Dr. Arvind Guru
General Surgery
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 60 year old female, who weighs 171 pounds. I have multiple stones in the gallbladder. And my vomits are greenish or yellowish in color. Once, I threw up brownish vomit, which my doctor said is blood, due to repeated vomiting. The gastric pipe gets torn and abraded a little, and the stomach is acidic, so the vomit was brownish. I am diabetic from the past ten years. I was also diagnosed with high blood pressure, and I am on a mild medication. My surgeon wanted a cardiac assessment as standard operating procedures. He wanted dobutamine stress echocardiogram (DSE), an alternative test for stress treadmill test, due to high BP of 168/93 mmHg. I did a normal echocardiogram, which was as per him fine. So, he did not perform the stress test and told to go for the surgery, as the TLC (total leukocyte count) count increased from 13500 to 19000 today. Today my BP is 138/80 mmHg. I have no cardiac history. Should I let them operate for gallbladder stones? I have doubts regarding my cardiac assessment.
Hi,
Welcome to icliniq.com.
The short answer, in my opinion, is yes, let them operate for gallbladder stones. Here is why. The surgeon's job was to see that the patient will be safe, so he asked for a cardiac assessment. Here dobutamine stress echocardiogram (DSE) was requested most likely as it must have been presumed that a 60 years old cannot run on a treadmill to do a regular stress test. Well, in reality, there is no well-documented literature that says DSE is mandatory before operating on such patients. In fact, only a few situations absolutely demand this kind of testing, the better judge of this is the cardiologist and not a surgeon. So trust your cardiologist. And there is no previous history of any heart disease and the ECG (electrocardiography) was also normal. Your BP (blood pressure) is also well controlled. WBC (white blood cell) of 19,000 in a diabetic patient with gallstone problems is a danger bell type of situation. It can go bad very swiftly. Along with that, the patient here is overweight. All these things put the patient at moderately increased risk in comparison to a normal patient. But at the same time, delaying surgery could be even worse for the patient. It is much better to be early, than late in this case.
I hope that helps. In case you need more information or second opinion after visiting your doctor or need help regarding what to do or which option to choose, kindly follow-up.
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General Surgery
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