On the way to the hospital every little bump and pothole was like pinball pain with my abdomen the game board and a searing red-hot metal ball shooting around. I was hoping the ER doctor would be able to get to the bottom of my abdominal pain.
Dr. Nelson at Kaiser emergency room in Vallejo was very thorough. After he had done all the physical exam and tests needed to rule out that nothing wrong with my heart, Dr. Nelson went ahead and ordered CT scan of the abdomen and X-ray. The CT scan results show no signs of kidney stone or gallbladder. The chest and abdomen X-ray results show no evidence of pneumothorax or any visible masses or abnormal calcifications. Then why so much pain?
Discharge Summary:
History of Present Illness: Hunter Austin is a 54 y male who presented to this emergency department with CHEST DISCOMFORT and CONSTIPATION. Patient on Methadone for chronic pain, having trouble with constipation for past five days. Seen Thursday by PMD, started on Lactulose. Feels like can’t pass stool, with some pain in LLQ. NO fever. No vomiting. Tried fleets enema without success. Today in bath had some upper midline sterna fleeting CP after straining on stool. Nonradiating, lasting only a few seconds.
Medical Decision Making/Diagnoses Considered: constipation, kidney stone, diverticulitis, hernia.
ER Course:
IV placed 1 liter bolus given
EKG: nsr, no acute changes. His chest pain is not his presenting complaint.
Soap suds enema given with po Magnesium Citrate for presumed obstipation.
Labs sent.
UA with trace blood, so sent for CT Renal, pending at this time.
CT Renal: “no radio-opaque urinary stones or obstructive uropathy; no signs of acute inflammation, incl. diverticulitis; borderline overdistended but otherwise normal GB;”
Assessment and Plan:
Abdominal Pain; Constipation; Chest pain, fleeting; History of CAD s/p PCI 2008, stable; Likely disposition: home with following medications: Metamucil; Go-Lytely 4 liters; Push fluids
Return as needed.
I was discharged to follow up with my primary doctor. I needed to see a gastroenterologist, and I knew it.
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