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7/6/2020 My Gallbladder Surgery Story. And: The Water Party Project | Daniel Rosehill Blog Daniel Rosehill Blog Linux, writing, and more

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 4 ADAR 5780  EDIT My Gallbladder Surgery Story. And: The Water Party Project Topics: alcohol

Part One: My Gallbladder Surgery

A lile more than seven months ago I underwent one of the most common surgical procedures in the world: a laparoscopic cholecystectomy.

Or in normal person English: I had my gallbladder removed (using “minimally invasive” keyhole surgery).

What prompted a surgeon to extricate this apparently non-essenal organ from an otherwise relavely healthy 30 year old you might be wondering?

Let me tell you the story.

And aer I’m done, I’ll explain why, as a result of the operaon, I’m now asking people to meet me for glasses of water rather than pints of beer.

Warning: I’ve tried to minimize some of the detail required to explain my recovery from the surgery. But at mes what I have wrien here probably qualiﬁes, for many readers, as ‘too much informaon’.

My Journey Towards Surgery

For years, I had been having a recurrent ache in my right hand side that would come and go — but seemed to always return to the same place. Aer this happened several mes, I decided to see a family doctor.

https://www.danielrosehill.co.il/myblog/my-gallbladder-surgery-story-and-the-water-party-project/ 1/20 7/6/2020 My Gallbladder Surgery Story. And: The Water Party Project | Daniel Rosehill Blog The family doctor did a lile bit of prodding and pushing but one parcular prod elicited a sharp pain (I later learned that this is called a posive Murphy’s sign). Success, the doctor had found something. Or so I thought! “That’s your gallbladder,” he said, nonchalantly — and then quickly wrote me up a referral for an abdominal ultrasound.

The doctor informed me that my gallbladder was inﬂamed and gave me a referral for emergency surgery just in case I had an acute aack and the organ suddenly decided to fall apart at the seams while I was abroad (did you know that bad gallbladders can turn gangrenous?). A week later I had the ultrasound done — which mysteriously showed nothing amiss in my gallbladder.

I thought he was exaggerang about possibly needing surgery and didn’t think too much of it — expecng that, as the scan had been negave, whatever inﬂammaon might have prompted the symptoms would hopefully die down on its own.

Unfortunately, the pain returned a few more mes — always to the same place more or less. (It should be pointed out that I had been doing lile to maintain the health of my gallbladder for some years at this point including subsisng on a diet of primarily falafel!)

This me, however, the scan found the gallstones that had presumably been the cause of my symptoms all along.

The line from the report, in Hebrew, is below.

It translates as “ the gallbladder contains stones, up to 3mm in diameter.”

“ The gallbladder contains stones, up to 3mm in diameter.”

r so the technician thought.

You might be wondering why, even if I indeed had gallstones (spoiler alert: none were ever found!), they wouldn’t try to … you know … give me a pill to take.

The very strange thing about gallbladder surgery is that the medical community has essenally given up on pharmacological treatment (pharmacotherapy).

Although, at first glance, it might seem strangely macabre to be in a rush to excise organs, there are good reasons why this state of affairs has developed. https://www.danielrosehill.co.il/myblog/my-gallbladder-surgery-story-and-the-water-party-project/ 2/20 7/6/2020 My Gallbladder Surgery Story. And: The Water Party Project | Daniel Rosehill Blog Although there are sll a couple of drugs in the pharmacopoeia that are supposed to dissolve gallstones — ursodiol and chenodiol — the drugs take months or years to work, if they do at all, and their effecveness is, in general, relavely hit and miss.

But there’s a much stronger raonale at play.

And that’s that healthy gallbladders, by deﬁnion, do not make gallstones. Or sludge (a viscous buildup of ﬂuids including bile and cholesterol which oen preempts the formaon of stones).

Thus, even if the gallstones are successfully dissolved, the likelihood — some would say near certainty — is that they will invariably return.

And as gallstone-included cholecyss, in the worst case scenario, can lead to life- threatening complicaons — there is a strong raonale to remove the malfunconing organ enrely rather than hold on to it and be forced to commit to possibly a a lifeme of ultrasounds and monitoring.

This is because while the eﬃcacy of pharmacological treatments is uncertain, what doctors do know is that humans can live just ﬁne without a gallbladder (at least in theory!).

Thus, since the advent of laparoscopic surgery — ﬁrst performed early last century but only really perfected in the past 50 years — surgical removal of gallbladders that make stones, or that are found to have sludge in them, has somewhat incongruously become the ﬁrst-line, gold standard treatment for gallstone disease.

And given that the now universally available laparoscopic surgery involves shorter recovery mes than open surgery — and is less risky — the impetus to avoid it has been lessened even further.

And, as I was about to ﬁnd out, the criteria to meet is not very exacng.

Meeting with Surgeons

Aer the second ultrasound showed various small stones up to 3mm in diameter I was referred to a surgeon working with my health maintenance organizaon (HMO) who advised me that my best course of acon was to have my gallbladder removed. (HMOs provide basic

https://www.danielrosehill.co.il/myblog/my-gallbladder-surgery-story-and-the-water-party-project/ 3/20 7/6/2020 My Gallbladder Surgery Story. And: The Water Party Project | Daniel Rosehill Blog medical services in Israel. There are four of them and, by law, every cizen needs to be subscribed to one).

The consultaon couldn’t have lasted more than ﬁve minutes and he assured me — decisively — that I could be back at work the day aer the surgery if I so pleased (if your surgeon tells you this then you have my permission to not listen to him!).

The health fund surgeon, in turn, referred me to a surgeon at the hospital — the one who actually performed my surgery. The hospital surgeon more or less repeated the same thing as the health fund surgeon and informed me that while there was no way of knowing for certain if the small gallstones found on the scan were the cause of my symptoms he sll recommended that I had the organ out. A deﬁnite and I believe misguided “well, you don’t need it so it won’t hurt to have it out,” line of thinking seems to prevail among surgeons regarding all things gallbladder-related.

And so, without much further a-do, I was booked in for surgery.

The surgery day came about quite a lot sooner than I expected.

Out of the blue one morning, while working on an arcle for a client, I received a call from the hospital.

I could either have the surgery in two weeks me — or not for another few months.

I asked if I could get back to the hospital tomorrow with my answer? No way I was told — I would lose the slot.

How about by the end of the day? No such luck. The receponist demanded an answer right now.

It was the ulmate case of being put on the spot about a prey drasc life decision.

With the adrenaline coursing through my veins I decided to do something that I rarely do: I was brave and resisted the urge to do my own research online. (Which, in retrospect, was either a very good or a very bad thing depending upon how you look at it — Facebook groups are internet fora are ﬂooded with people just like me who have been saddled with health problems arising from the surgery that far exceed the gravity of the problem that prompted the surgery in the ﬁrst place.)

And so the day of the surgery ﬁnally rolled around.

https://www.danielrosehill.co.il/myblog/my-gallbladder-surgery-story-and-the-water-party-project/ 4/20 7/6/2020 My Gallbladder Surgery Story. And: The Water Party Project | Daniel Rosehill Blog Stage one of the journey was complete.

Oh, and the pathology report, which I received two a month later: my gallbladder didn’t contain any stones!

My pathology report from Hadassah a few months aer the ultrasound. In Hebrew: “[gall]stones were not found.”

Above: my pathology report from Hadassah. In Hebrew: “[gall]stones were not found.”

And Then: The “Difculties” Began

Immediately post surgery in Hadassah Ein Karem. If I look weird, it is because I was heavily medicated with painkillers when this photo was taken. I can’t make the same excuse for my haircut, though!

Unfortunately this marked the beginning, rather than the end, of something of a much bigger health saga.

A saga that I am sll dealing with as a I type this. Immediately post surgery in Hadassah Aer the typical post-op pain ﬁnally died down, the ﬁrst untoward Ein Karem. If I look symptom was a very bier taste in my mouth. weird, it is because

I was heavily I didn’t make the connecon between that taste and gastris at the medicated with me. But I have come to know that it serves as an early warning for a painkillers when ﬂare up. this photo was taken. I can’t make That bier taste was followed, in very short course, by symptoms that I the same excuse for recognized almost immediately to be gastris: An insaable appete; a my haircut, though! relentless gnawing raw pain in my midri (“as if my insides were scraped” is a common, and accurate, descripon); and a feeling of hunger that would return almost immediately aer I ate, as if I hadn’t eaten anything. https://www.danielrosehill.co.il/myblog/my-gallbladder-surgery-story-and-the-water-party-project/ 6/20 7/6/2020 My Gallbladder Surgery Story. And: The Water Party Project | Daniel Rosehill Blog As these symptoms connued, nausea and voming then joined the party — the laer consisng, each and every me, of almost pure bile.

And although I was not given any speciﬁc dietary advice (at least that I can recall) I did what those friendly people on the internet recommended — avoiding alcohol and fay food and scking to a rather bland and uninspiring diet (bear in mind that I am an ethic food ﬁend and that Ethiopian and Indian are my two favorite cuisines; this was not fun!).

The kicker was that exercise would kick the gastris up a notch too. So although, on several occasions, I tried to restart a ﬁtness program (with the idea of shedding the excess weight I was gaining by snacking in order to keep the worst of the gastris at bay) it seemed to only worsen the symptoms. It was a frustrang situaon to say the least — as if I’d drawn a checkmate in a game against my own recovery. Even as bland a diet as I could tolerate didn’t seem like enough to put the gastris into remission — or even come close.

Aer it became clear that the gastris wasn’t going to go away on its own accord, my family doctor referred me to a gastroenterologist.

While I was waing for that appointment, four months later, a (very well-intended) friend organized a pub crawl for my birthday to which a delighul coterie of people dufully showed up — some from another city. An IKEA bear who was also recovering from surgery I did what people who are the center of birthday pub crawls thrown in their honor are expected to do: I parcipated in the consumpon of beer!

And that was the ﬁrst me that I realized that my tolerance for alcohol had dramacally decreased since surgery.

I’ll leave the ugly details aside — or at least some of them.

But suﬃce to say that the beers I had on that evening seemed to have about the same eﬀect on me as what 10 or 15 of them might have had if I was an 18 year old college student intent on geng recklessly drunk at some college party.

My stomach simply couldn’t handle it.

Aer a wave of nausea that lasted hours struck, an 8 hour voming marathon mercifully ensued — again, marked primarily by the expulsion of large amounts of bile. Oddly, I noced https://www.danielrosehill.co.il/myblog/my-gallbladder-surgery-story-and-the-water-party-project/ 7/20 7/6/2020 My Gallbladder Surgery Story. And: The Water Party Project | Daniel Rosehill Blog I meditated. I tried to stay calm naturally. And I failed.

Sequestered in the pre-surgery room for just a lile too long the nerves ﬁnally began to hit — the ﬁnal stretch of the waing period was dragging on beyond the limits of my ability to hold in my anxiety about the surgery.

I asked for a tranquilizer and began to calm down. Next thing I knew I was being wheeled into an operang theater while a very reassuring anesthesiologist informed me that everything would be okay.

Then the cold feeling of the milky-colored anesthesia inducon agent, propofol, shoong up into my vein.

And next thing I knew I was in the recovery room treang the enre room to the theme song to the Brish children’s television show Rosie and Jim which— oblivious to the presence of other paents — I quite obnoxiously decided to blast over my phone’s loudspeaker (one emerges from anesthesia in a state of temporary delirium; and yes, this actually happened!).

Rosie & Jim

I stayed overnight at Hadassah Ein Karem hospital and was discharged the following day with the most basic of painkillers possible: acetaminophen.

https://www.danielrosehill.co.il/myblog/my-gallbladder-surgery-story-and-the-water-party-project/ 5/20 7/6/2020 My Gallbladder Surgery Story. And: The Water Party Project | Daniel Rosehill Blog that the vomit contained some food from the previous day (more about gastroparesis, and its lesser known sibling, later).

The strange thing, the few mes this has happened, is how quickly I bounce back.

The next day, back working at my computer, I almost felt as if nothing had happened.

But clearly the situaon was not neither normal nor going to go away on its own.

There was more invesgang to do.

Complication 1: Bile Reux Gastritis

On foot of my persisng symptoms, I had an upper endoscopy one month aer the operaon which yielded a diagnosis of reacve gastris.

The likely causave agent: bile reﬂux.

For those who are not aware, bile reflux is an extremely common complicaon of gallbladder removal — as many as 90% of paents develop it . Although, for reasons that are not fully understood, it doesn’t irritate the gastric mucosa (stomach lining) enough to cause gastris in all cases. In fact, symptoms and full-fledged bile reflux gastris develop in only 3 to 30% of paents with endoscopic evidence of bile reflux.

And although I neither claim to be an expert in medicine nor physiology, understanding why that is so isn’t in inordinately complicated.

The gallbladder’s primary funcon is to store the bile that the liver produces between meals and secrete it whenever fat is ingested. Bile is that greenish liquid that is used to help break down fats (malabsorpon of fat-soluble vitamins and minerals is, unsurprisingly, therefore another common adverse outcome of the surgery)

Without the gallbladder to act as a reservoir to hold it, the bile, once synthesized by the liver, essenally has nowhere to go when it’s not immediately needed and therefore both drips down into the colon and reﬂuxes upwards into the stomach where it causes irritaon.

This laer retrograde movement of the bile is what causes paents difficules with gastris and reflux. Downstream, in the colon, the excess bile acids can result in bile acid malabsorpon whose symptoms include diarrhea and urgency. In fact, with bile reflux in play,

https://www.danielrosehill.co.il/myblog/my-gallbladder-surgery-story-and-the-water-party-project/ 8/20 7/6/2020 My Gallbladder Surgery Story. And: The Water Party Project | Daniel Rosehill Blog bile can make it all the way up the esophagus and into the sinuses: when my symptoms were at their worst I literally had disnct green bile coming out my nose while I vomited.

Over me one’s physiology aempts to adapt — such that, I have read, the body begins storing bile in the bile ducts themselves. But the adaptaon is a slow and incomplete process. And in many cases, a chemical gastris develops as a result of the bile’s frequent pooling in the stomach. As most bile reflux sufferers, including me, have spent their fair share of me throwing up bile that it can severely irritate the stomach lining, or other ssues it was never intended to come into contact with, is rather unsurprising. This common post-surgical condion — which some doctors mistakenly think is vanishingly rare (laparoscopic surgery has turned that on its head)— is known as bile reflux gastris.

People with their gallbladders intact tend to not experience bile reflux to an appreciable, or at least to a pathological, extent — although there are some doctors who think that bile reflux plays an underappreciated role in treatment-refractory Gastroesophogeal Reflux Disease (GERD) — and some evidence to support that. Amazingly, sufferers oen encounter a slew of unsympathec (mostly old-school) gastroenterologists who will tell them that bile accumulaon is “totally normal” or that gastris resulng from it is something “very rarely if ever seen” — as if the fact that the bile is causing them to vomit several mes a week is either normal or imaginary. If this were the case before the advent of widespread laparoscopic surgery it does not appear to be the case now. And neither of these things in okay.

Unfortunately, in the grand scheme of all things gastris-related, bile reﬂux is a tricky variant to treat.

Unlike, say, gastris caused by taking too many NSAIDs, drinking too much alcohol, or by an infecous agent like H.Pylori infecon the causave agent isn’t me-limited — the liver will go on making bile and it will connue to pool in the stomach indeﬁnitely. Even with a perfect diet one cannot simply stop making bile. So in many cases lifelong treatment is the only opon.

But even treatment isn’t straighorward. Unlike the beer known form of reflux caused by the backflow of hydrocholoric stomach acid, which usually responds very nicely to proton pump inhibitors (PPIs), bile reflux is unfortunately quite tricky to treat — and the class of therapeuc agents is both limited and seemingly not in acve development.

To try get the gastris under control I was put on just about the only medicaon that works for this: a bile binder. This is the ﬁrst line treatment for bile reﬂux gastris (the last one is another surgery).

“Bile binders,” also known as bile acid sequestrants, are actually simply repurposed old cholesterol-lowering drugs that are prescribed oﬀ-label to mop up bile so that it stops sing https://www.danielrosehill.co.il/myblog/my-gallbladder-surgery-story-and-the-water-party-project/ 9/20 7/6/2020 My Gallbladder Surgery Story. And: The Water Party Project | Daniel Rosehill Blog in the stomach and causing gastris.

They are resins which chemically aach to the bile (hence the name) and then excrete it fecally. If you’d like that described in cruder terms: bile acid binders sck to the bile, carry it through your colon, and then it emerges from your other end. Because the bile is bound in the stomach symptoms in the colon — diarrhea and urgency — are also reduced.

An upside for a change: they lower LDL (“bad”) cholesterol modestly because this is what the drug was actually designed and indicated for. Another upside: they remain sequestered in the GI tract and so systemic absorpon does not occur (the drug does not pass into the bloodstream). In theory, this is supposed to minimize side eﬀects — although some like metabolic acidosis and further impaired absorpon of nutrients are sll possible. A downside: bile binders to not bind to bile exclusively. They can also bind to meditaons. Thus one can’t take oral medicaon one hour before or three hours aer ingesng one. This is true whether they are taken by pill or as a liquid suspension.

Unfortunately, as I was soon to discover, acquiring cholestyramine — or colesd, the other commonly prescribed ﬁrst generaon bile binder (which is a pill formulaon rather than a powder) — can be a trying endeavor. (There is one second generaon bile binder, colesevelam/Welchol, which apparently has higher speciﬁcity for bile; however, I have not been able to obtain it).

As stans have almost enrely supplanted these drugs’ role in treang high cholesterol, the only people that actually rely on them these days are those le with bile reﬂux and bile salt diarrhea as unfortunate complicaons of abdominal surgery (other abdominal surgeries commonly kickstart the condion too). As well as a smaering of paents with Crohn’s disease and IBS. All told, it’s a relavely small paent pool. Which also means less of an incenve for pharmaceucal companies to keep the drugs in producon and distribute them.

Naonal shortages of the various bile acid sequestrants happen periodically and in various healthcare systems.

I was lucky enough to be able to source mine through my local pharmacy. But it had to be ordered in especially and could only be obtained from my health fund’s own chain of pharmacies (this is not normally the case).

But in spite of the diﬃcules in sourcing them, and of having to drink a chalky chemical orange juice that might erode your tooth enamel several mes per day, bile binders appear to work.

https://www.danielrosehill.co.il/myblog/my-gallbladder-surgery-story-and-the-water-party-project/ 10/20 7/6/2020 My Gallbladder Surgery Story. And: The Water Party Project | Daniel Rosehill Blog Within about a week of starng cholestyramine — or “mutant orange juice” as I somemes call it (the drug is administered as a ﬂavored soluon) — my gastris has goen appreciably beer. The relentless gnawing feeling and the hunger began to slowly abate.

As the gastris tended to get worse with exercise — and I was also pung on weight due to the relentless feeling of hunger — I was hopeful that this might be the beginning of a new start.

It sort of was.

And Then: A Weird Motility Problem Starts

Cholestyramine: it damages tooth enamel so its best to drink it through a straw. I call it my “mutant orange juice”

Sadly, gastris (and fague — I have developed a micronutrient deﬁciency) are only two of the problems that I have been dealing with since the op.

Cholestyramine / “mutant The other is a lile stranger: A feeling that, whenever I drink orange water”. This can liquids, they simply sit in my stomach. have a devastang effect on tooth enamel so it’s As far as I am aware, I began nong this soon aer the surgery important to drink it with a too. But the gastris and the voming were more pressing straw and rinse your mouth concerns. Distracted by work, I could force it out of my mind. I aerwards won’t say much about this one other than that I am thankfully now under the care of an engaged gastroenterologist and that — as the gastris was — this too is being looked into. Bile reflux sufferers are notorious for shuffling through a variety of specialists as many sadly seem content to leave them heaving bile into toilet bowls indefinitely. Thus, finding one that cares, and is prepared to help, is a important milestone along the way.

My presumpve diagnosis for this second complicaon is impaired gastric accommodaon — a vagus-mediated condion (like gastroparesis) but which, unlike gastroparesis, involves the nerves of the stomach failing to expand the organ to “receive” food and liquids thereby creang a sensaon of a “blockage”. (By contrast, gastroparesis is a nerve-mediated problem on the other end of the organ — with emptying of food and liquid into the colon.)

Like post-surgical gastroparesis, the problem is possibly a result of damage to the crical vagus nerve, which controls so many aspects of our physiology, during the surgery. (Certainly, I https://www.danielrosehill.co.il/myblog/my-gallbladder-surgery-story-and-the-water-party-project/ 11/20 7/6/2020 My Gallbladder Surgery Story. And: The Water Party Project | Daniel Rosehill Blog never had a sensaon like it before the operaon and I am not directly making that allegaon for ahem … reasons). But, either way, it is impossible that causaon can ever be proven. And whether the chicken or egg came ﬁrst maers not one iota to my recovery.

The symptoms are essenally those of dyspepsia. I burp a lot aer eang just about anything which was mildly comical for about a month unl it just became plain annoying. But the feeling that liquids sit and slosh in the stomach — rather than move eﬀortlessly through it — is certainly the most bothersome of the problems that it has caused me.

Unlike gastris this set of problems is uncomfortable rather than painful or aching — mostly I ﬁnd it incredibly distracng so I have been trying to reverse the distracon by burying myself in work. Right now it’s about the best I can do. But it’s sll very early days in the journey.

Update: I Can’t Really Tolerate Much Alcohol Any More — But Especially Beer

Unfortunately, since the surgery, my ability to tolerate any alcohol whatsoever has only goen worse rather than beer — although perhaps I’m just drinking so lile of it that my system reacts more forcefully to the periodic ingeson — and my tolerance has undoubtedly plummeted.

When lockdown started my usual Thursday night pub expedions went out the window. As they did, work, paradoxically, picked up — in a dramac and life-consuming sort of way. And I gradually, perhaps insncvely, began avoiding alcohol at all.

For the past month or two my alcohol consumpon has essenally been limited to a glass of wine to iniate weekend. And a glass or two on the odd Zoom call with friends in Ireland.

However:

For reasons that are as of yet unknown any me I drink beer — speciﬁcally — I become violently ill. And I mean violently.

This week, Jerusalem started to re-open.

To mark the occasion we headed out to one of the ﬁrst bars to resume operaons to some extent and basked in one of the ﬁrst manifestaons of relave normality — something we would have taken enrely for granted in The Olden Days.

https://www.danielrosehill.co.il/myblog/my-gallbladder-surgery-story-and-the-water-party-project/ 12/20 7/6/2020 My Gallbladder Surgery Story. And: The Water Party Project | Daniel Rosehill Blog Two “ shlish “ (330ml) beers of 5% lager were enough, to my disappointment, to kick oﬀ another marathon nausea and voming spree — the ﬁrst I had had in about four months.

Right now, other than knowing that something is deﬁnitely amiss, I’m not terribly sure what is going on with my health. Blood-work has eliminated any obvious causes — but has not provided an answer either. Yet the connecon to the surgery, to me, again seems obvious.

What I do know is that I can’t tolerate beer for whatever reason. And that my ability to drink any other alcohol seems to be capped at about one unit.

I hold out a lile bit of hope that, as I move through the diagnosc process and put pieces of the puzzle together, I will one day be able to enjoy a pint of Guinness again without knowing that it will probably trigger a dramac expunging of my stomach contents several hours later.

But there has been a sort of unhealthy self-pitying grieving process to work through in the meanme.

Why me? And why me at the start of my thires? These are the sort of quesons that I have been grappling with internally and which, at mes since the operaon, have pinned me down into a sort of temporary depression.

I’ve mostly moved through that necessary journey. Right now my best bet is probably to play it safe.

And thankfully, I’m not facing the bale alone. At least virtually.

These problems might, at ﬁrst glance, seem unexpected or even dramac.

But in my quest to ﬁnd answers online, trawling through Facebook Groups and other online communies, I have encountered countless scores of individuals — of both genders, of all age brackets, occupaons,and prior health states — who have been le with these exact problems, and sadly, somemes much worse ones.

The sheer numbers, to my mind, are staggering: I would esmate that tens of thousands of people around the world are suﬀering through protracted digesve diﬃcules brought about solely through laparoscopic gallbladder removal — an operaon we are repeatedly told is a “harmless” way to extract a “useless” organ.

More incredibly, perhaps, I have also met plenty of individuals who appear to have similarly experienced false posives on ultrasound and who, aer parng ways with the organ, learned that it either contained no stones — or only contained sludge, a condion which can be https://www.danielrosehill.co.il/myblog/my-gallbladder-surgery-story-and-the-water-party-project/ 13/20 7/6/2020 My Gallbladder Surgery Story. And: The Water Party Project | Daniel Rosehill Blog relavely benign but which might, on the other hand, also foreshadow the development of stones themselves.

So for a lot of us it’s very murky business. But a few things, at least to me, are clear.

Such as that in my opinion, and that of many, and as the simple 80–90% incidence of post- cholecystectomy bile reﬂux into the stomach makes clear, extracng the gallbladder is not a “nothing” medical procedure that can be dismissed as having no eﬀect on paents’ lives aer the acute recovery period is complete.

It is an indisputable fact that humans digest beer, physiologically, when their bile can be stored in a reservoir. And, to resort to a truism, we probably wouldn’t have been engineered with a gallbladder if one didn’t serve a purpose.

But the eﬀects might be more far-reaching than bringing up bile unless we can ﬁnd a way to keep it away from our stomachs.

There is evidence that excess bile acid is far from innocuous even when it doesn’t result in clinically apparent gastris — cardiomyopathy has been linked to the pooling of bile acid in animal studies, an apparent distal eﬀect of the acid accumulaon in the stomach.

On the posive side, where there are many other paents there is solace in numbers and the potenal power of crowdsourced brainstorming to help ﬁnd, if not cures, natural or medical treatments which might alleviate some of the unfortunate consequences of this very common surgery.

I recently went on an iHerb trawl and have begun exploring what natural supplements might provide relief instead of pharmaceucals: psyllium husk replaces the bile binder and other natural compounds aim to migate other parts of the picture, such as nausea. Whether it will work, for me, I haven’t goen around to invesgang yet.

The best I can do is try. And see what works. And hope that in me, as medicine advances, we will ﬁnd a way to treat gallbladder disease without excising the organ at all.

And that when that happens the ranks of those suﬀering with bile reﬂux gastris, post- cholecystectomy syndrome, and the other countless labels and condions ed to this “roune” operaon will therefore empty.

Part Two

https://www.danielrosehill.co.il/myblog/my-gallbladder-surgery-story-and-the-water-party-project/ 14/20 7/6/2020 My Gallbladder Surgery Story. And: The Water Party Project | Daniel Rosehill Blog The Water Meetup Project

While going through the above has been as diﬃcult as it might sound I have to be honest and say that a large part of me has greatly enjoyed cung down drascally on my alcohol consumpon — even if my hand, or rather my stomach, was forced into the change by unforeseeable circumstances.

No doubt, as I have menoned, I miss being able to enjoy a couple of pints in a pub once a week without that simple pleasure making the next 12 hours of my life a living misery. And unl I work out why that is the case, or how to avoid it, that acvity is squarely oﬀ the table.

But I’m also feeling a lot more posive mentally aer the turmoil of the last six months. I’ve lost a lile bit of weight. And my wallet is certainly beneﬁng — even by just cung out a once weekly excursion to a bar, and the subsequent taxi home.

In a sense, the bizarre conﬂuence of lockdown and forced teetotalism that the year to date has entailed for me have forced me over some kind of mental threshold in my relaonship with alcohol. One which I feel I had been planning on crossing soon anyway.

For one, I have become a terrible bore of sorts.

Most nights of the week my Kindle, with a cup of water to enjoy it with, is a more encing proposion than watching Nelix with a glass of wine in hand.

It’s more interesng, I learn a lot from it, and, most importantly, I know that it isn’t going to make me sick in a few hours.

People change.

I have — along with the world — but so far this is one change that I, mostly, would like to keep.

As the world reopens, I realize that the very strange hermec existence that the strict lockdown condions forced upon me, and many, were, frankly, depressing days that I would not want to repeat.

I want to see people again! To share stories about things other than my health! But sadly, this me, even if it’s what my friends want, I know that that storytelling cannot be done in the company of a glass of alcohol. At least not now — because alcohol and wellbeing seem to have become mutually exclusive for me.

https://www.danielrosehill.co.il/myblog/my-gallbladder-surgery-story-and-the-water-party-project/ 15/20 7/6/2020 My Gallbladder Surgery Story. And: The Water Party Project | Daniel Rosehill Blog When looking for informaon about ways to meet people who don’t want their evening socializing to involve alcohol any more one is invariably and quickly drawn towards informaon wrien for those that have been forced to give up alcohol due to dependence issues — speciﬁcally alcoholism but somemes people who come to the conclusion that their drinking is facilitang some other vice or an unwanted behavior and wish to desist for that reason. As is well known, this is a large and signiﬁcant populaon.

However, I feel that people that have been forced to give up consuming alcohol suddenly and due to a medical issue want to approach the issue from a slightly diﬀerent point of view — and that, without a doubt, AA meengs are not the right venues in which to recruit a group of friends excited to embark upon a shared new journey of alcohol-free socializing but without, necessarily, intending to do so indeﬁnitely.

Like recovering alcoholics, I want to ﬁgure out a way to stay social without alcohol playing a part in those social interacons. But unlike reforming alcoholics I don’t see any parcular wisdom in cung out alcohol enrely if that can at all be avoided. I would be lying if I told you that were the case.

Because I saw something of a lacuna (the one I have described) I decided, this week, to set up a small Facebook community. It currently consists of myself and just one other member but others are more than welcome to join.

And I chose the unusual tle — Water Party Meetups — because I couldn’t readily think up answers to some quesons. Quesons that had begun gnawing at my brain as soon as the bile had stopped gnawing at my stomach:

Why can’t people be honest about the fact that they want to meet other people simply because it is fun and fulﬁlling to do so?

Why do many adults feel an insncve need to frame their socializing around alcohol — like meeng up at the pub, throwing a house party (with drinks on hand), or heading out for dinner (and wine)?

And if we don’t automacally frame our social engagements around “meeng for a drink” why do we, insncvely, have to reach for some surrogate that also happens to be psychoacve — coﬀee is the obvious one but many people, on hearing that I have severely curtailed my drinking, have suggested that I take up cannabis-smoking in its place (no thanks).

Or if we not for those opons, why do we feel the need to complicate things by insisng that what might be our ﬁrst forays into alcohol-free socializing for some me be done in the https://www.danielrosehill.co.il/myblog/my-gallbladder-surgery-story-and-the-water-party-project/ 16/20 7/6/2020 My Gallbladder Surgery Story. And: The Water Party Project | Daniel Rosehill Blog context of some hobby that requires specialized equipment, commitment, and skills?

I have a lot of interest into geng into new hobbies.

But right now my ﬁrst priority is to unlearn the ingrained adult habit of thought that when adults convene to socialize, in the evening hours, meeng in a bar is the most obvious neutral territory in which to do so.

Because that false belief, drummed into many of us by dint of years of repeon, is a total falsehood.

I can recall plenty of enjoyable encounters with friends before I once touched a sip of alcohol. Why should things be any diﬀerent now just because I’ve aged by 10 or 15 years in the intervening period?

For that reason, I came up with the idea of inving friends to “Water Pares.”

The idea, as I conceived of it, is that these meengs will involve meeng, ostensibly, to share and partake in the simple act of drinking a glass of water.

Yes, a glass of water! And why water, you might be wondering?

Because what could possibly be as boring and unexcing as drinking water?

And what other “hook” could lay bare, as transparently, that the idea is, rather, simply to meet, and enjoy the company of, other people?

That the purpose is to just sit and enjoy a chat with friends, whether old or new — and without deparng from mental homeostasis, hanging upside down from the ceiling, or climbing a mountain?

In my view, centering meengs upon this acvity would be the most eﬀecve means possible of encouraging people to meet simply for the joy of meeng other people. And for everybody involved to realize that that is simply what the whole iniave has been facilitated to entail.

In a long and roundabout nutshell, that’s the story of my gallbladder surgery, where my health is at now, and why — in the coming weeks — I intend asking the queson plenty of mes “Hi! Any interest in meeng for a a glass of water tonight?”

As I have menoned, I don’t see this as necessarily hinged to the idea of living a teetotal life. https://www.danielrosehill.co.il/myblog/my-gallbladder-surgery-story-and-the-water-party-project/ 17/20 7/6/2020 My Gallbladder Surgery Story. And: The Water Party Project | Daniel Rosehill Blog While my current wellbeing and drinking beer are mutually exclusive the possibility of a future spent meeng people mostly for water and occasionally for a glass of wine certainly are not.

Rather than framing this through the prism of misfortunate medical suﬀering I am trying to see this as an embarking up on a necessary journey — for me, and for anybody interested in joining — to unlearn an ingrained and harmful belief (that alcohol is integral to ‘having a good me’ as an adult); to recreate in a more healthy way; and to do so in a way that allows one to maintain, and even improve, one’s social life — because, as the lockdown has painfully borne out, socializing is a vital human acvity and essenal to human happiness.

If I can have a great night that isn’t bookmarked by ancipatory anxiety of what eﬀect it might have on my body and then the actual unpleasant eﬀect that will be a great achievement. The ‘how’ — and whether that involves water or beer — is unimportant.

If the above jives with you and you are interested in seng up your own local water chapter meeng then please be in touch.

To your health!