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Cholecystectomy post-op questions, yellow bile, etc.

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Irritable Bowel Syndrome
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Posted 4/14/2011 2:03 AM (GMT 0)
As many of you know, had my GB removed in 1999. I've had nothing but trouble ever since.

Lately I've noticed my body seems to purge itself once or twice a week (dumping syndrome).

Even though my surgeons have always said my troubles are because I no longer have my sigmoid, I wonder if Welchol or Cholestryamime would help me?

I heard Welchol is very expensive, we have inadequate insurance (Rx co-pays are $30-50).

Does Cholestryamine do just a good a job as Welchol does? Does it come in pill form or only the powder?

Thanks so much. After all this time I'm starting to wonder if half if not all my IBS like troubles are related to having had my GB removed during my colon resection/cancer surgery.

Post Edited (Marsky) : 4/13/2011 8:24:45 PM (GMT-6)

Posted 4/14/2011 12:23 PM (GMT 0)
Okay, next question, if that's okay. Maybe this will grab someone's attn.

Instead of the above meds mentioned, I wonder if I should try the Caltrate tabs again. I did years ago but they constipated me and made me really ill. Now I'm wondering if I took too much with each meal (1/2 tab, 3 times a day). Maybe I'll try 1/4th tab with each meal?

Reason why I made this topic and post was I am revisiting this post-gall bladder removal situation I am in. Because my GB was removed during my 5+ hour colon resection, my doctors seemed to just gloss over the fact that I no longer have it. They focused their attn. on cancer, the temp ostomy, etc. Rightly so I guess but not one doctor has said my troubles might be attributed to excess bile (internal, I never see it as it exits my body, in other words I have never, ever had yellow stool or anything close to it, in 12 years).

Hoping inape/Linda is still browsing these boards, she may have ideas for me to try. I'm just growing so weary of the dumping episodes each week, lately it's more than once a week and I'm just drained afterwards.
Posted 4/14/2011 9:03 PM (GMT 0)
Cholestyramine is the basis of the meds used to treat bile salt diarrhea, including Welchol. Cholestyramine powder is much cheaper, plus it would allow you to more easily regulate the amount to control your diarrhea. Since you aren't having trouble after every meal, a lower dose might control the issue. Also, the powder form would last you longer. Cholestyramine products can constipate you if too much is used.

I use TUMs when I eat something that I know is going to run right through me. The calcium works well as a binder for me. Plus they are cheap. So trying your Caltrate might be worth it.

Here's a good article about bile-salt diarrhea that also explains the medications used to treat it. http://www.gihealth.com/html/education/bilesaltDiarrhea.html
Posted 4/14/2011 9:43 PM (GMT 0)
Ides - thank you so much for your reply. I've always thought I didn't fall into this post-gall bladder removal camp because I do not have on going diarrhea. What I do experience is the dumping, repeated trips to the bathroom after a meal, until I am nearly depleted of all stool. The stool isn't yellow or D, it's sometimes loose but again, not quite D. But lately I've been besides myself trying to figure all of this out. It certainly wouldn't hurt to take the powder, my internist I know would prescribe it for me.

Without the yellow bile or stool, and all out D, I just didn't think I fell into that 5%. Maybe I do afterall.

Thanks again for your post and also the link. The link was very helpful. I will also eat low fat foods too.
Posted 4/14/2011 11:30 PM (GMT 0)
I had my gallbladder removed February 1st, 2011, due to chronic pain, bloating, sludge and a low ejection fraction of 10%. I did not really have any problems until I was 7 or 8 weeks post op. Then the occasional "dumping" started. I do however seem to have chronically loose stools and suffer from hemmoroids and now an anal fissure because of it(sorry if that's TMI)

My PCP prescribed Welchol(colesevelam HCI) in a powder form and referred me to a Gastroenterologist for further study next week. My PCP did say that fiber is valuable for those like me with chronic loose stools and diarrhea. I have oatmeal, Fiber One Cereal, an apple, carrots and 2 servings of brown rice every day but even this will not stop those occasional attacks of diarrhea once or twice a week. Also, Welchol can be constipating, so if you do try it, make sure you are hydrated and have lots of fiber in your diet. Good Luck to you.

So I am curious, you had your surgery in 1999 and suffered the diarrhea ever since? I am sorry to hear that. I certainly am not a doctor, but any more when I hear someone say that you don't need your gallbladder, I beg to differ. Sure you can get by without one, but it was there for a purpose! I do not regret my surgery in any way, I just realize that it was nice to have it working properly.

Thank you to Ides for that link!
Posted 4/14/2011 11:58 PM (GMT 0)
TMI just doesn't exist here rufous57! So never apologize for details, we ask for them on healing well and nothing really makes us uncomfortable. There isn't anywhere that we can "talk" like this out in the real world so here, you are safe to spill all, or as much as you want to.

That said, yes I had colon cancer in 1999, a 1 inch tumor barely inside the rectal area. They resected my colon, removing 90% of the sigmoid (what is referred to as the large intestine's reservoir), where the tumor was located but also about 15 inches above that area or so they told me. They wanted clean margins and they got them, my cancer was Stage 1 and did not come back. I have not had even one polyp since. All colonoscopies are clean. Which is awesome news to hear but my life has been forever changed. They told me I would experience multiple bm's per day, not one, and I was suggested to eat several small meals, not 3 large ones. But I was told to eat anything I wanted and to enjoy life (taking Immodium if I had D). Well, I was a mess. And I mean a real mess, I had 3 bm's during one meal, the sheer second I chewed food, I had to go. I joked I was going to take a TV tray table in the bathroom and eat in there. Over time I found message boards, thank goodness. I learned that a low residue diet was recommended for people going thru chemo (which I wasn't but my symptoms were pretty much the same). I went on the LRD and was a brand new person within 48 hours. FYI, this is a low fiber diet. It worked GREAT for several years. Granted I still went many times a day but my stool was formed and I could leave home, as long as I knew where a bathroom was when needed.

But over time, my body has changed a bit, I went back to work, my daughters grew up, went to college, we got a ski boat and well, I don't know, my quiet stay at home mom phase was no more.

So who the heck knows why I'm having all this trouble - again and now it's the dumping. Each time I've been home, except one, on a trip to Wash. DC to visit my daughter. I had to leave the fun outings we had planned and return to her house (she rents a room with friends there). I never so happy to return to her house. Prior to that I was on the subway, walking around, waiting in lines for bathrooms at museums. My gut was heaving. I knew it was telling me to head "home".

I'm just trying to figure out what is going on again, inside. I am due for a colonoscopy in August, and I will mention these changes to my GI doc.

If there's anything that has been consistent about my "newly" created gut (ie, much smaller reservoir) is that it is not consistent. Just when I think I have everything figured out, I go thru more changes.

I forgot to add, that we have a sweet new puppy too. Perhaps that is why I am also worn out, having trouble. But he will become my new therapy dog, I can feel it. I have to be patient with him. He's already my new bathroom buddy. He's going to want to go in there with company, no doubt. I've trained another dog to hang out in the bathroom!
Posted 4/15/2011 2:32 AM (GMT 0)
Marsky - I just looked at your signature. Why are you taking Colace, a stool softener? Could that be contributing to your loose and frequent stool issues?
Posted 4/15/2011 2:54 AM (GMT 0)
That's another piece of my puzzle. Mid-way thru my 12 year post-cancer phase, my GYN doctor said I should take it, so I never have a blockage (I have mild scar tissue near my left ovary, where my temporary colostomy was located). I laughed when he said blockage because well there hasn't been one day since 1999 that I haven't had a bm. But he grew serious and said that Colace is very mild and it would give me the stool conistency I was missing. I tried 100 mg but it was too strong, so I ordered 50 mg from the pharmacy.

Lately I have wondered about taking it, but honestly if I stop, then I get a little backed but it's not like constipation either. It's almost as if they didn't create a large enough exit/rectal area. I know that feeling is from inflamation that I get when messed up (but from reading the colitis forum here my inflamation doesn't seem like colitis).

I hope I'm making myself clear in all of these explanations.

A few times I've forgotten to take Colace and then I get into that inflamed, irritated stage and have trouble going for about 6 hours. Again, not quite constipation, just restriction.

This is all so confusing. At one time my colon specialist suggested I have more surgery and get an inverted colostomy, one that I would irrigate once a day for an hour. The more she talked, the more I stressed out and said no thank you. #1 we have lousy insurance, so #2 we'd owe no doubt 20% of the hospital and surgeon's bill and #3 my colon resection was extremely painful to recover from. So I'm not going the surgical route, just maintaining what I have for now. As best that I can.

Over the years doctors have suggested several options - such as the inverted colostomy, another said I should have had a J pouch which I could still have I guess - but others said high fiber, bran cereal and Metamucil which I did try, but I was confined to the commode for hours.

I've tried so many, many things. While it's frustrating, I am open to new suggestions. Even at this stage, after living this way for so long.

And yet a few times I threw caution to the wind and did nothing, I ate what I wanted (chili even), no meds whatsoever but I was also off work and could stay home. And yes I paid for that little experiment.
Posted 4/15/2011 11:23 PM (GMT 0)
Marsky, you have certainly been through a lot - wow! Congrats on getting a new puppy, I bet that keeps you busy! And thank you for your statement that we are free to discuss without fear of TMI, this forum is a great place!

Clearly, the colon resection you had is a life changing experience, you are a cancer survivor, congrats! My DH had a colon resection in 2007 for a perforated colon due to diverticulitis. They only removed a foot and a half, laparascopically, and although the surgeon told him that when you gotta go, you gotta go, everything else in his life has not changed so we know he was fortunate. What does your GI say about the gallbladder affecting your bowel habits? I could certainly see that after my surgery, it can mean at least 2-3 trips to the bathroom, can be more than that if I don't watch what I eat, that's why I went ahead and got the Welchol, although I have only used once or twice. Take care, Ruth
Posted 4/16/2011 12:17 AM (GMT 0)
i have had nausea, pain, D and C, low grade fever every night, and some vomiting but mostly dry heaves the last 3 years.  Was diagnosed with IBS and nothing worked, when last Friday my new GI told me the results of my HIDA scan (first time dr.s thought to check GB in 3 years).  Lazy gall bladder 28% evacuation fraction, any of you gall bladder removal posters have similar symptoms and did the the removal of your gall bladder help?? I know I can potentially have more D, but marksy your story almost scares me. 

Marksy, on the colace issue......ask your Dr. for a different stool softener.  Miralax couldn't keep me from being constipated and I drank buckets of that stuff. Relatively cheap too. Just a thought.

Post Edited (IBS_sucks) : 4/15/2011 6:44:02 PM (GMT-6)

Posted 4/16/2011 12:30 PM (GMT 0)
IBS_sucks - well don't necessarily think you'll fall into my situation if you get your GB out. Less than 5 or 10% have post-removal yellow bile D. And yet I don't think I have it, you're apparently supposed to actually see the yellow bile remnants and mucous (sorry for that detail), in your stool and it may burn when exiting but I've never had that symptom. Never.

The reason why I am revisiting why I am in such dire straits, is maybe you can still have these post-removal symptoms w/o yellow bile? That's really my main question. I was hoping someone would say they've never had the yellow bile discharge either.

My surgeons and all the doctors/nurses, etc. have always told me that w/o your natural God-given sigmoid, stool has virtually no where to collect, back up and then ideally be released once or twice a day. I have at best only 10% left of my old sigmoid. The area where my stool "collects" for a loose term, is now very narrow and small in size, in the part of my pulled down, newly created lower colon/rectal area. I can feel it slide down and after 15 minutes I have serious pressure to go. I've often tried to hold it for longer and that's when I have accidents.

The way I've approached my situation is to accept the fact that I will have multiple bm's per day, for the rest of my life, as long as I continue to eat solids that is. So now my goal has been to keep the stool easily passed, not messy, but not D, so I can use any ordinary public bathroom. Which is why the LRD and Colace used to work great for me. Along with the evening probiotic for good measure.

I think I may make an appt. for my colon specialist over the summer (I work for a school district and I know she will instruct me to do one or two enemas before examining me, so I'd need the entire day off of work). Maybe I could ask her to pretend I have just come to her and see what she'd recommend today, 12 years later after my surgery (my orig. surgeon moved to Atlanta 6 months after my surgeries, sometimes I'd love to talk to him).

Thanks for your reply and also Ruth (again, welcome to the forum).

Post Edited (Marsky) : 4/16/2011 6:33:50 AM (GMT-6)

Posted 4/16/2011 9:24 PM (GMT 0)

Finally! Someone who works at a school and has bowel issues.  I was begining to think I was the only teacher (not really).  2nd year out of school, last year i could substitute for about 5 days a month, this year not at all.  The nausea for me made it impossible, i have to keep my house at 60 degrees to keep from throwing up and having to move in order to interact with students in a 70 degree room was just too much for me.  How do you make it through the school day?? Are you only going once or twice at school or do you have some really bad days, and if so what do you do then?

Posted 4/17/2011 12:39 AM (GMT 0)
I wish I was a teacher! I have over 2 years of college credits for elementary education but then life happened - I remarried, quite happily second time around, then we started having children, I got cancer and well I started and stopped my college phase several times (after starting it at age 30 to boot!). Someday I'd like to go back to college but probably forego the elementary education at my age.

Along the way I knew I needed to work part time, ideally full time if possible. Since I was active at my daughters' excellent school district, another PTA mom I knew suggested I apply for teachers' aide positions and I did. Nothing panned out, they were always filled. Then someone suggested working part time in the cafeteria and well, I landed in a position I never thought I'd have, I run the computerized register at a busy elementary (even though years ago I was used to the clerical world). Sometimes I wonder what if I had landed that teachers' aide position, if so I'd be working nearly 7 hours a day and I think that would be too much. 4 hours per day is actually ideal. Since I had never worked in food service, it was an eye opener, let me tell you. Hard work but again, I love the mid-day hours - 10 to 2. Perfect for managing my situation.

But I hear you, I have to tip my hat to you teachers, you are on the go ALL the time, no downtime and certainly not a calm part of your day. You don't even have a place to eat a quiet lunch, there are always PTA parents coming in, other teachers interrupting you, correct? And then there isn't a good bathroom for you to use. There is one by our kitchen but guess what? Teachers walk all the way down to our area to use it and I don't blame them. Since we work in an elementary, if we use the girls' restroom, the toilets are very low to the ground!

The profession I hear that is very sympathetic to IBS, etc.? Nursing. A relative tells me that all her coworkers seem to have IBS or the dumping issues. They work 12 hour shifts which are actually nearly 13 hours (for overlapping, reviewing patients' charts). She said someone is always running and I mean running down the hall to the bathroom. But the good thing is she says there are tons of bathrooms in hospitals. True, I've noticed that.

Well you certainly can't change professions. The only thing I can you though is when I am messed up and passing gas, some poor kid catches the blame for it (if anyone smells it that is).

The days I start work not feeling well, somehow I get thru that day and the kids and their antics take my mind off my IBS woes.

My routine is to get up at 6 am everyday, eat a light breakfast by 6:30 and I'm done in the bathroom by oh 9 am. Perfect for starting work by 10. My boss and supervisor understand my situation and have told me not to worry, should I feel sick, I can go home. And because they've told me this (ever so nicely I might add), it's never been an issue. Just hearing those understanding words, really calms my gut and I have honestly never had to leave work for GI troubles (started working there in 2005). That's a pretty good run!
Posted 4/19/2011 4:00 PM (GMT 0)
My story is pretty simular, only I was a basketball coach this year. Nausea and vomiting done around 1:00 practice at 3:00. That is one thing I've noticed as well, schools don't have many bathrooms for the adults that work there. I've only been a substitute, so not comfortable leaving a class for the next door teacher to have too watch as well.
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