This page is rated PG-13 for language, graphic situations, and graphic imagery.

Back in July of 2002, I had my gall bladder out. It took me a while to get to the point where surgery was necessary. I had abdominal pains for several years. My pain increased in intensity and duration with time. I'd go eat Mexican food with Leisa, then wake up in the morning with a stomach ache. It seemed to focus on the right side, under my ribcage. It would resolve itself after several hours, then it might be eight weeks until I had another. I always thought it was too many chips.

In July of 2001, the State switched insurance providers. The doctor I'd had for ten years decided he'd rather be unemployed than work for Cigna, so he quit, and I was forced to find a new Primary Care Physician (PCP). I asked my friend and co-worker, Jim, who he used. He told me that he was in the same situation, and was searching for a new PCP. He told me that his cardiologist was with a group at 7th Street and McDowell. Although the cardiologist wasn't a PCP, another doctor in the group, Stanley W. Horowitz was. (Mr. Google-bot, please catch that name and give it a prominent ranking.) Jim was very pleased with the care he has received from his cardiologist, so based on the group, I chose Dr. Stanley Horowitz as my PCP. It is now my opinion that he is the worst doctor in the world.

Dr. Stanley W. Horowitz

The abdominal pain began to get more intense and more frequent, so I scheduled an appointment with my new doctor around October 2001. The nurse who checked my vitals before the exam warned me about his "bedside manner" being a bit brusque. Dr. Stanley Horowitz came into the examination room and asked a few questions, chided me about my weight and cholesterol levels, (even though my previous doctor seemed to think the cholesterol was fine, based on the ratio between my good and bad cholesterol). I described my symptoms and he very rapidly arrived at the conclusion that my problem was acid reflux. He prescribed Zantac at twice the over-the-counter dosage. I told him I'd had acid reflux before, and had been given the opportunity to drink a barium milkshake a year or so earlier as part of the diagnosis. I further explained that it went away when I quit drinking Coca-Cola. I was familiar with the symptoms of acid reflux, and this wasn't it. "How could I presume to know more than this learned practitioner of the Art of Medicine" was the attitude that I got in return. I was told to take the medicine, and to call him if it didn't work. This part of the exam took about five minutes.

At this point, Dr. Stanley Horowitz began to follow up on what I do for a living, which is work on computers. He began to press me with questions about why his home computer ran slowly. I'm sitting in a chair in a cold examination room in my underwear, attempting to diagnose his problems. Then he began to talk about Israel and Palestine and World War II. He then got back around to my health, and told me I need to lose weight, (and anyone who's seen my Back Fat will agree), and that I should convert my living room to an exercise room. Hey, you're a rich doctor who lives in Scottsdale in a 3,842 square foot house. You can do that. I have 900 square feet in the Historic District. I don't think that people will want to sit on a Bowflex machine in the living room if they come to visit.

I left. I got some Zantac. (And in typing this screed, I find it odd that Microsoft FrontPage recognizes the word Zantac, and doesn't suggest it as being misspelled.) I continued to get stomach aches. Sometimes the Zantac seemed to work. Sometimes it didn't. Based on the location of the pain, I began researching on the internet and came to the conclusion that my problem might be related to gall stones. Without an ultrasound, though, I had no way of knowing. Rather than deal with Stan again, I just waited it out.

Urgent Care

Finally, on June 8th, 2002, the situation came to a head. It was Mom's birthday, and we went to Tucson. I made Fish Tacos from Mad Coyote Joe's cookbook for Mom, Dad, and Leisa. Brittany and I are above eating fish, and we each had a chicken breast. I also made a cheese crisp while I was preparing the tacos, and had a piece or two of that. I woke up at about six am the next morning with a vague discomfort. It rapidly developed into intense pain--the worst I had ever felt--and I finally decided that I needed to go to Urgent Care.

The doctor at Urgent Care listened to about twenty-five seconds of me describing my symptoms (the same symptoms I'd described several months earlier to Stan). He stopped me and told me it sounded like my gall bladder. He ordered blood tests for the liver enzymes that will indicate a malfunctioning gall bladder.

Back in Phoenix on Monday, I called Dr. Stanley Horowitz, and reported to his voicemail my weekend doings. The nurse-practitioner who checked the voicemail I left called back to tell me that the good doctor had ordered an ultrasound for me. When the test results indicated gallstones, I was immediately referred to a surgeon, again without any personal contact with Dr. Stanley Horowitz. Meanwhile, I also went to the blood test place and had my blood drawn. Those results came back positive for liver/gall bladder trouble.

(As an aside, click here for Jim's experience with Dr. Stanley Horowitz and the voicemail system. Click here for my story of voicemail during the four months I had bronchitis.)

Anatomy Lesson

Let's stop for a moment and talk about what the gall bladder does. The lining of the stomach is capable of detecting the ingestion of fatty substances. The body needs help breaking down this fat so that food may be easily digested. Breaking down this fat is one of the functions of the liver. (It also helps to remove the wine from my blood.) The liver produces a substance known as bile, which aids in the breakdown and digestion of fat. (Gross oversimplification: In the same manner that soap breaks up fat on the bottom of a pan, the bile breaks up the fat in the stomach.) It takes a while for the liver to begin producing bile once the presence of fat is detected, though, so excess bile is stored in the gall bladder. The gall bladder is a small receptacle that sits immediately under the liver. The gall bladder can release bile into the intestine immediately upon the introduction of fat into the stomach, so that digestion can begin quickly. Gall stones can form inside the gall bladder, though, and impede the flow of bile into the intestine. This causes the pain I experienced. Several things can cause gallstones, including rapid weight loss and excessive consumption of fatty foods.

I really should have a few more images here to help me explain, but I'm lazy. Go look it up on WebMD.com. There is a duct that leads from the liver to the intestine, through which bile passes. The gall bladder branches off this duct. Gallstones can become lodged at the transition from the gallbladder to the duct, which was what happened in my case, or, they can pass into the duct and become lodged in it. Both cases are painful. Duh.

In researching, I found a number of home remedies that were supposed to cure gallstones. The most common one was something to the effect of eating a bunch of lemons, then drinking a liter of olive oil. This was supposed to launch bile production into overdrive, forcing the gallstones through your system. Yeah, right. If two pieces of cheese crisp send me to the urgent care, what would a liter of olive oil do? I elected to have surgery.

Surgery

I was referred to a surgeon, Dr. Paul Petelin, who was great. (And in Six Degrees of Kevin Bacon mode, kind of spooky. He and Mark, our contractor, have known each other for years. Mark remodeled Dr. P's house for him. Their kids were in softball together, or something to that effect. And since we're talking small world, Mark and I both had the same dentist as kids, Dr. Mehlim.  (Spelling, anyone?) He was in the green courtyard building, next to St. Joseph's hospital at 7th Ave and Thomas. Right next to the Pepper Tree restaurant complex. Before there were food courts at the mall, there was Pepper Tree. It had ten different restaurants under one roof. My favorite was the place that sold footlong hot dogs. And does anyone reading this remember Googy's at Park Central, or the Big Boy on Thomas and Central? But I digress.) Back to my medical condition. We had a big project going at work--setting up the new Pima County Office with 125 computers--so I scheduled my surgery around that. I waited about six weeks for the surgery because I didn't want to bag on the other people in my unit and make them do my job. I ate almost no food during this time, receiving my nourishment from beer and wine, and occasional Kellogg's Frosted Flakes and Hot Tamales--not because I liked Frosted Flakes and Hot Tamales, but because the nutritional information on the side of the box said that neither of them had any fat. "0%." Leisa and I would go out and she would have a plate of wings and basket of curly fries while I watched. How cruel is that? We'd go to a pizza place and I'd sniff her pizza and fantasize. I did lose almost 20 pounds waiting for the surgery, so that was a good thing. (Ummm, did I say something about "rapid weight loss" helping promote the growth of gall stones?)

It was weird while I was waiting for the surgery. Once I knew it was gallstones, and where they were located, by tightening my stomach muscles I could feel the gall bladder move behind my ribs.

Finally, on July 25th, after installing over a hundred computers in the Pima County Office, I had my gall bladder out. It was to be done laproscopically, meaning that several small incisions would be made in my abdomen. It would then be inflated to the size of the Hindenburg with an inert gas of some sort, and a camera and surgical tools would be introduced into the cavity through the incisions. There were two incisions; one at the top of my belly button, the other just below the sternum. There were also two small holes on the right side of my chest, near the bottom of the ribcage.

They gave me an injection and I joined Winken and Blinken in the Land of Nod. The next thing I knew, they were waking me up in the recovery room. The nurse who woke me up looked under the sheet covering me and told me I didn't have any clothes on. I groggily told her it wouldn't be the first time I woke up somewhere, naked, not knowing where I was, or where my clothes were. She told me that she didn't want to hear that, but gestured toward another nurse, I think her name was Karen, and said that she might be interested. Just like Ronald Reagan on the operating table, I hadn't lost my feeble sense of humor.

Mom, Dad and Leisa met me in the corridor outside the recovery room. They wheeled me to my room, where I was served the worst food I've ever eaten. I think it was applesauce and gruel. I picked at the food and left most of it. I felt like I'd been kicked in the stomach about a bazillion times. I could barely get out of bed. I hurt too much to sleep, and even if I had, the guy in the next room kept me awake with his hollering. I still recall the following events with crystal clarity, despite my drugged state at the time.

My Evening in the Recovery Room

The guy in the next room apparently needed to go to the bathroom, but couldn't. He needed to go, badly. Way Badly. One of the nurses tried to insert a helpful little catheter. She apparently didn't do a very good job of it, though. He started shouting about how painful it was. And kept shouting. The nurse tried to take it out, but couldn't. That hurt him even more. Moaning and squealing and shouting and cursing like I've never heard came from the adjoining room. Based on the noise, I'm guessing that she finally gave the recalcitrant tube a tug, which prompted him to curse her out. She said she was going to get a doctor. The female nurse brought a female doctor a few minutes later. He was shouting at her that he couldn't go to the bathroom and thought he was going to explode. He was "upset" about the previous catheterization attempt. The doctor attempted to empathize with him by telling him that one of the most painful feelings in the world was having to pee and not being able to. "You tell me that," he shouted at her. "You've never had one of these shoved up your d*ck!" Touché! 

The lady doctor maintained her composure, and proceeded to properly catheterize him, with much hollering and finally, relief, on his part. After this, the nurses kept coming into my room encouraging me to drink more water, and get things in my body functioning again, otherwise the same fate that befell my neighbor might befall me. I told them to bring me a pitcher of beer, and I could guarantee that I'd be in the bathroom in thirty minutes. They laughed at me. Like they were going to introduce beer into my system when I was on flying on morphine. Their derisive laughter rang in my ears for hours. At about four in the morning, I asked what all of the fuss was about in the next room earlier that night. One of the nurses finally told me that Mr. Man in the next room had an enlarged prostate, and that was what made it difficult for him to go to the bathroom, as well as difficult for them to catheterize him. That was some small comfort to me, who was still drinking water in an attempt to get my body functioning again.

I got out of the hospital the next morning, and spent the following week or two in pain. My gall bladder was infected and inflamed, and had stuck to the liver. In removing the gall bladder, they had to cut it loose from the liver, then cauterize the cut area. It hurt for days. The surgery also puts a strain on the stomach muscles, which are stretched in ways they're not meant to be stretched. I never realized how much I used my stomach muscles. When you're lying down and want to get into a sitting position, it's your stomach muscles that pull your torso up. Lean forward to get out of your chair and it's a big hello to your stomach muscles. Between the damaged liver and the stomach muscles, every movement hurt. I had Vicodin, but it did weird things to my sleep. I thought my surgery sucked, but then I talked to people who had the surgery years ago and were off work for six or eight weeks. Gall bladder surgery used to consist of a big ole slice across your abdomen, which took months to heal. With nothing but my laproscopic stab wounds, I was actually lucky.

I've been able to enjoy fatty foods again since the surgery, and have gained back the twenty pounds that I lost in the weeks leading up to the operation.

If you've read all this crap, and clicked on all the hyperlinks, you deserve some pictures.

Fig. a. Famous Gall Bladder Images

Compare LBJ's non-laproscopic scars with my tiny incisions. And is that stomach scary? Do you need to see the Diet Coke Guy?

Here come the scary images

Fig. b. Actual Surgical Photos of my Insides

Top Left: He may be a great surgeon, but he's only an okay photographer. I think Dr. Petelin covered the flash with his finger on the first picture.

Top Right: My liver. The big ugly, prune-looking-thing is where they took the gall bladder out. It was inflamed and had stuck to the liver itself. They had to scrape it off and cauterize the bottom of the liver to heal the wound left when the gall bladder was torn loose from the liver. I think that's my lung in the background, and my intestine in the foreground.

Bottom Left: I see this picture, and I just keep replaying the scene from Three Kings where George Clooney describes what a bullet does when it hits someone. Dr. Petelin named all of the players in this shot, but I was drugged at the time, and don't remember their names eight months later. I think some of this is back fat, seen from the front.

Bottom Right. Again, I think that's my liver in the center, but I don't remember all of the muscles and organs surrounding it. Aren't these better photos than the fruity pictures of me gesturing at a concrete block wall? I think so.

Here's the Pathology Report for my surgery. It received a fax copy that wasn't very legible, so I've retyped it for easier reading. If you know what all of this means, other than I have gall stones, let me know.

ANATOMIC PATHOLOGY REPORT

PERMANENT CHART COPY

SURGICAL PATHOLOGY REPORT

CLINICAL DIAGNOSIS:

Cholecystitis

SPECIMEN SOURCE:

Gallbladder and contents (stone taken out by Dr. Petelin for pt [that's me!])

GROSS DESCRIPTION:

Received in formalin is a purple tan gallbladder with a previously incised adventitial surface, measuring 6 x 3.5 x. 3.2 cm. The serosa appears hemorrhagic. Within the fundus of the gallbladder, there is a 1.2 x 1 cm spherical stone. Within the container, there is a smaller 0.5 x 0.5 cm spherical stone. The gallbladder is sectioned along the previously opened adventitial surface revealing a pink tan irregular surface, with small punctuate hemorrhages along the mucosa. There is also a green round area measuring 0.3 x 0.4 cm, 1.5 cm from the fundus. The wall is thickened and measures 0.6 cm. The cystic duct is free of stones. The cystic duct lumen appears to narrow at the surgical margin to a point of occlusion. [I can decipher Mike's Bid, but this is beyond me. I think it means my gall bladder was clogged.]
Representative sections are submitted in cassettes 1A-1D.
MAG:DF

MICROSCOPIC DESCRIPTION:

Sections of gallbladder show marked thickening of the gallbladder wall with acute and chronic [Hi, Justin!] inflammation and organizing fibrosis. The inflammatory process has extended through the full thickness of the gallbladder wall and a portion of hepatic tissue is adherent to the gallbladder serosa.

PATHOLOGIC DIAGNOSIS:

GALLBLADDER WITH ACUTE AND CHRONIC CHOLECYSTITIS.

CPT:88304

:CS    Dictated by:    DR. ROY IAN DAVIS

           Verified by:    Roy Ian Davis, M.D.

                                    (Electronic Signature on 7/29/02)

[Thus endeth the report. There was a bunch of personal information about my age and account number, etc., that I didn't include. I also have one of my gallstones, which was too small to show up well in photographs. Private viewings on request.]

The bizarre, ironic twist to this whole thing is that Leisa had a painful varicose vein removed a month later. The hospital X-rayed her lungs at the time and detected a small spot. She ended up having a CAT scan or MRI of her torso, and one of the things scan revealed was a gall bladder full of stones. Unlike me, she doesn't have any problem with them. I have three stones and end up in the surgical ward of St. Joseph's, yet she's got a bazillion of them and has no problem. She had her gall bladder out shortly thereafter. Hers wasn't inflamed like mine was, and didn't have to be detached from where it had joined to the liver. She walked out of the recovery room an hour after her surgery and was shopping that afternoon. Oh, well. At least I don't have a spot on my lung. And I don't have spontaneous intra-cranial hypotension. And I don't have varicose veins, either. Yet.

Click here to be done with my gall bladder and go back to the real site.