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truly produced gallstones, I will ask them to bring them along in a bottle so I can send it to the lab to prove that they are little pieces of carrot. It is always carrot.
    A gallbladder attack can be so bad that some patients become the complete opposite of the ‘poo sifters’ and will actually beg to have their gallbladders removed. ‘Just do it,’ they groan, out of their minds with pain. Therein lies the genius: this simple operation can magically transform a desperate person into a serene being within hours ofleaving the operating theatre. This turnaround from sick to well is a powerful thing for me and this is the appeal of removing a gallbladder. Thankfully, so many diseases that we used to see in their most advanced stages have virtually disappeared because of modern medicine. We understand a lot more about why things happen and can even prevent diseases before they occur. Gallstone trouble, however, can still be just as terrible as it was in 1420 when the problem was first described. It is incredible that a stone the size of a ballbearing can end the life of a fully grown man. Gallbladder disease is now perhaps worse than ever before, as western society gets fatter and older. So, when they eventually figure out a cure for cancer and I happily won’t have to operate for that any more, I figure I will still have gallstones and all the intriguing problems they cause to keep me busy.
    Bile is the thin, golden liquid that the liver churns out 24 hours a day. It leaks out of the cells where it is made and collects in the bile ducts that form an amazing arboreal network of pipes, draining every section of the liver. Thousands of branches coalesce into larger right and left ducts that unite just outside the liver, forming the main bile duct. The bile then takes a 15-centimetre journey down this conduit before emptying into the bowel. Once there, it mixes with the food we have just eaten and becomes the detergent that breaks down the fat. If you shake a container of bile, it even froths up like soap. If bile is a typeof soap, then the gallbladder is the reservoir of the soap dispenser. It stores and concentrates a little extra bile that the body keeps up its sleeve for when a fatty load of fish and chips comes along. A normal gallbladder is a delicate, almost translucent sac about the size of a Roma tomato. It is loosely attached to the undersurface of the liver by a thin layer of connective tissue. It is joined to the main bile duct by a short spiralling tube called the cystic duct. When there are stones present and a fatty meal comes along, the gallbladder tries to do its usual thing and eject its load of bile. This catapults the stones straight into the spirals of the cystic duct where they become wedged. If you can imagine what happens during childbirth, when a baby’s head tries to emerge from a vagina, it is not a big leap to figure out what will happen when a gallstone attempts to do the same thing and exit the gallbladder. The experience is one of indescribable pain. It is so bad that patients will often believe they are having a heart attack.
    Why humans get gallstones is still a little bit of a mystery, but it definitely seems to have something to do with oestrogen, fat and cholesterol, and what too much of any of them will do to bile. An excess of body fat generates extra amounts of the hormone oestrogen – in both men and women. This seems to increase the amount of cholesterol in bile, making it thick and slimy like green treacle. Thick bile is a fertile environment for crystals to form in and, over time, stones seem to grow from these tiny nidi.Anything that changes the oestrogen balance in the body increases the chances of stones forming. Rapid weight loss can do it too, and a cruel side effect of doing a good thing can be a gall attack. Pregnancy is also a time where women develop stones, so as well as their bundle of joy, many women experience a bundle of pain, with their gallstones