Centered on Health 4-11-24 - Gall Bladder Disease and General Surgery with Dr. Danielle Humphrey

Centered on Health 4-11-24 - Gall Bladder Disease/General Surgery  with Dr. Danielle Humphrey

Episode Transcript

(00:01):
It's now time for Centered On Helpwith Baptists Help on US Radio. Wait
for each albody wit JS Now,here's doctor Jeff Tublin. Good evening,
everyone, and welcome to this week'sepisode of centered On Help with Baptist Help
here on News Radio eight forty WHJAS. I am your host, Doctor Jeff

(00:21):
Tublin, and we're joined tonight,of course by our producer mister Jim Fenn,
who's in the studio waiting to takeyour college to talk to our guests
this evening, and you're in fora treat. We've got doctor Danielle Humphrey
tonight to talk to us about generalsurgery and gallbladder diseases. Our phone number
is five oh two, five sevenone eight four eighty four. That's five

(00:43):
oh two, five seven one eightfour eight four if you want to call
in and be a part of theshow. Doctor daniel Humphrey is a general
surgeon with the Baptist Hospital Medical Group. She attended University of Louisville for medical
school, internship and residency, andI can personally vouch for the fact that
she is still a loyal and avidCards fan and support. She has practices

(01:04):
in Louisville and Lagraine, practicing generalsurgery with treatment of anything from abscessors of
the skin to hernia surgery and gallbladderdisease, and many others in between.
Welcome to tonight's show, Doctor Humphrey. Hello, Hello, Hello, I'm
good. How are you? Iam good. I know we just saw
each other earlier today, that isright, and I know the buzz is

(01:26):
all around, so I know thereare people out there excited that you are
doing the show tonight, So thankyou for doing that, and welcome for
you and to our listeners. SoI just want to kind of start by
having you tell us a little bitabout you and kind of what made you
choose general surgery as your field andmedicine. Sure, I was born and

(01:48):
raised here in Louisville. I camefrom a family that didn't really have any
other members of the medical community otherthan my uncle who's a radiologist. Other
than that, though, I reallydidn't know much about medicine, didn't know
much about healthcare. But I wentto Center College and was a math in
chemistry double major, and I lovedall things dorky, you know, math

(02:12):
and chemistry. So I've think whenyou're in college and you like those sorts
of fields. You either go intoa lab and you work as a chemist,
or you kind of go into healthcare. And I tend to be a
little bit more of a people personthan most lab rats are. So I
decided to look into healthcare, andI had no idea what I was getting
into. I just kind of doveinto it blindly, and then kind of

(02:36):
every step of the way, justkept thinking, Okay, what's the next
hardest thing that I can do nowthat I've achieved this stuff. And so
it's funny. When I was inmedical school, it just seems like all
of the rotations I was doing,whenever anyone was in trouble, no matter
what their specialty was, they alwaysseem to call general surgery to bail them
out. And I always thought,gosh, I want to be I want

(02:58):
to be that person who everybody called. Don't want to have to be in
the weeds and have to call someoneelse to bail me out. Now,
don't get me wrong, I stillhave to do that sometimes, but I
just always thought, I want tobe that person who everybody calls. And
so that was sort of what drewme to general surgery. And once I
started shadowing certain general surgeons around town. I just found that I don't know,
I got along with them personality wise, we meshed and it just felt

(03:22):
like, Okay, these are mypeople. This is who I would like
to hang out with outside of work. And I think that's kind of when
you know what your niche is,when you feel like you have colleagues who
are friends and not just work partners. If that makes sense. It's a
great and a very interesting answer.And I had the complete opposite experience where
I got thrown out of more ors than I care to. To remind

(03:44):
me, keeping a sterile field wasnot my best attribute through aboutical school.
So you know, we choose ourpaths for various reasons, obviously, So
tell us about a typical day fora general surgeon and the kinds of surgeries
that you do throughout the day.So actually that is part of why I
lodgnal surgery, because a typical dayis different one day to the next.

(04:10):
On a Monday, I might spendhalf my day calling patients about results,
kind of reviewing CT scans, andthen the other half of my day I'm
in our endoscopy apartment doing screening kolonoscopiesand egps for patients who have reflux.
Tuesdays, I spend half the dayseeing patients and clinic. The other half
of the day I'm in the operatingroom. Wednesdays are my all day in

(04:31):
THER day, so that's my favoriteday of the week. And then Thursdays,
again I'm doing a half day inthe endoscopy department doing scopes, and
then the other half day I'm inclinic. Friday is an other half day
in clinic and half day in theor. So I really like to split
up my week so that no dayis the same. Every day is different,
and there's just a lot of variety. When I'm in ther there are

(04:54):
so many different technologies that I takecare of me and all of my partners,
So one day I might have sixor seven cases and they're all different
things. So I do hernias,I do colon resections, I do masstectomies
and lumpectomies for breast cancer. Ido gallbladder surgery, which is my favorite.

(05:14):
I do lots of lumps and bumps. I have a few good friends
of mine. They are dermatologists.They send me all of their lipomas that
they can't take care of in theoffice. I really like though my office
is set up or the clinic isset up where we have a little minor
surgery room at the back of ourlittle office suite, so I do a
ton of lumps and bumps just inthe office, kind of like doctor Pincil

(05:35):
Popper does very nice. Well,I'm going to give you a pass on
the fact that your favorite day ofthe week is not endoscopy, because I'm
going to give you a pass onthat. But you mentioned gallbladder. That's
clearly something that we do want tocover tonight. So tell us, like,
why do we have a gallbladder,what is it function? And why

(05:58):
can we live without it? Sothe only function that you really need it
for it is a storage facility forbile, which is a digestive fluid that's
actually made in your liver that getsexcreted into your bile duct. But the
bial duct is a thin little straw. It can only hold so much bile,
and so whatever doesn't fit into thebial duct spills over into the gallbladder.

(06:23):
So it's truly just a reservoir tostore bile. When you eat,
your body produces a hormone that travelsthrough the bloodstream to the gallbladder and says,
hey, we need that bile,And so that hormone makes the gallbladder
contract and squeeze, and that bilethen flushes out of the gallbladder back into

(06:45):
the bialduct and onward in gu intestineto break down your food. What frequently
happens, though, is that youcan develop gallstones, which is just clumping
up of typically cholesterol. Sometimes it'salso billy ruben that clump up into stones.
And when stones start to develop inthe gallbladder, it can lead to
a lot of symptoms, lead toa whole plethora of complications that usually warrant

(07:10):
sticking out the gallbladder. So whenyou have the gallbladder get removed for any
one of those issues. What ispretty cool, I think, but I'm
a nerd again. Back to thatis that your body, your body makes
all kinds of little investments so thatthe bile still gets made like normal in
your liver. Now it just funnelsinto the bile duct and it's got nowhere

(07:32):
else to go. So over time, your bile duct it essentially starts to
stretch out because it's getting a lotmore input of bile than it ever did
before. And as it stretches out, it starts making more room to store
bile. So long story short,basically, your bile duct takes over the
function of the gallbladder once the gallbladder'sbeen removed. And you mentioned obviously gallstones,

(07:58):
and that's going to be a bigpart of the reasons people end up
getting their doll better out. Butthere are different types of golf stones.
What's the most common type that wewould as listeners need to know about,
probably cholesterol stones. That's going tomake up the majority of stones. And
so that type of gallstone can happento anybody who has a cholesterol rich diet.

(08:20):
So I probably have a bunch ofgallstones if I'm being honest. You
can also get a lot of gallstonesmade up of cholesterol if you're on cholesterol
medicine. Because the cholesterol medicine,so there's a family called statins that pulls
cholesterol out of the bloodstream and kindof concentrates it within the billiary system.

(08:41):
And so then your bile has alot more cholesterol in it than it should
and that tends to clump up intostones and what would I know, things
can present differently. We may touchon that a little bit too, But
in general, what what would bethe most common presenting symptoms that somebody might

(09:01):
have if they had gallstones that werecausing them problems. That is a good
question. So it can be prettyvariable from one person to the next,
but the most common symptom sort ofacross the board for everybody is going to
be a lot of abdominal pain withintheir upper abdomen on the right, so
usually ride under the rib cage.But you can also have nausea, vomiting,

(09:22):
just a sensation of indigestion when youeat, and it's almost always brought
on by eating fatty foods that tendsto stimulate the gallbladder a lot more than
non fatty foods. But I've hadpatients who come in and they feel like
they're having a heart attack because theirsymptoms are a little bit atypical. They
feel like they're having chest pain instead, and we do a whole work up
and realize their heart is fine andit's actually their gallbladder. I have elderly

(09:46):
patients who come in with, youknow, a gangrenous gallbladder, so gangreing
of the gallbladder, and they havefelt fine and they kind of come in
with more atypical symptoms like altered mentalstatus and confusion. So it's it can
be hard to diagnose sometimes, andwe're gonna we're gonna talk more about that
and some of those symptoms when wecome back. We're going to take a

(10:07):
short break. I want to letyou know you're listening to senat on Health
with Baptist Health here on news radioeight forty w h A s our phone
number five oh two, five sevenone, eight four eighty four if you
have a question par tonight Jeff,doctor Daniel Humphrey talking about all bladder disease
and general surgery. I'm your host, doctor Jeff Sublin, and we'll be
right now. Welcome back to Senateon Help with Baptist Health here on news

(10:46):
radio eight forty w h as.I'm your host, doctor Jeff Publin,
And if you're just joining us oryou're still with us, we're listening.
We're talking tonight with doctor Daniel Humphrey, general surgeon with the Baptist Hospital Medical
Group and need. We're talking aboutgeneral surgery in general, but focusing at
the moment on gall bladder disease,which is one of her favorite things to

(11:07):
take care of. Our phone numberonce again five oh two, five,
seven, one, eight, foureighty four are producing. The Sponcent is
ready to take your calls and putit through to have a conversation. So
doctor Humphrey, welcome back. Andright before the break, you were telling
us about some typical and atypical symptomsof gallbladder disease. But how has the
diagnosis once it's considered, how hasit made? What types of tests are

(11:31):
done to kind of point to thegallbladder as the potential ideology, and let's
use stone for an example. Yeah, yes, there's a lot of different
X rays you can do on thegallbladder. They're all kind of unique to
look for different pathologies of the gallbladder. So if you're looking for just stones,
the best ways to do an ultrasoundof the gallbladder. An ultrasound doesn't

(11:52):
involve any radiation. It's a veryquick and easy test to have done and
it's usually just done in the radiologydepartment. So that'll show if there's any
gallstones. There's also cts that canbe done of the abdomen impelvis that'll show
you sometimes if there are stones there, but some stones are invisible on cts,
so you won't catch them all.But CT will also show you if

(12:16):
you have something called a cute colascius, which is a lot of times what
happens when you get a gallstone thatblocks the gallbladder from emptying, and that
usually requires a visit to the erbecause you're in such intense pain. You
have a CP scan done and itshows really really bad inflammation around the gallbladder.
So that usually requires emergency surgery totake out the gallbladder in that situation.

(12:37):
And I'm sure that this happens allthe time when we send you pasians
and we are we see people inthe GI clinic or somebody of primary care
might see somebody we're working them upfor abdominal pain, which as we all
know, has a million different potentialpauses. And along the way, one
of the imaging tests shows gallstones.And so the question then becomes, you

(12:58):
know, is this real? Andwho wants to have surgery? You know,
if you don't need surgery. Andwhile we heard earlier that you can
live your life without your gallbladder,surgery is surgery. So how does the
decisions sort of get made like,yeah, I really do think this is
what it is. Well, Iwill give you and your team a lot

(13:18):
of credit because you all are greatabout really putting people who a relatively extensive
workout before you guys send patients tous, so that at that point,
by the time they come to seeeither me or one of my partners in
surgery, the diagnos is pretty cutand dry. Now there's an exception to
that rule, of course, alot of times where we have patients where

(13:39):
we're not quite sure if they havegallbladder related symptoms, and we really just
kind of have to go based onour clinical judgment and try to get a
thorough of a history from the patientto figure out is it really the gallbladder
or not. And it can behard because I've probably had about five percent
of the people who I've taken theirgallbladder out, they come back and say,
you know what, I feel alittle bit better, but not all
the way better. Those patients havefeel really bad because maybe taking out the

(14:03):
gallbladder didn't help. But in ninetyfive percent of the people who have taken
out their gallbladder, they feel dramaticallybetter, their quality of life is better,
they can get back to joy foodagain. So that alone is really
why gallbladder surgery is my favorite tobe able to, I guess, give
my patients back that quality of lifeand that freedom to eat and find joy

(14:24):
in eating again. It's really niceto be able to have that almost immediate
gratification from such a simple surgery.And aside from obviously the thing you mentioned
which is really important, which isthey just feel better if somebody were hesitant
about having their gallbladder out, andwhat are kind of what are some things
that could happen if you have symptomaticgallstones and you don't take the gallbladder out

(14:50):
other than just sort of living withthe chronic symptoms. Are their complications that
gallbladder stones can cause. Yes,so if you leave gallstones alone, but
you're experiencing what a lot of peoplewill call gallbladder attacks. What that means
is that when you have a gallbladderattack, the duck that actually drains the

(15:11):
gall bladder is becoming intermittently obstructed witha stone. With repeat attacks, that
stone can keep basically stretching the ductthat drains the gallbladder, and eventually that
stone can squeeze out of the gallbladder and into a bigger bile duct that's
called your common bile duct. Thatis the big pipeline that drains all of

(15:33):
the bile out of the liver andinto the intestine. When a stone gets
out into that bigger bile duct,it can cause a lot of complications.
So it can cause something called pancreatitis, which is where the stone kind of
goes through the bile duct and atthe very bottom of that bile duct,
it kind of shimmeys its way throughthe pancreas gland, and as it does

(15:54):
that, it irritates the pancreas,and that can be something that's just a
simple case of pancreatitis that just it'sbetter overnight. But I've seen probably a
handful like maybe five to ten patientswho have had such severe pancreat titus that
they've been in the hospital for monthson it ye never been able to go
home because their pancreast becomes so severelyinflamed that it essentially dives off, and

(16:17):
you have to have multiple surgeries totreat that. So that's part of why
I've only had a few in thatin that case where it's been that bad,
But it's been bad enough that I'malways pretty aggressive about encouraging people to
have their gallbladder removed so that thatnever has to happen to anybody. And
when and when somebody does present likethat, does the gallbotterer come out right

(16:37):
away? Or do you cool thepancreas down and then take it out,
Like, what's the when does thegallbotder get taken out when it's causing that
kind of problem. Yeah, Usuallywhen patients come to the hospital with what's
called gallstone pancreat titus, we letthe pancreas cool off first, which just
means starving people in the hospital fora few days, which is, you
know, inhumane, but it's theonly way to let the pancreas heel.

(17:00):
Every time you eat, it flaresup the pancreas. So if the pancreas
is already inflamed and mad and angryand then you let somebody eat a cheeseburger,
you're just spinning your wheels and makingthe pancreas get worse and you never
give it the time to get better. So, yes, we usually put
people in the hospital, put themon ivy fluids that have some sugar in
it to hopefully kind of calm downtheir hunger pans, and then just let

(17:22):
the pancreas heal. It usually takesa day or two to heal before we
can then go in and take thegallbladder out. Myself and all my partners,
we always routinely do an X raytest of the bio duct system when
we take out the gallbladder, andthat is done so that we can not
only check the bio duct anatomy andmake sure that we're working on the right
duct, but we also then cansee if there's any stones still out in

(17:45):
that common bile duct blocking pains.So that's done at the time of the
surgery to make sure that everything's wideopen and graining. And yes, yes,
Now what about if we see stones, we call you guys. That's
right, that's when well some ofus, right, that's right, some
of us do that, but we'realways happy to help. So what about

(18:08):
people who want to try and getrid of gallstones without removing the gallbladder,
like through oral agents that are supposedto dissolve them. Like, have you
had any patients have any luck tryingthose approaches? No? I wish,
I wish I could say yes,but no, I think maybe it might

(18:30):
work for some people, and Ijust never meet them because they don't need
surgery. But I have never foundthat those agents work. I've had a
lot of people who try applefider vinegar. There's all kinds of stuff on the
internet where doctor Google will tell peoplethat applefider vinegar will dissolve gallstones. I've
had a lot of people try thatand then they come back to see me,
usually within a few months, andsay, all right, I feel

(18:52):
no better. We repeat imaging,and sure enough, the stones are still
there, so we take out thegall bladder. Now, as long as
it's not an urgency situation, Ialways encourage people to try whatever route they
feel is best for their body.But yeah, it's been my experience that
they just don't work. And mostof the time, when you do the
gallbladder surgery, assuming it's not emergent, you're able to do it through the

(19:18):
laposcopic approach and kind of the minimallyinvasive stuff. Yes, that's correct.
So I would say probably like ninetyeight to ninety nine percent of all the
gallblader surgeries that I do, they'redone laposcopically through four very small incisions.
Sometimes we get in the belly andthe gallbladder has turned into gangreen of the

(19:38):
gallbladder and it sort of falls apartwhile we're working with it, or sometimes
we get into bleeding issues, especiallyfor patients who are on blootenners, and
it becomes a safety problem to keepgoing laparoscopically. And so in those very
rare cases, I'll convert from thelaparoscopic incisions to a larger incision on the
upper abdomen on the right and getit out safely. But that's not all

(20:02):
that common. In fact, Ithink a lot of residents now are coming
out of general surgery residency training havingnever done an open gallbladder surgery. I
trained at UVL and we did alot when I was in residency, so
it's something that I feel comfortable with, but we I try my darnedess to
not have to go that route becauseit does lead to more pain afterwards,

(20:22):
patients have to stay in the hospitalfor a few days longer. Yeah.
Absolutely. And is it different whenit's hoally societis as you mentioned that earlier.
Can you just remind us what thatwhat holy societys is and is there
a difference in your approach surgically atall? So a coales societis is more
of an emergency situation with the gallbladder, where most of those patients are coming

(20:45):
into the emergency room and have tohave surgery that night or the next morning.
It's still done laparoscopically, but itis more challenging and carries with it
more risk, just because the entiregallbladder is usually blocked by stones and is
almost starting to turn into an abscessor like a pocketive infection, and so
as that occurs, the gall butterbecomes harder to manipulate laparoscopically. It starts

(21:10):
to harden, it almost turns toconcrete at times, and it becomes really
difficult to do. But in mostcases we're still able to remove that laparoscopically,
but those patients usually have to stayin the hospital for a few additional
days of ivy antibiotics just to givetheir body the time it needs to heal.
Whereas patients who are coming in tohave an elective plan surgery for gallstones,
for example, that's a quick outpatient surgery and they don't have to

(21:33):
stay overnight. Well, we arelearning all about gallbladder with doctor Danielle Humphrey.
We're going to take a short break. Doctor Jeff Publin, you're listening
to Centered on Health with doptic health. Here our news radio eight forty w
AHS, our phone number five Otwo, five, seven, one,
eight four or eighty four if youwant to call in and ask the question.
We'll be right back after these messages. Welcome back to Senate on Health,

(22:12):
the Baptist Health Fear on Youth Radioeight forty WHAI. I'm your host,
doctor Jeff Publin, and we're talkingtonight about general surgery and gallbladder to
sez it with doctor Daniel Humphrey.General surgery with the Baptist Hospital Medical Group.
Doctor Humphrey. We have two callerson the line. Terry, I
know you're there and we are goingto get to but we're going to start

(22:34):
with David, who has a questionabout having had his gall about gallbladder removed
and some problems he's had since then. So David, are you there.
You are on Senator on Health andyou're on with doctor Humphrey. I'm here
the first the first twenty or thirtyyears I had paid him in all better

(22:55):
area. If I stay in lordthan a half hour, it almost shandered
my profession and as a minister andmissionary because I had to had to talk
from a stool and for the firstfifty years of my life, I've had
a diarrhea. A doctor who didthe surgery never told me anything about having

(23:15):
diarrhea afterwards. Everybody I've talked tothat has had all better remove. My
sister, other family members, andfriends all have had one hundred percent diarrhea,
and no doctors ever told them thatpob possible side effect. What is
your opinion, interesting, doctor,Yeah, so diarrhea after gallblader surgery is

(23:37):
the absolute most common issue that canhappen normally. It is because you're not
having as much bile emptying into yourintestine when you eat, because you're bile
duct even when it stretches out,it can't really match the same amount of
bile storage that your gallbladder used tobe capable of. So, in particular,

(23:57):
if you eat any food that hasfat in it, even if it's
good fats like avocados, it's notgoing to be broken down and digested as
well as it used to. Now, what that means is that the fat
stays concentrated in your poop and youpoop it out, and it causes you
to have a lot of diarrhea,which can sometimes be sort of explosive.

(24:17):
The biggest issue after gallbladder surgery isthat side effect, and so I always
caution my patients that that is possible. And so in particular, when I
have patients to come to see meand they're already having diarrhea, I tend
to be a little cautious about encouragingthose patients to have their gallbladder removed,
because I would hate to make thatworse. There are two medications that are

(24:40):
usually tried after gallbladder surgery if youhave persistent diarrhea. So one is called
coolist styramine and the other one iscalled cholestopol I think the first one I
mentioned, colis styramine works a littlebit better. However, it's a little
powder packet that you have to carryaround with you and you have to mix

(25:00):
it into water and drink it aboutthirty minutes before you eat. So I
have found that most patients who trythat coolest styramine just cannot make it make
it work. They don't want tohave to be carrying that around all day
every day. If you're a womanand you have a purse, it's feasible.
But if you're not a woman whocarries the purse around. It's harder
to achieve that, especially if youwant to eat out. So then that

(25:22):
parents depends would be bigger help thanwhat you're talking about. Do what you
say, a pair of depends andso you cannot pass up a restaurom anywhere
in town. You've got to knowwhere they all are and mark them down
on the map on your regular routineto work or from work. People have

(25:45):
an accidents, and I think it'sa it's almost criminal not to tell patients.
That's a side effect. Well,David, and a lot of those
patients actually end up seeing us aswell in g I and so I really
want to thank you for bringing thattopic up, because it was actually on
my list of things to ask doctorHumphrey to talk to us about. So,

(26:07):
David, I want to thank youfor calling in Tonight. We are
going to switch gears a little bitoff the gallbladder, although I am going
to come back to a doctor Humphrey. But we have Terry also on the
line who wanted to ask a questionabout the appendix. So Terry, if
you're there, you are on withdoctor Humphrey. Hi, doctor Humphrey.

(26:29):
I recently had my my appendix outin January. It was an emergency appendectomy,
and I was told that my appendixwas necrotic when they took it out,
and I just wondered what the bigdifference, because it seems like having
a ruptured appendix was always worse.And I spent six days in the hospital

(26:55):
left for my surgery, so Ikind of felt like I was really sick.
So I guess, yeah, somaybe, doctor Humphrey, the difference
is in the way the appendix presentsand how that affects what you're able to
do in the recovery time. Yeah. Absolutely. So the appendix is a

(27:15):
relatively useless organ. It is connectedto the colon in your lower right abdomen.
It frequently will develop something called appendicitis, which I think most people are
familiar with. That term appendicitis usuallyhappens when you did a little piece of
poop for lack of a better term, that that little poop ball will plug
up the lumen of the appendix andblock it. When that happens, that

(27:38):
creates appendicitis. And so really youngpatients, it's interesting their bodies will sense
that at a very early stage.They'll start to have a lot of really
intense right lower abdominal pain. They'llpresent to the er, have their appendix
removed laparoscopically, and usually go homethe next day, and it's a relatively
uneventful surgery and recovery. We getolder and become adults, our pain receptors

(28:03):
are not quite as sensitive as theyused to be when we were kids,
So in adults, frequently you willnot notice or feel anything wrong until it
has started to progress to more advancedcases of appendicitis, where you get a
lot of swelling of the appendix,and that swelling almost swells the blood vessels
shut if you will, And whenthe blood vessels to the appendix are swollen

(28:25):
shut and it cuts off the bloodsupply to the appendix, you develop a
necrotic appendix, like it sounds likeyou had. That is the step right
before the appendix perforates or ruptures.Those two terms are synonymous, and so
it's really imperative to try to getthe appendix out before it perforates. But
my experience has been during surgery toremove a necrotic appendix, just the manipulation

(28:49):
of the appendix introoperatively can sometimes causeit to perforate, So I can't say
for sure whether or not that happenedduring your surgery, But we usually sort
of treat a necrotic or a gangernousappendix much like a perforated appendix, and
you have to stay in the hospitalfor a few more days of ivy antibotics,
and sometimes even longer if you're intestinesdon't want to start working right away,

(29:12):
and you develop something called anfelius okay, and then this is so would
a necrotics appendix versus a ruptured appendixpresent with different u symptoms because I had
more of my pain was more justabove my belly button, and when you

(29:34):
hear people have an appendixitis, it'smore like right lower quadrant mm hmm.
So you're right, and that mostcases of appendicitis are going to be right
lower abdominal pain. And really youngkids frequently their symptoms will actually start more
around the belly button and then willeventually migrate to the lower right But in

(29:56):
adults, normally we don't really feelthat the umbilical type pain first. We
only sense it when it's already migrateddown to the right layer quadrant. So
I wonder if you maybe sensed ita little bit earlier. But we as
adults tend to always chalk up painaround the center of the abdomen as being
gas or constipation, and so that'salso part of why I think a lot

(30:19):
of times an adults, it's notrecognized as appendicidis until it's a lot more
progressed, because we sort of avoidedcoming to the hospital thinking that it's just
something more run of the mill,if that makes sense. And then you
mentioned the gallbladder being something we couldlive without, but apparently we can live
without the appendix too, So whatis right? So it's useless, it's

(30:45):
totally useless. Well, thank youfor calling in, and David, thank
you for calling in. We're goingto take our final break here. We'll
be back to talk a little bitmore about the gallbladder after we take these
brief commercial breaks. Is Senate onHealth with Doctor's Health on News Radio eight
forty. Our guest tonight, doctorDanielle Humphrey Baptor, talks on medical group

(31:07):
general surgeon, an expert on dallbladders and apendency. So I want to
remind you to download the iHeartRadio app. It's free, it's easy to use
to give you all of tonight's information, and we'll be right back. Welcome

(31:33):
back to Senate on Health with Doptor'sHealth here on news Radio eight forty whas.
I am your host, doctor JeffPublin. We're talking tonight to doctor
Daniel Humphrey about gall bladder disease ingeneral surgery. She's a general surgeon with
the Baptist Hospital Medical Group. Rememberto download the iHeartRadio app to re listen
to this or any of our previoussegments and to have access to all the

(31:53):
other features that the app has tooffer. So, doctor Humphrey, so
about back to the the gallbladder.Thank you for talking about that appendix issue.
But with the gallbladder specifically, oneof the things we run into a
lot is that sometimes it's not thatthe gallbladder is full of stones or has
coldes acided, but that it's justnot functioning properly. Now, how big

(32:17):
of a problem is that. Doesit cause symptoms? And is that something
that needs to come out surgically aswell? Yes, So that is a
diagnosis called biliary discnesia. That's thetechnical term for it. How I kind
of refer to it is you havea lazy or a sluggish gallbladder, which
is usually more of like an electricalwiring issue to the gallbladder, so that

(32:40):
can be a lot harder to diagnosebecause if you do an ultrasound of the
gallbladder or a CT scan of theabumen, the gallbladder is going to look
completely normal on both of those tests. But for these patients who have biliary
diskinesia, they will have very similarsymptoms. So they'll have a lot of
up abdominal pain, nauseating, butfrequently these patients also have a lot of

(33:01):
bloating. Their pain may be alittle bit more generalized all over the abdomen
and not so focused on the right. Usually the symptoms come on when they
eat, and in particular fatty foods, and if they don't eat, they
feel fine. For a lot ofthese patients, they struggle because they'll see
doctor after doctor who do tests andtell them, well, everything came back,

(33:22):
find your normal normal, yeah,and it's It can be infuriating because
a lot of these patients sometimes ittakes years before they're finally diagnosed, and
the only way to diagnose it isto have an X ray test called a
high scan, which is HIDA highto scan, and so that actually sort
of stimulates skawblader to pump much likeit should when you eat, and it

(33:43):
measures its functionality level by measuring somethingcalled the ejection fraction. And so when
it measures the ejection fraction, anythingabove thirty five percent of functioning is doable
with, you know, eating andleading a normal life. Below thirty five
percent is considered abnormal and not enoughto get by. And for those patients,

(34:04):
we always recommend taking out their gallbladderbecause they usually get pretty quick symptomatic
relief. And again that's usually justa quick outpatient procedure. And you know,
as somebody that also orders a lotof high to skins for that very
reason, you know, sometimes youget those you know, eighty five percent
and you're like, okay, I'mpretty confident that this is not the problem.

(34:27):
Or you get the five percent andyou're like, okay, I'm pretty
confident this is the problem. Butwhat do you do? What is your
approach when you get that like reallykind of in my opinion, unfortunate like
fifteen to twenty eight percent where it'snot normal, but it's not really like
super low. So what do youdo with those patients? So I have

(34:51):
noticed that across the board, everyone'severyone's body is different in terms of how
they start to feel symptoms and manifestissues of gawbladder at different levels. I've
had some patients who do not startto have symptoms until their percentage level of
their ejection fraction is in the singledigits. I've had other patients who come
to see me and they start tobecome symptomatic in a pretty significant way when

(35:12):
their ejection fraction is in like thethirty six, thirty thirty seven, thirty
eight percent range, which file youknow, book standards says it's normal.
But if they're symptomatic, I stilltreat it as though it's a dysfunctional gallbladder
and I take it out. There'salso a school thought that you can have
an overactive gallbladder, which is whereyou have an ejection fraction typically around ninety

(35:35):
percent or higher. That's something thatno one really ever teaches in medical school,
or it's not really in the literature, but anecdotally speaking, I have
really become a believer in this.In my last eight years being here at
Baptist, I have seen a lotof patients who come to see me with
what I consider to be pretty classicgallblader symptoms and their ejection fraction is high.

(35:57):
I always tell them, you know, this is not something that's really
taught, but I do believe init. We can give it a try
and see if your god better comingout makes you feel better, And in
most of those patients, they feeldramatically better afterwards, So I still think
it's worthwhile to remove it. ButI always caution patients about the side effects,
the diarrhea they could feel, andreally leave it up to each patient
to figure out what's best for them, and is there a cutoff there,

(36:20):
like do you think about that possibilityat ninety percent or ninety five percent,
or just if it's really high andthey have something, you think about it.
It's usually about ninety percent or higher. The other day, I think
I had a lady who had anobjection fraction around eighty eight percent or eighty
nine percent, but she had prettyclassic symptoms and she had been through such
an extensive work up to rule outeverything else that it could be. So

(36:43):
I felt pretty confident about recommending,you know, gallbladder surgery for her.
So we'll see how she feels afterwards. She will have to Yeah, well,
love to have you back and findout how she did. Yeah,
So we have about a minute orso left and tell us a little bit
about gallbladder polyps, because a lotof our patients call us because they saw
their primary care they had an imagingtest and their gall bladder looks okay,

(37:07):
but they noticed pollups. The patientshave to be worried about that. That's
a good question. Polyps in thegallbladder are not super common. They're not
as common as you know colon polyps, which we see day in and day
out. Gallbladder polyps are relatively benign, innocuous, and nothing to worry about
unless they get to be a centimeteror larger in size. Any polyp that's

(37:29):
over a centimeter in size needs tohave their gallbladder removed because it curies with
it a higher risk of developing agallbladder cancer, which is extremely rare,
very very rare. And in mostcases of gallblader polyps, what we do
is when we first find them,they're less than a centimeter in size,
and we just basically monitor them withyearly ultrasounds. And my experience has been
that they never really changed much insize, and so I've only ever had

(37:52):
to remove one gallbladder for a gobladderpolyup. Otherwise, the rest we just
watch and they're always asymptomatic. That'spretty much been my my experience surveying them
as well. Well, you know, for a an organ that we can
live without, we've sure learned alot about it tonight, which is really
great. So I just want tothank you so much for joining us tonight

(38:14):
with a great conversation. You've beenlistening to Danielle Humphrey, Centeral Surgeon about
the Hospital Medical Group. This isSented on Health with Aptor's Health. I'm
your host, doctor Jeff Covlin,our producer mister Jim Finn. I want
to thank our callers David and Kerryfor calling in and joining the conversation and
helping us learn about job oders revisalsthat will do it for this week's show.

(38:36):
Next week we're talking about healthcare screeningwith two of our primary care physicians,
doctor Connor O'Neill and doctor Ariah Holkins, also from the bapt Hospital Medical
Group. I hope everybody has awonderful week, a great weekend, and
we'll see you next week. Thisprogram is for informational purposes only and should

(39:02):
not be relied upon as medical advice. The content of this program is not
intended to be a substitute for professionalmedical advice, diagnosis, or treatment.
This show is not designed to replacethe physician's medical assessment and medical judgment.
Always seek the advice of your physicianwith any questions or concerns you may have
related to your personal health or regardingspecific medical conditions. To find a Baptist

(39:25):
health provider, please visit Baptistealth dotcom.