It took Greg, the very relaxed doctor in Wellington ED, about 15 minutes to diagnose my chronic pain as Gallbladder-related using this crude mnemonic. I wasn’t doped up on the morphine yet and must have shot him a look as he sat casually beside my partner explaining how I was a perfect fit for the 5 F’s, causing him to backtrack slightly and admit he probably shouldn’t have told me that.
The next three days were a whirlwind of doctors, surgeons, radiologists, consultants, nurses (many, many nurses) prodding and poking, taking my blood, administering drugs and ultimately removing my Gallbladder. The surgeons were really proud they managed to get the apparently massively inflamed organ out laparoscopically, they passed the jar of 6 marble sized gallstones around marvelling at how enormous they were and how close they were to cutting me open to get the job done.
Everyone told me how lucky I was to be there during Lockdown and luckier still in Level 3 where my partner could visit – albeit for limited visiting hours. They didn’t like to use the word quiet but that is the only word I can use to describe the hospital, ED and surgical wards which I have experienced as loud, understaffed and overcrowded on other occasions. I completely understand why as a nation we emptied our hospitals in preparation for COVID-19 and pleased to have benefited from the results.
To the 5F’s
This seemingly insulting means of diagnosing me so quickly warranted further investigation. Doctors have so much to retain so their use of mnemonics as shortcuts is rather inspired.
The Gallbladder 5F’s expanded translates to:
- Fair = Caucasian or Pakeha
- Fat = is pretty self explanatory
- Female = also pretty self explanatory
- Fertile = means has had babies in the past
- Forties = over the age of 40
In researching more about this I also discovered the dodgy sounding oxfordmedicaleducation.com website page where you can read the ruder medical mnemonics – yes there are some appallingly sexist ones!
What does a gallbladder do anyway?
It seems the gallbladder is one of those invisible organs that does something but we don’t actually need it to survive. Essentially the gallbladder processes and stores bile for the liver. It is really small and sits behind the liver – the surgeons drew me lots of diagrams as their strategy for how to extract mine developed (I genuinely think they were enjoying that part).
It doesn’t cause any issues unless gallstones grow and fill it causing inflammation or in my case a giant stone got lodged in the bile duct so bile couldn’t flow causing the gallbladder to get inflamed and the resulting pain. Gallstones are just like real stones but made from cholesterol.
Given the 5F’s I thought it worth investigating whether only women get them and found this American study. Basically, everyone has a gallbladder. Approx 20 million Americans have gallstones, of those approx 300,000 per annum have complications requiring a cholecystectomy to remove the gallbladder – so a tiny percentage of us go through this. As for gender the same study suggests 20% of women in my age group of 50-65 have gallstones compared with 5% of men in the same age group.
I don’t have high cholesterol and until the occasional pain started a few weeks before surgery had no signs there was an issue. Every time a nurse visited they asked what my pain level was on a 1-10 to determine pain relief. Using childbirth with no drugs 29 years ago as my 10 level the pain was at an 8 when I was admitted. People have since told me their pain was more painful than a heart attack but as I haven’t had one of those can’t comment.
Without a gallbladder the liver has no bile processing filter so the advice is remove fat from your diet. I have spoken to a few people who have been through this and been told some become really sensitive to any fat (don’t steal a chip from your partners meal kind of sensitive) and others who went back to eating the same diet with no impact. So I expect a few months of trial and error ahead (with a toilet close-by apparently).
What you can learn from this
- Emergency surgery bypassing the waitlists (apparently 6 months for a gallbladder removal) has its benefits.
- If you are a pakeha female who is overweight, had babies and over the age of 40 – AND you get upper right quadrant abdominal pain anytime, it might be your gallbladder so do talk to your GP.
- Nurses are awesome!