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Gallbladder Removal and Heartburn



Post-cholecystectomy Syndrome: What is it and will I feel like this for the rest of my life?


Post-cholecystectomy Syndrome (PCS) occurs after a patient has their dis-eased gallbladder and surrounding ducts surgically removed. It feels like the pain of having a gallbladder attack with gastrointestinal symptoms like fatty food intolerance, nausea, vomiting, heartburn, gas and bloating, indigestion, diarrhea and abdominal pain.


Not everyone that has had their gallbladder removed experiences PCS. This syndrome can develop shortly after surgery or months to years after the procedure


Epidemiology

In the US the number one most common elective procedure is the laparoscopic




cholecystectomy. Surgeons perform about 750,000 of these procedures annually in the US.


Risk factors for development of PCS include:

- Urgent need for surgery

- Not having gallstones (cholelithiasis) at time of surgery

- Having post-operative symptoms longer than expected

- Ages 20-29, especially female



PCS may be organic (natural dis-ease process) or functional:











Basically, what all this means is that there may have been another cause that was leading to gallbladder irritation prior to surgery. The allopathic model would have us believe that if an organ is dis-eased, removal is the BEST and the ONLY option we have left.


Please note that I am not saying that we should never have emergency surgery, there is a time and place. I find that we have been overusing this incredibly useful tool instead of using other methods to get treatment. As an ND, I discuss all the options for treatment with a client. It is my job to say hey I think this is the best course of action and there are other ways to go about this process as well. This is the basis for informed consent.


Finally, the end of the potential causative factors includes ‘it’s all in your head.’ I am here to tell you that I believe you and your experiences. I have personally dealt with medical practitioners telling me a time or two that my experience wasn’t real. ‘Here’s an antidepressant and be on your way’ approach.


The conventional approach to this syndrome is to treat the cause and medicate. As quoted from Zackria, “The goal of pharmacotherapy is to prevent complications and reduce morbidity.” Meaning to manage the condition and hope to reduce the suffering. This is all good and well, but from a naturopathic perspective there is SO much more than can be done to support PCS.


As a naturopathic doctor I start with the basics – breath, sleep, hydration, movement and what you are consuming (food, people, media, reading etc.) which ALL dramatically affect how we respond to various treatments.


I like the example of a plant, perhaps you have over-watered a plant and it starts to show you this by yellowing its leaves. Well, if we cut the leaves off, but keep over-watering it. Eventually the plant will die. So what do we do? Quit over-watering it. The leaves stop turning yellow and the plant begins to look vibrant again.


Just like a plant, our bodies show us symptoms in hopes that we humans listen to it. The symptoms get louder and louder via dis-ease presentation until we LISTEN and stop suppressing.


So what would I do if I had a client with PCS?

- Start with the foundations for health

- Castor oil pack

- Bitter herbs that support the liver, stomach acid production and bile flow

- Hydrotherapy

- Visceral manipulation


Why castor oil packs?

Castor oil packs are an old therapy, but highly effective. I get a fair bit of push back AT FIRST with clients because they don’t like that the oil can stain. Traditionally the flannel has been soaked in a pan filled with castor oil – ew no. This is not what I recommend to another. That is a sticky mess!


I like to grab the flannel cloth, warming it up on the heating pad with 2 tablespoons of castor oil and then directly applying it to your liver/gallbladder area. Regardless of not having a gallbladder or not our bodies still produce bile in the liver. And if we didn’t deal with the root cause that lead to gallbladder dysfunction in the first place then it is highly likely that we still have a thick bile issue. This is a mainstay of my treatments for clients.


Why bitter herbs?

Bitter herbs support the proper flow of bile, the proper secretions of stomach acid and the movement of the gut in general. Often times the initial cause of gallstones is gallbladder sludge, or thick bile. In conventional medicine this is not medically a treatable condition until it becomes cholecystitis or cholelithiasis.


Some of my favorite bitter herbs include Achillea millifolium or yarrow flowering tops, Rumex crispus or yellow dock root, Taraxacum officinale or dandelion root and Berberis vulgaris or Oregon grape root.


Why hydrotherapy?

Hydrotherapy is one of those procedures that is so gentle and incredibly effective that is it often over-looked. A procedure consisting of a series of hot and cold wet towels known as contrast hydrotherapy helps to stimulate the lymphatic system, calm the nervous system and help the body to take out the trash more effectively. Plus it is helpful at reducing overall inflammation.


Why visceral manipulation?

Visceral manipulation is a gentle and firm manual therapy that moves with the flow (yes, the organs have a flow) of the organs. The practitioner moves in the direction of least resistance to help remind the body that it has all the space to move in many directions. This is often the cause of the INITIAL gallbladder dysfunction that led to cholecystectomy.


If dyskinesia of the sphincter of Oddi is present, which is fairly common given our stooped desk sitting posture these days, then visceral is 100 percent indicated. I also find that even with surgery or several procedures that the scar tissue builds up and creates decreased movement in the guts overall. Again this is a protective mechanism given the trauma of the surgery. Visceral can help to restore proper gut movement.


References

Stinton L, Shaffer E. Epidemiology of Gallbladder Disease: Cholelithiasis and Cancer. Gut Liver. 2012;6(2):172-187. doi:10.5009/gnl.2012.6.2.172


Zackria R, Lopez R. Postcholecystectomy Syndrome. Treasure Island: NCBI Bookshelf; 2020.




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