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Gallbladder Surgery

What is the most common elective surgical procedure done in the western countries? Well, Susan knows the answer. Here is her story.

During the Christmas holidays, Susan has to rush to the Emergency Department as she develops severe pain in the right upper area of the abdomen where the liver and gall bladder reside. Pain is associated with vomiting.

After history and a physical examination, the emergency physician makes a provisional diagnoses of biliary colic i.e. pain due to gallstone. Susan gets a painkiller and gravol. She settles down and is discharged home for further investigations.

The first line of investigation is ultrasound of the abdomen. This test will check for problems in the liver, gall bladder, pancreas, aorta and kidneys. It may pick up problems in the stomach. The test is not 100 percent full proof but it is a good, non-invasive, and cost effective first line of investigation. For gallstones, quite often this is the only test required.

The ultrasound confirms Susan has gallstones. She is referred to a general surgeon. For most symptomatic gallstones, the best curative treatment is surgical removal of the gall bladder – cholecystectomy.

Each year, in Medicine Hat Regional Hospital, approximately 250 gall bladders are removed. About 95 percent of them laparoscopically- through four buttonholes. Patients are admitted to the hospital on the same day. Most patients are discharged within 24 hours of surgery with minimal complications. Most patients return to work within 7 days of surgery.

Compare this to the olden days when a patient would be admitted the day before surgery, have a long scar, stay about 5 to 7 days in the hospital and have 6 weeks of recuperation. A major life disruption when you think that this is the most common elective procedure done in western countries. And gall bladders have been removed for the past 116 years!

Observations of human gallstones go back to an Egyptian priestess at Thebes, around 1500 BC. Her mummy, when given to the Royal College of Surgeons Museum in London, was seen to contain a well-preserved gall bladder with 30 stones; unfortunately it was destroyed during the German bombing of World War II, says Dr. Knut Haeger in The Illustrated History of Surgery.

There are two types of gallstones: cholesterol stones (80 percent) and pigment stones (20 percent). Most cholesterol stones are mixed in nature. They are formed when bile becomes supersaturated with cholesterol and there is precipitation of cholesterol micro-crystals. This is a simple explanation of a complicated event in cholesterol gallstone formation.

Incidental finding of gallstones require no treatment if they do not cause any symptoms. Most symptoms are related to blockage of the gall bladder or one of its ducts by a gallstone. Cholecystectomy has minimal complications rate during and after surgery. But every procedure has some risk involved and should be undertaken after careful deliberation with the surgeon.

Susan is on the waiting list to have her gall bladder removed. She does not want to experience the pain of biliary colic again. Let us wish her good luck and speedy recovery!

This series of articles explore the health problems of Dave and his family. They are composite characters of a typical family with health problems. They believe in ELMOS!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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I SAY, I SAY: Change is inevitable

My friend Bill – not his real name – says what is happening to him in his personal life is similar to what is happening in the health-care system. Now he regrets he did not anticipate or prepare for these changes.

Changes in life are inevitable. Sometimes they are good, sometimes not so good. Sometimes they come suddenly, sometimes slowly. But things change all the time. What counts is how we anticipate, plan for and handle change.

Let us look at Bill’s true-life story.

Three years ago, Bill celebrated his 50th birthday. He was married with two children, a boy, nine, and a girl, seven. Bill was at the peak of his practice as a surgical specialist. He had plans to retire at 55. In fact, his financial advisor had made plans for Bill’s retirement in year 2002.

Bill’s main consideration was his children. They were very young and he wanted to put some money away for their education. He felt confident that with another five years of hard work he would be home free.

Well, people or nature can sabotage even the best-laid plans. That is what happened to Bill. A few months after his 50th birthday, he developed health problems. This put a significant scare in his head and he realized nobody is guaranteed immortality in this world – young or old.

Bill had to make significant changes in his practice, resulting in a major financial loss. His disability insurance did not kick in, as he was physically thought to be well enough to work. Mentally, he felt very insecure. He wanted to reduce the risk factors in his life to prevent deterioration in his health. Cutting down on stressful work was one way to do it.

Three years have gone by. Mentally and physically Bill has not done badly. He has curtailed his expenses (cutbacks) and managed to survive with limited income. But his children are now 12 and 10. Their needs and expectations keep mounting according to market popularity (peer pressure).

This is what is happening in the health-care system. The governments and health authorities may survive or limp along with cutbacks and limited resources, but people’s needs and expectations do not diminish. In fact they increase as new ways of diagnosis and treatment enter the market.

As we know, this is where governments have failed. They have no political will to change people’s expectations in a changing environment of “fiscal responsibility.” The burden falls on the physicians who are “independent practitioners” but still have the responsibility to do governments’ dirty job of rationing health care.

How can we be “independent practitioners” when we are controlled by two masters – the governments who pay the piper and patients who call the tune?

Physicians are angry and totally demoralized, as we did not anticipate the speed or prepare for the changes in the health-care system. These changes have been coming fast. And there is promise of more to come. But we – and our leaders – continue to fight change instead of becoming part of it.

Like stress, change is part of our lives. It is not going to go away. The question is: How do we plan to handle it?

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Changing Lifestyle

“Rome was not built in a day and sometimes it’s the smallest decisions that can pretty much change our life.”

This applies to me quite well. My surgical mentality makes me a very impatient person. When I see a problem, I want to fix it quickly and get to the next one! My son thinks that’s cool!

But life outside operating room is different. My son is too young to know that. But you and I know how difficult it is to make changes in life. Quite often these changes have to do with our habits and lifestyle that have been part of our life for many years. Then comes the month of December and all hell lets loose. By the time we finish the New Year’s eve party, we are deep into guilt and self-mortification.

Next morning, we decide to change our whole lifestyle. We think it can be done overnight. After a well-intentioned weekend, we open the newspaper on Monday morning. Experts are already out there predicting failure. They feel we are half-hearted, poorly organized individuals whose actions fall far short of the intentions.

So, it is left to us to prove them wrong. How can we do that?

Lesson No.1: Be prepared. Most people’s resolutions are about lifestyle changes: quit smoking, lose weight, exercise regularly, eat healthy, spend more time with family, learn to say no to excessive demand on time and many more. None of these can be done in isolation. So when we try to make one change, we have to be prepared to make changes in many more areas then we expect.

Lesson No.2: Know the benefits. We should have convincing reasons to change from the current situation. Take a moment and write down the advantages and disadvantages of the proposed change. If there are no obvious benefits then don’t do it.

Lesson No.3: Look at the ladder. Once the decision is made to go ahead with the proposed change, then make a list of the steps required to implement the change. This will require help and understanding from family, friends, and most important your co-workers.

Lesson No.4: Join a group. Ask yourself if you are going to do this on your own or join a group. It is easier to do it in a group – may be formal or informal. A little bit of competition and monitoring helps achieve the desired results and keeps the motivation going – if he can do it, so can I.

Lesson No. 5: Be patient. Rome was not built in a day and sometimes it is the smallest decisions that can pretty much change our life! Say it 10 times a day and keep smiling! Pick reasonable targets and be positive. Think of what you want – NOT what you don’t want.

The other day, I was looking at the book “Born to Win”. The back cover says, “Every person has the potential to be a winner: to be an authentic, alive, responsive, fulfilled human being.” You are that person. Go ahead. Plan it and do it!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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ELMOS

What’s going to keep us healthy in the next millennium? Is it going to be science and technology or ELMOS?

ELMOS is what I call the basic tenants of good health. If you take care of ELMOS then you know you have taken care of yourself. There is no better care than self-care.

ELMOS stands for: Exercise, Laughter, Meditation, Organic Healthy Food and Stress Management. Many of the modern day killers (stress, heart disease, accidents, and cancer) will be taken care of if we take care of ELMOS.

What about our genes? May be genetic engineering will take care of that. But, there are no guarantees in life! What we can do is build a good foundation for good health. I believe, ELMOS is that foundation.

EXERCISE. A study published in 1994, showed that regular exercise is important for health and reduces the risks of chronic diseases. The US Centers for Disease Control and Prevention and the American College of Sports Medicine encourage 30 minutes of moderately intense physical activity every day. But it is estimated that only less than half the adults in North America exercise regularly. We need to do more.

LAUGHTER. There is a lot of truth in the old saying – laughter is the best medicine. The happier you are the better you feel. Ashley Montagu has written about the origin of laughter. She says the only animal that speaks is the only animal that laughs. Laughter is an expression of joy and can be infectious. This is one infection worth spreading!

Montagu says: It is well known that laughter has a tonic effect on the mind and body, suffusing the body with a feeling of well-being that few other activities are able to provide, refreshing, relieving, enlivening, and involving the whole body in its “happy convulsion.”

MEDITATION. The practice of meditation has occurred worldwide since ancient times, says Encyclopedia Britannica. There are numerous techniques of meditation – religious or otherwise. It is considered holistic and humane. Medical and psychological studies have shown that meditation is effective to varying degrees in the symptomatic control of migraine headache, hypertension, and other conditions. It helps in the purification of body, mind, and soul.

ORGANIC HEALTHY FOOD. The Environmental Magazine says: Of the 300 pesticides approved by the federal government, 73 (including some of the most frequently used) are “probable” or “possible” carcinogens (substances which cause cancer). There is also a risk to nervous system damage. What about the balanced healthy diet?

The Canadian Cancer Society, the Heart and Stroke Foundation of Canada, and the Canadian Produce Marketing Association have recently launched a campaign to encourage Canadians to eat at least five servings of vegetables and fruit every day. This will help “prevent thousands of future cases of cancer”.

STRESS MANAGEMENT. I did not use the work “prevention”. As Newsweek magazine says: Living a stress-free life is not a reasonable goal. The goal is to deal with it actively and effectively. Some of the coping mechanisms are: exercise, meditation, relaxation and massage therapy. Learn to philosophize and rationalize issues. It is good for the soul.

I believe, ELMOS will save many painful moments in our lives in the next millennium. But we need to find time and make an effort. Nobody can help us with that. We have to set our own priorities.

I wish you and your family a happy, healthy and prosperous thousand years!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!