After experiencing recent weight loss and a change in bowel habits, I had a CT scan, which discovered a large gallstone. My doctor says just to leave it, unless it causes trouble. Is there anything I can do, such as adjusting my diet, to stop it causing problems?
Elisabeth Gardner, Eastbourne, E. Sussex.
Gallstones are small stones that form in the gallbladder for unknown reasons. As in your case, they are often found by chance, having been silent and caused nothing in the way of symptoms.
The gallbladder is a small, pear-shaped organ that is found on the right-hand side of the abdomen, tucked under the liver. It stores and concentrates bile, the yellow-green liquid made by the liver to help digest fats.
Bile also transports some waste products away from the liver, including pigment from old and worn-out red blood cells.
Gallstones are small stones that form in the gallbladder for unknown reasons (file photo)
Around one in five gallstones is made from this pigment, while most of the rest are formed from cholesterol and a few from a mixture of each.
Gallstones are common — five per cent of men and eight per cent of women have them and the risk increases with age. In most cases, they cause no problems, but, if one gets trapped in a duct in the gallbladder, it can cause sudden, severe pain.
Known as biliary colic, it often comes on after a fatty meal and lasts several hours, before easing when the stone works its way free.
However, if the stone isn’t expelled, the gallbladder can become infected and inflamed and may have to be removed.
As your doctor advised, when gallstones are symptom-free, there is no need for treatment. But, with there being up to a one in four chance that they will go on to cause problems, you have posed a very valid question.
The only dietary rule to stand the test of time in terms of reducing the risk of biliary colic is to adhere to a low-fat and low-oil diet.
I must add that it is important not to lose sight of the initial problem for which you sought help: weight loss and altered bowel habits. If the instruction is to leave the gallstone alone, then I assume that your doctor does not attribute these symptoms to its presence — so a diagnosis must still be found and it is important that their cause is pursued.
The gallbladder is a small, pear-shaped organ that is found on the right-hand side of the abdomen, tucked under the liver. It stores and concentrates bile, the yellow-green liquid made by the liver to help digest fats
I’ve had chronic osteomyelitis, a bone infection, since contracting it aged five. It flared up in my 20s, when I had to have the infection surgically drained and intravenous (IV) antibiotics.
I’m now 64 and it has flared up again. Blood tests show no sign of infection, but I can feel it getting worse — yet the orthopaedic doctors refuse to give me IV antibiotics.
Name and address supplied.
Osteomyelitis is a bone infection, which, though relatively rare in developed countries, is most common among children. You had haematogenous osteomyelitis, which occurs when bacteria enter the bloodstream, typically as a result of an infection elsewhere in the body — for example, tonsillitis — and take up residence in part of the skeleton.
In children, this tends to be in the long bones in the arms or legs. In adults, more often the pelvis or spine is affected — but why that should be the case is unknown. I am guessing from your letter that one of the long bones of your leg was involved.The bone fills with pus, resulting in a fever and pain at the site of the infection.
In all my years in medicine, I have come across only one case, and this occured in the spine following a bout of tropical gastroenteritis.
Non-haematogenous osteomyelitis occurs as a result of the spread of infection from adjacent soft tissues, or by direct infection of bone resulting from trauma or surgery.
Either form can lead to chronic osteomyelitis, an infection that can persist for months or years. The infection and the accompanying inflammation may reduce the blood supply in the bone — as a result small sections of bone may die and form what is called a sequestrum.
This may not cause any symptoms, but, left in place, it can be a source of further infection in the future, as a sequestrum may act as a foreign body where bacteria may lodge and be inaccessible to the antibiotics in the bloodstream — ready to reactivate at a later stage.
Another complication is the infection breaking through the skin, which requires treatment with high-dose antibiotics.
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Always consult your own GP with any health worries.
It is characteristic of the form of osteomyelitis you had for recurrences to take place, especially if there has not been a surgical clearance of any dead bone.
It appears you’ve recently suffered pain at the site of the previous infection, which is why, as you set out in your longer letter, you’ve been prescribed pregabalin and amitriptyline (drugs to treat epilepsy and depression respectively, but used at lower doses to treat nerve pain).
If there was an active infection, it would invariably be associated with a rise in inflammatory markers in the blood. Diagnosis of an infection can also be confirmed by an MRI or isotope bone scan — but your MRI was clear.
So there is a conflict between your sense that infection has recurred and the findings of the investigations.
At the very least, your GP could repeat the blood tests for inflammatory markers. If there is a significant elevation in these, then there would be a powerful incentive to repeat the scan.
IN MY VIEW: Teens and early starts don’t mix
Teenagers are to be allowed to start school at 10am as part of an Oxford University study to see whether having a lie-in improves their performance.
A recent U.S. study found delaying the start of the school day meant the pupils slept on average 34 minutes longer and there was an improvement in their classroom performance. The inference is that teenagers don’t suit early starts.
Sleep studies have previously shown that the production of the hormone melatonin, which sets the sleep-wake cycle, is altered in teens so they remain awake and unready for sleep until much later than when younger.
But, during adulthood, this pattern changes back, which is why parents find it so hard to understand why their teenage children are not ready for bed at the same time they are. Yet research informs us adolescents have poor decision-making skills and are more liable to taking unhealthy risks. So, at this stage of life, sufficient sleep is essential for many reasons.
But how do you solve the conflict of the teen who does not want to turn in for the night, even when they face an early start for school the next day? There is no easy answer; banning the use of screens (laptops, tablets, phones, etc) beyond a certain time and hammering home the value of regular exercise will go some way to stabilising sleeping patterns.
And if your teenager sleeps a little longer at weekends or during holidays, then try to remember: they are just doing what comes naturally.