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Solve the Medical Riddle: “What’s Wrong with Me?”

Editor’s note: Welcome to our new ThirdAge feature, which gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

We’ll start this week by letting you know what the patient told the doctor and how the doctor proceeded with the examination. Next week, the doctor will continue to look for clues to the medical riddle. The third week, we’ll let you know what some people have suggested as possible diagnoses. The fourth week, the doctor will reveal the actual diagnosis and outline treatment options and lifestyle recommendations. Then we’ll move on to a new riddle for the following month!

The Patient’s Reports Her Symptoms

Sally G., a 53-year-old first grade teacher, presented with severe constipation.

Her doctor used the classic S-O-A-P notes as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

This week, we’ll cover S, Symptoms or Chief Complaint. Here’s what Sally told the doctor:

“I used to be regular, like clockwork. I’d eat my breakfast and go to the bathroom right after that, no problem. Then a year ago, I took a new and better paying job at an elementary school about an hour’s drive from my house. The old school was a ten-minute walk away. Now I most often skip breakfast and eat a power bar in the car. That’s the only change I can think of in my daily routine. I bring a healthy lunch the way I always did, usually a turkey sandwich on brown bread and raw veggies or an apple. For dinner I serve fish or chicken for our entrée and make a salad. We almost never have dessert.

Wait! I just remembered a couple of other changes that have come about because of my problem. My husband and I love to play tennis and we used to get out on the courts every Saturday morning. But now that I’m not having bowel movements every day, I feel so bloated and uncomfortable that I’ve started staying home on Saturdays and just reading or watching TV.

Also, I used to babysit for my one-year-old granddaughter fairly often but I just don’t have the energy to keep up with her these days.

Sometimes once I start teaching in the morning, I do have the urge to have a movement. However, there’s no way I can leave a roomful of six-year-olds alone. I hold it until lunchtime but the bathroom is right off the Teacher’s Room where we eat and you can hear everything that goes on in there. I hate the idea of having male teachers listen to my, um, efforts on the toilet. I just keep holding it until I get home in the evening but by then the urge is usually gone.

I hope you can help me. I’ve tried Milk of Magnesia but it actually doesn’t do much for me. I just can’t go on like this!”

After hearing Sally’s complaint, the doctor considered the following causes as a start toward reaching a final diagnosis:

Acute constipation, which usually comes on suddenly and can be caused by:

o Bowel obstruction