Part One: My Gallbladder Surgery
A little more than seven months ago I underwent one of the most common surgical procedures in the world: a laparoscopic cholecystectomy.
Or in normal person English: I had my gallbladder removed (using “minimally invasive” keyhole surgery).
What prompted a surgeon to extricate this apparently non-essential organ from an otherwise relatively healthy 30 year old you might be wondering?
Let me tell you the story.
And after I’m done, I’ll explain why, as a result of the operation, I’m now asking people to meet me for glasses of water rather than pints of beer.
Warning: I’ve tried to minimize some of the detail required to explain my recovery from the surgery. But at times what I have written here probably qualifies, for many readers, as ‘too much information’.
My Journey Towards Surgery
For years, I had been having a recurrent ache in my right hand side that would come and go — but seemed to always return to the same place. After this happened several times, I decided to see a family doctor.
The family doctor did a little bit of prodding and pushing but one particular prod elicited a sharp pain (I later learned that this is called a positive Murphy’s sign). Success, the doctor had found something. Or so I thought! “That’s your gallbladder,” he said, nonchalantly — and then quickly wrote me up a referral for an abdominal ultrasound.
The doctor informed me that my gallbladder was inflamed and gave me a referral for emergency surgery just in case I had an acute attack and the organ suddenly decided to fall apart at the seams while I was abroad (did you know that bad gallbladders can turn gangrenous?). A week later I had the ultrasound done — which mysteriously showed nothing amiss in my gallbladder.
I thought he was exaggerating about possibly needing surgery and didn’t think too much of it — expecting that, as the scan had been negative, whatever inflammation might have prompted the symptoms would hopefully die down on its own.
Unfortunately, the pain returned a few more times — always to the same place more or less. (It should be pointed out that I had been doing little to maintain the health of my gallbladder for some years at this point including subsisting on a diet of primarily falafel!)
This time, however, the scan found the gallstones that had presumably been the cause of my symptoms all along.
The line from the report, in Hebrew, is below.
It translates as “ the gallbladder contains stones, up to 3mm in diameter.”
r so the technician thought.
You might be wondering why, even if I indeed had gallstones (spoiler alert: none were ever found!), they wouldn’t try to … you know … give me a pill to take.
The very strange thing about gallbladder surgery is that the medical community has essentially given up on pharmacological treatment (pharmacotherapy).
Although, at first glance, it might seem strangely macabre to be in a rush to excise organs, there are good reasons why this state of affairs has developed.
Although there are still a couple of drugs in the pharmacopoeia that are supposed to dissolve gallstones — ursodiol and chenodiol — the drugs take months or years to work, if they do at all, and their effectiveness is, in general, relatively hit and miss.
But there’s a much stronger rationale at play.
And that’s that healthy gallbladders, by definition, do not make gallstones. Or sludge (a viscous buildup of fluids including bile and cholesterol which often preempts the formation of stones).
Thus, even if the gallstones are successfully dissolved, the likelihood — some would say near certainty — is that they will invariably return.
And as gallstone-included cholecystitis, in the worst case scenario, can lead to life-threatening complications — there is a strong rationale to remove the malfunctioning organ entirely rather than hold on to it and be forced to commit to possibly a a lifetime of ultrasounds and monitoring.
This is because while the efficacy of pharmacological treatments is uncertain, what doctors do know is that humans can live just fine without a gallbladder (at least in theory!).
Thus, since the advent of laparoscopic surgery — first performed early last century but only really perfected in the past 50 years — surgical removal of gallbladders that make stones, or that are found to have sludge in them, has somewhat incongruously become the first-line, gold standard treatment for gallstone disease.
And given that the now universally available laparoscopic surgery involves shorter recovery times than open surgery — and is less risky — the impetus to avoid it has been lessened even further.
And, as I was about to find out, the criteria to meet is not very exacting.
Meeting with Surgeons
After the second ultrasound showed various small stones up to 3mm in diameter I was referred to a surgeon working with my health maintenance organization (HMO) who advised me that my best course of action was to have my gallbladder removed. (HMOs provide basic medical services in Israel. There are four of them and, by law, every citizen needs to be subscribed to one).
The consultation couldn’t have lasted more than five minutes and he assured me — decisively — that I could be back at work the day after the surgery if I so pleased (if your surgeon tells you this then you have my permission to not listen to him!).
The health fund surgeon, in turn, referred me to a surgeon at the hospital — the one who actually performed my surgery. The hospital surgeon more or less repeated the same thing as the health fund surgeon and informed me that while there was no way of knowing for certain if the small gallstones found on the scan were the cause of my symptoms he still recommended that I had the organ out. A definite and I believe misguided “well, you don’t need it so it won’t hurt to have it out,” line of thinking seems to prevail among surgeons regarding all things gallbladder-related.
And so, without much further a-do, I was booked in for surgery.
The surgery day came about quite a lot sooner than I expected.
Out of the blue one morning, while working on an article for a client, I received a call from the hospital.
I could either have the surgery in two weeks time — or not for another few months.
I asked if I could get back to the hospital tomorrow with my answer? No way I was told — I would lose the slot.
How about by the end of the day? No such luck. The receptionist demanded an answer right now.
It was the ultimate case of being put on the spot about a pretty drastic life decision.
With the adrenaline coursing through my veins I decided to do something that I rarely do: I was brave and resisted the urge to do my own research online. (Which, in retrospect, was either a very good or a very bad thing depending upon how you look at it — Facebook groups are internet fora are flooded with people just like me who have been saddled with health problems arising from the surgery that far exceed the gravity of the problem that prompted the surgery in the first place.)
And so the day of the surgery finally rolled around.
I meditated. I tried to stay calm naturally. And I failed.
Sequestered in the pre-surgery room for just a little too long the nerves finally began to hit — the final stretch of the waiting period was dragging on beyond the limits of my ability to hold in my anxiety about the surgery.
I asked for a tranquilizer and began to calm down. Next thing I knew I was being wheeled into an operating theater while a very reassuring anesthesiologist informed me that everything would be okay.
Then the cold feeling of the milky-colored anesthesia induction agent, propofol, shooting up into my vein.
And next thing I knew I was in the recovery room treating the entire room to the theme song to the British children’s television show Rosie and Jim which— oblivious to the presence of other patients — I quite obnoxiously decided to blast over my phone’s loudspeaker (one emerges from anesthesia in a state of temporary delirium; and yes, this actually happened!).
I stayed overnight at Hadassah Ein Karem hospital and was discharged the following day with the most basic of painkillers possible: acetaminophen.
Stage one of the journey was complete.
Oh, and the pathology report, which I received two a month later: my gallbladder didn’t contain any stones!
Above: my pathology report from Hadassah. In Hebrew: “[gall]stones were not found.”
And Then: The “Difficulties” Began
Immediately post surgery in Hadassah Ein Karem. If I look weird, it is because I was heavily medicated with painkillers when this photo was taken. I can’t make the same excuse for my haircut, though!
Unfortunately this marked the beginning, rather than the end, of something of a much bigger health saga.
A saga that I am still dealing with as a I type this.
After the typical post-op pain finally died down, the first untoward symptom was a very bitter taste in my mouth.
I didn’t make the connection between that taste and gastritis at the time. But I have come to know that it serves as an early warning for a flare up.
That bitter taste was followed, in very short course, by symptoms that I recognized almost immediately to be gastritis: An insatiable appetite; a relentless gnawing raw pain in my midrift (“as if my insides were scraped” is a common, and accurate, description); and a feeling of hunger that would return almost immediately after I ate, as if I hadn’t eaten anything.
As these symptoms continued, nausea and vomiting then joined the party — the latter consisting, each and every time, of almost pure bile.
And although I was not given any specific dietary advice (at least that I can recall) I did what those friendly people on the internet recommended — avoiding alcohol and fatty food and sticking to a rather bland and uninspiring diet (bear in mind that I am an ethic food fiend and that Ethiopian and Indian are my two favorite cuisines; this was not fun!).
The kicker was that exercise would kick the gastritis up a notch too. So although, on several occasions, I tried to restart a fitness program (with the idea of shedding the excess weight I was gaining by snacking in order to keep the worst of the gastritis at bay) it seemed to only worsen the symptoms. It was a frustrating situation to say the least — as if I’d drawn a checkmate in a game against my own recovery. Even as bland a diet as I could tolerate didn’t seem like enough to put the gastritis into remission — or even come close.
After it became clear that the gastritis wasn’t going to go away on its own accord, my family doctor referred me to a gastroenterologist.
While I was waiting for that appointment, four months later, a (very well-intended) friend organized a pub crawl for my birthday to which a delightful coterie of people dutifully showed up — some from another city.
I did what people who are the center of birthday pub crawls thrown in their honor are expected to do: I participated in the consumption of beer!
And that was the first time that I realized that my tolerance for alcohol had dramatically decreased since surgery.
I’ll leave the ugly details aside — or at least some of them.
But suffice to say that the beers I had on that evening seemed to have about the same effect on me as what 10 or 15 of them might have had if I was an 18 year old college student intent on getting recklessly drunk at some college party.
My stomach simply couldn’t handle it.
After a wave of nausea that lasted hours struck, an 8 hour vomiting marathon mercifully ensued — again, marked primarily by the expulsion of large amounts of bile. Oddly, I noticed that the vomit contained some food from the previous day (more about gastroparesis, and its lesser known sibling, later).
The strange thing, the few times this has happened, is how quickly I bounce back.
The next day, back working at my computer, I almost felt as if nothing had happened.
But clearly the situation was not neither normal nor going to go away on its own.
There was more investigating to do.
Complication 1: Bile Reflux Gastritis
On foot of my persisting symptoms, I had an upper endoscopy one month after the operation which yielded a diagnosis of reactive gastritis.
The likely causative agent: bile reflux.
For those who are not aware, bile reflux is an extremely common complication of gallbladder removal — as many as 90% of patients develop it . Although, for reasons that are not fully understood, it doesn’t irritate the gastric mucosa (stomach lining) enough to cause gastritis in all cases. In fact, symptoms and full-fledged bile reflux gastritis develop in only 3 to 30% of patients with endoscopic evidence of bile reflux.
And although I neither claim to be an expert in medicine nor physiology, understanding why that is so isn’t in inordinately complicated.
The gallbladder’s primary function is to store the bile that the liver produces between meals and secrete it whenever fat is ingested. Bile is that greenish liquid that is used to help break down fats (malabsorption of fat-soluble vitamins and minerals is, unsurprisingly, therefore another common adverse outcome of the surgery)
Without the gallbladder to act as a reservoir to hold it, the bile, once synthesized by the liver, essentially has nowhere to go when it’s not immediately needed and therefore both drips down into the colon and refluxes upwards into the stomach where it causes irritation.
This latter retrograde movement of the bile is what causes patients difficulties with gastritis and reflux. Downstream, in the colon, the excess bile acids can result in bile acid malabsorption whose symptoms include diarrhea and urgency. In fact, with bile reflux in play, bile can make it all the way up the esophagus and into the sinuses: when my symptoms were at their worst I literally had distinct green bile coming out my nose while I vomited.
Over time one’s physiology attempts to adapt — such that, I have read, the body begins storing bile in the bile ducts themselves. But the adaptation is a slow and incomplete process. And in many cases, a chemical gastritis develops as a result of the bile’s frequent pooling in the stomach. As most bile reflux sufferers, including me, have spent their fair share of time throwing up bile that it can severely irritate the stomach lining, or other tissues it was never intended to come into contact with, is rather unsurprising. This common post-surgical condition — which some doctors mistakenly think is vanishingly rare (laparoscopic surgery has turned that on its head)— is known as bile reflux gastritis.
People with their gallbladders intact tend to not experience bile reflux to an appreciable, or at least to a pathological, extent — although there are some doctors who think that bile reflux plays an underappreciated role in treatment-refractory Gastroesophogeal Reflux Disease (GERD) — and some evidence to support that. Amazingly, sufferers often encounter a slew of unsympathetic (mostly old-school) gastroenterologists who will tell them that bile accumulation is “totally normal” or that gastritis resulting from it is something “very rarely if ever seen” — as if the fact that the bile is causing them to vomit several times a week is either normal or imaginary. If this were the case before the advent of widespread laparoscopic surgery it does not appear to be the case now. And neither of these things in okay.
Unfortunately, in the grand scheme of all things gastritis-related, bile reflux is a tricky variant to treat.
Unlike, say, gastritis caused by taking too many NSAIDs, drinking too much alcohol, or by an infectious agent like H.Pylori infection the causative agent isn’t time-limited — the liver will go on making bile and it will continue to pool in the stomach indefinitely. Even with a perfect diet one cannot simply stop making bile. So in many cases lifelong treatment is the only option.
But even treatment isn’t straightforward. Unlike the better known form of reflux caused by the backflow of hydrocholoric stomach acid, which usually responds very nicely to proton pump inhibitors (PPIs), bile reflux is unfortunately quite tricky to treat — and the class of therapeutic agents is both limited and seemingly not in active development.
To try get the gastritis under control I was put on just about the only medication that works for this: a bile binder. This is the first line treatment for bile reflux gastritis (the last one is another surgery).
“Bile binders,” also known as bile acid sequestrants, are actually simply repurposed old cholesterol-lowering drugs that are prescribed off-label to mop up bile so that it stops sitting in the stomach and causing gastritis.
They are resins which chemically attach to the bile (hence the name) and then excrete it fecally. If you’d like that described in cruder terms: bile acid binders stick to the bile, carry it through your colon, and then it emerges from your other end. Because the bile is bound in the stomach symptoms in the colon — diarrhea and urgency — are also reduced.
An upside for a change: they lower LDL (“bad”) cholesterol modestly because this is what the drug was actually designed and indicated for. Another upside: they remain sequestered in the GI tract and so systemic absorption does not occur (the drug does not pass into the bloodstream). In theory, this is supposed to minimize side effects — although some like metabolic acidosis and further impaired absorption of nutrients are still possible. A downside: bile binders to not bind to bile exclusively. They can also bind to meditations. Thus one can’t take oral medication one hour before or three hours after ingesting one. This is true whether they are taken by pill or as a liquid suspension.
Unfortunately, as I was soon to discover, acquiring cholestyramine — or colestid, the other commonly prescribed first generation bile binder (which is a pill formulation rather than a powder) — can be a trying endeavor. (There is one second generation bile binder, colesevelam/Welchol, which apparently has higher specificity for bile; however, I have not been able to obtain it).
As statins have almost entirely supplanted these drugs’ role in treating high cholesterol, the only people that actually rely on them these days are those left with bile reflux and bile salt diarrhea as unfortunate complications of abdominal surgery (other abdominal surgeries commonly kickstart the condition too). As well as a smattering of patients with Crohn’s disease and IBS. All told, it’s a relatively small patient pool. Which also means less of an incentive for pharmaceutical companies to keep the drugs in production and distribute them.
National shortages of the various bile acid sequestrants happen periodically and in various healthcare systems.
I was lucky enough to be able to source mine through my local pharmacy. But it had to be ordered in especially and could only be obtained from my health fund’s own chain of pharmacies (this is not normally the case).
But in spite of the difficulties in sourcing them, and of having to drink a chalky chemical orange juice that might erode your tooth enamel several times per day, bile binders appear to work.
Within about a week of starting cholestyramine — or “mutant orange juice” as I sometimes call it (the drug is administered as a flavored solution) — my gastritis has gotten appreciably better. The relentless gnawing feeling and the hunger began to slowly abate.
As the gastritis tended to get worse with exercise — and I was also putting on weight due to the relentless feeling of hunger — I was hopeful that this might be the beginning of a new start.
It sort of was.
And Then: A Weird Motility Problem Starts
Cholestyramine: it damages tooth enamel so its best to drink it through a straw. I call it my “mutant orange juice”
Sadly, gastritis (and fatigue — I have developed a micronutrient deficiency) are only two of the problems that I have been dealing with since the op.
The other is a little stranger: A feeling that, whenever I drink liquids, they simply sit in my stomach.
As far as I am aware, I began noting this soon after the surgery too. But the gastritis and the vomiting were more pressing concerns. Distracted by work, I could force it out of my mind. I won’t say much about this one other than that I am thankfully now under the care of an engaged gastroenterologist and that — as the gastritis was — this too is being looked into. Bile reflux sufferers are notorious for shuffling through a variety of specialists as many sadly seem content to leave them heaving bile into toilet bowls indefinitely. Thus, finding one that cares, and is prepared to help, is a important milestone along the way.
My presumptive diagnosis for this second complication is impaired gastric accommodation — a vagus-mediated condition (like gastroparesis) but which, unlike gastroparesis, involves the nerves of the stomach failing to expand the organ to “receive” food and liquids thereby creating a sensation of a “blockage”. (By contrast, gastroparesis is a nerve-mediated problem on the other end of the organ — with emptying of food and liquid into the colon.)
Like post-surgical gastroparesis, the problem is possibly a result of damage to the critical vagus nerve, which controls so many aspects of our physiology, during the surgery. (Certainly, I never had a sensation like it before the operation and I am not directly making that allegation for ahem … reasons). But, either way, it is impossible that causation can ever be proven. And whether the chicken or egg came first matters not one iota to my recovery.
The symptoms are essentially those of dyspepsia. I burp a lot after eating just about anything which was mildly comical for about a month until it just became plain annoying. But the feeling that liquids sit and slosh in the stomach — rather than move effortlessly through it — is certainly the most bothersome of the problems that it has caused me.
Unlike gastritis this set of problems is uncomfortable rather than painful or aching — mostly I find it incredibly distracting so I have been trying to reverse the distraction by burying myself in work. Right now it’s about the best I can do. But it’s still very early days in the journey.
Update: I Can’t Really Tolerate Much Alcohol Any More — But Especially Beer
Unfortunately, since the surgery, my ability to tolerate any alcohol whatsoever has only gotten worse rather than better — although perhaps I’m just drinking so little of it that my system reacts more forcefully to the periodic ingestion — and my tolerance has undoubtedly plummeted.
When lockdown started my usual Thursday night pub expeditions went out the window. As they did, work, paradoxically, picked up — in a dramatic and life-consuming sort of way. And I gradually, perhaps instinctively, began avoiding alcohol at all.
For the past month or two my alcohol consumption has essentially been limited to a glass of wine to initiate weekend. And a glass or two on the odd Zoom call with friends in Ireland.
However:
For reasons that are as of yet unknown any time I drink beer — specifically — I become violently ill. And I mean violently.
This week, Jerusalem started to re-open.
To mark the occasion we headed out to one of the first bars to resume operations to some extent and basked in one of the first manifestations of relative normality — something we would have taken entirely for granted in The Olden Days.
Two “ shlish “ (330ml) beers of 5% lager were enough, to my disappointment, to kick off another marathon nausea and vomiting spree — the first I had had in about four months.
Right now, other than knowing that something is definitely amiss, I’m not terribly sure what is going on with my health. Blood-work has eliminated any obvious causes — but has not provided an answer either. Yet the connection to the surgery, to me, again seems obvious.
What I do know is that I can’t tolerate beer for whatever reason. And that my ability to drink any other alcohol seems to be capped at about one unit.
I hold out a little bit of hope that, as I move through the diagnostic process and put pieces of the puzzle together, I will one day be able to enjoy a pint of Guinness again without knowing that it will probably trigger a dramatic expunging of my stomach contents several hours later.
But there has been a sort of unhealthy self-pitying grieving process to work through in the meantime.
Why me? And why me at the start of my thirties? These are the sort of questions that I have been grappling with internally and which, at times since the operation, have pinned me down into a sort of temporary depression.
I’ve mostly moved through that necessary journey. Right now my best bet is probably to play it safe.
And thankfully, I’m not facing the battle alone. At least virtually.
These problems might, at first glance, seem unexpected or even dramatic.
But in my quest to find answers online, trawling through Facebook Groups and other online communities, I have encountered countless scores of individuals — of both genders, of all age brackets, occupations,and prior health states — who have been left with these exact problems, and sadly, sometimes much worse ones.
The sheer numbers, to my mind, are staggering: I would estimate that tens of thousands of people around the world are suffering through protracted digestive difficulties brought about solely through laparoscopic gallbladder removal — an operation we are repeatedly told is a “harmless” way to extract a “useless” organ.
More incredibly, perhaps, I have also met plenty of individuals who appear to have similarly experienced false positives on ultrasound and who, after parting ways with the organ, learned that it either contained no stones — or only contained sludge, a condition which can be relatively benign but which might, on the other hand, also foreshadow the development of stones themselves.
So for a lot of us it’s very murky business. But a few things, at least to me, are clear.
Such as that in my opinion, and that of many, and as the simple 80–90% incidence of post-cholecystectomy bile reflux into the stomach makes clear, extracting the gallbladder is not a “nothing” medical procedure that can be dismissed as having no effect on patients’ lives after the acute recovery period is complete.
It is an indisputable fact that humans digest better, physiologically, when their bile can be stored in a reservoir. And, to resort to a truism, we probably wouldn’t have been engineered with a gallbladder if one didn’t serve a purpose.
But the effects might be more far-reaching than bringing up bile unless we can find a way to keep it away from our stomachs.
There is evidence that excess bile acid is far from innocuous even when it doesn’t result in clinically apparent gastritis — cardiomyopathy has been linked to the pooling of bile acid in animal studies, an apparent distal effect of the acid accumulation in the stomach.
On the positive side, where there are many other patients there is solace in numbers and the potential power of crowdsourced brainstorming to help find, if not cures, natural or medical treatments which might alleviate some of the unfortunate consequences of this very common surgery.
I recently went on an iHerb trawl and have begun exploring what natural supplements might provide relief instead of pharmaceuticals: psyllium husk replaces the bile binder and other natural compounds aim to mitigate other parts of the picture, such as nausea. Whether it will work, for me, I haven’t gotten around to investigating yet.
The best I can do is try. And see what works. And hope that in time, as medicine advances, we will find a way to treat gallbladder disease without excising the organ at all.
And that when that happens the ranks of those suffering with bile reflux gastritis, post-cholecystectomy syndrome, and the other countless labels and conditions tied to this “routine” operation will therefore empty.
Part Two
The Water Meetup Project
While going through the above has been as difficult as it might sound I have to be honest and say that a large part of me has greatly enjoyed cutting down drastically on my alcohol consumption — even if my hand, or rather my stomach, was forced into the change by unforeseeable circumstances.
No doubt, as I have mentioned, I miss being able to enjoy a couple of pints in a pub once a week without that simple pleasure making the next 12 hours of my life a living misery. And until I work out why that is the case, or how to avoid it, that activity is squarely off the table.
But I’m also feeling a lot more positive mentally after the turmoil of the last six months. I’ve lost a little bit of weight. And my wallet is certainly benefiting — even by just cutting out a once weekly excursion to a bar, and the subsequent taxi home.
In a sense, the bizarre confluence of lockdown and forced teetotalism that the year to date has entailed for me have forced me over some kind of mental threshold in my relationship with alcohol. One which I feel I had been planning on crossing soon anyway.
For one, I have become a terrible bore of sorts.
Most nights of the week my Kindle, with a cup of water to enjoy it with, is a more enticing proposition than watching Netflix with a glass of wine in hand.
It’s more interesting, I learn a lot from it, and, most importantly, I know that it isn’t going to make me sick in a few hours.
People change.
I have — along with the world — but so far this is one change that I, mostly, would like to keep.
As the world reopens, I realize that the very strange hermetic existence that the strict lockdown conditions forced upon me, and many, were, frankly, depressing days that I would not want to repeat.
I want to see people again! To share stories about things other than my health! But sadly, this time, even if it’s what my friends want, I know that that storytelling cannot be done in the company of a glass of alcohol. At least not now — because alcohol and wellbeing seem to have become mutually exclusive for me.
When looking for information about ways to meet people who don’t want their evening socializing to involve alcohol any more one is invariably and quickly drawn towards information written for those that have been forced to give up alcohol due to dependence issues — specifically alcoholism but sometimes people who come to the conclusion that their drinking is facilitating some other vice or an unwanted behavior and wish to desist for that reason. As is well known, this is a large and significant population.
However, I feel that people that have been forced to give up consuming alcohol suddenly and due to a medical issue want to approach the issue from a slightly different point of view — and that, without a doubt, AA meetings are not the right venues in which to recruit a group of friends excited to embark upon a shared new journey of alcohol-free socializing but without, necessarily, intending to do so indefinitely.
Like recovering alcoholics, I want to figure out a way to stay social without alcohol playing a part in those social interactions. But unlike reforming alcoholics I don’t see any particular wisdom in cutting out alcohol entirely if that can at all be avoided. I would be lying if I told you that were the case.
Because I saw something of a lacuna (the one I have described) I decided, this week, to set up a small Facebook community. It currently consists of myself and just one other member but others are more than welcome to join.
And I chose the unusual title — Water Party Meetups — because I couldn’t readily think up answers to some questions. Questions that had begun gnawing at my brain as soon as the bile had stopped gnawing at my stomach:
- Why can’t people be honest about the fact that they want to meet other people simply because it is fun and fulfilling to do so?
- Why do many adults feel an instinctive need to frame their socializing around alcohol — like meeting up at the pub, throwing a house party (with drinks on hand), or heading out for dinner (and wine)?
- And if we don’t automatically frame our social engagements around “meeting for a drink” why do we, instinctively, have to reach for some surrogate that also happens to be psychoactive — coffee is the obvious one but many people, on hearing that I have severely curtailed my drinking, have suggested that I take up cannabis-smoking in its place (no thanks).
Or if we not for those options, why do we feel the need to complicate things by insisting that what might be our first forays into alcohol-free socializing for some time be done in the context of some hobby that requires specialized equipment, commitment, and skills?
I have a lot of interest into getting into new hobbies.
But right now my first priority is to unlearn the ingrained adult habit of thought that when adults convene to socialize, in the evening hours, meeting in a bar is the most obvious neutral territory in which to do so.
Because that false belief, drummed into many of us by dint of years of repetition, is a total falsehood.
I can recall plenty of enjoyable encounters with friends before I once touched a sip of alcohol. Why should things be any different now just because I’ve aged by 10 or 15 years in the intervening period?
For that reason, I came up with the idea of inviting friends to “Water Parties.”
The idea, as I conceived of it, is that these meetings will involve meeting, ostensibly, to share and partake in the simple act of drinking a glass of water.
Yes, a glass of water! And why water, you might be wondering?
Because what could possibly be as boring and unexciting as drinking water?
And what other “hook” could lay bare, as transparently, that the idea is, rather, simply to meet, and enjoy the company of, other people?
That the purpose is to just sit and enjoy a chat with friends, whether old or new — and without departing from mental homeostasis, hanging upside down from the ceiling, or climbing a mountain?
In my view, centering meetings upon this activity would be the most effective means possible of encouraging people to meet simply for the joy of meeting other people. And for everybody involved to realize that that is simply what the whole initiative has been facilitated to entail.
In a long and roundabout nutshell, that’s the story of my gallbladder surgery, where my health is at now, and why — in the coming weeks — I intend asking the question plenty of times “Hi! Any interest in meeting for a a glass of water tonight?”
As I have mentioned, I don’t see this as necessarily hinged to the idea of living a teetotal life.
While my current wellbeing and drinking beer are mutually exclusive the possibility of a future spent meeting people mostly for water and occasionally for a glass of wine certainly are not.
Rather than framing this through the prism of misfortunate medical suffering I am trying to see this as an embarking up on a necessary journey — for me, and for anybody interested in joining — to unlearn an ingrained and harmful belief (that alcohol is integral to ‘having a good time’ as an adult); to recreate in a more healthy way; and to do so in a way that allows one to maintain, and even improve, one’s social life — because, as the lockdown has painfully borne out, socializing is a vital human activity and essential to human happiness.
If I can have a great night that isn’t bookmarked by anticipatory anxiety of what effect it might have on my body and then the actual unpleasant effect that will be a great achievement. The ‘how’ — and whether that involves water or beer — is unimportant.
If the above jives with you and you are interested in setting up your own local water chapter meeting then please be in touch.
To your health!
Further reading:
Bile reflux and bile reflux gastritis:
- Bile Reflux: Symptoms and Disease (Mayo Clinic)
- Shortage of Bile acid sequestrants (UK NHS)
- Does Cholecystectomy Increase the Esophageal Alkaline Reflux? Evaluation by Impedance-pH Technique (“Bile reflux into the stomach is reported in a rate of 30%-100% after stomach surgery and 80%-90% after gallbladder surgery”)
- Biliary Reflux (Science Direct) “Symptoms result in only 3% to 30% of patients with endoscopic evidence of bile reflux”
- Bile acid sequestrant relieves refractory GERD symptoms
Impaired gastric accommodation. (Compared to gastroparesis) a relatively obscure clinical entity that is believed to play a very significant role in dyspepsia. Functional dyspepsia (FD) is another common adverse outcome of gallbladder and other abdominal surgeries, possibly related to damage to the vagus nerve.
Impaired gastric accommodation:
