Discouraged And Frustrated

[Aleshia]

hey, I just need a place to vent.. and some encouragement I've been to like 3 different doctors in the last few weeks... doctor #1 said "you don't have celiac because you don't have diarrhea and you're not losing weight." the good thing is he had an ultrasound done and discovered that I have gallstones (have had attacks for more than 9 years and no doctors even thought about that possibility before" bad thing is he wants me to have my gallbladder removed and I'm refusing to do it. if God gave me a gallbladder he did so for a reason and I'm not giving it up. I believe that it is my right to decide if I want the gallstones removed without taking the gallbladder out and am trying to find a surgeon who is willing to do that.... anyway, he also said that these stones were probably in my gallbladder as a teen since I started having attacks when I was 20 years old and it takes awhile to build up to that point. from reading on celiac.com the only time a young person would have gallstones is in relation to celiac disease (don't know if I got that right or not but that is my understanding) so I showed him my list of symptoms (huge long list i can paste on here if anyone is interested in knowing them) and he still says its not celiac and "why are you so determined to have celiac disease??" (very condescending) I told him I am not determined to have it but if I do have it I want to know and if he has any better ideas to let me know. so he did the test for celiac (which I know will come back negative cause i had just had one done by a different dr. a week before that) and also for my thyroid levels. referred me to a GI who isn't a dr. but a nurse practitioner and a surgeon who will say he is gonna take my gallbladder... I also talked to him about the fact that my spine hurts and is worse after a walk, I've lost at least 2 inches of height in 3 years (I'm only 30!!) he said that that's not measurable (!? ) and that it doesn't necessarily need to be looked into.... anyway and then doctor #2 she's a naturopath who I saw as a teen and also a year ago. I liked her... I still might go to her but I'm not sure what to think anymore. when I found out I had gallstones I called to talk to her about it and about the natural remedies that make you pass the stones by drinking olive oil and grapefruit juice or whatever... said don't try that cause you have too many stones and they will clog up on the way through and you will end up with emergency surgery anyway which will be worse. she said to see the surgeon and make sure that they do the surgery where they take hte stones and not the gallbladder. so yesterday I called her again and left a message with the receptionist to find out if she knows a surgeon who does that surgery. they left me a message this morning and said that she told them to tell me that I need to get my gallbladder removed cause there are so many stones and that if they take just the stones I'll just get more in a few years and have to have the same thing again... she has never even seen the ultrasound report to know how many stones there are or anything so I'm getting all discouraged and freaked out and I went online to search for doctors in the area that know at least SOMETHING about celiac and I found one who is the director of digestive diseases at the University of Washington. but I can't get an appointment with him unless I have a referral so I called up doctor #3 and had an appointment with her today, she is at one of the UW clinics so I thought "ok if this GI dr. is trying to hard to educate dr's and patients about Celiac then maybe he would start with the dr's at the university clinics!" I got in there and she wouldn't look at my list of symptoms she wanted me to summarise them for her (I have horrible memory and concentration......) I got about 1/2 way through and she's like "that's enough.. is there anywhere on your body that DOESN'T hurt??" and then she told me that I am depressed "classic case of depression" and that I have fibromyalgia and that antidepressants with treat both those things... she tested me for autoimmune disorders and rheumatism... by the time she was done telling me that I was depressed I was fighting back tears cause I was so disappointed that it was one more doctor who wasn't gonna listen to me. she said that I don't have ANY symptoms of celiac disease. I did get her to do the referral for me though. she said ti will be about 3 weeks before someone calls to schedule anything though... (hopefully she isn't just saying that hoping I'll forget about it and didn't actually put the thing through!)

[Aleshia]

oh also, the last dr. said that until my "brain chemicals" are fixed that she can't do anything about my other symptoms including loss of height....

[mamaw]

sorry you are having a bad go with the doctors but it doesn't surprise me at all.... I had my gallbladder removed when I was 24... The stones will come back if you don't have the gallbladder removed. And they do cause alot of pain..... I knew nothing about celiacs back then.

I understand where you are coming from becasue I just did the same thing with my thyroid. I refused to have the RAI & choose to have a man slice my throat to remove my thyroid but when the doc seen my results of off the charts thyroid hormone he refused to do surgery . He said I would die on the table. He advised me to take the RAI pills or I would have a major stroke... I went to three other doctors & got the same opinion. So I think maybe you should reconsider the surgery. No one wants surgery but at times it is the best procedure. I was so glad to know something was actually wrong with my body because at first they keep telling me it was all in my head & imagination.... I was excited to know I actually was not a mental case...

You will get in so much pain that in the end you will agree to anything to reduce the pain & sickness of gallstones. My gallbadder was pitted from the stones & they did not know that until they opened me up.... and it is much less invasive today than it was when they cut you from mid-section to the right side...I have a hugh scar.....

best of luck

mamaw

[home-based-mom]

God gave you an appendix, too, but that doesn't mean you shouldn't have it out when something goes terribly wrong with it!

Gallbladder removal is now done as outpatient surgery.

[Aleshia]

sorry you are having a bad go with the doctors but it doesn't surprise me at all.... I had my gallbladder removed when I was 24... The stones will come back if you don't have the gallbladder removed. And they do cause alot of pain..... I knew nothing about celiacs back then.

I understand where you are coming from becasue I just did the same thing with my thyroid. I refused to have the RAI & choose to have a man slice my throat to remove my thyroid but when the doc seen my results of off the charts thyroid hormone he refused to do surgery . He said I would die on the table. He advised me to take the RAI pills or I would have a major stroke... I went to three other doctors & got the same opinion. So I think maybe you should reconsider the surgery. No one wants surgery but at times it is the best procedure. I was so glad to know something was actually wrong with my body because at first they keep telling me it was all in my head & imagination.... I was excited to know I actually was not a mental case...

You will get in so much pain that in the end you will agree to anything to reduce the pain & sickness of gallstones. My gallbadder was pitted from the stones & they did not know that until they opened me up.... and it is much less invasive today than it was when they cut you from mid-section to the right side...I have a hugh scar.....

best of luck

mamaw

thanks mamaw, I just feel like if I do have celiac disease and that is what is causing the "faulty bile" as they say and causing my gallbladder to be underactive then there seems that there would be a chance that if I got rid of the stones and went gluten free that my gallbladder would start functioning normally... plus I think there is a higher risk of bowel cancer if you take the gallbladder out from the dripping bile into the gut... and my family already has a huge rate of cancer... all my grandparents had at least one type of cancer and lots of my aunts and uncles and other relatives... I just feel like if they take the gallbladder and then find out I do have celiac disease its not really giving me a fair chance to recover naturally or whatever... it seems it should be my choice if I want to have surgery every 5 years from recurring gallstones or not... its my money right? anyway... its just frustrating me to no end

[Aleshia]

God gave you an appendix, too, but that doesn't mean you shouldn't have it out when something goes terribly wrong with it!

Gallbladder removal is now done as outpatient surgery.

that is true. I just feel attached to my gallbladder I guess hehe and I just don't want to risk the whole leaky gut thing and I've heard people say that within 2 weeks they have the same pain back anyway and they can't have their gallbladder taken out twice!

[Fiddle-Faddle]

Why don't you try posting a plea for someone to recommend a celiac-savvy doctor in the Seattle area? (Or wherever is convenient to you)

I think there are quite a few people on this board from your neck of the woods. You can also look for a celiac support group in your area, and people there should be able to point you in the right direction.

You could even contact your health insurance company, and insist to them that it would be cheaper for them if you could find a doctor that would correctly diagnose you based on symptoms, as the insurance company would then NOT need to pay for stupid things like antidepressants that you obviously don't need.

Good luck, hang in there, and no , you are not crazy! But your doctors are total idiots.

Find out exactly what "test for celiac" they ordered--if it was a wheat allergy test, it would be negative unless you are having a true allergic (histamine) reaction.

If it was a celiac panel, it should test for antibodies to gluten and a few other things. If you were not eating a lot of gluten prior to the test (for like, 4 months straight), it would be negative.

Of course, when it comes down to it, if it really IS celiac--you do not need a diagnosis. You do not need a doctor's permission to cut gluten out of your diet. You do not need a doctor's permission to do whatever it takes to feel better. You might even be better off without an official diagnosis, as that can be used by insurance companies to deny you insurance! (insane, isn't it?)

You only need a doctor if it turns out that celiac isn't the answer, because then you're back to square 1.

[Aleshia]

Why don't you try posting a plea for someone to recommend a celiac-savvy doctor in the Seattle area? (Or wherever is convenient to you)

I think there are quite a few people on this board from your neck of the woods. You can also look for a celiac support group in your area, and people there should be able to point you in the right direction.

You could even contact your health insurance company, and insist to them that it would be cheaper for them if you could find a doctor that would correctly diagnose you based on symptoms, as the insurance company would then NOT need to pay for stupid things like antidepressants that you obviously don't need.

Good luck, hang in there, and no , you are not crazy! But your doctors are total idiots.

Find out exactly what "test for celiac" they ordered--if it was a wheat allergy test, it would be negative unless you are having a true allergic (histamine) reaction.

If it was a celiac panel, it should test for antibodies to gluten and a few other things. If you were not eating a lot of gluten prior to the test (for like, 4 months straight), it would be negative.

Of course, when it comes down to it, if it really IS celiac--you do not need a diagnosis. You do not need a doctor's permission to cut gluten out of your diet. You do not need a doctor's permission to do whatever it takes to feel better. You might even be better off without an official diagnosis, as that can be used by insurance companies to deny you insurance! (insane, isn't it?)

You only need a doctor if it turns out that celiac isn't the answer, because then you're back to square 1.

Thanks I did contact someone from a support group about a month ago and they said there was a dr in the everett area and said I can call them if I need any help. anyway, I found only 2 dr.s on celiac.com in washington and one of them has a bad review (it said he was very old school and wouldn't let them ask any questions or anything... ) I was still possibly considering trying to see him though because he was listed as one of the top 100 doctors in 2006 and he specializes in celiac disease... I'm just tired of doctors telling me I can't have it because I don't have diarrhea and I'm not losing weight as if those are the only 2 symptoms when they did the test it was the celiac panel

TTG antibody, IGA <3 reference range: NEGATIVE: <5

EQUIVOCAL: 5-8

POSITIVE: >8

IGA Serum 151 reference range: 81-463

GLIADIN ANTIBODY (IGA) 5 reference range: NEGATIVE: <11

EQUIVOCAL: 11-17

POSITIVE: >17

clearly negative

maybe I should just go gluten free... I just wanted to be tested first so that I wouldn't have to go back onto gluten later

[pinkdljj]

Hi,

I just read your post. I can relate with the whole doctor thing. I'd been to 9 doctors until I finally decided to go a different route. Thank God I did. There is a clinic in Renton called the www.Tahomaclinic.com. Dr. Wright is the founder. He is on the board at Bastyr, teaches at Bastyr and a well-known Naturopath Doc around the country. I wasn't able to get in to see him, but I did see Dr. Wendy Ellis. I gave her my list of symptoms, pain, Depression, anxiety, etc.... no diarrhea and no weight loss. She said that I probably was intolerant to wheat and casein. I laughed because at the time I had never heard of it causing such symptoms as mine. Well after the tests all came back it showed malabsorption, casein and wheat blood antibodies and a celiac gene.

She didn't advise biopsy but immediate removal of all dietary casein and wheat. I am on several supplements I get at Super Supplements and also vitamin B12 shots. I feel 1000% better. The docs all wanted me to be on meds, birth control pill for ovarian cysts, etc... and she encouraged an all natural approach. I love that about this clinic. They will find a way for you to keep your body parts and to heal you naturally.

Give them a try. It was the best decision of my life, literally saved it.

Take care,

Leslie

[Fiddle-Faddle]

I mean, you should create a separate thread here asking specifically for recommendations for doctors in the Seattle area! Seriously!

I see someone already posted a recommendation in the post above, but if you are looking for something closer, or if that one doesn't wrok with your insurance, you'll get much, much more attention (translation: more answers) from a separate thread.

[ravenwoodglass]

You don't need a doctors permission to go gluten free. If I was you I would stop the doctor search and just do the diet and see if it helps. I was finally diagnosed by an allergist, a very elderly one who guided me through an elimination diet. I was close to death and only went because my PT nagged me for a couple of months. I had been to doctors to the tune of 17 thousand a year the last prediagnosis year for copays for multiple meds and testing. We searched for over 10 years trying to find the cause of my agony but all doctors were clueless, they drew the blood repeatedly for celiac and since I always came back negative they never even told me what celiac was.

I saw considerable relief after just a short time on the diet, enough to convince all my family members to blood test. They all showed up positive. Lucky them. Oh well at least the severity of my illness had them gluten free even with what seemed like minimal symptoms.

Long story short, try the diet, strictly, for a couple months. That may very well give you the answer.

As to the gallstone issue, I know that is causing you a great deal of pain. Being gluten free may not help the stones that are already there. I agree fully with the idea that any 'home-brew' cleansing is not for you. You run a real risk of rupturing your gallbladder if you do that. I will let some of those more familiar with dealing with those give advice I what to do with that issue.

[RiceGuy]

If you haven't started the gluten-free diet, do so immediately. As is often said, you don't need to be told to do so by any doctor. IMO, you aren't so likely to have more gallstones if you're on the gluten-free diet. Seems to me that's what has caused them, so why would there be more without the cause? That is my reasoning, wrong or right, and I wouldn't allow them to remove any part of my anatomy. It sounds to me like all the doctors you saw do not know or believe in being able to flush out stones, or Celiac, or much anything else that isn't specifically taught to them. Can you tell I hate doctors? I didn't get relief from any of my health problems until I gave up on so-called "modern medicine".

There are a few threads which discuss how to flush out gallstones, so I'd start by looking those up. Hang in there, and hang on to your body parts too! (besides, with all the mistakes these days there likely to goof up and remove a kidney or something)

[cyberprof]

Waving hello from Northgate!

I don't know any celiac-savvy doctors in Seattle/King County, sorry.

Although this is secondary to your gall-bladder question, I would suggest having a bone scan for osteoporosis if you've lost height. That IS a celiac symptom or side-effect. No doctor can say that lost height is a pyschological symptom and no legitimate doctor should refuse a bone scan, although you can get them done a health fairs or maybe a chiropractor's or naturopath's office.

Regarding the gall-bladder, you've gotten good advice here but I can only say not to rush into the surgery. Take time to understand your options but I agree with the NP, don't do a cleanse.

Hope you're better soon!

~Laura

[Aleshia]

Hi,

I just read your post. I can relate with the whole doctor thing. I'd been to 9 doctors until I finally decided to go a different route. Thank God I did. There is a clinic in Renton called the www.Tahomaclinic.com. Dr. Wright is the founder. He is on the board at Bastyr, teaches at Bastyr and a well-known Naturopath Doc around the country. I wasn't able to get in to see him, but I did see Dr. Wendy Ellis. I gave her my list of symptoms, pain, Depression, anxiety, etc.... no diarrhea and no weight loss. She said that I probably was intolerant to wheat and casein. I laughed because at the time I had never heard of it causing such symptoms as mine. Well after the tests all came back it showed malabsorption, casein and wheat blood antibodies and a celiac gene.

She didn't advise biopsy but immediate removal of all dietary casein and wheat. I am on several supplements I get at Super Supplements and also vitamin B12 shots. I feel 1000% better. The docs all wanted me to be on meds, birth control pill for ovarian cysts, etc... and she encouraged an all natural approach. I love that about this clinic. They will find a way for you to keep your body parts and to heal you naturally.

Give them a try. It was the best decision of my life, literally saved it.

Take care,

Leslie

thanks I will definitely look into that. I needed to hear something about a good doctor for a change

[Aleshia]

You don't need a doctors permission to go gluten free. If I was you I would stop the doctor search and just do the diet and see if it helps. I was finally diagnosed by an allergist, a very elderly one who guided me through an elimination diet. I was close to death and only went because my PT nagged me for a couple of months. I had been to doctors to the tune of 17 thousand a year the last prediagnosis year for copays for multiple meds and testing. We searched for over 10 years trying to find the cause of my agony but all doctors were clueless, they drew the blood repeatedly for celiac and since I always came back negative they never even told me what celiac was.

I saw considerable relief after just a short time on the diet, enough to convince all my family members to blood test. They all showed up positive. Lucky them. Oh well at least the severity of my illness had them gluten free even with what seemed like minimal symptoms.

Long story short, try the diet, strictly, for a couple months. That may very well give you the answer.

As to the gallstone issue, I know that is causing you a great deal of pain. Being gluten free may not help the stones that are already there. I agree fully with the idea that any 'home-brew' cleansing is not for you. You run a real risk of rupturing your gallbladder if you do that. I will let some of those more familiar with dealing with those give advice I what to do with that issue.

I've been thinking about going gluten free.. not sure what is holding me back except that I have certain symptoms that I feel need to be looked at further... like bone pain and loss of height and stuff like that... if I have osteoporosis or osteomalacia or something like that I want a doctor to take it seriously and I don't know that going gluten free is going to be enough to treat or reverse that.. what if I need some kind of treatment for it? I just want someone to take me seriously... there is no way that depression causes you to lose height!! maybe I will go glutenfree though...

[Aleshia]

If you haven't started the gluten-free diet, do so immediately. As is often said, you don't need to be told to do so by any doctor. IMO, you aren't so likely to have more gallstones if you're on the gluten-free diet. Seems to me that's what has caused them, so why would there be more without the cause? That is my reasoning, wrong or right, and I wouldn't allow them to remove any part of my anatomy. It sounds to me like all the doctors you saw do not know or believe in being able to flush out stones, or Celiac, or much anything else that isn't specifically taught to them. Can you tell I hate doctors? I didn't get relief from any of my health problems until I gave up on so-called "modern medicine".

thats how I feel... if I have celiac and I go gluten free I probably won't get more gallstones... thats why I want to just remove the stones... I was told by my naturopath that if my gallbladder is full of stones they will get stuck if I do the flush and I will have to have emergency surgery to repair the biliary tract or something which is far more serious than the gallbladder surgery... but I don't want to have my gallbladder out! I saw on a website about the other options for gallstones instead of surgery and one of them was actigall and it said "but that is very expensive you would have to be on it for months so it would add up fast" I looked online and actigall is on the list of $4 prescriptions!! so I'm gonna look into that but first I have to find out if my gallstones are made of the right stuff for it to disolve. anyway my gallbladder wasn't inflamed when they did the ultrasound so that is one very good thing and if I'm careful not to eat chocolate or icecream (2 of my favorite things!) I don't seem to get any attacks.

[Phyllis28]

I went to four doctors when I was told I had to have my gallbladder taken out and did research in the internet. I did not find any viable alternatives to surgery. The four doctors (1 internist, 1 family doctor, 1 Celiac knowegelable GI, and 1 surgeon) I had it out and feel a lot better. No more dibilitating attacks and a lot more energy. One of the points a couple of the doctors made was that the attacks were caused when I passed a gallstone. They explained that the gallstone could end up in the wrong place and be fatal.

I had it out and feel a lot better. No more dibilitating attacks, a lot more energy, and no more risk of death. The surgery is done laproscopically (SP??). The recovery time is about two weeks.

Also, between time of diagnois and surgery I had to stay on a very low fat diet to prevent attacks.

Hope you feel better soon.

[Aleshia]

Waving hello from Northgate!

I don't know any celiac-savvy doctors in Seattle/King County, sorry.

Although this is secondary to your gall-bladder question, I would suggest having a bone scan for osteoporosis if you've lost height. That IS a celiac symptom or side-effect. No doctor can say that lost height is a pyschological symptom and no legitimate doctor should refuse a bone scan, although you can get them done a health fairs or maybe a chiropractor's or naturopath's office.

Regarding the gall-bladder, you've gotten good advice here but I can only say not to rush into the surgery. Take time to understand your options but I agree with the NP, don't do a cleanse.

Hope you're better soon!

~Laura

yeah I think the next doctor I see I'm going to ask for a bone scan, I have an appointment with my NP again on the 8th. I'm just frustrated with her cause she is the one who first knew that I lost 2 inches... I ALWAYS measured between 5'10 1/2 and 5'11" and when she measured me I was 5'8 1/3" thats more than 2 inches... anyway she just said it was probably just the discs in my back were thinner than they used to be... and she didn't test my calcium levels or vitamin d levels or do a bone scan or ANYTHING. she did have me start taking vitamin D pills though cause she said almost everyone in Washington is depleted in vitamin D cause we don't get enough sun. I had been in NewZealand for 5 years though and coming over here just in summer so basically I was getting sun almost year round.... I just don't know what to think... I mean shouldn't she be taking it more seriously? should I go to a new dr. even though I like her other than that and risk a new dr. being even worse? one thing I know is I will never go back to the dr. who told me I'm depressed and have fibromyalgia and that the only treatment for either one is antidepressants!

[Aleshia]

I went to four doctors when I was told I had to have my gallbladder taken out and did research in the internet. I did not find any viable alternatives to surgery. The four doctors (1 internist, 1 family doctor, 1 Celiac knowegelable GI, and 1 surgeon) I had it out and feel a lot better. No more dibilitating attacks and a lot more energy. One of the points a couple of the doctors made was that the attacks were caused when I passed a gallstone. They explained that the gallstone could end up in the wrong place and be fatal.

I had it out and feel a lot better. No more dibilitating attacks, a lot more energy, and no more risk of death. The surgery is done laproscopically (SP??). The recovery time is about two weeks.

Also, between time of diagnois and surgery I had to stay on a very low fat diet to prevent attacks.

Hope you feel better soon.

Hi were you gluten free at the time? I just think that if the stones are formed because the gallbladder isn't active enough to get the bile out efficiently, and that the gallbladder isn't active enough because of celiac that if you take out the stones that are already there and treat the cause and not the symptom (go gluten free) that no more stones should form... I believe (not sure if its totally correct but I have read some stuff about it) that the stones are formed because of bread and other grain based foods and that it is the greasy foods that make your liver produce more cholesterol which makes your gallbladder produce more bile which makes more stones because of the stuff from the grains... ... or something like that

[Phyllis28]

I have been gluten free for 30 years. My gallbladder problems are related to being female, over 40, and overweight. I do not know if celiac had anything to do with my gall bladder problems. The first symptoms showed up about 7 years ago.

[VioletBlue]

I agree with those that have said to go ahead and start the gluten free diet. You have nothing to loose and everything to gain.

Please also remember that it is YOUR body. The doctors do not own it, YOU DO. They do not have the right to do surgery you do not want. You know your body from the inside in a way they never will. Trust your intuition about your own body. Your intuition is JUST AS VALUABLE as their opinions.

Now they can refuse to do surgery on you if they don't believe it's in your best interests, but they cannot force you to have non emergency surgery, nor can they agree to do one type of surgery and do another without your approval or knowledge. Please do not be intimidated by doctors. They are partners in your health care at best, but they are not the authority on YOUR BODY.

Please also understand that gluten intolerance can have psychological effects. It can cause mood swings, depression and brain fog. I believe it literally effects every part of your body to one degree or another; every system, every body part, how we think, how we feel, how we view the world.

[Tim-n-VA]

Your intuition is JUST AS VALUABLE as their opinions.

Maybe not but as long as it is only you who will be affected you can give it as much weight as you want...

The human body is very complex. There is much variation within that complexity from individual to individual. There are many diseases/conditions with overlapping symptoms. A good doctor will listen to your observations about how you are reacting/feeling.

However, to call a doctor ignorant because he won't make a diagnosis based on the patient's self-described symptoms when other conditions could casue the same symptoms is pretty dangerous.

[RiceGuy]

Since Celiac is known to cause osteoporosis and other bone problems, delayed growth, and more things than I can name, I think going gluten-free will be addressing those issues - probably better than anything else you can do IMO.

As for breaking up gallstones, seems to me I heard about ultrasound being used to do that, which makes sense when you know that ultrasonic waves are used to clean all sorts of things, from jewelry to engine parts. Not having looked into this or any other method to remove gallstones, I cannot advise further, other than to search the board, use Google, and see what you find.

[Aleshia]

However, to call a doctor ignorant because he won't make a diagnosis based on the patient's self-described symptoms when other conditions could casue the same symptoms is pretty dangerous.

but shouldn't a doctor at least listen to the symptoms and try to come up with SOMETHING? do some tests or send you to another doctor until it is figured out???

[Aleshia]

Since Celiac is known to cause osteoporosis and other bone problems, delayed growth, and more things than I can name, I think going gluten-free will be addressing those issues - probably better than anything else you can do IMO.

As for breaking up gallstones, seems to me I heard about ultrasound being used to do that, which makes sense when you know that ultrasonic waves are used to clean all sorts of things, from jewelry to engine parts. Not having looked into this or any other method to remove gallstones, I cannot advise further, other than to search the board, use Google, and see what you find.

I think the FDA has stopped them from using the ultrasound for gallstones, Not exactly sure why but that is what I found online. they still do the one with lasers to shatter them and then suck them out with a vaccuum but they say they only do that on elderly or people too sick to have it removed or on children who haven't reached puberty yet

seems like the patient should have some say though