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Amanda Wilde (Host): A healthy gallbladder functions smoothly, efficiently storing and releasing bile as needed. However, several factors can disrupt this process leading to gallbladder problems. Gallbladder issues are a common experience for many people. The good news is that there are effective treatment options to help patients.

Today we are joined by Dr. Whitney Guerrero, Board Certified General Surgeon, and Fellowship Trained Colorectal Surgeon. Dr. Guerrero, will discuss gallbladder health and when a cholecystectomy or gallbladder removal surgery is necessary for patients. This is Hello Healthy, a Dignity Health Podcast. I'm Amanda Wilde. Dr. Guerrero, welcome back to the podcast.

Whitney Guerrero, MD: Thank you so much for having me.

Host: It's great to have you here to explain what exactly is the gallbladder? It's an organ I don't think we think about unless it does malfunction. What function does the gallbladder perform in our body?

Whitney Guerrero, MD: Like you said in the introduction, the gallbladder stores the bile that our liver makes. Bile is kind of a nasty green fluid whose job is to help us digest the food that we eat. So when food comes into your stomach, your stomach sends a chemical signal to your gallbladder that makes it squeeze to send the bile down into your digestive tract to help with digestion.

Amanda Wilde (Host): What are some of the gallbladder issues that patients can experience?

Whitney Guerrero, MD: The most frequent issue will come from gallstones, which is what happens when bile sits in the gallbladder, which is what it's supposed to do, and some people are just unlucky that way, and the bile will form a gallstone. If that gallstone gets stuck in the cystic duct, that's the tube connecting the gallbladder to the biliary tubing and the rest of the digestive system, then the gallbladder will squeeze and it's like squeezing against a ball valve and this can cause really terrible pain.

 Other issues can arise when your gallbladder doesn't empty efficiently or it empties too efficiently. You can end up with that same crampy pain, and that's what we call biliary dyskinesia. That may or may not be associated with gallstones.

Host: So something causes the gallbladder to not regulate itself the way it's supposed to. What are some signs or symptoms that you may experience with gallbladder issues?

Whitney Guerrero, MD: The number one sign is that crampy right upper quadrant pain. It's one of the first things you learn in med school. Gallbladder disease is so common that we all need to know how to recognize it, and so when somebody says, after I eat food, especially greasy food or spicy food, I get this pain on the right side of my stomach and almost everyone will grab the right side of their stomach and kind of double over, and it's a classic crampy pain, and occasionally it's accompanied by nausea, sometimes vomiting as well. It can be very unpleasant.

Host: We are learning more and more, we lay people, about how the digestive system is related to our overall health and our mental and even emotional health. How would you say gallbladder issues impact overall health?

Whitney Guerrero, MD: Gallbladder issues can have a huge impact on your overall health, especially if you haven't gone to the doctor and gotten a proper diagnosis. A lot of my patients, especially my strong women, will experience this crampy pain and they write it off as the cost of doing business. You know, the cost of being alive.

But when you have gallbladder problems, think about this, if every time you eat food, you have pain, that's going to really cause an issue with mental health eventually, that's not the normal human experience. People can actually be so afraid of the pain that they're going to experience, that they stop, not eating, not only the foods they enjoy, but food in general, and they start losing weight. It can be very serious.

Host: Well, if people are experiencing gallbladder issues, what next steps should they take?

Whitney Guerrero, MD: If you are feeling pain after you eat and you suspect it could be from your gallbladder, but you're not sure, it's always good to call your family doctor and schedule an appointment. Like I mentioned before, we learn about this in med school right at the beginning because it is so common, and so if your doctor agrees that your symptoms sound like gallbladder issues, then they can start the appropriate workup.

Host: Then what are treatment options for gallbladder issues? We know there's surgery, but is that sort of the final solution to this? And you try other things first? What do we look at in terms of options of ways to address this?

Whitney Guerrero, MD: Well first we start with diagnosing the problem. So the most common test would be an ultrasound, which is relatively painless. It's very quick, and that gives your doctor an idea of whether you have gallstones. If you don't have gallstones, but you're still having symptoms, then we may proceed to another test that's a little more involved, but still non-invasive, that can show us actually the function of the gallbladder.

Once you have your diagnosis, unfortunately there's no good way to make your gallbladder heal itself. There's not a medication that's effective to dissolve gallstones. Unfortunately it's a joke that we have among surgeons that the gallbladder keeps surgeons in business. Because it goes bad so frequently and really the best, most effective treatment, most efficient treatment is surgery.

Host: So that is what is known as cholecystectomy, or what is more commonly known as gallbladder removal surgery. When is that surgery necessary for patients who are experiencing gallbladder issues?

Whitney Guerrero, MD: My personal advice for patients who come to see me if they've had one gallbladder attack, that tells me that it could happen again. It won't necessarily happen again, but it could. And so once you start having symptoms, it's time to start considering surgery, and I will never tell somebody when it's time for them to have an elective surgery, meaning a surgery that's scheduled, but I can tell you from personal experience that if you ignore your gallbladder for long enough, it will come back to bite you.

And what we want to avoid is getting into that emergency surgery situation where a patient ends up with a gallbladder infection, then they have to go to the emergency room, and then we're talking about, you know, a surgery that nobody was planning on, and then you have to take time off of work. Instead, if a patient has symptoms, I say, let's think about getting it out and let's do it on our own terms so that you can plan the rest of your life accordingly.

Host: So what can patients expect if they do get the surgery and remove the gallbladder?

Whitney Guerrero, MD: Gallbladder surgery or cholecystectomy is almost always an outpatient procedure. If you're a watcher of medical shows or you have a family member who has gone through this, you'll hear laparoscopic cholecystectomy a lot. That means minimally invasive, tiny incisions. I personally perform robotic assisted cholecystectomies.

That is my preferred approach because I really appreciate the excellent visualization and biliary imaging that I can do with the robotic platform. It is also a minimally invasive approach. We're talking five to eight millimeter incisions. These are very tiny. You'll have four incisions and we're usually able to use these long instruments. On the robot, they're wristed instruments. They're very precise. To get the gallbladder out, you know, usually half an hour or so, and you're asleep the whole time. So it's an outpatient procedure. You come in, you go to pre-op, you talk to your surgeon, you roll back, have your surgery, and then you're home by lunchtime.

Host: That sounds pretty good for surgery. Are there any restrictions after having a cholecystectomy?

Whitney Guerrero, MD: The thing that I tell my patients after they're having any surgery where I'm entering the abdominal cavity, where I'm making incisions, is you really want to avoid heavy lifting. That's anything over 10, 15 pounds for about six weeks. The reason for this is we don't want you to end up with a hernia. So an incision that I make, has to heal itself.

And if you put stress on it, then it becomes weak, and then you end up with a hernia and you may need surgery to fix that. By avoiding lifting, you're sort of avoiding stress on your abdominal wall and allowing it the full six weeks it takes for your body to return to about 80% of its original state of strength. You never get as good as it was, you know, when you were born, right. You never go back to completely normal there. But after about six weeks, that's when it's safe to get back to your normal activities.

Host: So what does it mean, Dr. Guerrero, when now we've lost this organ? At what kind of changes can we expect in the future?

Whitney Guerrero, MD: Luckily for us, the gallbladder is not an essential organ and that's why we're able to take it out and send people on their merry way. Now remember, the gallbladder stores bile, so that bile is released on demand when you eat food. The main differences that we'll see after gallbladder surgery have to do with the fact that you're not storing the bile anymore.

So instead of having pulses of bile to help you digest, you have a constant flow of bile from the liver. What this means is some people will experience looser stools usually in the first only couple weeks after surgery. And it almost always resolves by about six weeks. And this just comes from that constant bile flow so that you have the constant breakdown of contents of your GI tract.

Some people don't experience that at all. You may also find after gallbladder surgery that you are no longer able to tolerate, we say in doctor speak, that really means enjoy the foods that you enjoyed previously. One of my patients can't eat Chinese food, absolutely cannot do it anymore, and she loves it, just can't eat it.

Other patients will say that they experience no differences at all. Personally, I don't have any differences than I had preoperatively, except I don't hurt every time I eat.

Host: I was wondering if there's any lifestyle modifications you can employ pre getting surgery? Because you said earlier that people basically do cut out a lot of the foods and things that cause these attacks, but that they're not living life to the fullest. So are there things you can do before you get to the state of surgery? Also, if you have had surgery, are there lifestyle modifications you should make?

Whitney Guerrero, MD: As far as ways to prevent gallstone formation, the best thing to do really is adhere to that Mediterranean diet, low fat, high fiber, because the main job of bile is to assist in fat digestion. And so the idea is if you are adhering to the lower fat diet, you're not stressing that delicate balance. Once you have a diagnosis of gallbladder issues, whether that's biliary dyskinesia, or whether that's gallstones; the way to control your symptoms is to avoid your trigger foods. Fatty foods, spicy foods. For some people it's coffee. Some people it's alcohol. Some people it's chocolate, heaven forbid. But after surgery, your body will tell you what you can and cannot eat. Which I think is true for most of my surgical patients, and that's the advice that I give.

Feel free to introduce the foods that you previously enjoyed, but be prepared because your body may say no thank you. But like I mentioned before, some people have absolutely no difference in their ability to eat the full spectrum of foods before surgery and after surgery.

Host: You mentioned earlier that sometimes patients when they're experiencing the gallbladder difficulties will restrict their food intake and what they eat, and that that's not living life to the fullest, but are there lifestyle modifications patients can implement before getting to the point of needing surgery in other words, in order to prevent gallstones from forming?

Whitney Guerrero, MD: That's a great question and something that I hear a lot from my patients. They'll ask, how did this happen? Why did this happen to me? The bottom line is some people are just unlucky, but there are some risk factors that can play into gallstone formation. One of the most common would be a rapid shift in weight.

Now, this is something that is all over social media and things that people are talking about now, especially with the GLP-1 medications, the injected diabetes and weight loss medications. When you have a rapid shift in weight, whether you're losing weight or gaining weight, say in somebody who's pregnant, your body is more likely to produce gallstones.

So if that is a condition you've been experiencing that is rapid weight loss or rapid weight gain, so if you have had any recent weight loss or weight gain, and you're also experiencing that crampy right upper quadrant pain, it's definitely time to talk to your doctor.

Host: Well, Dr. Guerrero, thank you so much for giving us a clear picture of what the gallbladder is, what it does and gallbladder health.

Whitney Guerrero, MD: My pleasure, Amanda. Thank you so much.

Amanda Wilde (Host): That was Board Certified General Surgeon and Fellowship Trained Colorectal Surgeon, Whitney Guerrero. For more information, visit Dignity health.org/bakersfield/surgery. If you found this podcast helpful, please share it on your social networks and explore our entire library for more health topics of interest.

This is Hello Healthy a Dignity Health Podcast.