Dr. JB Lim's Comments on Gallstone Removal

The blogger consulted his most learned e-buddy Dr. Lim Ju Boo regarding his cousin Pan’s recent suffering from cholecystitis (胆囊炎) as confirmed by ultrasound test. 

Pan has suffered from this problem of the presence of gallstones in his gallbladder in 2014 and Dr. JB Lim had also then provided kind advices as posted by the blogger in the following link:

https://taionn.blogspot.my/2014/06/therapies-for-gallstone-problems-by-dr.html

(Therapies for Gallstone Problems by Dr. JB Lim) 

The blogger is very grateful for the following responses via WhatsApp from Dr. Lim in spite of his current “solitary confinement” in KL GH for treatment of his year-long leg ulcer pain:

[9/6, 8:13 PM] Dr. JB Lim: 

Dear Ir Lau,

I am sorry about your cousin Pan.

It looks to me he has all along been having gallbladder stones, but were asymptomatic, meaning no pain in the upper right abdomen, no jaundice, etc.

Actually most of us do have some gallstones but we do not realize it because we do not have symptoms, so never take care or go for treatment.

But in Pan’s case there was possibility he may have consumed too much meat containing cholesterol, fats and oil to aggregate his existing condition.

His doctor was right in giving him two options, namely by medication or by surgery to remove the gall bladder, a procedure called cholecystectomy   (see: https://www.healthgrades.com/procedures/cholecystectomy).

There is actually another method besides medication or surgery, and that is, through dietetics, or even by using herbal medicine provided his condition is not too severe.

However, methods other than surgery are much slower, and may come back if your cousin goes back to his old lifestyle of a high meat and fat consumption and do not drink enough fluid.

There are drugs that can slowly dissolve away the stones, but this may take some time, and may reoccur.

The same thing using dietary means. It is slow but long lasting

Since I do not know how serious your cousin case is, I am not in a position to advise him or yourself which route to take.

His doctor who saw him would be the best person, because he would know the actual situation, such as the size of the stone or whether they were many little stones, and whether it is actually now blocking the bile duct, and preventing the bile from flowing?

Also I do not know if he is in acute pain, and is jaundiced (yellow in the white of eyes).

All these need to be considered before making a rational decision.

If he has all these signs and symptoms, my feeling is to have it removed by surgery since the gallbladder is not essential for life - it is just a storage bag for bile.

But if it is just mere discomfort, loss of appetite, and the bile is still flowing (colour of his stool brown and as usual), and if he does not want to lose his gallbladder that is not essential for life, then he can take medication, followed by proper dietary treatment.

I am in no position to make all these decisions for your cousins, especially when I have not even seen him, or have access to his medical records.

I do not even know how big the stone or stones are, or whether or not their sizes can be dissolved by medication alone?

Sometimes even medication cannot help. In that case surgery is the only choice.

On the other hand, there is also risk in surgery. In that case medication is the other option.

But if both cannot help, then dietary, nutritional and herbal medicine would be the best. It all depends. I cannot decide for him as I do not know his actual current condition.

In the meantime your cousin should go on a soft diet with as little oil as possible except olive oil which may help. Green tea is especially very useful. Ask him to drink warm green tea without milk and sugar instead of water.

Apple cider vinegar, lecithin and vitamin B complex and olive oil may also help if it is not too serious.

There are other dietary approaches that are also useful in the long run to prevent recurrence, but a healthy lifestyle with plenty of water, fruits and vegetables, body weight reduction, exercise, is still the best

But if his condition is serious with lots of pain, jaundice, loss of appetite, etc, then may be immediate surgery is the choice.

But even with surgery, if his eating habits and lifestyles are not healthy, such as consuming a lot of fat and red meat, obesity, lack of fruits and vegetables, no exercise, lack of sleep, stress....etc they will lead to far more serious illnesses such as stroke, heart and vascular disease, cancers, kidney and liver diseases, and so on later.

These are far, far more serious than just gallbladder stones.

Surgery to remove the gallbladder can never prevent these far more serious diseases from creeping in years later.

Hence it maybe far better to change his nutrition and dietary habits that will solve both his gallstones problem and the other far more life threatening diseases I have just explained.

Surgery merely removes the gallbladder but gallbladder removal can never remove all the other future very serious diseases I like to emphasize here.

So in that way, a change of lifestyle and nutrition is far better than mere mechanical removal of the gallbladder.

At least now I have explained so that your cousin can make an informed choice on his own.

I hope I have been of help.

With pleasure,

Regards

Lim jb

The blogger subsequently obtained from Pan a copy of his Radiology Report which confirmed his gallbladder was filled up multiple stones measuring 5-11mm and the impression was “acute calculus cholecytstitis”. 

Upon presenting this Report to Dr. Lim, the blogger is most indebted for further comment from Dr. Lim as follows: 

(Note: Names and particulars of the persons involved in the report are purposely blanked out for protection of privacy) 

[9/7, 11:39 AM] Dr. JB Lim:

Dear Ir Lau,

I saw the echo report and looks like he has a lot of small stones inside the gallbladder itself but not within the ducts in the liver or are they dilated, except the gallbladder walls which is tender that may explain why he is in pain.

Since he is 60 years of age, and if he has no other attending problems such as heart or lung disease, and if his doctor thinks he will be fit for an operation, he can consider.

But if he chooses medication, he can also opt for this for two weeks or so and see how he responds without surgery.

I think he needs to be further investigated and reviewed by his doctor, but it is up to him to choose.

Some patients are unfit for surgery, and have to be treated medically, but sometimes medication may not work especially if the stones are large.

But I did not see any obstruction to the bile duct except tenderness suggestive it may be inflamed with thickened bladder walls.

I cannot suggest anything based just on an ultrasound report.

Best to let his doctor advise, but the decision should only be made by your cousin.

Lim jb