Ep 128: The Gallbladder and Pregnancy with Dr. George Crawford, MD

Ep 128: The Gallbladder and Pregnancy with Dr. George Crawford, MD

Nicole: In today's episode, you're going to learn about gallbladder disease with Dr. George Crawford. Welcome to the All About Pregnancy & Birth podcast. I'm Dr. Nicole Calloway Rankins, a board certified OB GYN who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, confident, and empowered to have a beautiful pregnancy and birth. Quick note, this podcast is for educational purposes only and is not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now let's get it.

Nicole: Hello. Hello. Welcome to another episode of the podcast. This is episode number 128. I am delighted that you are spending some of your time with me today. So in today's episode, you're going to learn about the gallbladder. And I invited my friend long-term friend, Dr. George Crawford onto the podcast to talk about it. Dr. Crawford is the founder and lead surgeon at the Crawford Clinic in Anniston, Alabama. He graduated from Morehouse College. That's how we met. He was at Morehouse, I was at Spelman many, many, many years ago. Shout out to HBCUs. He earned his bachelor's degree, Summa cum laude with phi betta Kappa distinction from Morehouse. He was also a road scholar nominee. He then went on to get his MD from Baylor College of Medicine and completed his residency at Emory University. In addition to running his clinic, he's on the board of trustees at the Northeast Regional Medical Center.

Nicole: He volunteers through a mentorship program he created for high school students. It gives them a practical firsthand experience in medicine. Dr. Crawford also loves inventing. That's one of his greatest passions. He got his first patent at the age of 16. He recently received his first surgical patent and he has two patents pending and is the founder of a biotech company, Modern Surgical Design. And then on top of all of that, he is the proud father of four, very active children who participate in family hobbies like soccer, fishing, and a host of other hobbies as well. You can follow him on Instagram. He's on Instagram @surgerymd. He has about 50,000 followers there. And often in his stories, he shares fun stories about, um, the adventures with his kids. And then he does surgery videos there as well. In this episode, you are going to learn what the gallbladder is, what it does, what are problems that can happen with the gallbladder in pregnancy, some risk factors for having gallbladder disease, as well as how gallbladder disease is treated.

Nicole: I'm seeing gallbladder issues more and more, the longer I'm in practice. So I definitely think you need to check this episode out. You are going to learn something about gallbladder disease, for sure. All right. So before we get into the episode, let me do a quick listener shout out. The person who did the review is called Hans. And the title of the review says, glad I found this podcast. And the review says, I'm expecting a baby here in the next few weeks. And I felt like I needed some extra information to help me feel more confident. I've really enjoyed listening to Dr. Nicole and her guests she has on. She comes to each podcast prepared with really thought-provoking questions. The guests enjoy speaking to her as well. I'm also studying to be a doula. And I think the podcast provides a lot of great information and I feel like its purpose is to provide enough information, not to push you in one direction or another, but to educate you enough for you to make a great decision for yourself and your family.

Nicole: Thank you Hans for that lovely, lovely review. I so appreciate you taking the time to leave that review. And I hope everything went well with your birth. Now you are spot on in that I am here to provide information to help you feel confident to help you make great decisions for yourself during your birth. And then you can take it up to another level when you join the Birth Preparation Course. The Birth Preparation Course is my signature online childbirth class that gets you calm, confident, and empowered to have a beautiful birth. It'll help you prepare yourself so you have a calm and peaceful mind, you'll understand your body and what happens in labor and birth as well as the postpartum period. And you will learn how to advocate for yourself. You can check out all the details of the Birth Preparation Course at drnicolerankins.com/enroll. Over 1000 mamas have gone through the Birth Preparation Course. I'd love to have you there too. It's an incredible amount of value in the course for what you pay for the price. So check it out, drnicolerankins.com/enroll. Okay. Let's get into the conversation about gallbladder and pregnancy with Dr. George Crawford.

Nicole: Thank you Dr. Crawford for agreeing to come on to the podcast. Y'all, I'm a tell you upfront I have known George for a really long time,

Dr. Crawford: When you said Dr. Crawford I'm like, why is she talking about my dad? What is this? Oh that's right, that's me this time.

Nicole: So forgive us if we sound like small children, as we talk about the important topic of gallbladder disease in pregnancy. So welcome to the podcast.

Dr. Crawford: Thank you for having me. Thank you, for having me.

Nicole: All right. So why don't you start off, tell us about yourself, your work and your family, if you'd like to.

Dr. Crawford: Yeah, so I am a small, I call myself a small town, general surgeon, um, all though I'm really not a small general surgeon. So I do a lot of advanced laparoscopic work, um, laparoscopic liver resections, laparoscopic colons, gastrectomies, bariatric surgery. So it general surgery practice, but focuses on laparoscopy, um, being in a medium size market because I'm stuck between two academic centers, about an hour away. It allows me to kind of do what I want without a lot of pressure. Uh, as far as me, single four kids, one of them's graduated from Spelman this weekend and, uh, a 14 year old, 12 year old boy and a eight year old daughter that just pulls every nerve I have every chance she gets. But she's so cute though. That does not help.

Nicole: Oh, she's, she's delightful. She's delightful.

Dr. Crawford: Yeah, okay.

Nicole: So what training did you go through? I like folks to get, get, get an idea of what, um, we go through in our training. So how many years of training did you go through to become a surgeon?

Dr. Crawford: So four years, uh, at one of the world's greatest institutions, Morehouse College in Atlanta, Georgia. So graduated as a chemistry major from there. Once I left Morehouse, went to Baylor College of Medicine in Houston, Texas, not Baylor University with the football team. Um, and then four years there. And from Baylor, I went to Emory University where I did my general surgery, training five years.

Nicole: Awesome. Awesome. All right. And you've been in practice now for..?

Dr. Crawford: Too long. Lemme see...

Nicole: I'm 15 years and I was a little bit behind, so you gotta be a little couple more. Yeah. So

Dr. Crawford: I started here. Yeah. So I started here in Anniston in 2005, so 16, 17 years.

Nicole: Okay. Yeah. All right. All Right. All right. So let's get into it. Let's talk about the gallbladder and pregnancy first off. And I get this question a lot. What is the gallbladder? Where is it? What does it do?

Dr. Crawford: Okay, so gallbladder sits right underneath the liver, which is on the right side of the abdomen. Uh, in surgery, we call it the right upper quadrant. Um, what it does is, yeah, I know you don't eat fast food or any nasty stuff

Nicole: I try not to,

Dr. Crawford: But if you eat hamburgers and hot dogs and pizza, the amount of grease in that meal is just a little more than your body can handle. So what it does is it stores up bile um, in the gallbladder. So the liver produces bile. It gets stored and conjugated in the gallbladder. And then when you eat that fat burger or fried pizza, it gives it a little squeeze. The juice comes out, helps your body digest that food.

Nicole: Love it. Nice, easy explanation. Perfect. So then what are common conditions that affect the gallbladder and are they different? Whether it's during pregnancy or outside of pregnancy?

Dr. Crawford: So I think that's where a lot of people get confused with the gallbladder because you have gallbladder disease and you have gallstones. Gallbladder disease is when your gallbladder doesn't have the ability to give that squeeze anymore. Um, so think of it like a water hose. Okay. If you take a water hose and it's suppose you turn the faucet, the stuff's supposed to come out, it works like it's supposed to, but if the pressure is not there and the water is just trickling out, it's building up behind and it causes pain. So most people, when they have a gallbladder attack, it's that gallbladder kind of spasming because it just can't get stuff out and just stuff doesn't want to come out. So that's what causes pain. Now that's different from gallstones. So gallstones can actually block that hose. So the water can't come out because its got a blockage, it's got stone in it.

Dr. Crawford: So then that pressure builds up. And now that feeling and that full sensation is what causes that pain again. So it can either be because of spasming or because it's got so much pressure that it can't squeeze out. Um, you can get into stuff like pancreatitis and all this other stuff, host of problems down the line. But for the most part, that's really what gallbladder disease is. Now the other time it gets a little weird is because about 10 to 15% of the population, probably 20%, um, in America now actually they have gallstones, but just because you have gallstones doesn't mean you have gallbladder disease. So if you go to the doctor and he says, you have gallstones, it's not like you have kidney stones. It's not the same kind of thing. It's just like, well, if you have them and you're not having any pain when you eat spicy or fatty foods, don't worry about it.

Nicole: Gotcha. Gotcha. Now, when does gallbladder like infection come into play like cholecystitis?

Dr. Crawford: Yes. So if the duct gets blocked, either because there's a stone stuck in it, or because the gallbladder stopped working because it's not able to squeeze anymore, that's when they can get infected. Now, the other thing you got to remember is that the gallbladder comes right off of the small intestine, right where the stomach and small bowel connect. So what that means is there's actually bacteria that free floats in and out of your gallbladder all the time, as long as it's squeezing and emptying, it's not a big deal. Um, you know, cause if you think about it for that bile to come out the liver and then go back up into the gallbladder is kinda gotta be able to do a two way street thing. Um gotcha. And what happens is some people will just, will get a little infection in there and then if it can't empty it, like it's supposed to, you got a bad gallbladder.

Nicole: Okay, okay. So what are then some of the symptoms of your gallbladder is bad?

Dr. Crawford: So the classic story is right upper quadrant abdominal pain radiating to your back worse when you eat spicy or fatty foods, nausea, not necessarily vomiting. Um, if it gets really bad, your urine can be dark. If it's, um, just your stools can be light colored, um, your skin can turn yellow, you can have real bad itching. Um, those are kind of bad signs. So like fevers and chills. Um, but for the most part epigastric or right upper quadrant abdominal pain and nausea, sometimes 30 minutes after you eat hamburgers or pizza

Nicole: Spicy greasy kinda? Got it. Got it. So how common is gallbladder disease in pregnancy?

Dr. Crawford: So, uh, instead of giving an, an incidence, what I'll say is the a gallbladder removal or laparoscopic cholecystectomy is the second most common non obstetrical operation that occurs during pregnancy, first is appendicitis. Um, you know, and it's funny people, I believe that the incidence of gallbladder disease is higher in pregnancy than the incidents of appendicitis. But I think the trick is, is that appendicitis, we automatic, as soon as you take somebody who has appendicitis, you send them to the surgeon. You're like, Hey, we got to rule it out, find it, take it out because it's clear that sepsis infections has, has a known risk to the mother and the child. Right. Um, with gallbladder, what happens is you, ain't got that first trimester. You all I'm always worried about is this hyperemesis, is it just nausea associated with first trimester? So it could be that, or it could be gallbladder. So it's kind of hard to say which one it is or isn't. And, um, a lot of times I think a lot of those gallbladder patients just kind of get grouped into that first trimester, nausea, vomiting. And then by the second third trimester, they just like, oh, this is cause you're pregnant. It's not a big deal. And it gets missed. So we don't take out as many gallbladders as people actually have gallbladder disease during pregnancy.

Nicole: Gotcha. Gotcha. That makes a lot of sense. Actually, we do T most often tend to think that it's related to nausea, vomiting or pregnancy. So what puts you at a higher risk for having gallbladder disease? Are there any risk factors that we, other than eating spicy fat

Dr. Crawford: Other than not doing what you're supposed to, what else? I mean, realistically high cholesterol does. Um, that's, that's one thing and that's something that you can probably treat you definitely treat before, um, getting pregnant, being overweight, um, which is a national health problem in the United States, at least also puts you at risk. Um, the funny part about gallbladder disease in pregnancy is most of the patients, if you talk to them, they probably were having attacks around that first pregnancy, or even before they were pregnant, kind of blew it off and then they get pregnant again. So, um, a lot of the patients that I take the gallbladders out, um, that are pregnant, it usually occurs during the second pregnancy, but then when you start talking to them, they all had clear classic signs and symptoms during the first pregnancy. Um, and just kind of didn't do anything right. From a pregnancy standpoint, I would say, you know, if you have those symptoms or if you're kind of like, you know, you know, when I was eating, you know, KFC and it did bother me during my pregnancy, at least let me go get my gallbladder checked out in between the first and second one. Um, I think you'd see a lot more people that are actually suffering from gallbladder disease during pregnancy they just get missed.

Dr. Crawford: So I would say that's the biggest thing is to check in between the two pregnancies if you're having two pregnancies.

Nicole: Yeah. What about the old and y'all, don't don't roast me for this

Speaker 3: [inaudible]

Nicole: We used to, we used to learn in medical school that the risk factors were female fat, fertile and 40. Is that it?

Dr. Crawford: Yeah. Yes, yes. You know, and so it's, it's weird female. Yes. Without question, the majority of gallbladders that I take out are, um, females, um, you know, when you are a class, a classy physician like myself, we say obesity, we don't say fat. Um, um, the problem now is, especially in the state of Alabama, one third of the population is obese. So, you know, it's, it's, uh, it's, everybody's got it. So, you know, that, that, that's probably the biggest risk out of all of that other than being female, I think. So its kind of hard now. So now just everybody's at risk for it, you know, and the other funny part is that I probably take out one, maybe two pediatric gallbladders. Oh yeah. The youngest gallbladder I've ever taken out. That's got a nine-year-old oh my goodness. Again, they're female and now they're overweight.

Nicole: Right, right, right. Okay. All right. All right. So how is it treated?

Dr. Crawford: Traditionally it's laparoscopic cholecystectomy or taking it out laparoscopically through small incisions. It used to be called laser surgery. Um, every once in a while, if you have someone that for whatever reason, you know, they're high risk pregnancy, uh, or not healthy enough, they're have a lot of stuff going on and you can't take a gallbladder out. Um, there's a medicine called ACTA gall that basically thins the fluid that makes up a bile in your gallbladder, and that can help dissolve stones as well as make it for the stuff to come out. You know, again, think of it as, you know, going back to that water hose scenario, if you can make the water a little S little more wet. I noticed that one of the things I was talking about an internet is water wet, but, you know, if you can make the water come out a little easier than you wouldn't have as much of a buildup in pressure. So ACTA fall does that, um, you know, it wasn't really used as a favorable medicine in pregnancy up until it became more favorable recently. Um, but in the past, um, we didn't do that. Everybody just, you know, just kind of, uh, it sounds bad, but I mean, I know, you know this as an OB, we just kind of blew it off until the baby delivered and we kinda, you know, that's not a, it's not something that we're proud of, but that's what we used to do. Yeah.

Nicole: I have to say there are, it depends on the surgeon. Obviously, you, you are more up to date and progressive and understanding that we have to take care of the pregnant person in order for the baby to be healthy. But I still have some surgeons who are like, but what about the baby? And it's like, well, her gallbladder is infected, she's going to die if you don't take it out. So will you please take it out?

Dr. Crawford: Right. You know, and I think the funny part is that even here, I mean, we have a bunch of general surgeons and, um, I am probably, there may be one other guy that will do it, but there are a lot of general surgeons are just like, no, send them to George. They just don't, you know? Yeah. But you know, part of it also is the, you know, we kind of got crappy training in residency when it comes to OB patients. Um, at least from most, I mean, you know, you wouldn't see it because you're an OB, but, you know, from a, every other specialty standpoint, we were just kinda like, OB's taking care of it. Don't worry about it. You don't need to learn it, just call the OB. And, you know, that kind of puts that patient population at a detriment because you didn't have people that don't want to take care of them.

Nicole: Sure, sure. So what are the risk of laparoscopic surgery and pregnancy?

Dr. Crawford: So it depends on when you're talking about, if you're going in the first trimester, it is actually, um, early termination, uh, spontaneous abortion of the fetus. Um, if you are looking in the third trimester, it's usually early delivery. Um, as far as during the second trimester, that's like the honey spot. That's where we always want to take it out. Um, because the baby is, um, secure enough in the uterus where we're not worried about, um, an early delivery. And at the same time, you're secure enough to where, um, developmentally, where we're not as worried about having problems with the CO2, um, having problems with it, with anything. Um, the, the crazy part is, is that a gallbladder, I'm gonna ignore the baby for a second, and then I'm gonna come back to the baby. Okay. So if we ignore the baby and we just look at the mother, a laparoscopic cholecystectomy is just as safe in a pregnant woman, as it is in someone who is not pregnant. If the surgeon knows what they're doing, and they start by putting your trocar in the left upper quadrant,

Nicole: And guys, that's all about the placement of the surgical instrument, it's really about understanding the pregnant person's anatomy and adapting the surgery to that.

Dr. Crawford: Yes, yes. Now, once you start throwing in the fetus, you then have the host of, you know, then you start getting into anesthesia, you then start getting into, um, the medicines that they're using. So there are some risks there. Um, but again, most of those we've kind of worked out over time. And, uh, you know, the other thing, the other tricky part is how long to monitor the fetus after surgery. If you're having to do it in the third trimester before you send the patient home, you remember that time I called you, I think I sent you a text message and I was like uhhhh

Dr. Crawford: You know, cause let me tell you what happened. So I had this lady, she was 33 weeks pregnant and, you know, and I kinda got mad at the OB cause dude just kind of left me hanging. I was like, um your lady's sick. She needs a gallbladder out. And he was like, well, well you just do what you gotta do. I'm like, that is not, that is not something I can put on the chart. I can't say, you know, will be said, do what I gotta do. So that's my, you know, that's my thing. Um, so he was just, you know, I'm not going anywhere Dr. Crawford. I'm like, okay. So that's why I called you. Cause I was like, I just need to know, but you know, but that's the thing is, you know, so that kinda made me mad, but, but, uh, can

Nicole: We really should work together like that? It's completely inappropriate. Yeah,

Dr. Crawford: Absolutely. And especially when, you know, my part of the procedure takes anywhere from five minutes to 30 minutes and I'm done the rest of it is making sure that the mother and the child are safe. So it's recovery time. It's follow-up with their OB. Um, there is the making sure I'm not writing for something crazy that can cause the patient and the fetus a problem. So a lot of that is OB care and it's just weird sometimes when people are like, oh, well it was just good luck. I'm like, dude, it's your patient, you the OB, come on family. Yeah. And part of that, I think is that when you start getting into that third trimester, the OBs get a little kinda kinda jumpy, cause they know that the baby can come early. Um, so they kind of want to avoid a little, you know, avoid that as well versus the second trimester everybody's on board. But I think that's also because it's a lot safer in the second trimester and in the third year.

Nicole: Sure, sure. But in general, to be very clear on balance, if it needs to come out, it needs to come out.

Dr. Crawford: Yeah. Yeah. And that's the thing is that, you know, I probably the, the only, so if I also went in the first trimester and they're not gaining weight, like they're supposed to, or the fetus is not measuring from a growth standpoint, the way that they're supposed to, and they have gallstones and we kind of tease through it and they have signs and symptoms before, I will do it in the first trimester. And I just have to, you know, the, I usually usually what happens is the, um, the, um, female comes in without any other family support. So when I'm doing a first trimester cholecystectomy, I say, okay, well, we're going to do this next week, but I need you to bring your husband, your boyfriend, your mama, your wife, whoever in, so we can have this conversation together. So they understand what we're doing and why we're doing it.

Dr. Crawford: Right. And then if you do that, most people will. And I did it with third trimester as well. But if you do that, most people are just kind of like, okay, do it. Everybody's on the same page. And I say, Hey look, worst case scenario. If we do not do this and you get sick and have a problem, we lose you and the child. I'm not asking you to make a choice between you and your child. But I'm telling you is that if something happens, I would rather lose one of you than both of you. And from my standpoint, I have to do what takes care of the mother and what takes care of the mother is best for the family, which also includes the child

Nicole: One hundred percent.

Dr. Crawford: And most people get it, once you put it that way, they're like, okay.

Nicole: That's, that's how I always frame it. Like we, in order to have a healthy baby, we have to have a healthy mom. And if you're not healthy, then the baby doesn't stand a chance. Not everybody is comfortable having that conversation, I would say. So. Um, is it, is it, are there ever any times though where you are like, okay, we can wait and do this, like right after you deliver or shortly after you deliver, are there any other options? Is it ever an option to wait?

Dr. Crawford: Oh yeah. Listen. No, I given the option. I'm wait.

Nicole: Okay. So if you're, if you're talking about taking it out, then it's like, it's yes, this is the option.

Dr. Crawford: Yes. Yes. But if you, if you're like, if you know, if you come like, I got a little nausea when I eat Starbucks or whatever. I'm like well stop eating Starbucks. If that works leave it alone, you'll be fine. But, and most of those patients, I say, look, but six weeks after that baby comes out, you and I are going to dance, we're going to get this thing done. And you would be surprised. I'd probably about 80% of the patients I have that conversation with do show up around six weeks and they're like, let's get it done. Let's do it. Let's do it. Right. Because, because again, if it happened in the first one, it's gonna happen with the second one.

Nicole: Right, right, right. That makes a lot of sense. So what can people expect after the gallbladder is removed and in terms of like physical recovery and then also like what happens to their body when they don't have a gallbladder.

Dr. Crawford: It turned green, and look like Martians. No. So, okay. So laparoscopic cholecystectomy done safely. Traditionally has a recovery time of about a week. Um, they're going to be most tender at the umbilical port. Uh, for two reasons. One, the uterus is pushing up on it anyway. So it's stretching it just because of pregnancy. Um, and two, that's what we bring the gallbladder out. So with that, that's going to be the most tender site. Um, and it's also the largest incision that we make now, after you get over that pain, which usually lasts about a week, there's about a four to six week time where you still can't eat spicy or fatty foods because you have Phantom pain, your body basically says, okay, the gallbladder is still there. And then part of it saying, no, it's not. So your body has to have time to figure it out. And eventually that goes away. Um, and we usually, there's not really anything to do with that.

Dr. Crawford: It's just takes time and you just kind of have to slowly introduce those favorite foods that got you to where you were in the first place. Anesthesia is kind of weird is that laparoscopic cholecystectomy now, um, the anesthesia recovery is almost harder than the recovery from surgery, just because, yeah, because if you think about it, we're giving you all these medicines, your body's got to metabolize them. You have to, um, you know, get back to homeostasis or the way that your body normally runs. And you know, when I do a gallbladder, I have a one centimeter incision in the belly. I mean, excuse me a one inch incision in the belly button and a five millimeter incision on the side and that's it. So the incisions themselves are small. Um, the inside of your body, you know, doesn't really feel pain like the rest of your body does.

Dr. Crawford: So a lot of it is just, they're tired. You know, patients are tired because you know, they, even though, even though they have the growth of a fetus, you now have this metabolism, downregulation from the anesthesia and this, but your body needs all of this energy to recover. Um, so it's this weird kind of, I'm tired, but I feel better because I can eat, but I have a loss of appetite just because my body's trying to figure out that the gallbladder is gone. Um, so it's not so much the physical surgery, but once you add the anesthesia on there, it's a little bit different. Um, most of my patients after about a week, they're pretty much doing fine, except for, um, the changes that go along with her diet. Um, every once in a while. And this is probably not so much a pregnancy issue, um, not pregnancy issue, um, an issue for patients who have a gallbladder removed during pregnancy, is it sometimes you have what's called post- cholecystectomy syndrome. So you can have diarrhea or constipation depending on how your body deals with the, um, increased bile salts that are now coming out because your gallbladder is gone.

Nicole: Okay. So they're still coming out of your liver. They're just not being stored anymore.

Dr. Crawford: Correct. And your body has to, your body depends on how good your liver is if, you know, if you were in college drinking way too much Morehouse college and doing stuff like that, you know, your liver probably doesn't, um, function as well as it used to. It may have a little problem now rating down-regulating and upregulating over time after your gallbladders removed. If, you know, if you over here eating vegetables for follow your life and you just studied at, um, was that broadly? Why did you stay with your hips? That was Spellman,

Nicole: I was in LLC.

Dr. Crawford: LLC, oh yeah.

Nicole: LLC 1 and 2.

Dr. Crawford: Yeah. You fancy, I forgot, honestly, like you were also, it's not about, this is not about me. This is your podcast is all about you. So, you know, if you live in that good LLC life. And you know, eating healthy, um, and you know, you have a pretty good diet and your liver functions great. And you just happen to get a bad deal with a bad gallbladder. Cause your mama gave you, you know, your mama had a bad gallbladder. Her grandmother had a bad gallbladder, take your gallbladder out. You're ready to go.

Speaker 3: Okay.

Dr. Crawford: Without, any problems. It's really person specific.

Nicole: Got it, got it. Does it run in families?

Dr. Crawford: Why are you going to ask me that? Um,

Nicole: Just curious.

Dr. Crawford: Okay. That's like a, I'm gonna say sort of, I'll say,

Nicole: Cause maybe it's related to families having the same diet or similar

Dr. Crawford: Yeah everybody's eating the same nonsense. But part of it also, you know, goes to that question of, you know, if you eat a lot, you know, is your cholesterol high because you eat a lot of cholesterol or are you one of those people that genetically predisposed to having high cholesterol regardless. Gotcha. Um, you know, there's that component as well. Um, you know, and they're hormonal differences, you know, no one's hormone level, especially in females is the same. So, you know, if this one has a little more estrogen and progesterone versus this person has that put them in a predisposition to having a bad gallbladder possibly. But how do we regulate, you know what I mean? There's no magic number if I had to guess, I would say yes, but we haven't pinned it down yet.

Nicole: Okay. Okay. Okay. So is there anything people can do to reduce their risk other than helping, you know, having, uh, uh, a healthier balanced diet? Is there anything they can do to reduce their risk of developing gallbladder disease,

Dr. Crawford: Lose weight?

Nicole: Okay. All right.

Dr. Crawford: I mean, if you're a decreasing the cholesterol and your diet, you staying away from the red meat, a lot of dairy, a lot of fried foods, um, and you have a high fiber intake. Um, you know, that's, you're doing everything you can. So, but th th but also the funny part is if you're doing all that, you're probably not going to be overweight. Anyway. You're probably going to have a pretty healthy diet. Um, you know, oh, this is not for mothers. This is for children. Um, make sure that if you have kids that are involved in sports, especially in hot climates, like the south, make sure that they drink a lot of fluids. One of the biggest reasons we see, um, bad gallbladders in kids is from dehydration. Yeah. So, yeah, you'll see patients that are thin, you know, I have a thin 16 year old female that comes into the office. She has a bad gallbladder. And you know, you look at the mom and she's, you know, maybe she's overweight. And then you started talking to mom. Well, my grandmother had it out. My mom had it out. I've had mine out. Why is she getting hers out at 16? And we have ours out of 30. It's like, well, cause she's dehydrated. Oh okay.

Nicole: Got it. Got it. Okay. Okay. I will say that in general, I feel like I have seen over the years, more folks need their gall bladder removed in pregnancy. It seems to be increasing.

Dr. Crawford: I think part of it is also, we're doing a better job of it. That's true. You know, I think, you know, when we used to have to put big wax on people, when they come away with a big incision and in the hospital for like four or five days, you know, everybody's like, yeah, I'm not putting the pregnant lady through this ventral hernia. It's not, you know, all this stuff versus now you go home the same day. Yeah. Same day. Same day. Yeah. Yeah.

Nicole: Oh I guess I should ask. How often do you convert to a bigger surgery knock on wood hopefully

Dr. Crawford: Or not? How about in general? Uh, in general, I would say the conversion rate is probably, or the average general surgeons conversion rate is 5%.

Nicole: Okay. And guys by conversion, I mean, like you can't do it through the tiny incisions. You have to open it up to a bigger incision, which is a longer recovery, more pain is you're in the hospital longer. It's way more complex.

Dr. Crawford: Yeah. Routine gallbladder, 5%. If you're looking at somebody that has stones stuck in the duct or something, that's, you know, I call it a gallbladder plus, it's probably 10, 15%, but most people don't have gallbladder plus that's a whole different ballgame.

Nicole: Okay. Okay. Okay. Yeah. What is your, you want to say it or you want to spoil it?

Dr. Crawford: Less than 0.1%.

Nicole: Nice. Nice, nice, nice.

Dr. Crawford: Cuz I know what I'm doing.

Nicole: Well, good. All right. So just to wrap up, I ask everybody, all of my guests who comes on, um, these questions, what is one of the most frustrating parts of your work?

Dr. Crawford: It is the fact that healthcare is a business and not a right. I mean, not a right. It's you know what I mean? I mean,

Nicole: Yeah it's not something that we prioritize, that people should have.

Dr. Crawford: Everyone should have healthcare.You should be able to walk into hospital and get care, taken care of, walk out and not worry about a bill. This should be, you know, whether it's, you know, in a stuff like copays, you don't have patients that like, Hey, my gallbladder was hurting, but I can't get it out. I gotta go to work. Or I don't have time off at work, which is kinda crazy. Um, or I can't afford my $5,000 deductible, which again is kind of crazy. And, you know, you just get frustrated for all the hoops that we have to jump through to help people take care of themselves. So, you know, and it's no, it's a no brainer that people are not doing stuff that they're supposed to. If we're putting stepping stones in front of them, you know, obstruction, you're not stepping stones, but we're just putting blocks for them and to have to navigate around just to get taken care of, you know, and it's just, it gets to be a pain in the back. And it's not just insurance companies, it's hospitals, it's physicians, you know, we're all kind of part of it and it just gets frustrating.

Nicole: Yeah, for sure. For sure. So on the flip side, what's the most rewarding part of your work?

Dr. Crawford: Uh, two things. One is the main reason I got into general surgery and I'm not dogging any other specialty, but in general surgery, we fix people. People come in, they have a problem, I fix it and they leave. It was like a one night stand all over and everybody leaves happy, satisfied is the best one night stand that most of people ever gonna have in their life. They're like, see me in the Walmart. Like Doc hey, you did my hernia, you did my gallbladder. Good to see you, man. This is such a sight. So it's like giving out one night stands, left and right. You know, I'm like a hundred for a hundred. And I just like fixing people and knowing that they get well and move forward. Um, the other part is kind of a weird one. Um, I live in a small town, so, you know, um, I'll go somewhere and I'll run into a patient and you know, they'll say, Hey doc, uh, such and such such and such, thanks for taking care of my grandma.

Dr. Crawford: She passed, but you did everything you could. We really appreciate you being straightforward with us or, Hey, thanks for taking care of my daughter, such and such. And they say that when my kids are with me and you know, every once in a while, my kids are kind of like Dad, dude, you help a lot of people. I'm like, dude, it's important. You know? So, so being able to live in an where my kids can see me doing good work and see people acknowledging that, you know, I think that probably is the selfish part of helping people that I truly enjoy.

Nicole: Yeah. I like that. Love it. Love it, love it. So if you had to give one piece of advice to a pregnant person who has, uh, has gallbladder disease, what would, what would you say?

Dr. Crawford: So make sure that you research your symptoms. And if you can hone in on the story before you go see your OB, since you can help your OB understand that this may not just be the nausea and vomiting associated with pregnancy, that it may be a bad gallbladder because you will save yourself a lot of misery during the pregnancy. And if you think you've had gallbladder disease and you're planning a pregnancy, I would want to consider getting it tested, get your gallbladder tested, just to make sure that it's not an issue before you get pregnant, or if you get pregnant, you know, you're out here in the streets doing what you're not, you know, doing whatever and just end up pregnant between the first and second pregnancy. And if you have problems, make sure you at least address the gallbladder issue ahead of time. So you don't end up in a situation.

Nicole: Yeah. Great advice, great advice. So where can people find you? I know you make a lot of surgery videos. You have like 50 something thousand followers on Instagram. And if anybody who's interested, I have a fair number of like students and things like that, who I think would find your videos help. Or if you're just interested in surgery step, where can people follow you and watch what you do?

Dr. Crawford: So I'm um, @surgerymd on Instagram, um, I don't like to read, so I'm not really on Twitter, um, and have a YouTube channel it's called the Crawford Clinic and it pretty much goes over a host of general surgery topics. Um, we do a little bit of talking a lot of videos. So if you want to see dead feet cut off, or if you want to learn how to do advance colon surgery, um, that's a good reference. Some of the videos on YouTube are more geared to work towards healthcare professionals. Um, cause I do, um, I'm a professional education Proctor for Ethicon and uh, so I have to go around and teach people how to do gallbladders and colons, laparoscopically and other little fancy stuff. So a lot of, some of that content is how to learn, to take out a gallbladder, a colon. So, but if you just want to learn how to take out a colon in your basement and you've got all the equipment, its a good reference. Oh my God, I'm licensed in most states. I'm just saying he's licensed in most states. He cannot. If you just cut, I'm just saying, if you just want to learn how to do it,

Nicole: You got them. You can, you can teach them.

Dr. Crawford: You know, sometimes you need extra skills just case you never know what's going to happen and you end up somewhere and they got all the equipment and you won't know how to take a gallbladder out, l I got you.

Nicole: Oh my God. Oh my God. Well, thank you Dr. Crawford for coming on and educating us about gallbladder disease.

Dr. Crawford: My pleasure. Thank you.

Nicole: Isn't that a great episode. I bet you learned something about the gallbladder that you didn't know. I know that I did. All right. You know, after every episode where I have a guest, I do something called Nicole's Notes and here are my Nicole's Notes, which are my top three or four takeaways from the episode with my conversation with Dr. Crawford. All right, number one, if you need surgery or tests in pregnancy, you need surgery or the tests in pregnancy. Okay. I know that everyone wants to focus on the baby and understandably so, but sometimes there's a loss or people don't remember that in order for the baby to be healthy, the mom has to be healthy. That can be especially true with specialists who aren't obstetricians, where they're like, I'm not touching anything with a pregnant woman because I'm afraid I'm going to hurt the baby without remembering that in order for the baby to be healthy, the mom has to be healthy.

Nicole: So we don't do surgery. We don't do tests or things in pregnancy, unless it's absolutely necessary. So if you need it during pregnancy, you need it during pregnancy. Remember that in order for your baby to be healthy, you have to be healthy. Okay. Point number two, Dr. Crawford talked a lot about how gallbladder disease is influenced by what you eat. And when you eat foods that are considered you know less healthy that can exacerbate or make gallbladder disease worse, or, you know, make it happen. I want to remind folks that pregnancy is an opportunity to maybe improve your health and your diet. I know there's the old, Ooh, pregnancy is a time you can eat what you want because you're pregnant and we need to rethink that. Pregnancy can actually be an opportunity for you to make different food choices in order to have you be healthy, have your baby be healthy.

Nicole: So think of pregnancy potentially as an opportunity to improve your health and wellbeing, especially your nutrition. All right. And the third point that I want to make is that in relation to, um, his frustration about health care and healthcare really, it just really shouldn't be so complicated. Like nobody should go broke from needing healthcare. People should have access to affordable healthcare. It really shouldn't be that difficult. This is where policy and advocacy are important. This is where paying attention to what's happening in politics is important because that has a huge influence on policy and the things that happen in healthcare. So I would encourage you to keep your eye open for things like that. If it's something that's important to you, and it really should be important to all of us, that everyone has access to affordable healthcare, pay attention to the policy and things that are happening in your state and on a national level.

Nicole: All right. So you have it. Be sure to subscribe to the podcast in Apple Podcast or wherever you're listening to podcast. I'd love it. If you'd leave a review in Apple Podcast, I do shout outs from those reviews from time to time. And I love to hear what you think about the show. Also do check out the Birth Preparation Course, drnicolerankins.com. So you too can feel calm, confident, and empowered for your birth. That's drnicolerankins.com/enroll. Actually, I forgot to put the ending there. All right. So that's it for this episode do come on back next week. And until then, I wish you a beautiful pregnancy and birth. Thanks so much for listening to this episode of the All About Pregnancy & Birth podcast. Head to my website, drnicolerankins.com to get even more great information, including free downloadable resources on how to manage pain and labor and warning signs to look out for after birth. You'll also find information on my free online class, on How To Make A Birth Plan That Works, as well as everything you need to know about my signature online childbirth education class, the Birth Preparation Course. Again, that's drnicolerannkins.com and I will see you next week.