Fall 2012
No Stone Unturned

Mary Bodurtha of Stratford (pictured above, left, with her daughter, Vanessa), healed quickly after emergency gallbladder surgery at Bridgeport Hospital and felt strong enough to bake and decorate more than 200 cupcakes for her older daughter Jessica’s September wedding. Story and recipe inside.

Late one night last May, exhausted from stomach upset and chattering with fever, Mary Bodurtha of Stratford knew she needed to get to the hospital. Earlier in the week, she thought she had the flu. But when she suddenly developed unbearable pain in her abdomen, she knew it had to be something much worse. She mustered the strength to alert her husband, who was up late working on his computer. “Ernie,” she called, weakly, “you have to take me to the hospital right now.”

In Bridgeport Hospital’s Emergency Department, the staff took one look at Mary and jumped into action. A blood test began uncovering the mystery: her body’s enzyme counts (enzymes are proteins that help cells do their jobs) were much higher than they should have been—a clue that what was causing Mary trouble was related to her gastrointestinal (digestive) system. “Normal liver enzyme levels are around 30. Mary’s topped more than 300,” says Gastroenterologist Andrew Bedford, MD, who took care of Mary that night. Her CT scan (special X-ray) results were most alarming. “Mary’s bile duct—the tube that connects the gallbladder to the small intestine—had doubled in size,” says Dr. Bedford. “This suggested that a gallstone was blocking a bile duct. That blockage was making her feel so sick—pain, fevers, chills and nausea. The source of the stone or stones was the gallbladder, which she needed to have removed (cholecystectomy), but we first had to deal with the blocking stones.”

What are gallstones?

Chief of Gastroenterology Caroline Loeser, MD, responds:
Bile is made by the liver and stored in the gallbladder. Over time, the stagnant bile that pools in the gallbladder can form into tiny “stones.” These stones, which can range in size and shape, are typically hardened bits of cholesterol.

Gallstones can cause inflammation (swelling) in the gallbladder. The stones can also travel out of the gallbladder through a tube called the cystic duct and block the common bile duct—a tube leading to the small intestine. That blockage can cause extreme abdominal pain, vomiting, fever and confusion. Sometimes an infection can develop. Depending on the patient’s condition, a doctor may remove the gallstones, prescribe antibiotics and/or recommend surgery to remove the gallbladder.

Gallstones can develop in anyone at any time. Some people can have gallstones for years and not realize it, passing off the pain as indigestion that just won’t go away. Your doctor can recommend strategies that are right for you to decrease the risk.

 

Mary was whisked to a special procedure area so Dr. Bedford could perform a pre-surgical ERCP—endoscopic retrograde cholangiopancreatography—to examine Mary’s bile duct and remove any gallstones. Anesthesiologist Glen Kaiser, MD, administered an anesthetic to Mary so she would be comfortable during the procedure. Dr. Bedford carefully passed a long flexible tube, fitted with a tiny camera, down through the length of Mary’s upper digestive tract and stomach until he could clearly see the bile duct and remove the stones. “It is extremely important to remove any gallstones or bits of stones from the bile duct prior to removing the gallbladder. Those stones can also block the drainage system of the liver or the pancreas, which have ducts in the same general area,” Dr. Bedford says. “Using this thin scope with a miniature camera, I can clearly see the blocked duct and scoop out the stones.”

After the ERCP, Surgeon Roselle Crombie, MD, who often cares for patients with gallbladder conditions in tandem with Dr. Bedford, introduced herself to Mary and Ernie. “The origin of Mary’s pain was a clear indication that surgery was necessary,” says Dr. Crombie. “We knew that she would feel relief as soon as the gallbladder was removed.”

“Dr. Crombie started to talk about the gallbladder removal procedure, and I told her, ‘Whatever it is, do it.’ I just wanted to feel better,” Mary remembers.

“Before, between and after the procedures, Dr. Crombie and Dr. Bedford kept us informed and explained everything that was happening with Mary,” Ernie says. “They were very good at keeping me and our children at ease.”

As soon as the anesthesia team, led by Anesthesiologist Mihaela Costin, MD, administered general anesthesia with breathing support for the surgery, Dr. Crombie was ready to remove Mary’s gallbladder through tiny keyhole incisions (laparoscopically). “Laparoscopic surgery is ideal for gallbladder removal,” says Dr. Crombie. “More than 90 percent of removals are done this way. Laparoscopic surgery has evolved significantly since introduced in 1990 and is now the standard of care.”

Could you have a gallstone?

Most people with gallstones have no severe symptoms until one blocks a duct.

If you experience these symptoms, contact your doctor. You may have a gallstone or gallbladder disease.

  • Pain in the middle of your abdomen or on the right side that comes and goes (this can happen over months or years and is sometimes mistaken for indigestion)
  • Pain in the middle of your abdomen or on the right side that happens after eating and disappears after about one hour
  • Pain that does not go away after taking an over-the-counter pain reliever
  • Nausea or vomiting

Seek medical attention right away if you have the following symptoms. You may have a gallstone blocking a bile duct.

  • Sudden, severe pain in your abdomen or shoulder
  • High fever and chills
  • Nausea or vomiting

In the operating room, Dr. Crombie made three tiny incisions on Mary’s abdomen and a fourth through the navel (belly button). “The navel is a perfect distance from the gallbladder, making it an ideal entry to the abdomen. Plus, it is a scar we all already have,” she explains. Dr. Crombie then inserted a thin, lighted tube fitted with a tiny video camera through one incision, and small surgical instruments through the others. Once she could clearly see the gallbladder on a video screen, she swiftly removed it through the belly button. The incisions were then carefully closed with tiny dissolvable stitches. Mary’s operation took about 35 minutes.

“By the next morning, I felt 100 percent better,” Mary exclaims. “The pain, nausea and fever were gone!” “It was good to see the color back in her cheeks,” says Ernie. “Dr. Bedford and Dr. Crombie were just wonderful,” Mary says. “They came to visit me the following day and answered all my questions.”

Mary stayed in the hospital a second night to fully recover from her surgery. “The nurses were so kind to me and my family, and so helpful. They were funny, cheerful and upbeat, and liked to make me laugh. One even served me my cranberry juice with a paper umbrella! That little surprise really lifted my spirits,” Mary says. “I have so much respect for nurses who take care of surgical patients.”

Just three weeks after leaving the hospital, Mary felt well enough to vacation with Ernie on a pre-planned cruise to the Caribbean. She spent most days relaxing in a deck chair and enjoying the ocean air next to her husband. “It was perfect,” Mary says. “And much better than recovering in my living room!”

Since the surgery, all of Mary’s incisions have healed and she has been busy preparing for her daughter Jessica’s fall wedding. Dress fittings and calligraphy have cheerfully occupied her time, as has baking. Mary offered to bake and decorate the special vegan cupcakes that will be served at Jessica’s wedding (see recipe, next page). “I’m thrilled that my fast recovery has allowed me to participate in all of the preparations,” Mary says. “I couldn’t ask for anything more.”

Mary’s Vegan Cupcakes and Buttercream Frosting

For the Frosting:

3 cups all-purpose flour
2 cups white sugar
2 teaspoons baking soda
1 teaspoon salt
3⁄4 cup unsweetened cocoa powder
3⁄4 cup canola oil
1 teaspoon vanilla extract
2 tablespoons white vinegar
2 cups water

Preheat oven to 350 degrees. Combine flour, sugar, baking soda, salt and cocoa powder in a bowl. Add oil, vanilla, vinegar and water. Mix until combined, then beat at medium speed for 60 seconds or until smooth. Do not overbeat. Pour into 18-24 lined cupcake pans. Bake for 20-25 minutes. Let cool before frosting and decorating.

For the Cupcakes:

1⁄2 cup vegan butter (1 stick)
1⁄2 cup vegetable shortening
1⁄2 cup vegan cream cheese
1 teaspoon vanilla extract
1⁄2 teaspoon almond extract
51⁄2 cups powdered sugar
3 tablespoons plain soy creamer

Mix the vegan butter, vegetable shortening and vegan cream cheese until smooth. Beat in vanilla extract and almond extract. Turn off mixer. Add 2 cups powdered sugar and 1 tablespoon plain soy creamer. Beat at high speed until fluffy. Repeat twice. Frosting should be creamy and stiff and peaks should hold.