Ask Dr. H: She's had digestive distress since gall bladder removal

Question:

I'm a 66-year-old female who had gallbladder removal 31/2 years ago. Ever since then, I've had more abdominal pain, cramping, nausea, pressure, belching, and flatulence than ever before! I've had all the tests done - colonoscopy, upper endoscopy, small-intestine study, and stool samples - all normal. Can you offer advice on how to deal with life without a gallbladder?

Answer: Just to review, the gallbladder is a hollow sac that's attached to the liver in the right upper part of the abdomen. Its job is to store bile - a "detergent-like" liquid that helps digest fats much as liquid soap breaks up the grease on your pots and pans.

Bile is made by the liver and transported to the gallbladder where it's concentrated and stored. After meals, the gallbladder contracts and squeezes concentrated bile into the small intestine. Any waste that the liver produces (the liver detoxifies harmful substances and any medications you might be taking) is released into the gallbladder and eventually into the intestines where it's disposed of in the stool.

When the gallbladder is removed surgically, the liver still makes bile that is directly secreted into the intestines in a non-concentrated form. For most folks, this is quite adequate for digesting fats you eat and elimination of liver waste products.

An extremely fatty meal may result in diarrhea, so you may want to try a strict low-fat diet and see if some of the symptoms improve. Two other possible reasons for your bloating and abdominal discomfort are post-surgical adhesions and motility problems of the bowel. Motility problems are usually seen in the immediate post-surgical period, and generally resolve. Adhesions, or intra-abdominal scars, as a late complication of your abdominal surgery, are much tougher to treat.

If you've been unable to find relief in your area, perhaps a consultation with a gastroenterologist may be helpful.

Q:

I'm a 38-year-old man who saw the doctor a couple of months ago because of a tender lump in my right breast area. I know that men do rarely get breast cancer, so I was pretty worried about it. After bloodwork and a mammogram came back normal, he sent me to a surgeon.

The surgeon thought that the Zocor I was taking for my cholesterol might have caused it. After being off the Zocor for a few weeks, the area does seem to be much less tender and smaller. How often does this happen from statin drugs? How can I get my cholesterol down?

A: It's not all that common, but statin cholesterol drugs and fibrate triglyceride-lowering drugs can cause "gynecomastia," the development of increased breast tissue in a man.

The exact reason they can cause gynecomastia is unclear, but it's believed that in some folks, the effect of these drugs on the cholesterol-forming pathways in the liver extends to the male sex hormone-forming pathways. This creates a hormonal imbalance between testosterone and estrogen. An interesting observation is that switching a patient from one statin drug to another (e.g., Zocor or Crestor to Lipitor) may reverse the gynecomastia.

Besides statins and fibrate cholesterol drugs, there are actually many prescribed medications that have the potential to cause gynecomastia. The list is extensive, and includes antidepressants like Zoloft, Effexor, Wellbutrin and Prozac; blood pressure medications like Norvasc, ACE inhibitors (Vasotec, Captopril) and clonidine; acid blockers like Tagamet, Prevacid, Prilosec and Pepcid; pain medications like Motrin, Clinoril, and Indocin; antibiotics/antifungals like Cipro and Sporanox; heart medications like digoxin and Norpace; and antipsychotic/bipolar medications like Seroquel, Zyprexa, Haldol, and Xanax.