Where do gallstones come from?
DEAR DR. DONOHUE: It has been one week since I had my gallbladder removed. It was full of stones, and I suffered numerous painful attacks because of it. I am glad it is gone. I should have asked this years ago, but I didn't: Why do gallstones form, and how can they be prevented? -- L.G.
ANSWER: Most gallstones begin their lives as crystals of cholesterol in the gallbladder. Bile acids keep cholesterol dissolved. When cholesterol saturates bile beyond the capacity of bile acids to keep it liquid, the cholesterol crystals form. It's much like putting too much sugar in a cup of coffee. No amount of stirring will dissolve all the sugar. A portion of it sinks to the bottom of the cup. Crystals are the start of a stone.
This leaves unanswered the question of why there is too much cholesterol in the bile. Female hormones must have a hand in oversaturating bile with cholesterol, because twice as many women as men have gallstones.
Diet also plays a part. A high-fat diet favors stone formation. Obesity is a definite risk for gallstones. Rapid weight loss is another factor that brings on gallstones.
Age definitely influences gallstone generation. Stones don't usually make an appearance until well after age 40, with the highest incidence a decade or more later.
Genes are also responsible. Quite frequently, a person who has gallstones can find relatives who have or had them. To cement the relationship of genes to gallstones even more solidly, some ethnic groups tend to be prolific stone formers. One tribe of American Indians is a constantly cited example.
Some illnesses have gallstone formation as one of their signs and symptoms. The inherited anemia thalassemia is a case in point.
More than 20 million North Americans have gallbladders with stones in them. A majority of those people never have a twinge of pain and never need to have their gallbladders removed.
DEAR DR. DONOHUE: Is it possible to have gallbladder attacks without having gallstones? I am told this is my problem. When I tell others, they look at me in disbelief. One even said my doctor is simply trying to make money by removing my gallbladder. -- C.G.
ANSWER: Your doctor is not trying to con you. It most certainly is possible to have attacks of gallbladder pain without gallstones. The condition goes by the name of acalculous (ay-CAL-cue-luss -- no stone) cholecystitis (COE-luh-sis-TIGHT-us -- gallbladder inflammation). It causes the exact same pain that comes from a gallbladder irritated and inflamed by gallstones. The pain can double a person over and is felt in the upper right side of the abdomen just below the ribs. It usually comes on after eating fatty or fried foods, or onions, cabbage or spicy foods.
Not being able to detect stones with ultrasound or X-ray pictures makes the diagnosis more difficult. There are, however, ultrasound, X-ray and scanning procedures that lend credence to the diagnosis.
Your friend needs to apologize to your doctor.
DEAR DR. DONOHUE: What is the difference between myocardial ischemia and myocardial infarction? I saw both words in a report my husband's doctor wrote to his employer. -- C.S.
ANSWER: "Myocardial" denotes heart muscle. A myocardial infarction (in-FARK-shun) is a heart attack. Myocardial ischemia (is-KEY-me-uh) is the forerunner of a heart attack. It indicates that the heart muscle is getting an insufficient supply of blood to support normal heart pumping. The chest pain of angina is a symptom of myocardial ischemia.
DEAR DR. DONOHUE: Is it possible for genital herpes to infect the eye? -- Anon.
ANSWER. It's possible for a person to touch the infected genital area with a finger and then spread genital herpes to the eye by touching the eye with the same finger. So the answer is yes. It does not happen frequently. The involved virus is the herpes-2 virus.
Herpes eye infections are more commonly caused by the herpes of cold sores, the herpes-1 virus.
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Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.
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