Without pain, surgery dosen’t seem so urgent to reader

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Without pain, surgery dosen’t seem so urgent to reader

DEAR DR. ROACH: I am 66 and am generally healthy, with a pacemaker. I started to feel a small, very mild pain in my right side, under my ribs. My doctor checked my liver, and it was normal, with diffusely increased echogenicity (diffuse hepatic steatosis). Then I was sent to imaging, where they checked my gallbladder. My gallbladder functioned only 18 to 30 percent. It was recommended that I remove my gallbladder. That was two months ago, and since then I hardly feel a pain, just sometimes a very small one. My question: Do I still have to remove the gallbladder if it isn't bothering me too much? — P.K.

ANSWER: It sounds like you are describing functional gallbladder disorder, a condition of recurrent abdominal pain, similar to the pain that comes from gallstones, but without gallstones being seen on an ultrasound.

The diagnosis is made more likely by a HIDA scan, a nuclear-medicine study where the ability of the gallbladder to squeeze is measured after stimulating it with a hormone called CCK (I bet that's what you had to get the gallbladder function number). Your result suggests that you have functional gallbladder disorder. However, other conditions, especially stomach ulcers, reflux disease and heart disease, can have very similar symptoms and should be excluded before considering this diagnosis. The HIDA scan is not definitive.

The most effective treatment for functional gallbladder disorder is removal of the gallbladder; surgery makes the pain go away completely in the vast majority of people.

When considering any surgery, one always has to weigh the risks against the benefits. Gallbladder surgery is relatively simple and safe, but if you are hardly ever having pain, I can understand your reluctance. It all depends on how frequent and severe your symptoms are and whether there is an alternative explanation. I think it's worth discussing with a surgeon.

DEAR DR. ROACH: I had a chest X-ray, which showed I have an enlarged right hilum. The doctor never explained what that means. I have had cancer two different times, so I worry about it. Could you explain a little more? — D.B.

ANSWER: The hilum of the lung is where the blood vessels (artery and veins) and the airway enter the lung. Lymphatic vessels and nodes also are prominent in the lung hila. Enlargement of the hilum generally means there is an enlarged structure in the area. The pulmonary artery may be enlarged in pulmonary hypertension, while the pulmonary veins are enlarged in someone with congestive heart failure or valvular disease. However, in someone with a history of cancer, there is always the concern about enlarged lymph nodes. This does not mean cancer is present, as lymph nodes can become enlarged in infectious or inflammatory processes.

Often, the key is whether the hilum is continuing to enlarge. Size stability is reassuring. A CT scan usually is the best test for identifying what structure is causing the hilum to appear enlarged. Occasionally, a CT scan shows that there are no abnormalities, even if the chest X-ray suggests it.

DEAR DR. ROACH: The bottom of my arms looks like chicken skin. Am I missing some vitamins? — C.L.H.

ANSWER: That sounds like keratosis pilaris, an extremely common skin condition. It usually comes on during adolescence, but it can be earlier or later. It's not caused by lack of vitamins. A dermatologist can diagnose it just by appearance. I usually recommend lactic acid or urea creams as first-line treatment.

*** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.