you don't get a hernia where we pulled your gallbladder out.
The other big question everybody has is what is my diet going to look like afterwards? That's what they're also asking in recovery.
You after we take out your gallbladder, you can usually eat whatever you want. I typically tell people, I mean, I wouldn't start, you know, stop at Taco Bell on the way home, you know, really challenge this thing.
But usually people do just fine resuming their normal diet that they they did in trying out some of the foods that maybe were triggering it before.
Some people in the post op will have those looser bowel movements because your body just needs time to adjust to not having it right. And so usually that resolves in about eight weeks.
[00:19:32] Speaker A: So. Okay, very good. Good stuff.
Dr. Whitlatch, thank you so much for joining us.
[00:19:39] Speaker B: Of course.
[00:19:39] Speaker A: Please come back anytime.
And I definitely better understand and I know our viewers signs and symptoms of gallbladder disease and why listening to your body matters.
So thank you. Thank you so much.
[00:19:54] Speaker B: Of course, thank you for having me.
[00:19:56] Speaker A: To our listeners, our bodies have a way of telling us when something isn't right.
The key is listening. If reoccurring pain after eating, nausea or discomfort is becoming part of your normal, don't just learn to live with it. Talk with your healthcare provider about what you're experiencing. Getting answers early can make the difference. And today's minimally invasive treatments can often help people get back to feeling themselves sooner than they expect.
If you found this episode helpful, share it with someone who may have been living with symptoms they've been brushing off. And one conversation could encourage them to get the care they need.
And as always, taking care of your health is an important part of healthier you. Until next time, stay healthy.
Thank you for listening to this episode of Healthy you. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com.
