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Alcohol Abuse, Abdominal Pain, Rectal Bleeding
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Alcohol Abuse, Abdominal Pain, Rectal Bleeding

  I am 37 and have a 10 year history of alchol abuse.  I have never been in rehab, but quite every few days to feel better.
  Drinking now causes sever pain in my stomach and back muscles.  I try to quit, but replase often.  Most recently was admitted to the ER after 9 days of NOT drinking.  I suffered from severe stomach pain (left side tender, belly blotted and right side lumpy) and had blood tests and Chem 7 liver profiles indicating a GT of 129.  I am continiously quiting drinking, each time suffering withdrawal symptoms such as fever, body pain and lack of sleep, but never this bad.
  MOST IMPORTANTLY my abdominal pain is now chronic.  I have small amounts of bright red blood in my stool, occasional dark stools and frequent diarreha.  My HMO primary care provider is aware of all the above and refered me to an gastroenteroligist.  He reviewed the ER test results and ran tests for H. pylori which were negative.
  I am going back to AA, not drinkling and an Upper Endoscopy is scheduled in one week.  I attended AA three months ago and stopped drinking for 21 days, relapsed (4 days) and stopped again for 30 days.  Few withdrawal symptoms were experienced.  I know I need to go back to AA and I need to quite drinking but my HMO will pay only for 3 days detox treatment.
  QUESTION>
  1) Is upper endoscopy nessary if I don't drink again?
  2) Should I wait a few weeks OR go ahead with the proceedure?
  3) What about stool samples, and tests for bowel disease, Chron's disease?
  4)  Can my HOM refuse me in-patient rehabilitation?
  Thank you for your assistance!
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Dear Jay,
Your primary care physician, who knows you and examines you, is in a much better position than I am to determine which procedures and tests are necessary at what time.  If you don't trust your physician, that's a problem, and you should share your concerns with him or her and consider getting a second opinion or changing doctors.
That being said, I think that gastrointestinal damage caused or aggravated by excessive drinking may not disappear once the drinking stops, so you should have these symptoms, which are potentially serious, evaluated appropriately.
In my opinion, HMOs should not refuse any treatment which is medically necessary.  However, many patients do quite well with intensive outpatient day or evening treatment programs following brief hospital stays.  If you and your treatment providers believe that a longer inpatient stay is medically necessary, you should communicate this clearly to the HMO.  If you are still refused, find out about the process for appealing a "denial of care."  Just this morning the NY TIMES reported that a patient denied care by an HMO was awarded $114 million  by the courts.  Managed care organizations are aware of this trend and some are less fussy than they used to be when previously denied treatments are requested.
Good luck, and check my Ask DrSteve web site (hyperlinked below) for a lot more information about drinkers and their many medical problems.

This information is provided for general medical education purposes only. Please consult your physician for diagnostic and
treatment options pertaining to your specific medical condition.

Ask DrSteve:  The Real Story About Smoking, Drinking & Getting High




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