Saturday, August 27, 2011

Post Gallbladder: Health Apocalypse

I had really hoped that after getting my gallbladder removed, my health would start to improve, or at least get back to normal. There were a few things I was worried about, for example, how my digestive system would adjust to having one of its organs removed. Both before & after the surgery, the hospital was measuring everything I excreted (fun fact: my bladder will hold about 200ml of urine before I get the urge to pee). Although I didn't make any bowel movements while I was there, I was told that one of the criteria I had to meet before being sent home was that I was "passing gas." Apparently, farting is a sign that your digestive system is waking up after the anaesthesia. 

I also read some rather horrible stories about how one's digestive system can react with no gallbladder. I was also told by co-workers and others I knew that had their gallbladder removed that they could no longer eat certain foods, as it would give them tummy troubles, followed by toilet troubles. Dr. Zink (my surgeon) said she didn't expect that I would have any of those symptoms, given that my diet was already quite healthy. Her only long-term concern was the very small chance that the pieces of gallstone she saw in my main bile duct could grow larger, eventually obstructing the bile duct, causing great pain and probably, a need for more surgery. 

I wasn't having trouble eating anything - my biggest test was 5 days after surgery, when I had calamari - and rather than having urgent needs to go to the bathroom frequently, I was actually constipated for quite some time. But things got back to normal in my bowels, and I went back to work 9 days after surgery. 

This is when things started to go downhill. I began getting quite fatigued, although my energy levels should have been improving. I was sleeping for 12-15 hours and still feeling run-down, and at one point I was running a fever. The surgeon's office didn't think that it was related to the surgery - if I'd had an infection, the reasoning went, the symptoms would be much more severe. They recommended I see a general practitioner. This was not as easy as it sounded - I had trouble getting an appointment anywhere, even from offices that allegedly were accepting new patients (according to my health insurance provider's website). Eventually, I was able to sign on as a new patient with Dr. Scott at West Linn Family Health Center, although my appointment was actually with Cherie Martchenke, a nurse practitioner. 

Cherie was great about listening to my concerns about fatigue, especially when I mentioned that these concerns are not exactly new, but they've become a much bigger problem recently - especially sleeping for such a long time. I had missed a day of work. She ordered blood work, including a thyroid hormone test and CBC. When she called back with the results, I was surprised to learn that my thyroid test had come back normal, since I would have liked to pin my frustrations with weight loss (or rather, lack thereof) and the fatigue neatly on hypothyroidism. What she was able to tell me is that I did have deficiencies in Vitamin D and Iron. The office called in prescriptions for supplements, and I need to return to get my blood levels checked in 8-12 weeks. 

I was a little surprised to hear that I had an iron deficiency, since I eat a lot of foods that are quite rich in iron, such as lentils, garbanzo beans, black beans, fish, broccoli, spinach, and even tofu. The vitamin D deficiency made more sense to me, since I tend to stay out of the sun if possible & wear sunscreen with a high SPF when I will be exposed to the sun for more than a few minutes. 

Right now, I'm taking a Vitamin D supplement weekly, with a strength of 50,000IU. The Iron supplement is 325mg of ferrous sulfate, and I take it daily. I'd like to give a shot-out to my pharmacist for warning me that iron supplements can make your urine or feces differently colored, because I would have been freaked out without that heads-up. I've been feeling a little better, a little up & down - last night I slept for 16 hours, so a little more down than up, perhaps. 

The last immediate recommendation from the doctor's office was that I see a dietician. The theory right now is that the training program I was doing may have had something to do with both the gallbladder attack and the sudden fatigue. I had heard that exercise and fat loss can lead to various toxins being released in your body, but this was a new one. Apparently, the training can put strain on your liver, as the liver performs several roles in carbohydrate, lipid & protein metabolism, as well as the breakdown of toxic substances - stress on the liver can translate into stress on the gallbladder, as the gallbladder stores extra bile that maybe the liver is too preoccupied to produce. The liver also has a role your body's absorption of iron and vitamin D. Before I start the same level of exercise, a dietician may help me reconfigure my diet to best help with these issues and take a look at my recent weight gain. 

I haven't yet seen a dietician, since I'm not sure whether or not it's covered under insurance - my insurance is saying that these services are covered for preventative care only and not as part of a referral for a medical condition, such as high blood pressure or diabetes. The girl answering the phone at the insurance company couldn't say whether my situation would be considered preventative care or not, so I've got to call my doctor's office again and see if they can talk to insurance and sort that out. The business end of getting healthy is not always pretty. The next step, if insurance won't cover it, is finding out how expensive those services might be, because in the end, it's a service I probably need to move forward.

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