ROJoson PEP Talk: Gallbladder Stones - How Effective and Useful are Non-Surgical Treatment?

ROJoson PEP Talk: Gallbladder Stones - How Effective and Useful are Non-Surgical Treatment?

1. May 25, 2024 1400H - 1500H Via Zoom GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? Empowerment objective - for laypeople to have an essential  understanding on the EFFECTIVENESS, USEFULNESS and LIMITATIONS OF NON-SURGICAL TREATMENT FOR GALLBLADDER STONES as part of their health management.

2. May 25, 2024 1400H - 1500H Via Zoom GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? Empowerment objective - for laypeople to have an essential  understanding on the EFFECTIVENESS, USEFULNESS and LIMITATIONS OF NON-SURGICAL TREATMENT FOR GALLBLADDER STONES as part of their health management. Welcome all! MUTE yourself but always show your video picture. Sign in your name, FB account, or email address in the Chat Box! Include names of companions attending. Use the Chat Box to ask questions and make comments while the PEP TALK is on. There will be group pictures at start and end of PEP TALK – show your face in video.

3. Reminder after the PEP Talk: Take the Online Learning cum Evaluation Test Exercise (OLETE) for mastery of learning and have a perfect score to get a Certificate. Link is in Chat Box.

4. Reminder: 25 OLETE Certificates = 1 Voucher for ROJoson Medical Consultation either Face-to-Face or Telemedical.

5. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? Empowerment objective - for laypeople to have an essential  understanding on the EFFECTIVENESS, USEFULNESS and LIMITATIONS OF NON-SURGICAL TREATMENT FOR GALLBLADDER STONES as part of their health management. ROJOSON’S REQUEST: FEEDBACK TO THIS PEP TALK! Pls. type in your feedback in the chat box during the open forum and before we adjourn! Thank you!

6. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? Empowerment objective - for laypeople to have an essential  understanding on the EFFECTIVENESS, USEFULNESS and LIMITATIONS OF NON-SURGICAL TREATMENT FOR GALLBLADDER STONES as part of their health management. LET’S NOW HAVE A GROUP PICTURE TAKING BEFORE WE START PEP TALK PROPER IN 2 MINUTES! Pls. turn on your video! Show your face!

7. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? Empowerment objective - for laypeople to have an essential  understanding on the EFFECTIVENESS, USEFULNESS and LIMITATIONS OF NON-SURGICAL TREATMENT FOR GALLBLADDER STONES as part of their health management. ROJoson PEP Talk I have a Patient Empowerment Program in which I like to empower the lay people or patients to take control in the management of their health.

8. I started the PEP Talk on May 15, 2021 during the COVID19 Pandemic. There are 3 courses in the PEP Talk. I completed the Core Course on October 9, 2021.

9. From October 23, 2021 onwards, I have been tackling Health Disorder and Health Issue Courses. May 18, 2024 marks the start of YEAR 4 of ROJoson PEP Talk. How long the PEP Talk will last will depend on our enthusiasm , discipline and perseverance .

10. L GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? Empowerment objective - for laypeople to have an essential  understanding on the EFFECTIVENESS, USEFULNESS and LIMITATIONS OF NON-SURGICAL TREATMENT FOR GALLBLADDER STONES as part of their health management. My PEP TALK today is entitled: GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT?

11. Contents What are gallstones or gallbladder stones? What are the different types of gallstones? What are the causes of gallstones? Do all patients with gallstones have symptoms? Do all patients with gallstones need treatment? What are the commonly heard non-surgical treatment for gallstones? How effective and useful and what are the limitations of non-surgical treatment? What are the advice on non-surgical treatment for gallstones? Disclaimer: ROJoson PEP Talk contains ROJoson’s Thoughts, Perceptions, Opinions and Recommendations (TPORs) culled from experiences of ROJoson and writings of other health professionals . GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT?

12. What are gallstones or gallbladder stones? Gallstones are hardened, concentrated pieces of BILE that form in gallbladder or bile ducts. “Gall” means bile, so gallstones are bile stones. Gallbladder is the bile bladder. It holds and stores bile for later use. The liver makes bile, and the bile ducts carry it to the different organs through the biliary tract. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? https://my.clevelandclinic.org/health/diseases/7313-gallstones

13. What are gallstones or gallbladder stones? Gallstones form when bile sediment collects and crystallizes. Often, the sediment is an excess of one of the main ingredients in bile. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? https://my.clevelandclinic.org/health/diseases/7313-gallstones

14. What are the different types of gallstones? Cholesterol stones Pigment stones Mixed stones with calcium salts – most common in the Philippines GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT?

15. What causes gallstones? Gallstones may form if bile contains too much cholesterol, too much bilirubin, or not enough bile salts. Researchers do not fully understand why these changes in bile occur. Gallstones also may form if the gallbladder does not empty completely or often enough. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones/symptoms-causes#:~:text=Gallstones%20may%20form%20if%20bile,empty%20completely%20or%20often%20enough.

16. What causes gallstones? Gallstones are thought to develop because of an IMBALANCE in the chemical make-up of bile inside the gallbladder. The exact cause of the imbalance is not known. Gallstones form when there’s an excess of one of the main ingredients in bile. The excess ingredient turns to sediment at the bottom of your gallbladder or bile ducts, and the sediment gradually hardens into stones. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? https://my.clevelandclinic.org/health/diseases/7313-gallstones

17. Do all patients with gallstones have symptoms? Gallstones can be asymptomatic or symptomatic (with symptoms, particularly pain at the right upper quadrant of the abdomen). GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT?

18. t Do all patients with gallstones need treatment? If the gallstones never cause problems, NO treatment is needed. If they are causing pain, treatment is needed. If gallstones cause a blockage in the biliary tract, the blockage have to be remedied — not just the blockage, but all of them (gallstones). Once gallstones have caused a blockage, they’re highly likely to do so again. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? https://my.clevelandclinic.org/health/diseases/7313-gallstones

19. Do all patients with gallstones need treatment? Most people who need treatment for gallstones will have surgery to remove them. SURGERY IS THE ONLY WAY TO ENSURE GALLSTONES WON’T CAUSE ISSUES AGAIN. But if you can’t or don’t want to have surgery , it is said there are some alternative treatments to try, including medications and other procedures. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? https://my.clevelandclinic.org/health/diseases/7313-gallstones The question is: HOW EFFECTIVENESS AND USEFUL ARE THE NON-SURGICAL TREATMENT FOR GALLSTONES? Our main topic / issue for discussion in this PEP Talk!

20. ive What are the commonly heard non-surgical treatment for gallstones? Observation Gallbladder cleanse or flushing Medications Avoidance of fatty foods GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? The question is: HOW EFFECTIVENESS AND USEFUL ARE THE NON-SURGICAL TREATMENT FOR GALLSTONES? Our main topic / issue for discussion in this PEP Talk!

21. What are the commonly heard non-surgical treatment for gallstones? Observation The risks of developing symptoms or complications from gallstones in patients who have no symptoms is on the order of 20% over 20 years.  Thus, patients who are older than 40 years of age and have no other indications for gallbladder treatment can be observed.  Although there is a risk of having an attack at an inopportune time or developing one of the complications, this is small.  However, patients with symptoms should consider treatment. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? Observation is the recommendation if there are NO symptoms associated with the gallstones because it is believed that gallbladder cleansing or flushing and medications are not effective or cost-effective. https://www.lifespan.org/centers-services/general-and-gastrointestinal-surgery/about-gallstones/non-surgical-treatments

22. What are the commonly heard non-surgical treatment for gallstones? Observation Observation is recommended for patients with asymptomatic gallstones . As only about 4% of patients with asymptomatic gallstones develop symptoms including cholecystitis , obstructive jaundice, pancreatitis, and gallbladder cancer. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? Observation is the recommendation if there are NO symptoms associated with the gallstones because it is believed that gallbladder cleansing or flushing and medications are not effective or cost-effective. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8923050/#:~:text=Cholecystectomy%20is%20currently%20advised%20only,%2C%20pancreatitis%2C%20and%20gallbladder%20cancer.

23. What are the commonly heard non-surgical treatment for gallstones? Observation Observation is recommended for patients with asymptomatic gallstones . Patients developed symptoms at a rate of approximately 1% to 2% per year. Complications were rare (approximately 4% over 25 years) except when preceded by biliary colic. Complications typically include acute cholecystitis (0.3% per year), obstructive jaundice (0.2% per year), acute pancreatitis (0.04% to 1.5% per year), and gallstone ileus (rare ). GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? Observation is the recommendation if there are NO symptoms associated with the gallstones because it is believed that gallbladder cleansing or flushing and medications are not effective or cost-effective. https://www.aafp.org/pubs/afp/issues/2014/0315/p468.html#:~:text=Complications%20were%20rare%20(approximately%204,and%20gallstone%20ileus%20(rare).

24. s What are the commonly heard non-surgical treatment for gallstones? Observation Observation is the best form of therapy for patients with asymptomatic gallstones. Surgical management offers the least risk and greatest benefit to patients with symptomatic gallstones. Gallbladder cleansing / flushing are ineffective. Medication – dissolution therapy is not cost-effective. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? Observation is the recommendation if there are NO symptoms associated with the gallstones because it is believed that gallbladder cleansing or flushing and medications are not effective or cost-effective. https://pubmed.ncbi.nlm.nih.gov/3945594/

25. What are the commonly heard non-surgical treatment for gallstones? Medicines to dissolve the gallstones There are medicines in the market (particularly, URODEOXYCHOLIC ACID) commonly prescribed by physicians for patients with gallstones. These are expensive (about P50 / cap) and these are usually taken 3 x a day for 6 to 12 months (minimum of 3 months). GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT?

26. What are the commonly heard non-surgical treatment for gallstones? Medicines to dissolve the gallstones The drug works only in patients who have cholesterol or primarily cholesterol stones. Majority of gallstones in the Philippines are mixed stones. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? https://www.lifespan.org/centers-services/general-and-gastrointestinal-surgery/about-gallstones/non-surgical-treatments

27. What are the commonly heard non-surgical treatment for gallstones? Medicines to dissolve the gallstones Patients with cholesterol gallstones who take the drug for two years have a 20% chance of having their gallstones dissolved.  These patients need to continue taking once per day after the stones dissolve since their gallbladder remains diseased and there is a 30 to 50% chance of recurrence of gallstones in 3 to 5 years without further treatment.  GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? https://www.lifespan.org/centers-services/general-and-gastrointestinal-surgery/about-gallstones/non-surgical-treatments Conclusion: It is not cost-effective to take dissolution therapy ( urodeoxycholic acid) for gallstones. It can take months or years for all of the gallstones to break up . There is recurrence.

28. What are the commonly heard non-surgical treatment for gallstones? Gallbladder Cleanse or Flushing Gallbladder Cleanse Myths If you see a gallbladder cleanse promoted, it most likely encourages you to eat or drink olive oil in combination with a particular fruit juice over a certain period of time. Claims include that these ingredients break up gallstones in your gallbladder and stimulate your body to pass them in your stool when you use the bathroom. Olive oil does have laxative properties, but there is no proof that it has an impact on gallstones. If you look at your stool following an olive oil cleanse, you may see lumps in your stool that you suspect are gallstones. Instead, they are GLOBS of olive oil, juice, and other food from your digestive tract. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? https://www.webmd.com/digestive-disorders/what-is-a-gallbladder-cleanse

29. Gallbladder Cleanse or Flushing Using apple / apple juice, Epsom salt, oliv e oil, lemon juice First five days You can eat 4-5 apples or drink 4 glasses of apple juice for the first five days. Sixth day – Skip your evening meal. Instead, you have to drink a big cup of warm water along with a teaspoon of Epsom salt mixed in it. Repeat this process again after 1.5 hours. This will aid in releasing the gallstones. With your second drink of warm water and Epsom salt, you can try various combinations for proper lubrication that will help in releasing the bladder stones out of your bladder. You can add a tablespoon of sesame oil or olive oil in this drink. Else, you can mix lemon juice of a whole lemon in this drink. Seventh-day You will have your bowel movement. You will observe stones with a greenish tint in your stools. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? https://www.pristyncare.com/blog/apple-juice-for-gallstones-removal-naturally-pc0113/

30. What are the commonly heard non-surgical treatment for gallstones? Avoiding fatty foods won't prevent or get rid of gallstones, but it may reduce the frequency of attacks . GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? https://www.health.harvard.edu/womens-health/what-to-do-about-gallstones

31. What are the commonly heard non-surgical treatment for gallstones? Changing your diet won't get rid of gallstones that are already there, but eating a healthy, balanced variety of nutrients and limiting the amount of saturated fats and cholesterol-heavy food you eat may help ease your symptoms. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? https://www.webmd.com/digestive-disorders/features/gallbladder-diet-foods-for-gallbadder-problems

32. one What are the commonly heard non-surgical treatment for gallstones? Lithotripsy Lithotripsy, or shock wave dissolution of gallstones , is a technique that uses a highly focused sound wave to break the stones up into tiny particles that can then pass through the cystic duct into the common duct and out into the intestine. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? https://www.lifespan.org/centers-services/general-and-gastrointestinal-surgery/about-gallstones/non-surgical-treatments

33. in What are the commonly heard non-surgical treatment for gallstones? Lithotripsy Can be used for small single stones (not more than 2cm). Gallstones may recur – high incidence. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT?

34. What are the advice on non-surgical treatment for gallstones? For asymptomatic gallstones, just observe. Avoid fatty foods. For symptomatic gallstones, go for surgery to remove the whole gallbladder with the stones. Do not go for gallbladder cleanse and flushing as it is not effective. Do not go for oral dissolution medications (such as urodeoxycholic acid) as it is not cost-effective. If you do not want surgery, eat healthy diet, exercise, avoid fatty foods, drink a lot of water and hang-on. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT?

35. t GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? Summary Take Away Contents What are gallstones or gallbladder stones? What are the different types of gallstones? What are the causes of gallstones? Do all patients with gallstones have symptoms? Do all patients with gallstones need treatment? What are the commonly heard non-surgical treatment for gallstones? How effective and useful and what are the limitations of non-surgical treatment? What are the advice on non-surgical treatment for gallstones?

36. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? Take Away in relation to Patient Empowerment Be always in touch with reliable medical information on EFFECTIVENESS, USEFULLNESS AND LIMITATIONS OF NON-SURGICAL TREATMENT ON GALLBLADDER STONES. Knowledge is power; it gives power. Use the 4Ks of Patient Empowerment: Kaalaman , Kakayanan , Karapatan and Kapangyarihan to gain greater control over decisions / make better decisions on EFFECTIVENESS, USEFULLNESS AND LIMITATIONS OF NON-SURGICAL TREATMENT ON GALLBLADDER STONES as part of your health management.

37. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? Empowerment objective - for laypeople to have an essential  understanding on the EFFECTIVENESS, USEFULNESS and LIMITATIONS OF NON-SURGICAL TREATMENT FOR GALLBLADDER STONES as part of their health management. This ends my PEP TALK today on: GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT?

38. Reminder after the PEP Talk: Take the Online Learning cum Evaluation Test Exercise (OLETE) for mastery of learning and have a perfect score to get a Certificate. Link is in Chat Box.

39. Reminder: 25 OLETE Certificates = 1 Voucher for ROJoson Medical Consultation either Face-to-Face or Telemedical.

40. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? Empowerment objective - for laypeople to have an essential  understanding on the EFFECTIVENESS, USEFULNESS and LIMITATIONS OF NON-SURGICAL TREATMENT FOR GALLBLADDER STONES as part of their health management. ROJOSON’S REQUEST: FEEDBACK TO THIS PEP TALK! Pls. type in your feedback in the chat box during the open forum and before we adjourn! Thank you!

41. GALLBLADDER STONES – HOW EFFECTIVE AND USEFUL ARE NON-SURGICAL TREATMENT? Empowerment objective - for laypeople to have an essential  understanding on the EFFECTIVENESS, USEFULNESS and LIMITATIONS OF NON-SURGICAL TREATMENT FOR GALLBLADDER STONES as part of their health management. LET’S NOW HAVE A GROUP PICTURE TAKING BEFORE WE START Q&A AND INTERACTIONS! Pls. turn on your video! Show your face!