Each year over the holiday season, the number of people in the emergency room experiencing upper abdominal pain spikes. Sometimes, the pain radiates into the chest or may even extend into the back and shoulders, and people fear they are having a heart attack, says Sarah Himmelstein, MD, of St. Luke’s General Surgery. Often, however, these patients are experiencing a gallbladder attack.

“People go into the emergency room and get an EKG, and the physician will tell them their heart is fine. Then, they’re discharged without ever knowing what happened,” said Dr. Himmelstein, who sees patients in west Allentown and operates at St. Luke’s Sacred Heart Campus. “And it was their gallbladder the whole time.” Besides pain, patients often also have nausea and vomiting after eating a meal with fatty foods.

Gallbladder attacks brought on after eating rich foods are so common at the end of the year that general surgeons call the period between Thanksgiving and New Year’s Day “gallbladder season.” July 4th is another big day.

White, overweight women aged 30–60 are most susceptible to gallbladder disease, but it affects both genders and adults of any age, body type, and race. Also, there appears to be a genetic component, because many families will have several members who have had gallbladder disease. People who have diabetes or who have experienced rapid weight loss, such as after delivering a baby or bariatric surgery, may also be more at risk.

Dr. Himmelstein explained that the gallbladder is a storage bag for bile, a dark green liquid produced by the liver. When you eat something fatty, the gallbladder contracts, shooting bile into your small intestine to help you digest the food. Sometimes, stones develop in the gallbladder, and when the organ attempts to release bile, these deposits get stuck, causing pain.

“Typical symptoms are right upper abdominal pain that usually starts within 30 minutes after eating a fatty meal when those stones get stuck,” she said. “Most of the time, the stones fall back down when the gallbladder relaxes, and pain usually subsides after 30 to 60 minutes. So, we call it a gallbladder attack. Biliary colic is another term for it.”

If this recurs often, you should see your primary care physician, who can evaluate your condition and refer you to a general surgeon. Gallstones are usually diagnosed using ultrasound scans.

Dr. Himmelstein suggests surgical removal of the gallbladder because, usually, the condition gets worse over time. It’s better to have the surgery when you’re healthy in your 50s and 60s than when you’re in your 80s or 90s and have an increased risk of complications from general anesthesia, she says. However, since Dr. Himmelstein began working at St. Luke’s four years ago, the oldest patient for whom she removed a gallbladder was 96.

“Sometimes, if the gallstones get stuck and the pain lasts for more than a few hours, we consider that to be cholecystitis, meaning you have an infection of your gallbladder, and that becomes an emergency, where you have to have surgery urgently.”

Gallbladder removal is a relatively simple procedure, she explained, adding that 99.9% of the time, she performs minimally invasive laparoscopic surgery. While the patient is under anesthesia, Dr. Himmelstein makes four small incisions and fills the belly with carbon dioxide. Then, she inserts a tiny video camera and special tools through the incision to see inside the abdomen and then removes the gallbladder. She then connects the liver directly to the small intestine. The gallbladders and the stones removed vary greatly.

“I’ve seen gallbladders that have so many gallstones they look like a bag of marbles,” she said. “I’ve also removed gallbladders with a stone bigger than a golf ball. Everyone’s a little bit different, but most people feel much better once their gallbladder is out.”

Immediately following surgery, Dr. Himmelstein recommends patients eat a low-fat diet for about six weeks so the body can adjust to not having a gallbladder. Then, slowly reincorporate fat. Usually, patients are sore after surgery, and she recommends they not work for a week or two or a little longer if their job requires heavy lifting. When patients return for the post-op visit, they’ve often lost weight because of their healthier diet. And sometimes, patients have some unexpected perks.

“I had a patient once who thought she was lactose intolerant, and her favorite food was ice cream,” she said. “She didn’t eat it because every time she ate dairy, she had right upper quadrant pain. Then, after I removed her gallbladder, she said she wasn’t lactose intolerant after all; she just had gallstones. So now she enjoys eating ice cream again without any problems. If you love something, you should be able to indulge yourself. We only get one life to live, so enjoy.”