Gallstone symptoms require further investigation

Q. I am a 71-year-old female. I have been nauseated for about 10 weeks. It started with just nausea, went to being unable to eat, then to where I cannot stand the smell of foods cooking, especially greasy foods.

I have been eating apples, cheese strips and Wendy's Frosties for about a month and am now able to eat sliced tomato and mayonnaise sandwiches. I still can't stand the smell of or eat anything fried.

About two weeks ago I went to my primary care physician. He ran some tests, including an upper GI, X-ray and ultrasound of my abdomen and esophagus. The results seem to show gallstones. He is sending me the diagnosis and a recommendation for a visit to a general surgeon.

I am not convinced that this is my problem because I haven't had any pain related to the nausea. The only time I had abdominal pain was when he examined me a couple of weeks ago and hit a very tender spot in my stomach.

I am overweight but have lost about 12 pounds since this whole thing started. I haven't had a fever, vomiting or a cold, but I have had a few chills on occasion during the night.

I need to get to the bottom of this and hope to do so without gallbladder surgery. I have elderly parents that need my constant attention. I read your column every day and trust your judgment.

A. Gallbladder inflammation, also known as cholecystitis, can cause chills, loss of appetite, nausea, tenderness over the abdomen when touched, vomiting, fever and abdominal bloating. Symptoms are most often seen following a meal, especially a large or fatty one.

Gallstones don't typically cause symptoms until or unless they block a duct. When this occurs, it usually results in pain in the upper right or center (just below the breastbone) of the abdomen, right shoulder pain or back pain just between the shoulder blades.

You have already undergone testing that indicates gallstones, and you are exhibiting some signs and symptoms of gallbladder inflammation. You are likely dealing with a gallbladder problem. The only way to be sure is to undergo further testing.

There are other possibilities. Some medications can cause nausea and loss of appetite. Certain stomach conditions such as gastroparesis may be to blame. Another possibility is stress. Given that you are taking care of your parents on a full-time basis, this is a strong possibility or perhaps a contributing factor. Keep in mind, however, that you may truly have gallbladder disease and surgery may be your best option.

Ask your primary care physician to refer you to a gastroenterologist rather than a general surgeon. Schedule an initial appointment, which should include an examination and review of your previous testing. While waiting for that to happen, try adding a nutritional supplement shake such as Boost or Ensure and continue to try to add more foods to your diet. Fruits, vegetables, whole grains and lean protein, either in the form of meat or meat-free options such as beans, peanut butter, eggs, tofu and other soy products, are good choices. Avoid fried, greasy and fatty foods.

You should also consider bringing in some outside help for your parents — perhaps a visiting nurse who stays for a few hours a couple of days each week. This will allow you some time to yourself, to run errands or just relax, while ensuring your parents are well-taken care of.

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