Question for Dr. Royes Patients

Hi everyone, I just received my packet today .  So far 3  of my appts were made  and of course I have to reschedule one of them already. I have a couple of questions if anyone can help, Does anybody know what kind of test(s)  an HIDA and GBEF are?  I don't have to do the stress test but I do need these.  I'm not sure if its one test or  two  separate ones.  Any clues as to what these are and what they do for the test. Anyone have a suggestion as to which Psy to get an appt with Dr Messier/Zimmerman or Boerescu. I think they are the only ones who take Blue Cross.  Any details on how long this appt is  or what the process is once you go to there office? Thanks everyone for any info. I would be lost without all of you. 

I can help you with the medical exams they are 2 different test that look at the gallbaldder, A HIDA scan is an imaging test used to examine the gallbladder and the ducts leading into and out of the gallbladder. In this test, also referred to as cholescintigraphy, the patient receives an intravenous injection of a radioactive material called hydroxy iminodiacetic acid (HIDA). The HIDA material is taken up by the liver and excreted into the biliary tract. In a healthy person, HIDA will pass through the bile ducts and into the cystic duct to enter the gallbladder. It will also pass into the common bile duct and enter the small intestine, from which it eventually makes its way out of the body in the stool.

 GBEF ( Gallbladder ejection fraction test) is an exam where  a radioactive marker is injected into the patient and the marker is then taken up by the liver and gallbladder. A hormone, known as CCK (Cholecystokinin), is then given via IV to stimulate the gallbladder to contract and empty. The size of the gallbladder is measured both before and after the CCK is given. The amount of the marker that leaves the gallbladder is called the ejection fraction.  I had my psyc eval with Dr Zimmerman and it was a half day process, you need to fill out an extensive  questionnaire, then see a psychologist, after I saw the psychologist and she did her report I saw Dr Zimmerman later that day. Good Luck Marc

Hi Marc: If I understand you correctly one test will inject something into an IV.  Do they watch it with an x-ray or something like an ultrasound? The GBEF test doesn't sound very pleasant to go through. How do they  monitore this one with x-ray also? Any other info as to how long these might take to do or how much discomfort  is involved with either one.  (I need to prepare mentally for stuff like this-I hate when it's suppose to be nothing and turns out to be torcher) By the way Marc, any idea about the gall bladder itself?  I think it filters the cholesterol from your body but if they take it out what happens to that process.  Any problems down the road if its removed?  Something to think about in case it comes up. You seem to understand this medical stuff quite well so thank you for all your help.  I like to think ahead about all this stuff.  It makes me less nervous when I know what to expect.   One more thing,  When you went to Dr. Zimmerman if I read it correctly you went once during the day and spoke to psy and filled out questions for 1/2 day, left and came back later that day to see Dr. Zimmerman to get the results.  Did I understand you correctly.? Thanks again, Marc.  I really appreciate it.

the removal of your gall bladder is fairly routine. All of my family members had ours removed within 2 years of each other. I had mine out at 19. The only significant problems you'll encounter without your GB is not being able to tolerate real fatty food - like anything fried.  which we know we all shouldn't be eating anyway! significant weight loss or weight gain can cause gall stones, whcih then lead to impacted gall bladders, which cause the need for removal. Many gastric bypass doctors these days just take the extra precaution up front and remove the gall bladder when they're doing the bypass just to avoid any future complications. I'm not sure how Dr. Roye handles this - as mine was already taken out long before I met him.  Usually when any kind of radioactive dye is injected into your body - the only discomfort stems from the insertion of the IV itself (which isn't always pleasant). The dye will sometimes make you feel really warm - and honestly, i've always found it kind of pleasant - if not a little weird. LOL But it's never been anything that would hurt.  Good luck! Kristen*

I just had my Psych done by Dr. Freidman.  It went really well.  I felt so comfortable with him.  I was given a green light from him and the report should be to Dr. Roy next week.  My insurance was not accepted my Dr's Messier, Zimmerman and Boerescu.  I had to pay 300.00 to Dr. Freidman, but it was WELL WORTH IT!  From what I understand the 1/2 day testing is a drag and to be quite honest, I don't think it is needed.  My advice to you is to pay for Dr. Freidman and try to submit it to your Ins. to get reimbursed.  You have enough to do rather than be in an office that long.  I think it is more than 1 visit, isn't it.

Good Luck,

Jen

Hi Jen, How long was the process with Dr. Freidman?  If it wasn't as long as Dr. Zimmerman how long did it take you and what do you have to do with Dr. Freidman?  Long questionnaire or something else. Thank you Jen for your help.

The appt. was about an hour and 15 minutes.  I think it was painless.  He was awesome.  I answered some questions and then he looked at my food journal.  Then we had some in depth conversation about my weight history and what I have done in the past.  Really, It was easy and nothing to worry about.  I would go to him again in a minute, even since if my  insurance did not cover it. Good luck! Jen

Hello,  The Gallbladder stores about 50ml of bile, which is released when food ontaining fat enters the digestive track, stimulating the secretion of (CCK). The bile, produced in the liver, emuslsifies fats and neutralizes acids in partly digested food.

After being stored in the gallbladder, the bile becomes more concentrated than when it left the liver, increasing its potency and intensifying its effect on fats. The HIDA scan and  GBEF use a special camera that can detect radioactive material, it captures these pictures and allows the phsyician to examine the results. These test are painless, except for a little pinch when they start the IV, you may feel a warm feeling when they inject the radioactive material. These tests are used to check the condition of the gallbladder, see if the bile is truning into a "sludge" like consistency or if any gallstones are forming or present.  The psyc eval took some time I did the questionnaire and meet with the psycologist in the morning, the psycologist did her report. I left came back in the afternoon had my appointment with Dr Zimmerman. Hope this helps, I am an RN  so  all of these tests I am familiar with. Marc  

Pretty impressive Marc! Nice to see male RN's out there!

 Marc, Thanks again for your help.  You are very good at explaining the medical process of these tests so anyone can understand.  Great job with these two. Let me ask you another gall bladder question.  I want your opinion before I call and ask the NP hers.  I had about 8yrs ago an ultrasound of my gall bladder because I had already had 2 attacks .  The diagnosis was a healthy GB but I did have multiple gall stones.  So far I haven't had anymore attacks. Ok here is my question.  I know you are not a Dr and this would be just your opinion but do you think I should just have the tests and see what they suggest or since I do have a previous diagnosis should I ask the NP if I should bother with the tests or just have them take my gall bladder out during the surgery.   They also have me scheduled at the same day/time for and upper GI.  They made the appts so I assume  these test don't take much time and  what ever these test entail they won't interfere with each other. Any clues Marc. I'd hate to reschedule any more than is necessary.  It takes long enough when things run smoothly. Marc thanks again  for your wonderful  descriptions. PS  I 'm not sure but did you have RNY .