Losing an 8st and dropping several dress sizes after giving birth might seem like cause for celebration – but not for Amy Cooper.
The dramatic change in her size was a minor condition that usually affects people who have had their gallbladder removed (one of the most common procedures carried out by the NHS) without a diet and exercise regimen.
It has left the 28-year-old former shop assistant from Wellington, Shropshire, who lives with her fiance Gary, in debilitating pain and tired of playing with her children, aged eight and four.
Amy says, ‘Before I could eat, hang out with my kids and enjoy life. ‘Now I can’t eat, throw up all the time, have no energy and am in pain every day.’
Known as sphincter of Oddi dysfunction (SOD), it is caused by muscle dysfunction. It normally opens and closes to release juice and bile from the liver into the small intestine to digest food. But in people with this condition, this muscle that drains the liver from the liver doesn’t open properly, leading to bile backup and severe abdominal pain.
Losing an 8st and dropping several dress sizes after giving birth might seem like cause for celebration – but not for Amy Cooper
SOD affects around 10 per cent of the 70,000 people a year in the UK who have their gallbladder removed.
The gallbladder, a small, sac-like organ, stores bile but is not necessary for the healthy functioning of the body. Its removal is a routine operation to treat gallstones (crystallized fatty deposits).
However, in some cases surgery can cause problems with the sphincter of Oddi – possibly due to passage of gallstones or damage to the nerves in the sphincter during the operation.
About 1.5 per cent of the population (hundreds of thousands of people in the UK) are thought to have sphincter of Oddi syndrome, says Professor Brian Davidson, consultant hepatic biliary disease and liver transplant surgeon at the Royal Free London NHS Trust.
While this is usually triggered by surgery to remove the gallbladder, it can also be spontaneous.
It is often mistakenly attributed to gallstones when not caused by surgery, as the symptoms – pain, especially on the right side of the abdomen, nausea and vomiting – are the same.
Sphincter of Oddi dysfunction mostly affects women. This may be because they are more likely to form gallstones, as the female hormones estrogen and progesterone make bile more concentrated (especially during pregnancy) and reduce the contraction of the gallbladder, so bile is more stable and more likely to crystallize.
Christian Macutkiewicz, consultant general and hepato-pancreato-biliary surgeon at Manchester Royal Infirmary and director of The Gallstone Clinic, says: ‘Rapid weight loss and yo-yo dieting can also increase the risk of developing gallstones.
One theory is that dieting reduces the number of times the gallbladder contracts.
Although she had a classic case of SOD, Amy struggled to get a diagnosis. Shortly before she became pregnant with her first child, Amy began experiencing excruciating pain on the right side of her abdomen.
Six months later, she was referred for an ultrasound scan, which revealed gallstones in her gallbladder. But she was advised to ‘wait and see’ if she needed surgery to remove her gallbladder.
During a procedure performed under local anesthetic, doctors diagnosed SOD and decided to cut the muscle wide to alleviate the problem. However, afterwards Amy was still in pain, requiring several hospital visits and morphine [File photo]
Amy became pregnant with her first child and six months after giving birth in 2014, she was taken to the hospital in severe pain, again due to gallstones, and this time underwent emergency surgery to remove her gallbladder.
For many patients, this surgery—called a cholecystectomy—is a cure for frequent gallbladder problems.
Amy says, ‘I was told that now that it was out, I would be free of the pain that had kept me on and off for almost two years.
‘I was warned not to eat greasy or spicy foods – because these are difficult to digest and can cause pain without a gallbladder there to help control the flow of bile – but that was it.’
But three weeks later Amy experienced the same sharp pain, which started on the right side of her abdomen and spread to her right shoulder. ‘It felt like a gallbladder attack, but because I didn’t have a gallbladder I thought: “Am I having a heart attack?” ‘ she says.
Aimee went to A&E where blood tests showed high levels of the enzyme alanine transaminase, a marker for liver damage.
But after her gallbladder was removed, doctors concluded it wasn’t related to her previous problems — one asked if her liver enzyme levels were caused by too much alcohol.
‘I was angry,’ says Amy. After doctors could find no cause for the attacks, she was given morphine for the pain and sent home. But the pain started coming back – and Amy started losing weight.
‘I was eating carefully, avoiding greasy or spicy food, never drinking, taking care of myself,’ she says. ‘But this pain – which felt like the pain of my gallbladder attack – kept coming back.
‘I felt very unwell. I tried to eat but was having diarrhea or diarrhea for a few days.
‘I felt so weak and tired, I had to stop doing housework and quit work.’
During the pregnancy of her second child, she lost weight, and when her baby was born in 2018, ‘I was tired and unable to enjoy it, I was in a lot of pain,’ she says. She continued to lose weight, shedding 8st in eight years – from 15st to 7st (she’s 5ft 3in).
While SOD ‘usually does no long-term damage,’ patients suffer pain that could be avoided if diagnosed, says Mr Macutkiewicz. Finally, last year, Amy’s consultant, now suspecting her sphincter of Oddi, advised an invasive diagnostic procedure called endoscopic retrograde cholangiopancreatography (ERCP).
It involves inserting an endoscope – a thin tube with a camera on the end – down the gullet, through the stomach and into the bile duct. If necessary, treatment can also be performed during the procedure. Although it carried a small risk of rupturing the bile duct, Amy decided to go ahead as she was ‘in such pain’.
During a procedure performed under local anesthetic, doctors diagnosed SOD and decided to cut the muscle wide to alleviate the problem.
However, afterwards Amy was still in pain, requiring several hospital visits and morphine.
Mr. Macutkiewicz admits cutting the sphincter of Oddi doesn’t always work. ‘It’s not a magic wand,’ he says. ‘Some patients may develop pancreatitis [inflammation of the pancreas] As a result of the operation and this complication is very dangerous. For others, the cut is not enough and it doesn’t help and the patient may still be in pain.’
This was the experience of Alison Fletcher, 47, an accountant from Stockport, who had her gallbladder removed in 2016. A few weeks later she developed severe pain and underwent ERCP.
It didn’t help and she was ‘constantly in A&E’, the pain was unbearable,’ she recalls.
She had a total of four ERCPs but her symptoms still did not improve.
Aimee still struggles with pain daily and hopes to find another counselor who can offer different treatments.
Other possible SOD treatments include Botox injections – some studies show that this provides short-term relief in up to 80 percent of patients.
Anti-spasmodic medications, such as Buscopan, may also help.
Still in pain and unable to eat solid food, Amy’s wish is simple: ‘I want my life back,’ she says.
When beauty routines cause health problems. This week: Dry shampoo can damage the scalp
Dry shampoo can make you skip washing your hair if you’re busy, but anecdotal evidence suggests that overuse can also cause scalp damage — and potentially affect hair growth.
‘Relying on dry shampoo can lead to a build-up of unwanted products and oils on the scalp which can at the very least lead to itchiness and flaking, and at worst, a fungal or bacterial infection if left unchecked. ‘ says Eleanor Richardson of the Institute of Trichologists. ‘And when the scalp environment isn’t good, hair growth can be less than optimal.’
So how often is it okay to use dry shampoo? ‘Keep it only for emergencies – if, say, you’re camping, or away from home for a night or two,’ says Eleanor Richardson.
‘Don’t use it for more than two days in a row and avoid it completely if you have a sensitive scalp or a known scalp condition.’
In bullet position
How your condition may affect medication. This week: Tilt your head when using your asthma inhaler
To open up the airways and ensure asthma medicine reaches the lungs, ‘it’s best to use your inhaler sitting upright or standing up, as this helps expand the lungs,’ explains Dr Samantha Walker, director of research and innovation at Asthma + Lung UK.
‘Tilting the head back slightly to widen the neck can help open up the airways and improve drug delivery.’ In a study in children with exercise-induced asthma, published in 2015 in the journal Respiratory Medicine, using this technique with preventive inhalers delayed the onset of asthma symptoms from 1.6 to 2.5 minutes after an exercise challenge. Dutch researchers also found that tilting the head resulted in less drug being passed into the oropharynx (back of the mouth), reducing the risk of coughing, hoarseness or oral thrush.
Source: | This article is originally from Dailymail.co.uk