"The 33"-Road Bike Racing - The gall of my gall bladder to f up my race plans...

I'm having it ultra sounded on Friday. The TT is Saturday. I am switching to a bottled water/bland food/prilosec diet in an attempt to race regardless. After that it may be straight to the hospital for gall bladder removal surgery early next week. Never let it be said that Pcad wasn't hard core. Right now I feel like somebody hit my upper right rib cage with a 20 lb. sledge, but hopefully that will abate to allow me to ride Saturday. Doesn't actually bother me too much when I'm riding. Only when I eat, so I'll be doing that through a straw for the next few days.

The bright side to this is that it will help with the Pcad Summer Weight Loss Programme. F my health. I can focus on that after I'm dead.

That is all.

Bummer. I would tell you to skip the TT because your health is more important, but I know you won't listen. So, insteaad I wish you a speedy TT followed by a speedy recovery.

Bummer. I would tell you to skip the TT because your health is more important, but I know you won't listen. So, insteaad I wish you a speedy TT followed by a speedy recovery.

Ironically, I don't sense that exercise is BAD for this condition. It actually felt better today the longer I got into my ride, and the harder I rode, the better I felt. Then I had a bagel afterwards -BLAMMO, massive attack. You have to avoid high carbs, high fat foods while your ball bladder is inflammed. Protien, complex carbs are fine. So I think my doctor would agree that as long as I eat right, the riding - even competitive cycling - won't be harmful, as long as I'm up for it.

I may not need surgery. Often patients with my condition try modified diets for a while. Depends how bad it is. Bloodwork today indicated white blood cell count and liver/pancreas function was normal, so it's not an acute situation like an infection or a condition that has compromised other organs. It's an initial bout of gall bladder distress (apparently, we'll know for sure Friday). Whether I ride or not Saturday depends how I feel tomorrow (I'm doing an interval ride) and Friday. If the modified diet/medication kick in, I should be OK. A decision on surgery will follow the test results Friday (which I may not get until Monday anyway) and may have to wait to see how a modified diet works.

And of course this could be acid reflux or something less involved, but the symptoms are classic gall bladder. Not such a serious condition, but it could land me in the hospital for a day or so. There are far worse health conditions, and I've had one or two of them : ).

You don't need a gall bladder. Lose it. Wife suffered with it a bit and opted to get the SOB extracted. They did 4 or 5 very tiny incisions and -BLAM- it's gone. She's in much better shape than before it started acting up. Do the same - and have them take out the appendix while they're in there. Ok, joking on that one. :)

P-cad: God is punishing you. Send the Zipps to me, say 3 Hail Marys, and see the doctor.

As an aside, my wife had hers yanked out as well. It's had a deleterious effect on her carnivorous ways. The price for a good steak is now a bit painful for her. Pity, she can put away more prime than me.

You don't need a gall bladder. Lose it. Wife suffered with it a bit and opted to get the SOB extracted. They did 4 or 5 very tiny incisions and -BLAM- it's gone. She's in much better shape than before it started acting up. Do the same - and have them take out the appendix while they're in there. Ok, joking on that one. :)

How much does a gall bladder weigh anyway? What about the appendix? Maybe you can get this done quickly before your hill TT?

How much does a gall bladder weigh anyway? What about the appendix? Maybe you can get this done quickly before your hill TT?

The TT is Saturday, so no chance of that, but excellent observation. That SOB has to be 20-40 grams.

If all you have is inflammation of the gallbladder, dietary changes and meds may help. For a while. If you have stones in your gallbladder, start thinking now about surgery. If a stone obstructs the common bile duct, you will be screaming for DrPete or another general surgeon so fast it will make your head spin. If your clinical condition permits, and your surgeon is skilled, a lap chole is the way to go.

Good luck with your race and your gall bladder. You better house them at the TT.

It makes sense that riding hard makes you feel better--your GI tract slows down under stress, so the "rest and digest" functions slow down. The gallbladder is one of those. It's just a bag that stores bile (the stuff that helps you digest fats). That's why fatty foods set it off--the gallbladder is blocked and trying to squeeze. This causes pain, as you've learned. ;)

If the ultrasound shows stones and it's causing you problems now, then I'd recommend getting out ELECTIVELY at your earliest convenience. Statistically, if you have stones the chances are good that they'll cause a bigger problem eventually. This is especially true because the grouchier you are, the more likely you are to live forever and torture physicians. It's a medical fact. :D

If there are no stones on the ultrasound and you're still having gallbladder pain, the next step would be a HIDA scan to look for biliary dyskinesia, which is basically a gallbladder that doesn't empty. They inject you with a radioactive tracer that goes into the bile, then they watch the gallbladder empty. If it doesn't empty, out it comes.

What you don't want is for things to progress to intractable biliary colic or cholecystitis (infected gallbladder). You'll know if you get there...

One word of caution: If the ultrasound looks like there's evidence of cholecystitis, don't race and get the damned thing fixed. Older males have a tendency to tough it out longer than most, so when you take a gallbladder out of an older male you'll often find a nasty, necrotic gallbladder that looks like a bomb went off. This usually means bigger surgery, longer recovery time, and higher risk of bile duct injury and other postoperative complications. If you start running a fever or if the pain doesn't subside and/or becomes sharp, go to the emergency room. You won't feel good about toughing it out for the TT if you're spending 2 weeks in the hospital for your gallbladder.

Treat it with respect, pcad. It's just the gallbladder but things can get ugly if you tough it out.

I'd be happy to take it out for you too--all I'd ask for is a pair of PowerTap Zipps. :D

The TT is Saturday, so no chance of that, but excellent observation. That SOB has to be 20-40 grams.

wow 40 grams. thats like getting a pair of zero-g calipers! :D

seriously though, i hope you feel better soon. a member of my family was just going through the same thing and that looked like it sucked bad.

If exercise increases the amount of metabolic byproducts, and the metabolic byproducts are removed from the system by the liver via bile excretion; would not the combination of a diet that minimizes bile excretion and high intensity exercise be bad for your health?

Are you wearing yellow to the race?

If exercise increases the amount of metabolic byproducts, and the metabolic byproducts are removed from the system by the liver via bile excretion; would not the combination of a diet that minimizes bile excretion and high intensity exercise be bad for your health?

Are you wearing yellow to the race?

The biliary system doesn't do anything with metabolic by-products. Those get processed out via the portal venous system. The liver does make and store bile, but that's a separate function from glucose metabolism and all the processing via Cytochrome p450 and others.

And, as long as the common bile duct is open, you won't get jaundiced, because the bile can still empty from the liver.

The biliary system doesn't do anything with metabolic by-products. Those get processed out via the portal venous system. The liver does make and store bile, but that's a separate function from glucose metabolism and all the processing via Cytochrome p450 and others.

And, as long as the common bile duct is open, you won't get jaundiced, because the bile can still empty from the liver.

Thanks

The more you know because knowledge is power!

Thanks

The more you know because knowledge is power!

Finally got to repay you for the cod liver oil tip. I figured it was only a matter of time before gallbladder disease was somehow relevant to bike racing. ;)

I may wind up doing the TT if I feel up to it partly because I may not get meaningful input from the ultrasound until Monday. We'll see. The TT isn't as important to me as my my health that's for sure. Regardless, if there's strong indication this is going to be a persistent cause of medical woe, I will opt for surgery asap. If it's borderline, I'll try to deal with it through diet and medication for a month or two and see how it goes. Big thanks for all that info Dr. P., I'm printing it out to have it with me to ask questions when I consult with whatever gastro doctor I wind up seeing after the ultrasound.

Of course I really hope the ultrasound shows nothing, after two days of Prilosec I feel fine, and this is all ogita. Which is quite possible given the nature of BF, don't you think?

Good Luck P-Cad. Doc-P is right...base your "toughness" off the ultrasound. If it looks bad don't F around. If the Docs say race then I say race hard.

Doc-Ps Zipp deal is a good one. You wouldn't believe what that gall bladder will cost to be removed.

Good Luck P-Cad. Doc-P is right...base your "toughness" off the ultrasound. If it looks bad don't F around. If the Docs say race then I say race hard.

Doc-Ps Zipp deal is a good one. You wouldn't believe what that gall bladder will cost to be removed.

Incorrect.

I won't KNOW what it costs thanks to our excellent health insurance plan. Very glad we have it. Not everyone is so fortunate. We pay plenty for our health coverage of course, we always have, there is no free lunch.

Your insurance company would probably take that deal in a heartbeat. :D

Your insurance company would probably take that deal in a heartbeat. :D

Incorrect.

They are not cyclists.

Yeah, but when they look at the payout options, I think they'd be happy to call up Competitive Cyclist and order up a pair, shipped overnight to me with a fruit basket or something. :D

Yeah, but when they look at the payout options, I think they'd be happy to call up Competitive Cyclist and order up a pair, shipped overnight to me with a fruit basket or something. :D

Dr. P, if you can take a brief moment to stem your schwaglust frenzy, can you tell me how long I can expect to be completely off my bicycle after a laproscopic gallbladder removal procedure if everything goes smoothly? More than a couple of days I presume, eh? F me. I may need a straightjacket.

If it was up to me, I'd be out on my bike two days after the operation. Of course I may be able to restrain myself if I know that would land me back in the hospital. But it won't be easy.

How painful is post-op from this? I'm hoping to avoid opiates completely. Will Advil or something tame like Tylenol with Codiene for a day or two carry me over?

I've had so many friggin operations I'm starting to feel like that Milton Bradley Operation Game dude.

You do realize of course this could mean PCad will not be toeing the London starting line of the Tour de France in July. Alert the media.

Pcad hope all goes well the that dang little gall bladder and of course at the TT if you do it. toughin' it out only counts for cuts, hits, broken bones or other stuff you can see, take the docs advice and get yourself healed up. Good luck.

I keep waiting for Dr. Pete to say, "i'm not a real doctor but I did stay at a holiday inn express last night."

Pcad hope all goes well the that dang little gall bladder and of course at the TT if you do it. toughin' it out only counts for cuts, hits, broken bones or other stuff you can see, take the docs advice and get yourself healed up. Good luck.

I keep waiting for Dr. Pete to say, "i'm not a real doctor but I did stay at a holiday inn express last night."

Dr. Pete can no longer afford schwag hotels like Holiday Inn Express having squandered all his disposable income on ELS.

Provided you have an elective laparocopic procedure and all goes smoothly, you can go home the same day in many cases, and many patients can get by without opiates, but I'd still bring a handful of the good stuff home with me. Also, ask your surgeon to use local anesthetic. Even though you're asleep for the surgery and it doesn't matter then, it helps to decrease postop pain.

As far as time off the bike... hmm... I would stay off for a week and then stick with very easy recovery riding for another week or so. If there's talk of surgery, make sure you emphasize that you're a cyclist and want/need to get back to riding/racing ASAP.

The main complication to worry about is a port site hernia or wound-related stuff. Your liver will be good as new and your cystic duct stump will be clipped off with some way schwag Ti clips. Those aren't going anywhere. the enemy is anything that causes straining of the abdominal muscles, and hard riding qualifies.

The important thing is just to have a frank, honest conversation with your surgeon and let him/her know your needs/expectations, and give your body time to heal.

I had a lap procedure done and the recovery was wicked fast. All I got was T3 for pain and even then I only used half of the small container. Heck, I got more and stronger pain meds from my dentist for a wisdom tooth removal.

I rode my stationary trainer for a few minutes on day ten just to make my legs go through the motions. The recommendation was to titrate activity by pain level after day 7. So 1 week nothing, after that if it hurts stop. 1 month later I could run and ride hard. Your results may vary.

However, you sure won’t feel like doing situps for a while.

make sure you emphasize that you're a cyclist and want/need to get back to riding/racing ASAP.


Almost sadly this is important. Once I mentioned to my doc about how quickly I wanted to return to sport his attitude changed towards optimizing my recovery. This was only after a few sentences about how I am just addicted to the endorphin rush and it shouldn’t be so important to me….

Thanks again Dr. P.

Hoping to avoid surgery, but the persistent pain in my upper right rib cage consistent with all gall bladder symptom info I read has be wondering if that's possible. We'll see. I'm not afraid of surgery, but would rather avoid it. But I'm not going to jerk around, if indications are that this is going to persist - I'm not real good at going through life feeling like there's a 2 x 4 sticking in my friggin craw. I'll need a resolution to these symptoms very soon one way or another.

Just hoping the whole 'see the consultant, hem and haw, see when he can schedule your surgery yada yada' thing doesn't stretch out a month. I'm in pain. That would suck. I really would like get some relief in the next week or two. 4 days of this is quite enough already. Like my pal the glickster used to say in college, 'harsh me out big boy' (everybody was big to J. Glick, he was like 4'11").

Hmm. I cannot help but notice that DrPete is silent on intraoperative cholangiography during the lap chole! Now that is where he could really earn his Zipps; i.e.: not clipping or cutting the CBD.

Hmm. I cannot help but notice that DrPete is silent on intraoperative cholangiography during the lap chole! Now that is where he could really earn his Zipps; i.e.: not clipping or cutting the CBD.

I've had some excellent teachers when it comes to the dissection, so thankfully IOC's for unclear anatomy have been uncommon for me so far--just one, with lots of chronic inflammation. It's all about the critical view during the dissection. I'm not the fastest lap chole in the west, but the dissection is critical... The other IOC's were done due to recent gallstone pancreatitis or some other indication to clear the duct.

If patentcad came in with cholecystitis, I would probably go for a radiolucent table and have a C-arm ready just in case.

How's that? Do I get my Zipps? :D

Hmm. I cannot help but notice that DrPete is silent on intraoperative cholangiography during the lap chole! Now that is where he could really earn his Zipps; i.e.: not clipping or cutting the CBD.

Take it easy fellas, this is Bike Weenie Central not the Medical Millionaire Blog.

All that being said the thought of not even mentioning intraop cholangiography during the lap chloe is typical of Dr. P., holding out on the coolest stuff all the time.

What the hell does all THAT mean?

Good luck PCad. I hope you get to do that time trial but more importantly I hope for the best for your health.
Dr Pete - way cool of you to take the time to explain it all and arm him with good information for the discussion with his doctors.

I've had some excellent teachers when it comes to the dissection, so thankfully IOC's for unclear anatomy have been uncommon for me so far--just one, with lots of chronic inflammation. It's all about the critical view during the dissection. I'm not the fastest lap chole in the west, but the dissection is critical... The other IOC's were done due to recent gallstone pancreatitis or some other indication to clear the duct.

If patentcad came in with cholecystitis, I would probably go for a radiolucent table and have a C-arm ready just in case.

How's that? Do I get my Zipps? :D

Somewhere at Walter Reed, DrPete, a risk manager and/or the Department Chair is smiling.

Take it easy fellas, this is Bike Weenie Central not the Medical Millionaire Blog.

All that being said the thought of not even mentioning intraop cholangiography during the lap chloe is typical of Dr. P., holding out on the coolest stuff all the time.

What the hell does all THAT mean?

Intraoperative cholangiography (IOC) is used to either delineate the anatomy of the gallbladder and the bile ducts, or to make sure the common bile duct is free of stones. It involves snipping a little hole in the duct leaving the gallbladder (the cystic duct), passing a catheter into the duct, and injecting X-ray contrast under a live-motion X-ray machine. If you find stones you can sometimes extract them, etc.

The most dreaded complication of cholecystectomy is clipping or cutting the wrong duct, so you need to make absolutely, positively sure that you're cutting the right things. If not, extreme bad things ensue. So the IOC is something that needs to be in your back pocket any time you take out a gallbladder.

My new diet plan is to read any posts where Patentcad & DrPete discuss medical stuff...I don't feel like eating anything after reading these posts.... :(

They are informative but this is way more detail than I ever wanted to know about gall bladders

Mmmmm Yummy...Gall Stones with festered bile and an aromatic Chianti.:rolleyes:

Doc P...You get the Zipps and the SRM...:D

Forget the TT boys. I had a hard time breathing in BED last night. At one point it was so bad I contemplated a trip to the ER, but I calmed down and got back to sleep. Very nasty. Ooofaaa. I rode the bike for 2 hours early this morning, and the problem is that when my diaphram moves to take a deep breath it's like I'm getting slugged in the ribs. It got better today towards the end of the ride, but it's hardly the condition that will facilitate a 25 min. TT effort. Oh well. Ultrasound tomorrow AM, hopefully I'll know where this is going after that.

The good news is that I can barely eat food. That can't be all bad : ).

Forget the TT boys. I had a hard time breathing in BED last night. At one point it was so bad I contemplated a trip to the ER, but I calmed down and got back to sleep. Very nasty. Ooofaaa. I rode the bike for 2 hours early this morning, and the problem is that when my diaphram moves to take a deep breath it's like I'm getting slugged in the ribs. It got better today towards the end of the ride, but it's hardly the condition that will facilitate a 25 min. TT effort. Oh well. Ultrasound tomorrow AM, hopefully I'll know where this is going after that.

The good news is that I can barely eat food. That can't be all bad : ).

Don't wait. Go get seen. If you can't eat, pain is coming on at random times, etc. you should go get seen. Your gallbladder most likely belongs in a specimen cup.

As an extra little test, try this (and I'm being serious here): Press just below your ribs where you're having the pain, and try to take a big deep breath while still pressing down. What happens?

It has been almost 12 hours since Pcad posted to this thread. I cannot help but wonder if he is in post-anesthesia recovery right now. Did he go to the ER and was admitted for surgery? If you are there, Pcad, let us know what is up!

It has been almost 12 hours since Pcad posted to this thread. I cannot help but wonder if he is in post-anesthesia recovery right now. Did he go to the ER and was admitted for surgery? If you are there, Pcad, let us know what is up!

All is still well... I've gotten a couple PM's from him and he's posting in the main forum about OCP stuff. ;)

Did he report a Murphy sign, guarding or rebound upon palpating his RUQ? This would be so much easier if he would put up a live video feed for us and could follow our simple exam tips! The first ever Bike Forums telemedicine consult.

Did he report a Murphy sign, guarding or rebound upon palpating his RUQ? This would be so much easier if he would put up a live video feed for us and could follow our simple exam tips! The first ever Bike Forums telemedicine consult.

+1! We could send a crew over to set up a DaVinci in his living room too. :D

We are going to have to speak to Joe and see if he can start a new physician advice forum. You'll have Doc P and all of the other Docs providing us with Forum/biking medical advice...OH and he could have a sub forum for the psychiatrist to held all the schizoids in BF. Now THAT would be entertainment. :D

Alright, so Pcad's off at his ultrasound. I'm thinking it's going to show stones AND inflammation... We'll see.

I'd never bet against you!

Heh...I started noticing a "sharp"-type pain in the 'ol abdomen sorta near my right hip bone (in front) 1-2 days ago....I'll notice it for a few seconds, then it's gone. Seems to happen only a couple times per day. Kinda weird.

Goodluck Pcad!

Heh...I started noticing a "sharp"-type pain in the 'ol abdomen sorta near my right hip bone (in front) 1-2 days ago....I'll notice it for a few seconds, then it's gone. Seems to happen only a couple times per day. Kinda weird.

Keep an eye on it... Your appendix lives there. ;)

Outstanding.

How much does your appendix weigh?

:D

Outstanding.

How much does your appendix weigh?

:D

Not enough to make a special trip in there for it for weight savings. :D

Seriously, though, there are some who believe (and it makes sense) that the appendix can intermittently obstruct and cause pain without ever developing to acute appendicitis. Another thing to be on the lookout for is a hernia.