More fun with post-cholecystectomy syndrome (PCS)

I received a great comment on my previous post about PCS (the suite of annoying symptoms that can result from not havaing a gallbladder) and decided that a follow-up was in order. I also wanted to include some more personal details (hopefully not TMI) to put the information in context.

This will make more sense if you read the previous post first. It’s here.

I continue to struggle with PCS everyday, and the reason I wanted to revisit the topic is that I am my main test subject when it comes to trying out potential remedies (cue mad scientist laugh). I thought it might be useful to others if I actually reported on my findings, such as they are.

First of all I want to say that I fit the classic symptom profile from Traditional Chinese Medicine (TCM) really well. I can’t say for certain whether all these symptoms come from having no gallbladder, but they do post-date that time. For reference, I was 20 when I had it removed. Obviously I have aged since then, and I can’t be sure to what extent age and abuse through suboptimal diet may be influencing my symptoms. But they do correspond to exactly what you would predict for PCS. Also, I should point out that these symptoms did not appear immediately after I had my gallbladder removed–they have developed gradually over the years.

My PCS

Before having my gallbladder out, I tended to feel colder than other people. I did radiate heat–when riding in a car the window by my head would always get steamed up when nobody else’s was and people commented that I felt warm–but internally, I was usually cold. And I couldn’t stand any external cold at all. Since the gallbladder removal (I’m going to call it GBR to save my lazy fingers effort), I have excess heat (and dampness–I’ll get to that in a minute). I get heat stroke really easily and also the symptoms of what Chinese medicine calls “summer sickness”–dizziness, nausea, fatigue, loss of appetite, and diarrhea whenever it’s hot. Most days I have a feeling like there is a smoldering fire in my chest and solar plexus region that cannot be cooled. It’s not heartburn–it doesn’t have that acid burning feeling, just a sense of uncomfortable heat, as if I have been lying out in the sun on a hot day for a few hours.

Inflammation is supposed to be a sign of dampness, but I don’t happen to have that (at least not externally visible). I have, however, started to accumulate phlegm much more than ever before and I also have more skin tags. Not a huge amount, but I never used to have any. In TCM they are considered the result of heat coming from the liver and trying to emerge from the skin. I don’t have acne, but occasionally get small pimples in the liver zone (creases on either side of the nose). This is the only place I ever get zits.

furious bowels

Before my GBR, I had great digestion. There was pretty much nothing I couldn’t eat. I enjoyed all kinds of food, including spicy food and salads. Post-GBR, I am continually astonished at how pathetic my digestion is. Let us just say that these bowels? They are irritable. They are like one of those stereotypical crotchety old people, yelling “Get off my lawn!” at every dang thing I eat. I am now somewhat lactose intolerant where I never was before. I’m was never a big dairy-eater to begin with, but due to the hot feeling I mentioned above I like ice cream even more than I did before. My intestines do not like ice cream at all though. Yogurt and butter seem to be ok, but nothing else. I eat cultured butter, so the probiotics in the yogurt and butter may be having a beneficial effect even though I eat them in small quantities. I have recently discovered that raw leafy greens really piss my bowels off. Like I can’t even finish a salad without running for the bathroom (sorry, I know I promised this wouldn’t be TMI, but it won’t be useful if I’m not honest). I used to love eating salads all summer long–lettuces and such are cooling–but I now look at greens with mingled longing and trepidation. Other than these two, I haven’t yet been able to figure out exactly which things cause  digestive distress because that would require an elimination diet, which would be pretty much impossible in my circumstances, i.e., being my mom’s caregiver. (This issue is a long story and I don’t want to clutter the post up with it. I’m happy to explain if you really want to know, but for now suffice it to say that my dietary freedom is limited.)

My emotional states post-GBR have been exactly what TCM would predict: more anger, depression, and anxiety. Of course our emotions respond to many factors and I don’t want to oversimplify, but I have a lot more cranky, irritable days. It’s hard to tell sometimes whether an emotion is a cause or effect, but that’s one thing I like about TCM–it takes emotions into account and understands they can be both cause and effect. Fortunately I am managing my stress a lot better these days. As for depression, my opinion is that nowadays, it’s simply a reasonable response to the state of the world, not a mental illness. (Funnily enough, having come to that conclusion actually makes me feel much less depressed.)

Finally I have dull pain in the upper right quadrant of my abdomen, especially when I sit on airplanes. Something about that particular airplane posture and the immobility, I guess.

What I am doing about it

I have a plethora of different nutritional supplements and herbs–none has been a magic bullet, though most help a bit; but it can take time to find the right herbs and dosages. And sometimes it’s harder to get the mix right for yourself than for another person, for some reason. I take the following Standard Process supplements: Cholacol (bile salts), Drenamin (adrenal fatigue), and Livaplex (supports liver function). I also take the following herbs: dandelion and milk thistle (liver support) and bupleurum (liver and adrenal support) tinctures regularly, though I need to up my dosage, and agrimony. I also take melissa (lemon balm) and St. John’s Wort on an as-needed basis but need to make my melissa consumption more regular. I want to add rose to this list because my body seems to really like it and for its cooling effects.

cholacol

The results are that my energy levels are up a bit. I’m no ball of fire but at least I don’t have to take a nap after washing the dishes. My mood is much more stable with less depression and anger. My immune system seems to function pretty well–I get few colds and flus, maybe 1 per year, although the flu is more severe when I do get it than it used to be. There is still room for improvement here. My digestion is still suboptimal but I also need to work on that more, especially in terms of dietary change–on which more below.

What we all should be doing

I’m looking to both Chinese and Western herbal medicine for recommendations, and where they overlap I think we are really on to something. TCM offers dietary/nutritional remedies, which complement the herbs. Both camps advocate strengthening the digestion so we can extract the full nutrition out of what we eat (difficult without a gallbladder) and the use of foods and herbs with a bitter taste and cooling properties. The Taste of Herbs Flavor Wheel is extremely useful here (follow link to see a bigger version):

taste of herbsThis chart groups herbs by flavor, tells you their energetics, and correlates them with TCM and Ayurveda. All three systems are agreed that you want to seek out herbs in the red section. Astringents (the green section) can also help by toning weakened tissues. Because of the interconnectedness of the digestive system with every other system in the body, one seldom has only one issue going on. But the great thing about this chart is that you can classify foods and herbs that aren’t listed, simply by tasting them. By the way, if you’re wondering why I mention TCM so much it’s because it is so hard to find anything in the Western herbal literature specifically devoted to PCS/gallbladder problems.

Chinese medicine views the development of gallbladder symptoms and PCS as both being due to excess damp heat. The dietary guidelines for reducing dampness and heat recommend avoiding alcohol, sugar, greasy/fried foods, and dairy (except yogurt), refined flours, raw foods, chilled foods/drinks, coffee, meat, and spicy foods. I have not been doing so well with this, even though I know better. The hardest part, especially in summer, is avoiding the cold food and drinks. They do give a brief cooling feeling, and I’ve always preferred cold drinks even back when I felt cold all the time. That’s why I mostly take my herbs as tinctures instead of teas, because I just really don’t like hot drinks. But I should be taking things room temperature to warm.

PCS remedies part 1 graphic

Foods that are said to relieve heat and dampness include: onions and their relatives (garlic, chives, scallions, leeks), cinnamon, aromatic herbs (parsley, basil, dill, rosemary, oregano, etc.),  raw honey (like I need an excuse!), alfalfa, celery, lettuce, spinach, bamboo shoots, eggplant, potatoes (with skins), Chinese cabbage, dandelion greens, mustard greens, barley, buckwheat, strawberries, lemon, kiwi, hawthorn berry, fennel, mustard seed, ginger, turmeric, saffron, radish, asparagus, broccoli, turnip, radish, quinoa, amaranth, adzuki beans, and cucumber. This ain’t no paleo diet. You’ll notice there are items here that fit in the pungent (grey) and sour (green) categories on the flavor wheel, as well as bitters.

From a Western herbalism perspective, we need foods that will cool, move the dampness, and tone the tissues that get weak from poor nutrition. For advice on applying traditional Western energetics my go-to book is Matthew Wood’s The Practice of Traditional Western Herbalism: Basic Doctrine, Energetics, and Classification. According to Western energetics, there are two types of dampness: flowing and stagnant. Flowing, or leaky, dampness is a tissue state called “relaxation;” damp stagnation is “torpor.”

“[Relaxation] would include excessive sweating, salivation, digestive secretion, diarrhea, menstrual bleeding, and urination. … One of the ironies of the relaxed tissue state is that it tends to create a deep tension, which can be either psychological or physical, or both.” (Wood, pp. 199-200)

“[Torpor] is not only associated with a buildup of unneeded fluids, but with their precipitation into thickened phlegm–mucopolysaccharides, actually–which were called ‘humors’ in the old literature. In addition to the thickening of fluids, waste products build up because of the stuck state of transportation in the body. Indeed, even unused food becomes a waste product. Meanwhile, the tissues are not getting enough nutrition and they tend to become flabby and weak. The thickening fluids cause pain in muscles. It would be called fibromyalgia today, or rheumatism (dampness) as per the old books. The single most characteristic symptom is said to be skin lesions. Another typical symptom is hangover. The digestion and liver functions are backed up. Lymphatic stagnation and sluggishness is also typical. The channels of elimination may be taxed. Some cases of hypothyroidism would fit here.” (Wood, pp. 221-222)

Recommended herbs for tissue relaxation are all astringents and include blackberry (excellent for diarrhea, especially where the mucosal lining of the bowels is impaired, as is often the case due to weak bile dripping directly into the intestine from the liver–the fruit, leaf, and root may all be used; you can substitute raspberry leaf), sumac (not the poison kind–sumac is commonly available as a condiment in Middle Eastern groceries), black walnut (leaf, bark, black hulls; also helps with hypothyroidism but the hulls can be laxative so use these with caution), white oak bark (small doses of tincture), and sage.  The traditional recommendations for torpor are alteratives (“blood purifiers”) and laxatives. If you don’t have a gallbladder, there is a good chance you do NOT need laxatives. Recommended herbs for torpor include dandelion, burdock, and Oregon grape root. Sage and burdock particularly seem to help with digestion and metabolization of fats. I also just came across this wonderful piece on Cauldrons & Crockpots about ocotillo and how it helps move stagnant fluids in the body.   PCS remedies part 2 graphicFor cooling, Western herbalism recognizes that heat can be a secondary effect due to “sepsis and deterioration,” as Wood puts it, or primary, due to irritation and excitation, which is essentially acceleration of cellular function. With PCS there may be both types but I think the secondary heat arising from an under-performing gut and liver is the main issue. Recommended herbs include rose (all parts; cooling, astringent, and drying), yellow dock root (cooling, bitter, alterative), and yarrow (cooling and stimulating).

And of course, exercise. We’re not talking here about weight loss or get-fit exercise, we’re just talking about moving the qi and fluids around. I am a big fan of the website Katy Says which is all about the importance of proper body alignment. Working out, running, cycling, dance–all are fine but do not replace time spent simply sitting, walking, and carrying things in correct alignment. If you’ve been out of alignment, as most of us in the modern world are, at the beginning just standing in proper alignment will be a workout for the back of your legs, pelvic floor, and shoulders.

Anyway, I hope this helps somebody. As I said previously, I’m not a doctor, but this is the best information I’ve been able to glean on the subject. I have not found a lot of useful information, and much of what I have found doesn’t have any contextual information. I gave you all far more detail about my health than probably any of us are comfortable with, but I am hoping I have given you a clearer picture of how it all fits together to affect not only your body, but your mind and emotions too.

EDIT: I have revised my views on this topic somewhat, so please also read my latest post on herbal remedies for PCS.

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One thought on “More fun with post-cholecystectomy syndrome (PCS)

  1. Thank you so much for the post…i have started getting all the symptoms you mention, 2 years after surgery, I didn’t know it’s called PCS…
    Thanks again..

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