How to Pass a Gall Stone
Patients can be quite surprising sometimes. Like the time back in St Albans when a depressed patient with a personality disorder was so grateful her treatment had made her feel a bit better that she gave me a Paul Smith tee shirt and a “Osprey” leather soap bag.
However I’ve had few surprises as memorable as when Nigist (not her real name) came into my clinic this week with a small corked glass bottle containing what looked like a collection of pea-sized pale brown balls. I stared uncomprehendingly. “What are these?” I inquired. “My gallstones” she beamed, “I’ve got them out!” “Did it hurt?” I asked, slowly becoming incredulous. “Not at all” she replied. Now I’m interested!
Small stones usually made of cholesterol and sitting in the gall bladder under the liver in the top right-hand corner of the abdomen are very common, and are usually harmless and silent. A couple of years ago I had accidentally found that Nigist had a fair old collection of gall stones when she had had a scan of her abdomen for a completely different problem. If they don’t cause problems, they can be safely ignored. However in a few unlucky people sometimes a stone will pop out of the gallbladder and get squeezed and pushed down a narrow tube (the bile duct) into the small intestine – then the screaming starts. The pain of biliary colic as it is called can be as severe as passing a kidney stone, and can be as bad as being in labour (although it’s safe to say a baby is a much better outcome than a small ball of cholesterol). Nigist had dozens of little balls in her glass bottle – and no pain passing them? Tell me more!
Nigist doesn’t speak English, so the conversation took place with Tigist interpreting. Nigist had not had any problems associated with her gall stones at all, but she had told a friend that they were there, and the friend had given her a sheet of instructions to follow to try and get rid of them. Nigist brought me the sheet, entirely in Amharic, and Tigist translated it for me. So if you have gall stones, here’s what to do:
Instructions (verbatim from Tigist’s translation):
“1. Early in the morning, daytime and night, every 2 hours drink 2 glasses of apple juice. Use an alarm to take it on time.
2. Make sure you don’t eat or drink anything else. You might feel tired, but try to resist.
3. On the second day during the evening drink the apple juice. When 36 hours are finished the juice will be finished.
4. At 7pm take half a glass of olive oil, add a spoonful of salt, stir until it gets thicker, then slowly drink it using a straw. Sleep or lay only on your right side. Make sure you don’t sleep or lay using other positions.
5. Early morning around 7am on the third day take 1 litre of water, 1 spoon of salt, 1 lemon, boil it together and drink.
6. After 30 minutes take boiled/cooked potato and carrot, mix with olive oil and salt and eat it.
7. Use a bed pan whenever you want to use the toilet.
Do it properly.”
Nigist was delighted to educate me on this medical marvel. The ingredients had cost her 500 Birr (which she really couldn’t afford) but she felt it had been worth it.
Evidence drives good medical care, and I had some on Nigist – I had a scan report from 2015 that showed she had gall stones. Well getting some more evidence would be easy – she just needs another scan. I sometimes think the entire population of Ethiopia has at some time or other had an ultrasound scan of their abdomen. Tummy ache? Have a scan. Diarrhoea and vomiting? Have a scan. Got a fever? Have a scan. Back pain? Have a scan. Nigist was very happy to go and have another scan to confirm the success of her epic 36-hour apple juice diet.
Later that afternoon she was back, not as happy as she had been in the morning. She had told the radiologist all her stones were gone (she may have showed him the bottle). She was surprised and angry and regretful of 500 Birr wasted when he told her the stones were still there. He put it on the report she brought back to me in capital letters – “STONES IN GALL BLADDER”. Poor Nigist.
I will admit to a tiny bit of disappointment. After all, if it had worked, not only would there have been a PhD right there staring me in the face, there would have been a fortune to be made in the UK patenting the process and then painlessly emptying gall bladders.
So what was in Nigist’s bottle? I’ll leave that to your imagination. But I suspect it may be something to do with stage 6…