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a new case study...exciting!

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I'm an ortho PA covering a walk-in clinic/UC today for some extra cash...but had a new one I thought the students would like:

48yo male presents for abdominal pain "at the beltline" for a few weeks.  It's only during the day, and he has no pain in the mornings or evenings/overnight.  Before going to see him I checked his vitals and noticed he's gained about 20lbs over the last 2 months.  Upon asking I learned he hasn't changed his belt loop...🤦‍♂️.  He wears a belt for work, but changes when he gets home...right around the time his pain resolves.

Treatment plan: loosen belt and/or lose the weight

Also, did tell him to f/u with his PCP if persists on the off chance it's a hernia or something, but didn't seem like it.

Hope the students here learned something and those with lots of experience were able to glean a few pearls from this incredibly complex case study...😂

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1 hour ago, thinkertdm said:

So...he went to the doctor because he couldn't figure out how to work his belt? 

He just didn't put together the correlation of his symptoms resolving by taking off his belt...or that he needs to loosen his belt with a 20lb weight gain.  He was obviously embarrassed when it dawned on him...we both laughed.  While it is definitely not the greatest use of medical resources, it made for a good moment of comic relief in my day.  I like the extra cash...but never understand why I agreed to the shift when I'm in the middle of them.

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I can't find the clipping now, but I saw one from a doc with a 22 year-old who had a patient with a terribly itchy bottom. His erythematous anus was caked with stool. The doc advised him he needed to wipe his butt better. He asked, "How do I know when I'm done?" She replied when the paper is clean. He left with profound thanks, and she mused that she just taught a 22 year-old how to wipe his butt. 

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