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What Causes Fatigue And Fibromyalgia Post Cholecystectomy?

Posted on Sat, 28 Mar 2015

Question: I had an open cholecystectomy over six years ago and came through it relatively unscathed. I have also had a colectomy (24 years ago). Since the chole I have been dealing with profound fatigue and have had dxs suggested including: menopause; adrenal fatigue (previous medical problems); fibromyalgia protracted flareup; depression; "something else"; "a combination of factors". Any suggestions YOU can offer for me re the etiology for the fatigue post-chole?
XXXXXXX

Answered by Dr. Sagar (1 hour later)

Brief Answer:
this may be postcholecystectomy syndrome complex.

Detailed Answer:
hello
welcome to HCM,
i appreciate your concern Mrs Mbruce.
this symptom complex after cholecystectomy is called postcholecystectomy syndrome.
occurs 10-15% patients after cholecystectomy.
this may be associated with fatigue,gastritis,duodenal ulcer,vomiting,diarrhoea,jaundice etc.
most common symptoms are fatigue and gastritis.
treatments are mainly symptomatic.
if medical treatment fails surgical exploration or investigations like ULTRASONOGRAPHY whole abdomen or CECT whole abdomen is done to rule out any abdominal pathology are there or not..also metabolic work ups to be done to rule out metabolic causes of fatigue.

now you need to tell me what medication you have tried.so that i can help you further.
Hope I have answered your question. If you have any further questions I will be happy to help.
regards.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Sagar (26 minutes later)

Medications taken daily:
Losec (20 mg) (1/day)
Buscopan (10 mg) (6-8/day)
Ranitidine (150 mg) (2-3/day)
Codeine Contin (200 mg) (2-3/day)
Entrophen (enteric-coated ASA) (325 mg)(2-6/day)
Zoloft (150 mg) (1/day)
Activelle LD (HRT) (tapering, just about off)

Answered by Dr. Sagar (20 minutes later)

Brief Answer:
symptoms may be due to side effects of drugs

Detailed Answer:
hello,Mrs XXXXXX,

from your drug history, i found that you are taking codeine 400-600 mg /day.

codeine is a opioid analgesic and CNS depressant. it causes sedation and fatigue.
improper tapering of HRT may also cause fatigue.

when you are taking omeprazole, you can stop ranitidine too.

you should consult your prescribing doctor to switch over to other types of medications available that are devoid of sedation.

hope this will help you.

If you do not have any clarifications, you can close the discussion and rate the answer. Wish you good health.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Sagar (32 minutes later)

Appreciate your concerns re medications but problems began when using a different pain medication than codeine. Losec is for "acid stomach", i.e., level of discomfort most of the time, 2 gastroscopes determined excess acid, benign, long-term use recommended. BUT when I began codeine contin, Losec not sufficient to prevent significant stomach problems, therefore Ranitidine started, to be paired with codeine doses, which works. Am also dealing with chronic pain, myofascial pain syndrome, and chronic fecal incontinence post colectomy/pelvic pouch construction. In my research, I am finding that the literature seems to address only the digestion-related aspects of post-cholecystectomy syndrome, beyond immediate postop fatigue. Should the fatigue I'm experiencing now still be linked to the chole and are there any specific-to-situation measures I should be considering? Thanks in advance for prompt and cogent replies!

Answered by Dr. Sagar (37 minutes later)

Brief Answer:
you can change some medication and give a trial.

Detailed Answer:
Thanks for these informations.
Codeine can cause this fatigue..there are different causes of fatigue.i think you are well aware about those..let me know some datas:
Cardiac work up?
Metabolic work up?
Hemoglobin level?
Any proved etiology of your myofascial pain symptoms?
And what medication before using codeine caused it?
Then i can figure out more.
And by changing codeine to another medications for it you can give a trial if symptoms improves then this will be followed.
Typical postcholecystectomy syndrome fatigue is more acute than chronic but in case of you there is a colectomy. So it has a high chance to be a prolonged symptom.
Hope this is helpful.
If this answer satisfy you please give an user thanks.
Wish you a good day madam.

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Above answer was peer-reviewed by : Dr. Pradeep Vitta