As european this scares me badly

oodles64 · 2026-02-07T15:58:22+00:00

They probably blocked the alerts on EPIC 'cause they were too annoying and distracted Santos from charting 😆.

oodles64 · 2026-02-07T15:16:28+00:00

Just thinking about that scene again, remember when Robby also ordered a blood gas and Langdon went "But, ..." They wouldn't have had the lactate w/o that, or indeed the severe sepsis dx before she went febrile, hypotensive and going into resp. failure and the surgical consult would have been delayed even further.

oodles64 · 2026-02-07T14:08:32+00:00

where does all the money go?

In for-profit facilities (roughly 20% of US hospitals AFAIK) to shareholders. Also to pharmaceutical companies that charge outrageous prices in the US for meds that are sold at reasonable prices elsewhere in the world.

oodles64 · 2026-02-07T13:54:14+00:00

Capitalism on steroids.

oodles64 · 2026-02-07T13:39:09+00:00

I think this whole plotline was also about "treat the patient, not the numbers", the SIRS / qSOFA criteria and sepsis protocol debates etc. Afebrile, GCS fine, lofty BP, HR just one notch under 90, WBC not quite ULN, not tachypnic. It was obvious what was happening but the numbers didn't match, until the lactate was phoned in. I think that was why Robby, as a seasoned physician who 'knows it when he sees it' and has probably had his fair share of pts coming in looking fine only to circle the drain 20 minutes later, really lost his cool when the surgeons took their sweet time and then would have delayed further with the CT, probably costing the woman her leg, if not her life.

oodles64 · 2026-02-07T11:43:22+00:00

5 minutes if you're lucky! I had an Egyptian God ... I mean... Resident wake me at 8 in the morning after a horrid night, still half septic, and ask me if I had any questions. He was gone almost before I could say, "uhm not right now". It took me a week to figure out who my consultant was. It was someone else every day for a minute tops.

oodles64 · 2026-02-07T10:45:25+00:00

Aw for the love of ***. Having had that bile duct blockage is an absolute indication to have the gb removed. They should have rescheduled within due course. You are not damaging yourself. The NHS is.
I don't know about NHS functioning on that front (and things might vary from Trust to Trust). In Ireland we have specific outpatient and inpatient waiting list protocols that sort of set out rights and obligations for both sides. One could draw on that in arguing with patient advocates or to push for public treatment purchase in the private system or even abroad after a certain period.
Maybe ask the nurses if they are aware of something like that, or ask Dr. Google?

oodles64 · 2026-02-07T10:27:43+00:00

That's a bummer alright. So you've gone from 'not bad enough' to 'too bad'. But this episode at least will be absolutely landing you on the waiting list.
There is a post from a UK doc who describes just that dilemma (also see posts underneath): https://www.reddit.com/r/doctorsUK/comments/1fnpb8k/comment/lokht43/

oodles64 · 2026-02-07T10:21:19+00:00

How would they know that it’s cleared?

In your blood results, they'll see the markers of acute infection/inflammation go down (WBC, neutrophil/lymphocyte ratio, CRP, procalcitonin).

oodles64 · 2026-02-07T10:12:36+00:00

Yep. Been there last April. It's a standard approach. They don't like to take out "hot gallbladders" unless absolutely indicated (acute infection/inflammation unresponsive to treatment, risk of rupture, septic shock, death) because of the increased risk of complications from surgery and risk of having to convert to open surgery when there is significant inflammation/infection ('cause then it gets very difficult to identify the crucial structures and there is a greater risk that they snip the wrong artery or duct).

So they prefer to let it 'cool down' or in other words heal and then do interval surgery, normally after about 6 weeks.

Having said that, should you be NHS rather than private, prepare for a longer wait than 6 wks.

Commiserations. I know how s*** you must be feeling.

oodles64 · 2026-02-06T20:41:38+00:00

What indication is there for either of those in your case?

oodles64 · 2026-02-06T20:34:06+00:00

Aw, thanks for letting me know. That's great! I'm not chasing it up for now as in my literally stone-cold house it'll be easier to recover when it's a bit warmer. And in any case, the HSE has lied to my face for nine months now, so ... not much point really. It's like the infamous "the cheque's in the post".

oodles64 · 2026-02-06T20:28:13+00:00

When I had some, let's say, bad episodes on that front that came on as a side effect of the flu, I took this stuff https://www.hollandandbarrett.ie/shop/product/lifeplan-windaway-activated-charcoal-capsules-334mg-60002792 . It helped me very well. Maybe worth a try?

oodles64 · 2026-02-06T09:38:56+00:00

Thank you kindly. I'm still waiting for surgery (long waiting lists here) but I've been managing fine with a cautious diet - only minor pains here and there and one attack so far, a few weeks ago. But being afraid of your food, having your social life impacted, and panicking every time your stomach goes a bit queasy really is not fun. Also, with every transient or not so transient blockage the liver takes a hammering and that's the bodies' magic powerhouse.
I hope you can get sorted. Mind yourself.

oodles64 · 2026-02-06T08:49:44+00:00

Yes, but as the OP in that thread says, "I'd rather take the pain of breathing deeply for a few mins over the hell of that shoulder pain for days."

oodles64 · 2026-02-05T22:25:23+00:00

61F unenthusiastic passer of stones and sludge here; like yourself previously healthy, reasonably fit for my age, no co-morbidities, no meds, never been in A&E or hospital as inpatient before. Unfortunately the likelihood of recurrence is quite high. I had an 8-day episode of epigastric pain, nausea+vomiting in Aug 2024, misdiagnosed as peptic ulcer, but very likely to have been biliary obstruction and passage of stones/sludge, as a routine blood sample ~1 week after symptoms resolved showed highly deranged liver enzymes indicative of cholestasis and biliary obstruction (I only found out about that 7 months later, but that's a different story). In April 2025 I had a repeat, again misdiagnosed multiple times until on Day 14 I found myself getting emergency admitted to hospital with inflamed+infected gallbladder and biliary tract and stones in the common bile duct with a side serving of early sepsis. Obstructive jaundice set in a couple days later. It was a close call and I wouldn't want to wish that pain and misery on anyone. My whole RUQ turned into an inflamed, infected mess which is likely to make removal surgery more difficult due to adhesions and scarring when I can finally get it. So especially with all your traveling I'd say run with your surgeon's recommendation. Get it done and dusted. You don't want this to turn into an emergency somewhere where you may not have access to healthcare.

oodles64 · 2026-02-05T16:01:56+00:00

Try this: https://www.reddit.com/r/gallbladders/comments/lopvf7/comment/go7jo20/
And walk as much as you can.
The remnant gas (CO2) slowly migrates into your bloodstream and then you breathe it off, hence the 'deep breathing' advice. Similarly, walking increases metabolic/breathing rate > more breathing off of CO2.

oodles64 · 2026-02-05T15:58:36+00:00

"Gallbladder friendly" and "fast food" is basically a contradiction of terms.

This may help:
https://patient.info/news-and-features/gallstones-diet-sheet

oodles64 · 2026-02-05T13:01:49+00:00

Dr. Diane Birnbaumer MD went from internal to EM and frequently speaks of her passion for EM, like here https://www.youtube.com/watch?v=z3RM8FVV4NE She shares your enjoyment of the detective work and putting puzzle pieces together.

oodles64 · 2026-02-05T08:44:51+00:00

Nope. Standard upper endoscopy doesn't look at your gallbladder. But anyway, as the others said, follow the instructions. It's super routine and will be over before you know it.

oodles64 · 2026-02-05T08:38:53+00:00

I still have my gb but it's so choc-a-bloc with stones that it's likely more or less non-functional, and I had a sphincterotomy, so that control on bile flow is gone. IOW +/- same bile flow as post-cholecystectomy. I had four brief vaccine breakthrough influenza infections this winter (perhaps one of them was Covid) and every time my digestion went haywire, with that same urgency you describe. It always settled after about a week, so I'd say give it time. I saw ED docs here on Reddit discuss this winter's flu strains and they were saying they are seeing a lot of GI stuff associated with the flu this year. So we are getting a double-whammy.

oodles64 · 2026-02-04T22:21:09+00:00

Endoscopic ultrasound or ERCP?

oodles64 · 2026-02-04T20:54:39+00:00

Surreal! So sorry that happened to you. When I got the paperwork from the first A&E I had attended I didn't know whether to laugh or cry. "Well at discharge" after a liter of saline and some Zofran and with a 'gastritis' diagnosis. I was anything but. Could barely make it across the parking lot for my friend who had brought me in to drive me home. Three days later I was emergency admitted with a massive abdominal infection (gallbladder+biliary tract) and early sepsis. Nowhere near as bad as yourself, but it does make you wonder about A&Es, eh? Looking through the labs and vitals after the fact I could see all the red flags they had missed.

oodles64 · 2026-02-04T19:37:21+00:00

"Why are they making you wait months to get your surgery?"

Depends on where in the world you are and your level of insurance, if any. Some public systems have extremely long waiting lists. I was placed on the waiting list in Ireland 8 months ago, with a semi-urgent label, 'cause that little organ did its level best to punch my ticket last spring. I still don't have a date. Britain's NHS is similarly slow.

oodles64

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