Gall Bladder - To remove or not remove?

andiron

First off...I apologize for the long thread...but I feel my story is important for the questions I'm asking. Thanks in advance.

My experience has been a little strange. About 2 months ago I started having diarrhea which lasted for about 3 weeks. During this time I started noticing that I wasn't hungry as soon as others in my family. We'd eat lunch and then they were ready for dinner and I just wasn't hungry. As the 3 weeks progressed I started having actually pangs...like slight stomach cramps but no actual nausea. I decided after reading about chronic diarrhea online that I should get checked. My wife thought I had gall bladder issues. So I went to the doctor and he thought I might have a bug and put me on a strong antibiotic called Bactrum...and told me to take immodium for the diarrhea and drink gatorade and other fluids. ( I had been feeling weaker and taking more naps during this time which made me think that my electrolites were off and I was becoming dehydrated...despite my increased water intake)

Well, that plan seemed to work beautifully. My strength came back...the diarrhea went away and my appetite came back with a vengeance. (which isn't so good since I'm overweight). Just to make sure, the doctor sent me to have an ultrasound done. The ultrasound came back clear and I reported to my doctor for a follow up. I told him that I felt much better save for the fact that I had experienced almost phantom like pains in the area of my gall bladder and a bit of radiating pain in my right shoulder blade on one occasion. He said he really thought it was likely that my digestive tract was off a bit after the course of antibiotic but that we should follow up with a HIDA scan.

I had the HIDA scan done and it came back Normal. At least this is what was originally thought. Hmm. So I figured I was okay. Well about 2 weeks later I had what I thought must be a gall bladder attack. It just had to be...it was just as they are described. I was far away from a hospital and so my wife started with me in the car agonizing in pain toward the hospital. After a total of about 45 minutes the pain was barely present. At the one hour mark it was completely gone!

Sooo....I went back to the doctor who told me I must be having gas pains. I said that this just couldn't be gas pains. He turned, opened my file, and then said that he was very embarrassed. He apologized and said that while the HIDA scan said Normal...the CCK ejection fraction was low at 14%.

Next I went to a GI doctor for a second opinion. He asked me about family history and my experience to date. ( my 4 older siblings all had their gall bladders removed as did my mother but they all had emergency gall bladder attacks that put them directly into the hospital) The GI doctor asked me why I was there...he said..looks like a duck, walks like a duck and quacks like a duck...guess what? He said I needed a surgeon.

So it's been close to month from that visit and I have gone a few weeks with absolutely no symptoms...only to have some minor discomfort and then a return to no symptoms. I've never had another "attack". I've never had anymore right shoulder pain since that one brief time. I haven't lost my appetite. I feel pretty much normal. I can say I feel some conciousness of my right upper quadrant...but it's mild and then goes away.

Today I saw the surgeon. He said I'm in a "gray area". Off the record he said that if he were me he might wait a bit. But added he officially was recommending having my gall bladder out. He told me that the worst complication of not taking it out would be if Pancreatitis developed...due to the sludge and or stones that are in my gall bladder.

Oh and I should also say that my original bloodwork came back fine save for the fact that my liver enzymes are slightly elevated.

I know I've rambled...but based on my story I wanted to ask a few questions:

Because my symptoms tend to disappear should I not be in a hurry to get my gall bladder removed?

Asked another way...is an ejection fraction of 14% alone (with the few and varied incidents) enough to warrant the surgery?

Do I have a real risk of Pancreatitis if I don't have my GB removed or is that overstated?

Does the slight elevation in liver enzymes change how I should think about this procedure?

Is it obvious at this point with the low ejection fraction that it's not "if" but "when" I have the GB removed? If this is the case I might just as well get it done sooner than later...don't you think?

I realize I should have asked these questions of my Doctor/Surgeon but I just didn't think of them while sitting there. I think I was confused by his message of "Off the record...I'd wait...but on the record I recommend removal. I'm sure it's just CYA. The thing is...he followed that statement up with " I don't want your family in here suing me because you developed Pancreatitis". Kind of a strange visit..and while I think he was trying to help....I'm confused. Logic says to just have it removed...but then as asymptomatic as I have been as of late it makes me wonder if I shouldn't wait. Perhaps my gall bladder was inflamed and has settled down? Is this even possible?

Finally, he said a few other interesting things. He said my gall bladder could be affected by unknowns such as an infection...which might leave me experiencing some of the same things once the surgery is performed. He also said I wasn't an emergency case and that we had time...perhaps I could see how things go during the holidays. In other words...this surgeon wasn't in a hurry to book me. Hmm.

Okay, I'm coming up for air. Thank you for any advice you can offer. I'm hoping to gather some conviction for a decision.

Kevin