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Gastroenterology  (Expert Forum)
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Gallbladder Disease No Stones Worried About Insurance Denial
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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MedHelp Member's Question

Gallbladder Disease No Stones Worried About Insurance Denial

by sarabugstar, May 12, 2005 12:00AM
I've had nausea, diarrhea, and pain in back below shoulder blade for about a year now.  My family doc sent my to Gastroenterologist.  He has done colonoscopy, gastric endoscopy, barium small bowel, ultrasound, HIDA scan with CCK, gastric emptying series, SED rate test, and a series of blood tests.



All tests have come back in normal range.  I still throw up at least once a day. I haven't had a bowel movement that wasn't diarrhea in over 8 months.  I feel bad all the time.  If I eat late, I have severe pain below my right shoulder blade. I can only eat the smallest amounts without nausea, still will have diarrhea. If I sit down to eat, all of a sudden have immediate diarhhea.



I'm 26 years old, female.  Family history of gallbladder disease without stones includes father, both grandmothers.



GI prescribes reglan, prilosec - no relief.  GI then sends me to a surgeon for laparoscopic cholocystectomy with a liver biopsy.  Surgeon agrees and schedules.  Insurance stops surgery, says they won't pay if no stones or significant physical disfunction are found at time of surgery.  Have gotten third opinion that says to do cholocystectomy.



Should I risk the surgery? Any experiences with insurance not paying in this case?



Thanks!
Doctor's Answer

by Kevin Pho, MD, May 14, 2005 12:00AM
If all the tests are normal, including the ultrasound and the HIDA scan with CCK, there is no guarantee that removing the gallbladder will help.  



That being said, you have already been through a pretty comprehensive set of GI tests - most of the more common causes would have been found already.  



You can consider a 24-hr pH study as well as an esophageal motility study to definitively look for GERD as well as esophageal motility disorders that may lead to your symptoms.



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Kevin, M.D.

Medical Weblog:

kevinmd_b
Member Comments (7)

by yoshi, May 12, 2005 12:00AM
if your insurance said they wont pay if no stones or serious dysfunction found,they are not going to pay .

what kind of blood tests have you taken??

by sarabugstar, May 12, 2005 12:00AM
I've had SED rate, full liver panel, glucose, cholesterol, and I honestly don't know all the others by name.  I know the functions: white blood count, red blood count, CBC, thyroid panel to name a few.



Just had to fight off a bout of nausea from having a grilled chicken sandwich at lunch, and lost the battle to the nausea.  I have an appointment next week for yet another opinion, this from a GI Specialist who is also a surgeon.



I just want to feel better and get back some of the quality of life that have been missing for the better part of a year...

by yoshi, May 12, 2005 12:00AM
they left out a simple breath test for hector pylori bacteria,which can be done in doc's office.

did they test you for IBS??

by sarabugstar, May 12, 2005 12:00AM
no IBS, according to the GI... no Crohn's, not a single polyp, very minor irritation in stomach lining... no pancreatic tests or kidney tests done at all...

by surgeon, May 14, 2005 12:00AM
Given the normal results of every test you've had, it's actually a pretty long-shot that removing the gallbladder will help. To be honest, I'm a little surprised the surgeon agreed to do it; if I'd been the surgeon, I'd have been very reluctant. I can't say it's clearly wrong to go ahead; no tests we do are perfect, and sometimes you have to decide based on experience, instinct, etc. But unless you are so miserable you are willing to try anything, even knowing that the surgery may well do no good, and might make things worse, I'd advise waiting.

by sarabugstar, May 16, 2005 12:00AM
To: surgeon/Everyone
In your opinion, what should I ask my GI doctor to do? I am going today for a fourth opinion from another GI specialist.  I am at the point that every meal is a challenge - not knowing if I can keep dinner/lunch/breakfast down is now keeping me from going to certain business functions to avoid the embarassment of running out in the middle of the presentation.  When my nausea hits, i get hot in the face and it's immediate.  There's no warning period at all.  It's the same with the diarrhea.  If I'm not within 5 minutes of being able to go to the bathroom when the first cramp happens in my lower abdomen, then I'm in trouble.



Then, of course, I have days when I feel great all day.  However, the longer I deal with this, the fewer good days I have.  Over the weekend, I had the first extremely intense pain underneath my right shoulder blade.  When it hit, I felt like someone had knocked the breath out of me.  It lasted about 35 minutes, getting better after the initial cramping feeling.



What disorders would cause BOTH the nausea and diarrhea?  The two definitely seem linked.  Are there any homeopathic options available?

by pudntane, May 31, 2005 12:00AM
To: Sarabugstar
From my personal experience, gallbladder removal did NOT help me with diarrhea... it worsened mine.  (I DID have gallstones, lots of 'em).  They "claim" that your body gets used to not having a gallbladder within a year or so of removal, however it's been over five years, and just eating will send me RUNNING!  (Important Note: I have, just recently, been diagnosed with IBS.)  



I did a quick google and found the following website: http://aihc1998.tripod.com/gallbladder.html



From that site:

==

"A gallstone attack usually is marked by a steady, severe pain in the upper abdomen. Attacks may last only 20 or 30 minutes but more often they last for one to several hours. A gallstone attack may also cause pain in the back between the shoulder blades or in the right shoulder and may cause nausea or vomiting. Attacks may be separated by weeks, months or even years. Once a true attack occurs, subsequent attacks are much more likely."

===

Did you have an ultrasound?  They kept saying that I was too young to have gallstones (I was 32), but the "my gravel pit" showed up on the ultrasound.



Have you heard about the "F" test.  They originally called it the "4 Fs" but I've since heard 2 more:  Forty, Female, Fertile, Fat, Fair(?), Flatulent.  Lucky me, I fit all categories except 40. (Don't know what "fair" has to do with anything).



Homeopathic treatment?  For Gallbladder, there is something called a "gallbladder flush."  Basically consuming 1/2 cup olive oil followed by grapefruit juice or lemon juice. YUCK!



It's up to you whether or not you'd want to do something like that. (I figure it's great as a gallstone preventative, but if you already have stones, it would be #1. painful trying to flush out