PSA: Physicals & Gallstones

For someone who really does try to be relatively healthy, I feel like I come to you with a lot of PSAs. Like getting your dermatology checks for skin cancer, which I've somehow already had three times (2016, 2019, 2021, though nothing in the last 3 years!). I try to eat well(ish), I stay (relatively) active, I see doctors regularly, get my blood work done every year, and try to speak up when something is concerning me.

Which is why it was a shock when I signed up for an Executive Physical, expecting to get some helpful baselines for the future, and instead left with a referral to a surgeon to get my gallbladder removed as soon as practicably possible. As I waited to discuss my results in more detail with the doctor I was furtively googling "what is a gallbladder and what does it do?"

But first let me back up. One of my firm benefits is that it will reimburse partners for one executive physical a year. I kept putting it off, figuring I am relatively healthy and see quite enough doctors anyway (this was in the middle of all these issues). Then one of the partners I'm close to did his and strongly recommended it, so I called The Cooper Clinic in Dallas last November to make my appointment. And their first available spot was July 17, 2024. So, I booked that, and put it out of mind.

July 17th came and after fighting all month to keep the day clear of calls and meetings, I showed up at The Cooper Clinic at 7:30 a.m. in my exercise clothes to begin a day of learning all about myself. And you guys, it was incredible. It was one of those things where I felt simultaneously SO incredibly grateful I could receive this kind of testing and care, while also so mad that not everyone can. The inequality in healthcare in a nation with our resources is really a tragedy. But I was there, and I was going to get everything out of it that I could.

The day started with blood work and then meeting my internist who talked through the tests they generally do while getting an in-depth medical history to see if any should be added (like a bone density test when I mentioned my mom's struggles with osteoporosis). I was seemlessly walked through various rooms and doctors: an abdominal CT scan, the most thorough skin check I have ever received from a dermatologist who also mapped all my various little freckles or moles so they can be compared year over year, a dietician (so helpful!), an exercise test (so hard!), strength and flexibility testing, a thorough physical examination, and more that I can't remember. I learned so much and what I appreciated most was how you met with doctors in real time to go over your results, so everything was immediately put into context and presented in a very non-alarming manner.

I discovered my cholesterol is high, which was kind of a surprise. Over the years I had occasionally been on the high end of normal, but never outside the normal band like this was. I talked with the dietician about some simple changes to make and I'll get my blood work redone in 6 months. To my shock the results will go straight to that same doctor and then he'll call me to talk through it. My bone density was borderline low, so I'm adding more weight-bearing exercise and we'll retest that next year. My skin looked great (yay!) though there's a mark or two to keep an eye on. My exercise test found me in Excellent shape, which the doctor said is one of the greatest predictors of longevity. The only band that's higher was "Superior" so I'm working for that next year.

When we sat down to review my abdominal and chest CT scan, he said my heart was in perfect health (yay!) with a plaque score of 0, which is as good as it gets. My lungs, liver, and other organs looked great too. He kept reading and then his eyes got big and he said, "huh, I've never seen radiology use this phrase before:

"Patient's gallbladder is packed full of gallstones."

What?!

As I soon learned, the gallbladder is a small organ in the digestive system that stores and concentrates bile, a yellowish-green liquid produced by the liver that helps the body digest fats. When you eat, your stomach releases a hormone that causes the gallbladder's muscular lining to squeeze bile into the small intestine through the main bile duct. The more fat you eat, the more bile the gallbladder releases. Bile is made up of several substances, including cholesterol, bile salts, and water, and can form gallstones when the chemical composition of bile in the gallbladder becomes unbalanced by too much cholesterol (80% of gallstones are made of cholesterol; hmmm), bilirubin, and other factors like being female (great) and over 60 (not even close yet!).

In the paraphrased words of the doctor, sometimes gallstones are completely innocuous and regardless of what a scan shows, if the patient isn't exhibiting any symptoms, they usually don't take any action. However, mine was packed so full, they were very concerned about it turning gangrenous (as bad as it sounds) and/or trying to offload some of those stones into my digestive tract which would be very painful and require surgery anyway. Given how much I travel, he was also concerned something like that could happen when I'm away from home, which would not be great.

He expressed surprise I wasn't experiencing symptoms.

"Like what?" I asked.

"Oh, nausea, bloating, and digestive distress after eating, frequent feelings of heartburn, occasional intense stomach pain..."

"Oh I experience all of those things pretty often."

[glare from the doctor] "You didn't write any of it down on your intake form!"

"It never occurred to me those things could go away."

In the last few years I have never left the house without Pepto chewables, Pepcid pills, and gas pills in my purse. These always fixed whatever I felt, so it never occurred to me I could prevent them entirely.

And so, I called the surgical referral my new internist gave me. I met with her a couple weeks ago and she agreed the gallbladder needed to come out asap. I scheduled the surgery for this past Tuesday and was generally told this would be a simple surgery: laparoscopic, small incision, quick recovery, no prohibition on exercise or really anything, just to get up and walking and do whatever I felt comfortable doing. Great! I thought. I've already had the hysterectomy, this will be a breeze. I'd take off surgery day, do some calls from home on Wednesday, and be back in the office on Thursday for a presentation to a Board of Directors.

Except no. No, of course not.

The surgery was supposed to be 45 minutes but went well over an hour. My gallbladder was the largest my surgeon had apparently ever seen. It took "a lot of tugging" to get it out. I have a picture of it cut open once it was outside my body and the sheer volume of bile and gallstones is insane. My poor belly button, which started with a 1/2" incision, ended up with a 2" (!!!) incision, and my 3 other incisions were tugged on more than usual and my whole belly is swollen and tender and mad. (Note: the tiny scar in the bottom left corner of the picture is from the tubal and hysterectomy surgeries, which is more what I was expecting to see when I woke up yesterday!)

Needless to say I was NOT on my calls this morning and I'll be doing my board presentation from home tomorrow. I have slept a lot. Ice packs help the swelling. I wake up on my own every 6 hours for my next pain pill. Milo has once again stepped up as a nurse and takes his duties very seriously. I can't eat anything with fat for about a month while my body adjusts to not having a gallbladder, and it's probably a good idea to not go crazy with fried foods ever again, not that I really ever did, which is again why all this was so surprising.

So in the last calendar year I have had three abdominal surgeries: a tubal ligation and ablation, a hysterectomy, and now a cholecystectomy. Add in two c-sections and my mid-section looks like it's been to war and I feel like it blames me. But I'm excited to feel better, deeply grateful for the opportunity to have the opportunity for such a thorough physical, and glad that I've already scheduled my 2025 appointment.

In the meantime, Milo and I will be cuddling, I will be icing and taking my medicine, and my family will keep checking on me and giving me gentle hugs while they handle everything else that needs to be handled.