Hello, I am now 2 months post-surgery and would like a second opinion of the quality of my care. I am nearly 39 years old, male 155 pounds, 68 inches, no previous health issues except for Tinnitus. I'm married to a beautiful wife and have two beautiful girls. Life has been great. My main symptoms started at age 38 March 2020, I had 1 full night 8-10 hours of upper abdominal pain unable to sleep. April 2020 and May 2020 a repeat of the above once each month. I attributed it to eating the wrong thing. Nothing happened during summer 2020 and I made sure not to eat spicy foods. On another note, this all may have started in Fall 2018 when trying to figure out why I was having an odd but mild abdominal pain/faster heart rate. I had gone to some doctors who dismissed me even though I had mildly elevated ALT/AST (3x normal) and a clear ultrasound other than "Scant sludge found." I had previously taken a course of antibiotics given to me from my first point of contact and the university doctors blamed the antibiotics for the liver numbers. I had to order my own blood tests twice until the liver numbers receded and then I learned to attitribute my on/off mild RUQ pain to "I am crazy, I have anxiety, calm down" and it would come and go over the next years, very subtly. I never saw another doctor. Forward to October 2020 and the very bad pain from spring 2020 returns. This time it keeps recurring every 3 nights during one week. The third time I fell onto the floor with what felt like an extreme attack almost like a heart attack but lower than the chest, for about 10 minutes. After 8 hours, mild pain persisted, urine was dark, I gave up and went to an urgent care at 6AM. At the urgent care, they performed blood test. Abnormal results were liver enzymes at ALT 700, AST 500, bilirubin 4.0, WBC 8.0 (High for me - usually 4.0). I painfully describe in detail everything. The doctor there didn't know what to do, was fairly unprofessional in his slightly panicking demeanor "I don't have a clue, really I don't" and transferred me to the urgent care's associated advanced hospital. The hospital admits me overnight (first time ever) and the next day repeats blood work and orders an ultrasound and MRICP. I am now feeling great, no pains and I make sure the doctors knew this. At this point I had also been fasting since the urgent care and on constant IV Fluid. Repeat blood work ALT 900, AST 400, bilirbin 6.0 and WBC 5.0, the ultrasound and MRICP indicated gallstones in the gallbladder up to 1.3cm, dialated bile duct of 7mm but nothing seen in the bile duct. The doctors indicate I most likely need an ERCP and Gallbladder removal. This is all new to me and I pleaded with them not to do surgery yet as I'd like to research my options and try conservative methods. The doctors are not pleased with this and tell me that I need at least an ERCP to remove what is most likely a bile duct stone somewhere. ERCP is delayed until the next day due to specialist avaibility. The next day, still fasting on only liquids and IV fluid, blood work improves to ALT 500, AST 200, bilirubin 2.5 and WBC 5.0, I pointed this out to the doctor but the doctor still insisted there could be a stone and told me that numbers can improve if a stone moves somewhere new, in addition that fasting is quieting the system and may also improve these numbers. I gave up and waited for this ERCP, which I was told would be a short, simple endoscopic procedure to remove the stone, with only a 5% risk of infection such as pancreaitis, but the doctor performing it is a highly experienced specialist who does many ERCPs and this reduces risk. The ERCP is uneventful - Supposedly gallstones and sludge found, 5mm the largest one, successfully removed - and I am discharged from the hospital after another overnight stay to monitor me after ERCP. However, I was shocked to see my discharge paperwork - Sphincterotomy Performed and Bile Duct Stent Placed. I was never informed of this before the procedure. I did limited research on the procedure during my stay, but my mental state wasn't too powerful being that I was on a 48+ hour fasting routine. At the time, the ERCP didn't seem a big deal based off of "leaflet" style explanations. Afterwards, in the meantime, I made sure to get a second opinion through tele-med at a university hospital. They agreed with the prognosis and treatment. I would try to keep the gallbladder by eating right and taking it easy. I asked about ursodiol but everyone dismissed this drug and told me please get it removed. Fast forward several weeks and I had a recurrent bout of 3 day long horrible pain. Again I ask for ursodiol and get denied. So I return to the same hospital and an ultra-sound and CT Scan indicate a 10mm stone lodged in the neck of the gallbladder in addition to infection/fluids, WBC 15.0, CRP 100x normal, I agree to the surgery. Laparoscopic Surgery is performed the next morning after overnight monitoring and antibiotic IVs. I might say it went swell, I was operated on by one of the original doctors who saw me at the hospital (and who also saw me years ago). Discharged and home I go. I had to go back to another hospital to have the biliary stent removed a week later. I have made a complete recovery from the surgery within 2 months. I have zero abdominal pain, and very little digestive issues except for occasional loose stools, and a rare diarrhea. This is better than I had expected. I am eating smaller portions of the same foods I ate before. Mostly traditional food, no fast food. At times over several days, I seem to have lingering extra salivation and a sticky mouth feeling. This is the only effect I have felt besides the pain of the surgical incisions (pain now completely gone). Do I need to follow up for excess salivation? This seems to be a rare symptom that some, but not very many people have mentioned. My biggest concern goes back to the ERCP performed. This was probably justified, but I did not like the outcome. I feel the staff at the first hospital were unproffesional in that they never informed me entirely of this procedure and emphasized it was simple and carried low risk. Being in a shocked/fasting state I did not have much energy for in depth research. In fact, they had me sign the consent form while I was on the ERCP table with a sedative already IVed into me. This was my first ever surgery (the ercp), just horrible when I think back on it. Contrast this to the hospital where the specialist ercp doctor is from (inside the same system!), and they made sure I knew of things such as a sphincterotomy before going onto the table, haha what could I do then, I already had it done. I have recently researched the sphincterotomy and there seems to be controversy around this procedure. Is it safe long-term? Rendering the sphincter of oddi useless seems like a drastic step to removing a small stone. Recurring bile duct stones appear be a possiblility possibly due to bacterial colonization of a previously sterile duct, along with a tiny risk of cancer. The research on long-term effects is all over the place, some papers say 5% recurring stones others say 20% have recurring stones. I find it a bit frightening there is so little to be said about these possible after effects, not to mention the loss of spinchter function, not to mention this procedure is done on teens and twenty year olds. I have since learned of other procedures such as Laparoscopic Bile Duct Exploration that put away the short/long-term risks of a sphincterotomy/ercp. I am mildly upset that I was never offered the true explanation of this procedure beforehand. I may have tried to weigh my options and find a surgeon who performed both a cholecystectomy and LBDE. It is my understanding this is rarely done, maybe I would have had no other options. But it would have been nice to find out, I am only 39, I would think excellent standard of care should be expected for someone still somewhat "young." So my main questions are two months post-op.. Is excess salivation/sticky mouth anything to be concerned about? It went away for about three weeks, I felt completely great, but it recently reappeared. Is this a possible gerd symptom? I have no other pains/regurgitations (it actually seems like less regurgitation now than with gallbladder.. "burps seem cleaner") Were the staff at the first hospital unprofessional in their dealing with my first ERCP, if so, do I have any recourse with this? Do you agree with the overall course of treatment? ERCP, Stent Placed, Surgical Removal, Stent Removal? How much should I be concerned about the sphincterotomy? I think that long-term effects don't appear to be fatal, but they could just make life more complicated. Thank you very much for reading this and your thoughts. By the way, the surgeon who did the cholecystectomy I specifically went to back in the Fall 2018 due to my initial symptoms and the exemplary experience and reviews from doctors/patients. He took one look at me and told me "See a shrink, take some anxiety drugs" Well ha, I did remind him, he said "Sorry" However the results of my cholecystectomy, surgically, seem to be outstanding.