# Long term post-cholecystectomy issues



## obsidianoceans (Jul 29, 2011)

Hey everyone.So I am new here, but have been a lurker for quite awhile and am looking for some sort of guidance from others who have had their gallbladder removed laparoscopically. I am a male, 27 years old. I'm a bigger guy, 6'2 250#. I had my gall bladder removed in 2007 with no serious pre-op illnesses or much of anything really. I just suddenly started having really painful attacks which finally lead me to the ER, where I was told that it was inflamed and needed to be taken out. (Oh, if I only knew then what I know now, I would have NEVER gotten it removed and simply altered my lifestyle..)After the surgery, I was in pretty bad shape for about a month. I could barely even walk upright. Once the healing part of the surgery subsided, I started getting sick, every single day. Since then, my typical day-to-day symptoms include: painful gas/bloating, diarrhea as soon as I eat, heartburn/stomachburn, nausea(with the watery mouth that you get right before you vomit, although I rarely actually do), belching and feeling really full, despite not eating that much. I also am always tired (I suffer from sleep apnea as well, and do use a C-PAP machine for that) It's hard to explain it, but it feels like I'm not getting anything out of the food I eat as far as nutrients go. I can eat something and be flushing it down the toilet within in 30 minutes some days. This sometimes causes me to over-eat, as I just seem to be hungry all the time.About 2 years ago I also had weird incontinence/sever bladder pain issues that seemed to come out of nowhere. I had multiple urologists do tons of tests on me, but no one could find anything wrong! I have no idea if these are related, but I can't seem to pinpoint it to anything else. Story of my life, it seems. Luckily, those symptoms have subsided for the most part and only occasionally spark up if I drink coffee or a lot of caffeine.Anyways, it's been 4 years now and I am still getting sick almost every time I eat. I have had every kind of test you can have, endoscopies, colonoscopies, body scans, x-rays, blood tests, stool sample tests, everything. You name it, I've had it tested or prodded. I've been put on many different kinds of medicines, as well. From colestipol to simple OTC heartburn medications, I've been on it for at least a month or 2. I've also had some luck with "alternative" supplements such as Ox Bile and other digestive supplements, but I really can't seem to pinpoint exactly what it is that triggers my stomach off and can't find something that I can use daily to keep my symptoms leveled. Some days I can simply take a drink of water after I wake up and it will trigger my stomach to dump everything and anything it can and then make me feel like garbage for the rest of the day.So that's about it, I guess. I'm at my wits end. It's really difficult to live like this, especially in summer when everyone is active and feeling good. I have good days, (rarely) but when I do, I can barely enjoy them as I know it's just a matter of time before everything goes downhill again. I want to be healthy and drop some weight and exercise with my girlfriend, but I just can't seem to get up the energy (mentally, as well as physically) to do it. Having my gallbladder out was the biggest mistake I've ever done, but it's too late to go back now! So here I am, seeing if anyone can recommend anything at all that I can do for some relief. I know it's hard because you only know what has worked for you and all that, but like I said earlier, I've tried anything and that seems to be my only hope. I'm sick of the doctors telling me nothing, I'm tired of the meds they try to put me on having longer lists of side effects than my actual symptoms, and I just need to find something else to try.A quick edit here: We actually eat very light around my house. Natural foods, lots of grilling and veggies. I never eat red meat anymore as if I do, I might as well clear the calendar for 2-4 days as it will tear up my guts like nothing else. Fats definitely make it worse, so I steer clear of those the best I can. But it's weird. There have been days where I have eaten a burger, with everything and not gotten sick. Then the next day, I'll have an apple and feel like I'm going to die. It's the most frustrating, life draining thing that I've ever went through, and I just honestly can't see myself living this way for the rest of my life...There's gotta be SOMETHING that works. I take vitamins when I can, but a lot of them throw my heartburn into hardcore mode.Anything you can tell me or recommend would really be appreciated.


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## BQ (May 22, 2000)

So using a bile salt binder like Colestid or Questran didn't help you _at all_?Also do you have any pain?


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## obsidianoceans (Jul 29, 2011)

BQ said:


> So using a bile salt binder like Colestid or Questran didn't help you _at all_?Also do you have any pain?


Hey, thanks a lot for the reply. I've tried them both, and sure, they helped, about 25% of the time. Then I stopped taking them about 2-3 months later and I still felt better than normal about 25% of the time. With as many meds as I've been given over the last few years and as many times as I've dealt with docs not ever having a real answer for me, taking any drug for more than 60 days is a complete waste of time and money if it's not doing anything even remotely different than not taking it does. So it's pretty inconclusive, really. I've had more luck with Ox Bile supplements w/my meals, but even that gives up after awhile for no apparent reason.The only serious pain(by serious I mean, 8-10 on a typical pain scale, basically debilitating) I get is occasionally after I eat(1-3 times a month, more if I'm in a bad flare up), especially when we're out to dinner somewhere. Usually within 15 minutes of leaving the restaurant, I'll get horrible stomach cramps and feel like I have to go to the bathroom immediately. The cramps don't stop until I've gone probably 3-4 times, starting the moment I get home. Sometimes the bowel movements won't stop until I'm ready to go to bed, basically so tired from straining and not actually digesting any energy, that I just pass out or have to take a nap. I get sick after I eat at least 1/2 the time, and like I said in my first post, it can be from something as simple as a glass of water in the morning. It's like my stomach goes into purge mode and has to empty EVERYTHING inside my body...And yet, I still feel like I could go, or feel really bloated and ultra sluggish, after the fact.Stools can vary. About 1/8 I would say is formed and pretty normal, the others are at least soft, sometimes really mushy, other times the bowl will be yellow with nothing but liquid coming out. I'm pretty sure it's just straight up bile at that point, once all the actual food is out.


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## obsidianoceans (Jul 29, 2011)

double post, my bad


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## BQ (May 22, 2000)

Here.. look at this and see if it rings familiar to you.http://www.aboutgimotility.org/site/about-gi-motility/disorders-of-the-stomach/dumping-syndrome


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## obsidianoceans (Jul 29, 2011)

BQ said:


> Here.. look at this and see if it rings familiar to you.http://www.aboutgimotility.org/site/about-gi-motility/disorders-of-the-stomach/dumping-syndrome


The symptoms are totally something that I can say "yes" to on almost every one. The only thing that doesn't seem like it would help too much is the section that says:"Try increasing the amount of fats in your diet. Fats slow the stomach emptying and may help to prevent dumping syndrome from developing. Butter, margarine, mayonnaise, gravy, vegetable oils, salad dressings, and cream cheese are good choices; use some at all meals and snacks (for those trying to lose weight, an individual meal plan can be designed with a registered dietitian)."With no gallbladder, fats are kind of my enemy on all levels. Even healthy fats and soy can trigger just awful bouts. This morning I got up and was feeling really good...Had some cantaloupe and edamamae with a half of a ginger ale. Now I have nauseous, gassy, bloated feeling with watery mouth as if I'm going to throw up. I know I won't, though.


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## BQ (May 22, 2000)

Actually no.. depends on the fat. Try oleic acid.. usually found in Omega 9 supplements. Sometimes they were the only thing that would slow down the D for me.ETA: By the way.. I also have no gall bladder either and the Omega 9 supplements really helped me. I got them in GNC.


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## obsidianoceans (Jul 29, 2011)

BQ said:


> Actually no.. depends on the fat. Try oleic acid.. usually found in Omega 9 supplements. Sometimes they were the only thing that would slow down the D for me.ETA: By the way.. I also have no gall bladder either and the Omega 9 supplements really helped me. I got them in GNC.


i will totally go check it out. any particular brand? you take them with meals or at other times? daily, every other day?


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## BQ (May 22, 2000)

I took them with meals I believe. And like I said I used the GNC brand of Omega 9. I think it was called Omega Complete or soemthing like that. Oleic acid is what is important.


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## sorchapatrix (Jan 19, 2011)

I had my gallbladder out last year and am still having major issues with bile acid D. The Questran didn't work so well for me. Unfortunately, it's pretty much the only option for postcholecystectomy syndrome. Have you been tested for fat malabsorption?


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## BQ (May 22, 2000)

Sorch ask your Dr if you can try the Colestid. It might work better in pill form rather than the powder for you. Everyone is different and ya never know.


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## sorchapatrix (Jan 19, 2011)

I have tried the Colestid in pill form, I take 4 every day, maybe I should try taking more? I hear you can take up to 16. . .


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## obsidianoceans (Jul 29, 2011)

sorchapatrix said:


> I have tried the Colestid in pill form, I take 4 every day, maybe I should try taking more? I hear you can take up to 16. . .


Colestid/colestipol did absolutely nothing for me. I was choking down 6-10 horsepills a day with no results. Same yellow, loose stools, stomach pains, extreme dumping after I ate, no help whatsoever. But if you can get relief from it, awesome! I've also been trying the Omega 9 that BQ suggested, but that hasn't been doing anything for me either. I had some eggrolls about 4-5 days ago (big mistake it seems!) and I still have dull, crampy pains in my stomach and lower abdomen. Enough to zap me of all my energy though and keep me inside and depressed. I'm not constipated, although the pains are similar. Feels like I have tons of gas trapped inside combined with strained stomach muscles. I still have frequent bowel movements and my appetite is fine, I'm just sick of being sick. I go to the doc tomorrow,for those of you who have or are dealing with post-chol symptoms, do you suggest I talk to her about anything in particular? (drugs, diet, etc)


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## BQ (May 22, 2000)

eggrolls are deep fried hon. Try to stay away from fatty foods at least.And if you are having D... take imodium????


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## BQ (May 22, 2000)

Also make sure you have had stool cultures done to rule out parasites and C-Diff.


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## obsidianoceans (Jul 29, 2011)

BQ said:


> Also make sure you have had stool cultures done to rule out parasites and C-Diff.


I have had stool cultures done before and other than being diarrhea, nothing was abnormal. Doc gave me dicyclomine 20mg to try to help with the gastrointestinal cramping, but nothing is helping still. And I know that the eggrolls were a stupid idea, but hey, it's been 4 years since my surgery and when you're feeling good, it's easy to forget things. I started logging my foods today, but I feel like I'm making myself really nervous about what could be wrong. I wake up and my stomach aches, I'm getting the watery mouth as if I'm about to vomit, I also get hot flash-like feelings in my face. (That's probably more of an anxiety symptom though, and I do take Xanax occasionally to help with those.) I had an endoscopy about 3 years ago or so and I did have small sores in my stomach (they had me taking LOTS of ibuprofen back then though, which I rarely take anymore) but I'm worried it could be something else. I just haven't had a flare up this bad since the following months after my gallbladder was removed back in July '07. I really wish I could find something to settle my stomach down from churning, and to help ease the gas and bloating cuz it really sucks!My doc was hopeful that the dicyclomine would work for settling my intestines down, she said it definitely felt like they were full of gas and sounded like it too when she listened. Otherwise she said the only thing we can do is yet another colonoscopy. I just can't handle all these invasive tests anymore!


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## obsidianoceans (Jul 29, 2011)

hey everyone, just kinda bumping this as i'm sort of freaking out and have no one to talk to.my doctor recently left the state, so i'm doctorless at the moment, but the last time i talked to her, she was completely dumbfounded to why i feel like i do. she issued an ultrasound but i have to reschedule it and hopefully can get in next week. after doing some reading around the internet, i'm a bit worried about my pancreas. i have constant dull and occasional sharp pains under both sides of my ribs (feels like i got punched, actually) as well as lower on the right and left sides of my pelvis/lower abdomen(into my sides) it's not going away, and even though it just feels like sore muscles, it's very constant and very noticeable all the time. i've even been asleep and in my dream my stomach hurt. when i wake up, boom, there's the pain...i wasn't just dreaming it. that's really messed up.self-diagnosis is a horrible thing for me to do as it always just leads me to worry, but after 5 years of doctors telling me "i don't know what's wrong" or "just give it a few more weeks", i seem like the only one who can actually find new things to try. i'm sure some of you feel the same.this morning i had the weirdest BM i have ever had. it was semi-formed, but had what looked like orangish oil, floating on the top. i've had weird stools ever since i got my gallbladder out, but never had anything look like actual oil. i eat really healthy, for dinner i had baked fish, beets, and rice. banana before bed. (yes, beets change both my BM and urine color, so the color doesn't really bother me) i'm currently taking a digestive enzyme with every meal (it contains ox bile, as well as other things to help break down carbs and fats) but i haven't noticed any change or improvement. i've also taken pepcid ac for the first time ever (i'm only on pill #2, the first was before bed, before the weird BM) i've also noticed my BM smelling very putrid. not that they ever smell good, i mean, it's a BM, but hear me out.







it's just different, and in my years of talking to people with these problems, the small details are the ones that matter to help pin-point the issues.I've heard that post-chol sufferers can develop pancreatitis 3-5 years after surgery, and that has me worried as one of the main symptoms is this sore, tender stomach. i've been miserable for 4 years now, but these are all new symptoms suddenly, and that has me freaking out. any suggestions other than "go to the doc"? i need to call monday and get in for that ultra-sound...but does ANYONE out there have the same issues as me? what's worked for you? anything?


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## jmc09 (Oct 5, 2009)

There is a medication called welchol in the US or cholestagel in Europe that has been quite successful for people without gallbladders who get digestive issues after surgery,have you tried that one?A few people on here have posted about it helping them.


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## BQ (May 22, 2000)

Well I would definitely find yourself another Dr. and go with your gut (terrible pun I know...) and find out if your pancreas is ok. In the meantime.. try something to firm up the D... like calcium carbonate supplements. Try probiotics.. and keep trying them...with severe, frequent D one can mess up one's gut intestinal flora. Probiotics can restore a good balance.


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## obsidianoceans (Jul 29, 2011)

Hey guys, long time no chat. Well, I'm back. Hate to be bumping this old thread, but you never know who might be browsing the boards! Anyways, soon after my last posts, I got a new temporary doctor (because my last one moved away) and asked to try the Cholestyramine powder. And man, for a few months, life was awesome! I could eat pretty much anything, and I'd only have to use 1/3 of the scoop before I ate. It was so great. (I also had an ultrasound and scans and my pancreas checked out OK)But alas, as everything seems to do, it's stopped working. Even upping the dosage doesn't do anything. So here I am, back on the forums and taking any and all suggestions! I am trying the enzymes with ox bile again to see if I get any relief, along with prilosec OTC and even some tums here and there. I'm feeling very full and bloated all the time, with a decent amount of cramping and nasuea. And this is despite losing about 35 pounds since my last posts! (I've been forcing myself to exercise and really watch my food intake, so it's intentional weight loss) I've also gotten a new doctor who did a full blood panel last week and everything is still normal! I'm as healthy as a horse but my guts feel like hell, so your guess is as good as mine! Even my blood pressure is good for being in pain (128/84) BM have been semi-formed and regular, but feel really slow and gassy. Gas-X doesn't seem to help at all really, even though it feels like if I could just fart for like, an hour straight, I'd feel better. lol...Silly description, but I'm trying to describe symptoms! I'm still eating really healthy, too. Anyways, anything else you guys can suggest (medical or natural/herbal) I'm down for giving a try.Thanks so much for your time.


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## BQ (May 22, 2000)

Have you given probiotics a serious try? Good ones are Align, Florastor, Culturelle, Sustenex etc.


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## obsidianoceans (Jul 29, 2011)

BQ said:


> Have you given probiotics a serious try? Good ones are Align, Florastor, Culturelle, Sustenex etc.


if serious is every other day for over a year, then yes. taking them everyday makes me way too bloated to even function, though. flora is only a small part of PCS suffers problems, the main issue is bile, Oddi dysfunction, as well as nerve damage from the surgery.since my post, i actually started working with a natural bioclinic out in san fransisco who specifically deals with post-cholecystectomy patients. i am waiting for a call back from a doctor for a phone consultation, but will let you guys know if there are any good results!


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## BQ (May 22, 2000)

Well sometimes one type of bacteria in one type of Probiotic doesn't help us.. but another type might. But let's see what the phone consult brings. Wish you all the best.


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## lmchibimoon (Aug 30, 2010)

Have you tried going on a diet with absoutely no fat?? One thing is having light food and something different is having no fat or oils, for example, not eating olive oil, cookies (not even crackers), no milk, no bread,no sodas, no chips, an of course no fried food. I had surgery one month ago, and the truth is that my surgeon put me on this diet three months before surgery and I have been eating like that until now and I am slowly reintroducing fat in my diet and fortunately I haven't had any problem apart from IBS. Perhaps you should give it a try, it is a very restrictive diet, similar to the one that you had as soon as you left the hospital. This includes no soup, no pasta, no sauses, no anything that you suspect may have fats or oils, also, peel off the fruits since the skin may be irritating for your intestine; bananas are great for stopping d, as well as guavas. Many doctors make the mistake of telling their patients that they can eat normally as soon as you live the hospital, but the body needs time to heal, and some bodies need longer periods of time. By the way, eating out is off the table for a while since you can´t really control what they use to cook.


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## Thinkin (Sep 14, 2013)

Hello Folks,

I registered on this website to reply to the post "Long Term Post-Cholecystectomy Issues".

But first, my health history as to digestion issues:

I'm a Caucasian female age 56, 5'4" tall, 160 lbs.

I had gallbladder removed in 2009 (over 4 years ago) & continue to experience digestive problems which are now just as bad as the time I was about to get my gallbladder removed!!

One thing: the surgeon told me that *he didn't think the gallstones were my only digestive issu*e -- mainly because I hadn't experienced the typical pain that most people who get their gallbladders removed have.

He didn't elaborate on that.

My mother had a hiatial hernia, was obese & frequently consumed Tums.

My family has no history of digestive problems or digestive diseases otherwise.

Digestive history included *colic *as infant for a year (couldn't tolerate breast milk), hated red meat & didn't eat it until junior high (ate a lot of peanut butter). Recall having *diarrhea* often as a child & teenager; had *nervous stomach* once in senior high due to stress at home & treated by doctor.

Never have "dieted" like so many women so weight remains fairly stable & rarely fluctuates.

Tolerated a normal diet until around age 48.

Developed *G.E.R.D.* (acid reflux) around age 48, was on Prilosec & eventually doc increased dose to twice daily.

Developed *colitis* once around age 49 & benign tissue removed from end of colon & treated with Sulphasalazine (which worked very well).

Cholesterol & Triglycerides steadily climbed due to familial cholestemia & family history of heart disease so docs tried many statin drugs but all upset my stomach tremendously so am unable to tolerate them.

Only extreme daily exercise at one job in 2003 working 12 hours daily climbing 4 flights of stairs a day all day long lifting extreme heavy weights (50 - 100 lbs.) often throughout the day eating a healthy normal diet made my cholesterol & triglycerides drop to normal.

But my body couldn't tolerate extreme physical job for more than 4 months - I developed carpal tunnel & trigger fingers & it also exhausted me; thus I returned to office work.

Since then only one other remedy I have tried has helped reduce my cholesterol & triglycerides: *Hawthorn herb*. I harvest it from the mountains where I live - all parts are medicinal & beneficial for the heart. I made juice from the berries & simply drinking the juice lowered my lab levels by 50 points or so.

When I developed *G.E.R.D*. at age 48, I'd experienced tremendous stress in my life in the several years prior & after that. My current doc switched me to extended release Protonix as said it was a better job & the twice-daily Prilosec was no longer effective. I've been on Protonix now once daily for about 2 years.

I elevate my bed considerably, avoid greasy foods & strive to eat a low-fat diet.

I had my gallbladder removed in March, 2009 as it was to the point that all foods were bothering me to the point that I only felt good when I didn't eat anything. I had no pain, but had nausea & extreme upset stomach, diarrhea, etc. The surgeon removed gallbladder which contained six (6) brown stones.

In 2011, I had an upper endoscopy & colonoscopy done which identified *one small diverticuli* & *G.E.R.D*.

The reason I'm replying to this post is to let the person know that *they aren't alone* in their experiencing so many digestive problems although they had their gallbladder removed, & to ask others to please *share their knowledge* of medical & alternative medical aids for post-gallbladder digestive issues.

In 2012 I saw a gastroenterologist for post-gallbladder removal diarrhea, which was occurring with more & more frequency immediately after eating. She put me on Cholestyramine powder, which helped considerably & told me I was free to try to go off of it but that most people end up going back on it. I stayed on the powder for about 9 months & then weaned myself off of it by eating smaller portions of food, smaller meals, eating several times throughout the day with snacks rather than 3 solid meals & adhering to a low-fat diet.

However in recent months, I've been experiencing *frequent stomach aches, frequent bowel movements* (formed, pretty normal) & have been *missing work* due to it. So I saw my gastroenterologist a second time last week, she ordered a CT of the Abdomen & Pelvis & told me to try not eating dairy products. She said if the CT doesn't find anything, she'll order an upper endoscopy & probably a colonoscopy too.

I'm not having much gas & seldom burp; the Protonix with head of bed elevated seems to help keep the G.E.R.D. under control.

What I'm experiencing is *great tiredness*, despite my taking a good multi-vitamin plus Vitamin D. I also have S.A.D. & some depression so use light therapy for that prescribed by doc.

This summer I haven't done my normal routine of mountain hikes, etc. as *haven't felt good many days*. Which is a shame because winter will arrive soon & then getting regular exercise will be more of a challenge for me. I'm going to try signing up for an exercise class at the YMCA; also with cooler Autumn weather walking after work regularly will help.

Also am a* light smoker* & trying to quit with goal to quit by the years end & hope this might help with the digestion issues.

I'm avoiding spicy foods as well & researching all I can find to see what other therapies / alternative products are available that might help in addition to researching causes of the post-gallbladder digestion issues.

I did read that* brown gallstones are related to diverticula & that stones often reoccur with brown stone disease*. Hopefully the CT & if I get the endo & colonoscopy, will reveal if I've developed more diverticuli and identify what the problem is.

I've tried probiotics, yogurt, anti-gas Simethecone over-the-counter pills, & they don't help.

I consume coffee daily, avoid carbonated beverages, don't consume alcohol & job & life is very low stress.

I chew my food well & eat slowly.

I have a LOT of *stomach bloating*. My doc thinks I probably have *hiatial hernia* but said surgery isn't needed. It is *tender at the base of my diaphragm* to the touch. I hate wearing a bra as it compresses the area & asked her if she could write a prescription so I could go braless but she didn't do that. I wear very loose clothing that doesn't bind the stomach, etc.

I feel full only after a few bites of food -- *early saiety*. I've eliminated multi-grains from diet & peas, corn & other high fiber vegetables, including raw vegetables. I'm eating prepared fruit without skins (canned, etc.) & trying to eat anything that doesn't challenge/aggravate the digestive system. Avoiding high-acid foods like citrus, rarely eat out & prepare my own food from scratch mostly.

Even when I lowered my cholesterol, etc. in 2003 when I had an intensely physical job, my weight never got less than 140 (fat was replaced by muscle). I did lose around 30 inches of body fat though (took measurements), so my body definately could use some fat trimming. Most people don't consider me overweight but just a little chunky, which I've always been. I attribute my current weight & body proportions to genetics & a sedentary job with not enough exercise.

Several modalities I'm looking at:

*abdominal massage*. I used to be a massage therapist so perhaps that might help with the digestion.

*yoga & stretching*. There are yoga exercises to strengthen the abdominal muscles & need to look into that, and practice morning & evening stretching as sitting at a desk in a cubicle all day is surely a death sentence.

*herbal remedies including enzyme supplementation*. My doctor gave me the go-ahead to continue supplementing my diet with Hawthorn herb, but there are many more herbs out there including foreign country-grown herbs & I haven't tried enzyme supplementation. Pineapple & mango sit well with my gut but perhaps condensed forms of enzymes would help?

*getting a job where I'm more physically active*. Can't just quit a job but can be looking to see what is available that would offer a wider variety of physical movement; I have a career & don't want to trash it but want to improve my health & if it means having to move on to something else, that might be a solution that might help. However if I changed jobs & still experienced the digestion issues, that would really suck.

Thanks all for reading this, hope to hear from you...

Thinkin


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## kachinkie (Jun 29, 2018)

obsidianoceans said:


> if serious is every other day for over a year, then yes. taking them everyday makes me way too bloated to even function, though. flora is only a small part of PCS suffers problems, the main issue is bile, Oddi dysfunction, as well as nerve damage from the surgery.since my post, i actually started working with a natural bioclinic out in san fransisco who specifically deals with post-cholecystectomy patients. i am waiting for a call back from a doctor for a phone consultation, but will let you guys know if there are any good results!


PLEASE tell me you have some answers. I feel like you are telling my tale word for word, only not one doctor has been able to help. I also have vasculitis where I take chemo and prednisone nonstop for 14 years. THIS BOWEL PROBLEM IS WORSE THAT anything wegener's granulomatosis has thrown my way. I am extremely depressed from this, a prisoner in my home and this combined with my other diseases (also fibromyalgia) I feel like I have no life. If you have any advice, information, a doctor to call...anything!!! Someone help me.  my email is [email protected] thank you in advance. I'm praying you even see this.


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