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Thread: Chest Tightness

  1. #1

    Chest Tightness

    I found out the tightness is caused from gallstones. I am meeting with my docs this week seeing if any other options besides surgery. Anyone know of medications that will shrink or dissolve stones? Don't mind surgery, just sucks finding time. Especially since the only surgery I really want isn't this one!!

  2. #2
    backspace, I am glad that they got to the bottom of this. Depending of the size and number of gallstones, they can remove through endoscopy. However, because people with spinal cord injury have a high risk of gallstones, your doctor probably will recommend surgery to remove the gallbladder. Here are some abstracts on the subject of gallstones in people with spinal cord injury.

    Wise.

    • Apstein MD and Dalecki-Chipperfield K (1987). Spinal cord injury is a risk factor for gallstone disease. Gastroenterology. 92: 966-8. The purpose of this study was to determine the prevalence of gallstone disease among patients with a spinal cord injury. We identified all patients with a spinal cord injury of greater than 2 weeks' duration who died and underwent an autopsy between 1975 and 1985. These 38 patients with spinal cord injury were age-, sex-, and race-matched with 38 patients without spinal cord injury who underwent an autopsy during the same period. Gallstone disease was significantly more prevalent in patients with spinal cord injury (11 of 38 or 29%) compared to the control population (4 of 38 or 11%) (p less than 0.05; odds ratio of 3.46 with 95% confidence interval of 1.08-11.24). A significant difference in age or level or duration of spinal cord injury was not found between patients with spinal cord injury who had gallstone disease and those who did not. Possible explanations for this threefold increase in risk of gallstone disease among patients with spinal cord injury include abnormal gallbladder motility resulting in stasis, decreased intestinal transit leading to an abnormal enterohepatic circulation, and metabolic changes leading to abnormal biliary lipid secretion.
    • Fong YC, Hsu HC, Sun SS, Kao A, Lin CC and Lee CC (2003). Impaired gallbladder function in spinal cord injury on quantitative Tc-99m DISIDA cholescintigraphy. Abdom Imaging. 28: 87-91. Department of Orthopedics, China Medical College Hospital, No. 2 Yuh-Der Road, Taichung 404, Taiwan. BACKGROUND: Patients with spinal cord injury (SCI) have increased prevalences of gallstones and acute acalculous cholecystitis. A possible explanation for the increased prevalence of gallstone disease in SCI patients is decreased gallbladder motility causing gallbladder stasis, a known risk factor for gallstone disease. We investigated gallbladder function in SCI. METHODS: Twenty-five normal control subjects and 50 SCI patients were included in this study. Gallbladder function was measured by technium 99m-labeled imino-diacetic acid analogue (Tc-99m DISIDA) cholescintigraphy and represented by the filling fraction (FF) and the ejection fraction (EF). The SCI patients were assigned to subgroups: old versus young, female versus male, high- versus low-level injury, and long versus short injury duration. RESULTS: Forty-two percent of SCI patients had abnormal FFs and 54% of SCI patients had abnormal EFs. Significantly decreased FF and EF values were found in SCI patients, especially in those who were female and had high-level injuries. CONCLUSION: With the use of quantitative Tc-99m DISIDA cholescintigraphy, we found that SCI can significantly impair gallbladder function.
    • Ketover SR, Ansel HJ, Goldish G, Roche B and Gebhard RL (1996). Gallstones in chronic spinal cord injury: is impaired gallbladder emptying a risk factor? Arch Phys Med Rehabil. 77: 1136-8. Department of Medicine, Department of Veterans Affairs Medical Center, Minneapolis, MN, USA. OBJECTIVE: To confirm that spinal cord injured persons are susceptible to gallstones and to evaluate the role of gallbladder stasis as a risk factor. STUDY DESIGN: Twenty-nine subjects with chronic spinal cord injury underwent fasting ultrasonography to determine the incidence of gallstones and to quantitate gallbladder emptying response to a 20g fat liquid meal. Gallbladder emptying fraction was compared to that of healthy subjects studied concurrently. RESULTS: Gallstones or sludge were found in 6 spinal cord injured men, a minimal prevalence of 21%. Four additional subjects had prior cholecystectomy for stones, giving a potential maximal prevalence of 30%. Four of the 6 subjects had gallstone risk factors of diabetes, obesity, and/or family history. Gallbladder stasis was not apparent in chronic spinal cord injured subjects. Only 5 subjects had poor gallbladder emptying, and 4 of them had diabetes and/or obesity. CONCLUSIONS: The study confirms an increased prevalence of gallstones after spinal cord injury. However, gallbladder stasis did not appear to be etiologic, and most gallstones were associated with conventional risk factors. The results do not support a general policy of gallstone screening or prophylactic therapy after spinal cord injury.
    • Nino-Murcia M, Burton D, Chang P, Stone J and Perkash I (1990). Gallbladder contractility in patients with spinal cord injuries: a sonographic investigation. AJR Am J Roentgenol. 154: 521-4. Radiology Service, Veterans Administration Medical Center, Palo Alto, CA 94304. Approximately 30% of all patients who have spinal cord injuries have gastrointestinal symptoms. One cause is gallstone disease; indeed the literature suggests that gallstones are more common in patients with spinal cord injuries because these patients have impaired contractility of the gallbladder with a reduced ejection fraction. To test this hypothesis, we obtained gallbladder sonograms in 30 patients with spinal cord injuries (16 quadriplegics and 14 paraplegics) and in 32 uninjured age-matched control subjects. Four patients and four asymptomatic control subjects had gallstones and were excluded. The remaining 26 patients and 28 control subjects fasted for 12 hr. Longitudinal and transverse sonograms of the gallbladder were made immediately before the ingestion of 25 g of fat, and at 10, 20, 30, 45, and 60 min thereafter. Gallbladder volumes were measured by using the ellipsoid method. Resting and residual volumes and the emptying times were determined and the ejection fractions were calculated. The ejection fractions were significantly lower (p = .003) in the patients than in the control subjects because the resting volumes were lower than in the control subjects (p = .013). However, the emptying times and residual volumes were the same in the two groups. We conclude that gallbladder contractility is normal in patients with spinal cord injuries and that the lower ejection fraction found in such patients is due to a smaller resting volume.
    • Tola VB, Chamberlain S, Kostyk SK and Soybel DI (2000). Symptomatic gallstones in patients with spinal cord injury. J Gastrointest Surg. 4: 642-7. Department of Surgery and the Spinal Cord Injury Service, West Roxbury Veterans Administration Medical Center, Mass. 02132, USA. Patients with spinal cord injury (SCI) have an increased prevalence of cholelithiasis. The goal of this study was to clarify the presentation and management of symptomatic gallstone disease in patients with SCI. We performed a retrospective study of presentation of gallstone complications in patients with SCI who underwent cholecystectomy for complications of gallstone disease. The West Roxbury Veterans Administration Medical Center SCI registry (605 patients) was searched for patients who had undergone cholecystectomy more than 1 year after SCI (35 patients). Gallbladder disease profiles for the 35 patients undergoing cholecystectomy for complications of gallstone disease were prepared, including demographics, clinical presentation, diagnostic studies, operative and pathologic findings, and postoperative complications. All patients were white. Thirty-four were male and the mean age was 50 years (range 35 to 65 years). The majority of patients (66%) complained of right upper quadrant abdominal pain, even those patients with SCI at high (i.e., cervical) levels. Of the 35 patients in our study group, 22 (63%) had biliary colic and chronic cholecystitis, nine (26%) had acute cholecystitis (gangrenous cholecystitis in two), two (6%) had choledocholithiasis symptoms or cholangitis, and two (6%) had gallstone pancreatitis. Major perioperative morbidity occurred in two (6%) of the 35 patients (pulmonary embolus; intraoperative hemorrhage), and there were no deaths. In the great majority of patients with SCI, cholelithiasis presents with chronic pain and not with life-threatening complications. Our findings suggest that presentation is no more acute in patients with SCI than in the general population. Characteristic symptoms and signs are not necessarily obscured by SCI injury, regardless of the level.

  3. #3
    The stones are small from what my family do ctor said. He suggests removal.. I will be meeting with a surgeon next week. There aren' t any medi cations or vibration therapies? I would like to keep some organs. ;0)

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