Almost every time a gallbladder needs to be removed, it is because of gallstones. Gallstones are common. Six percent of men and 9% of women have them, but most of the time, people have no symptoms.

It isn’t always clear whether the symptoms people have are due to the gallstones that are found on imaging studies, such as CT or ultrasound, but there are some clues to help decide whether a gallbladder that contains stones needs to be removed.

The classic symptoms are pain in the right upper abdomen, especially after eating a fatty meal, such as fried food. Some people eat salads with lots of fatty dressing.

Sometimes gallbladder pain is not food-associated.

Symptoms at nighttime are not uncommon. Nausea, bloating, lower chest pain, belching and burning pain all are well-described with gallbladder disease, and the proof comes when surgery relieves the symptoms.

Sometimes, the imaging test can give clues. Thickening of the gallbladder wall or pain with pressure on the gallbladder — Murphy’s sign — are suggestive of acute gallbladder inflammation.

Unfortunately, doctors aren’t always right. Occasionally a person’s gallbladder is removed, and it doesn’t help the symptoms at all. Then, a new search needs to be done to discover the true cause of the symptoms.

Most people do very well after gallbladder surgery. The liver itself takes over the job of storing bile, in the ducts of the liver, and bile is released into the intestines appropriately after eating.

However, it takes time for the system to get adjusted to not having a gallbladder, and only 60% of people are completely back to normal after three months.

A few people have persistent symptoms for years. Thus, it’s wise to be as sure as possible that symptoms are due to gallbladder disease before undergoing surgery.

I have been unable to complete a yawn for a couple of years. You know, that final “aaah” feeling. My doctor just smiled and offered no explanation; I’m sure she had never heard of this before. I am a 70-year-old woman who is retired. Any ideas, suggestions or recommendations to end this unsatisfied feeling?

Nobody knows for sure why we yawn. It can be related to low oxygen, fatigue or boredom, but there is a “yawn center” of the brain — in the hypothalamus — and even fetuses have been shown to yawn.

I have read two possible explanations why some people have incomplete or unsatisfying yawns: The first is that in some people, anxiety is the impetus to yawn, and that type of yawn just isn’t satisfying.

The second is that stretching of the muscles of the face and jaw are necessary for the yawn to be complete. For some people, repeated stretching — from a “forced” yawn — and breathing in very deeply can lead to a satisfying yawn.

Dr. Keith Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. © 2019 North America Synd., Inc.

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