Ask the Bellydoc

[FJCarrie]

BellyDoc previously said:

I LOVE THIS QUESTION!!!!

The short answer is NO.

However, when have you seen me limit it to the short answer??

Here are the salient facts:

1) Gallstone material, like soap scale, once formed does not redissolve under physiologic conditions. Nothing you can pipe in by mouth creates anything that deviates from "physiologic conditions". Gallstones can be dissolved in diethyl ether when it is directly injected into the gallbladder... there is nothing physiologic about this. A medication known as "Actigall" which is urosdeoxycholine (a bile salt - basically a component of bile delivered orally) has the ability to prevent or arrest the growth of gallstones but I don't know of any dependable evidence that it shrinks them.

2) Gallstones pass or don't pass based on size. A 5mm stone isn't likely to pass, or if so, it isn't going easily. Stones less than 3mm pass readily in most cases without any signs of having been there. When gallstones cause pain, they're usually 5mm or bigger (some MUCH bigger) and they are restricting the ability of the gallbladder to contract in response to the stimulus of a recent meal. If a larger stone is ejected from the gallbladder into the duct, it can wedge in the duct and cause serious problems. This is one of my areas of surgical specialty - clearing the bile duct laparoscopically. The biggest stimulus to gallbladder contraction is oily/fatty oral intake.

3) In regard to the gallbladder cleanse that you put here, and a variety of others, you'll note the presence of two things... olive oil and lemon juice. Basically, what this recipe gives you is a fat loat that overwhelms your ability to break down oil into absorbable molecules. Fat molecules make it into the colon unbroken and these are tremendously ... um... lubricating! Additionally, there are conditions under which oils can be emulsified into a plastic goo mixed with water, and pH is a component of this. I enjoy this in the kitchen when I make humus... nerd that I am... I mix semi liquid and liquid ingredients together... and it makes a solid. It's like epoxy. I suspect this occurs in the fat that makes it to the colon.

What you get is a double-whammy. First, you get some hefty gallbladder contractions because of the fat (olive oil). Then you poop out a runny mix of lots of little green clumps of plasticized acid/oil. If you actually have gallstones, you might even become acutely symptomatic with the gallbladder contracting on its stones!

The real proof of concept which nobody has ever or will ever publish, would be before and after ultrasound images of the gallbladder - first full of stones and then empty - after this type of cleanse. It ain't happening. It's a square peg and a round hole. If the stones are small enough to pass, they don't need help. If they're not small enough, they're not going to respond to help. It would be possible to get into trouble acutely if you do have big stones and you cause strong gallbladder contractions so I really can't recommend this as a harmless thing to try.

20 percent of the population has gallstones by the age of 65. In the Hispanic and Native American communities the fraction is even higher (like basically 100%). Only about 1-2% of these people per year develop symptoms. However, with gallstones being that common, 1-2% of those people times the expected lifespan after they start developing stones (which could occur in the teens or twenties) is a lot of work for surgeons.

Of the people who develop symptoms, only a small fraction will develop more than pain. The potential for severe disease, though, is real. Some people get acute cholecystitis as a result of their stones. Just like you can get inflammation and perforation of the appendix requiring an emergency surgery, you can kill and perforate the gallbladder too - also requirring emergency surgery. You can block the bile duct (choledocholithiasis) and turn bright yellow. This has to be fixed, but its not as much of an emergency as perforation and infection. However, blocking the bile duct will eventually kill you from liver failure so this is no joke. When people pass stones, the stones can inflame the pancreas. This is called gallstone pancreatitis. Gallstone pancreatitis is usually a mild form of pancreatitis, but not always. Severe pancreatitis kills people. These situations can be unbelievable abdominal disasters requiring enormous and devastating surgical interventions in order to save life.

The trouble is, I can't say for sure who is and who isn't a ticking time bomb. Therefore, once I'm aware of someone having gallstones and those gallstones are causing symptoms, I have to recommend to take out the gallbladder which makes the stones in the first place. Once it's gone, the stone forming capacity is erased.

Removing the gallbladder is an extremely effective and well tolerated operation. Most people are in and out of the hospital in the same day.

However, if I wait till its an emergency, the gallbladder is hot, red and pissed off when I get to it. It bleeds more and it's more likely to be involved in some sort of surgical complication. People who have emergency surgery for the gallbladder don't do as well, and they hurt more.

I have to recommend that anyone who is suffering symptoms from gallstones therefore should undergo elective surgery at a time when there are little to no symptoms (between attacks), and that they should do so sooner rather than later.

Just get the damn thing gone.

Nobody misses it.

Wow, that was....very informative!! It all makes perfect sense. I'll let my roommate know that she can live without her gallbladder. Thanks, doc!

[FJCarrie]

max-9 previously said:

Thanks !
I often wondered about how deaf persons process written words or somthing in sign or brail.
When I 'm reading , I assign a voice to the person .

Example :When I read what Belly Doc wrote .....I heard Carl Sagans Voice
"We're reconciling the calendar with the position of the earth in it's orbit around the sun, relative to the surrounding stars. We don't exactly make it full circle in 365 spins of the globe (24 hour days).

The clock and the calendar aren't cleanly in agreement. The clock is set based on the earth's rotation on its axis, the calendar is based on the orbit of the earth around the sun. We're lucky that we don't have to clean it up even more!

The rules about leap-year, incidently, are actually a bit more complicated than 1 out of every 4 years... look it up. It's kinda cool! "
Sounds just like Carl Sagan.

Haha That's true. I didn't really think of it that way - adding different "voices" to the person. Everyone's tone of voice pretty much sounds the same to me (I have a Cochlear Implant). If I'm not looking at you while you're talking to me, I would be able to hear you, but my brain isn't trained to differentiate between the sounds (letters), thus it all sounds like mumbling to me. When I read, I pretty much use the same tone for every person!

[CheFJ]

BellyDoc previously said:

OK... here's one for the nerdophiles.

It's one of my all time faves.

You're on a TV game show. Your host shows you three doors. The game is called "Goat or GOLD"...

Behind 2 of the three doors are goats. 1 door hides a huge pile of gold.

Your job - just to be clear about it (I don't know what kind of goat loving freaks might be reading this so I have to specify) is to obtain the gold.

You're asked to pick a door, and you do.

Before opening it, your host goes to one of the two doors that you DIDN'T pick and opens it, showing you a goat.

"Now," he says, "you have to make a choice. Do you stick with the door you already chose, or do you want to change your mind?"

You can either go with your original choice, or you can choose the remaining door before he opens it and shows you what you'll get as your prize.

This leads to the following question.

Given the parameters of this scenario, what is a better guessing strategy: to stick or to switch?

Please... respond with not only your conclusion, but the reasoning behind it.

I'll private message people who answer correctly for the following 24 hours and then tomorrow night, I'll post my answer. There is no prize other than acknowledgement here that you answered in a manner noteworthy in the eyes of a nerdy guy recently compared (even if only by reference to the imaginary voice in somenone's head) to Carl Sagan.

I would love to answer but I actually saw this yesterday (or the day before) on another site...poop. I would love to look like a brainiac, but no...I'm too honest.

[RapidFJ]

CheFJ previously said:

I would love to answer but I actually saw this yesterday (or the day before) on another site...poop. I would love to look like a brainiac, but no...I'm too honest.

I'm no brainiac, nor perhaps that honest. But, I have seen this puzzle before, so I won't answer, either! It's a good one, though.

[BellyDoc]

4XX4 previously said:

Ok Doc,

in all my simplicity- and I have a lot of it- I go with my gut feeling and stick to my original choice.




I may be out of my league here since you have asked for nerdophiles, but I do post some things to give someone else a chuckle and brighten their day a little.

Your participation brightens my day!

[BellyDoc]

CheFJ previously said:

I would love to answer but I actually saw this yesterday (or the day before) on another site...poop. I would love to look like a brainiac, but no...I'm too honest.

RapidFJ previously said:

I'm no brainiac, nor perhaps that honest. But, I have seen this puzzle before, so I won't answer, either! It's a good one, though.

You two can enjoy the struggle along with me then.

[bandi]

That was an easy one... KOOL THO B-Doc... TY....

(in ref to goat or gold)

[AcadiaCruiser]

Ok, so I am going to get the DR Front Coilovers. But i need to make a decision about what i'm going to get for my rear suspension.

Here are my options: Donahoe Racing Rear Shocks and Springs or Extended Bilstein rear struts and toytec rear springs.

I'd like to keep my whole setup DR, but i've heard good things about the bilsteins. The thing with the bilsteins is that they aren't made specifically for the FJ, and along with the struts come these adaptors, so you can bolt the struts into the correct position.

Do you see any long term problems with these adaptors and the bilstein struts?

What would you go with, if you had to choose?

i figured i might as well ask

[homedad]

A gambler would play the odds and keep his first pick... but I'm no gambler so I can't explain why...but I will take you in Texas holdum when your ready Doc

[CheFJ]

homedadr previously said:

A gambler would play the odds and keep his first pick... but I'm no gambler so I can't explain why...but I will take you in Texas holdum when your ready Doc