Case Study #125-year old Caucasian female 5’6” 110 poundsAllergic to wheatNo medications currently takenCC:  Glossitis and diarrheaPatient noticed over the past week her tongue has become sore and inflamed.   She feels the pain is constant, aggravated by eating and alleviated by “not letting anything touch it.”  Patient states tongue feels “tender.”  She has no idea what is causing it.  No other treatments have been attempted.  Severity/significance is a 9 out of 10.  She also states she has had diarrhea “worse than usual for the past 6 months.”  When asked if she has an chronic conditions, she states she has Celiac Disease but has a “tendency not to avoid pastries – her favorite!” Currently, her diarrhea is worse after she eats going up to 6 times per day.  She does notice the frequency increases when she eats any bread product and it is stops when she stops eating bread products.  On occasion, she takes over the counter diarrhea medication.  The severity is 5 out of 10.  Blood work shows red blood cells are larger than normal (macrocytic).Case Study #270-year old Black male 5’10” 200 pounds.No Known Drug AllergiesCurrently taking Lisinopril and CrestorCC:  DysphagiaPatient has noticed he has had difficulty swallowing food over the past 8 months.  He has noticed that in the beginning it only occurred with solid food but now it has progressed to include really any type of food.  Nothing appears to alleviate the condition.  He is only reminded of it “when he starts to eat.”  He has tried no other treatments.  Severity is 8 out of 10.  When asked if he has noticed anything else, he mentioned he has lost 10 pounds without trying in the last month and feels he has lost his strength.  Also, he notices when he actually “decides to eat” he does not eat much and feels full quickly.  CT scan shows epigastric mass.Case Study #357-year old female5’5” 300 poundsNo Known Drug AllergiesCurrent medications – noneCC:  Sudden one-sided facial paralysisPatient states that her family noticed during Thanksgiving dinner that one side of her face became “frozen.”  Patient became extremely upset and wanted to be taken to the emergency room.  Family took her to the emergency room and the following exams were done:CT – negative for infarct but to be sure MRI was done and was also negative for infarct, mass lesion or hemorrhage.  Facial paralysis went away within the hour.  However, patient was kept in the hospital for observation.

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