After the first visit with Dr. Rubin,in January I had an EKG test on 01/06/2009 and blood tests on 01/08/2010. The tests results show nothing to be worried about an acute cardiac attack. However the pain did not go way but had escalated so he went to see Dr. Rubin for the second time with the same chief complaint of abdominal pain and constipation. Office visit notes show that I “reported several days of abd pains, constipation, usually effectively treated with fiber and stool softener.
Below is an excerpt from Hunt’s office visit notes:
Assessment & Plan:
ABDOMINAL PAIN (primary encounter diagnosis)
Note: likely constipation which may have been exacerbated by recent increase in methadone to TID dosing. Advised reduce methadone to BID at least temporarily and increase fluids and fiber and trial of lactulose. Patient was advised to return for re-evaluation if symptoms persist or worsen. Advised re-eval if bleeding or fever or increased pain or increased emesis.
Plan: LACTULOSE 10 GRAM/15 ML ORAL SOLN
Dr. Rubin also advised me that a hot bath would be very helpful to ease the pain. I went home and spent most of the night that night soaking in the tub and fell asleep there for a while. The next day the abdominal pain became severe and unbearable that I asked my wife to take me to the emergency room on the night of February 13, 2010.
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