Dr. James G. Mcdowell, M.D.

The incidental finding of a ‘stone’ in the appendix most commonly means nothing. These are called fecaliths. Actually, fecaliths are the cause of appendicitis. The appendix is a hollow tube that hangs off of the colon on the right side of your abdomen. Appendicitis occurs when a fecalith becomes impacted in the neck of the appendix. The appendix then begins to fill with its own secretions. Bacteria from the fecalith then begin to infect those secretions. As the pressure begins to increase within the appendix and inflammation sets in, the patient will begin to experience worsening Right sided abdominal pain. Eventually, the pressure builds up so much that the appendix will perforate. At this point, pus begins to spread throughout the abdominal cavity and sepsis sets in. Appendicitis is a short term illness. It usually manifests itself over 24-72 hours.

I definitely recommend smoking cessation prior to any surgical procedure. The reason for this is multifold. The first reason is that active smoking concurrent with an operation raises the risk of an an intraoperative cardiac event (heart attack, arrhythmia, etc,). Secondly, recovering from anesthesia requires that your lungs can oxygenate your blood adequately. If you are smoking, it increases that chance that this recovery may take longer and requiring a longer time on the ventilator. Believe me this is not a pleasant experience. Finally, in order for any operation to work, we surgeons depend on your body's ability to heal. Wound healing is dependent on several factors but the most important is blood flow to the wound. This allows new healing cells to be delivered to the wound while dead cells and infection are cleared from the wound. Nicotine has many effects but one of the most promininent is vasoconstriction. This means that the vessels providing the much needed blood supply to a fresh wound contract and cut off that blood supply with every drag on a cigarette. Therefore, patient's who smoke are at a much higher risk of wound infections, no healing, etc,.

Nausea after anesthesia is a problem for almost everyone. Traditionally, we have tried to pretreat with a meclizine patch. This works in most circumstances. This is sometimes not enough. The reason most patients experience nausea after any anesthesia is usually the use of opiates for pain control during the procedure. Opiates act directly on the nausea centers of the brain and many of the antiemetics we use, block receptors in that part of the brain. Recently, many medical centers have adopted the ERAS (Early Recovery After Anesthesia) protocols. The idea is to minimize the use of opiates during the procedure. If you have intractable nausea after any procedure, even with pretreatment, you should inquire if your provider uses the ERAS protocol.
There is also a new antiemetic on the market that has really helped many of my patients with this problem. Emend is an FDA approved medication that we actually start administering the night before a scheduled operation. You may consider inquiring your proceduralist about this drug. You might also need to make sure your insurance will pay for it as it is quite expensive.

Depends on the reason you are having it removed. The most common indication for cholecystectomy is symptomatic gallstones. If that is the indication, chances are that your gall bladder is not functioning well as it is. Thus, there should be no digestive consequences to removal. Rarely some will report looser stools or flatulence after cholecystectomy. This is usually self limited. Patients who have these symptoms for a long period of time after cholecystectomy likely have another problem unrelated to gall bladder removal such as IBS, Colitis, etc,.

Appendicitis is a disease that lasts for 24- 72 hours and does not come and go. Intermittent Right lower quadrant pain is not the usual presentation of appendicitis. I would look for an inguinal hernia, female gynecological causes such as ruptured corpus luteum cyst or endometriosis, or colitis. If you have appendicitis, chances are, the pain will become severe enough for you to present to a health care provider.

It depends on the reason the colostomy was placed. Reversible colostomies are performed to divert stool away from a diseased segment of the bowel to allow for healing or resolution of an infection. Once the initial cause of the disease is resolved, the colostomy can then be taken down and bowel continuity resumed. This of course if the patient has very little operative risk.