R.H. is a 74-year-old black woman, who presents to the family practice clinic for a scheduled appointment. She complains of feeling bloated and constipated for the past month, some-times going an entire week with only one bowel movement. Until this episode, she has been very regular all of her life, having a bowel movement every day or every other day. She reports straining most of the time and it often takes her 10 minutes at a minimum to initiate a bowel movement. Stools have been extremely hard. She denies pain during straining. A recent colonoscopy was negative for tumors or other lesions. She has not yet taken any medications to provide relief for her constipation. Furthermore, she reports frequent heartburn (3–4 times each week), most often occur-ring soon after retiring to bed. She uses three pillows to keep herself in a more upright position during sleep. On a friend’s advice, she purchased a package of over-the-counter aluminum hydroxide tablets to help relieve the heartburn. She has had some improvement since she began taking the medicine. She reports using naproxen as needed for arthritic pain her hands and knees. She states that her hands and knees are extremely stiff when she rises in the morning. Because her arthritis has been getting worse, she has stopped taking her daily walks and now gets very little exercise. C.B. is a significantly overweight, 48-year-old woman from the Winnebago Indian tribe who had high blood sugar and cholesterol levels three years ago but did not follow up with a clinical diagnostic work-up. She had participated in the state’s annual health screening program and noticed that her fasting blood sugar was 141 and her cholesterol was 225. However, she felt “perfectly fine at the time” and could not afford any more medications. Except for a number of “female infections,” she has felt fine until recently. Today, she presents to the Indian Hospital general practitioner complaining that her left foot has been weak and numb for nearly three weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. However, she reports that she has been very thirsty lately and gets up more often at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more water to keep hydrated. She has gained a total of 65 pounds since her last pregnancy 14 years ago, 15 pounds in the last 6 months alone.


R.H. and C.B. are two patients who present with different symptoms and medical histories. By analyzing their case studies, we can explore the potential underlying causes of their symptoms and formulate appropriate medical management plans. R.H., a 74-year-old black woman, complains of bloating, constipation, and heartburn. Meanwhile, C.B., a significantly overweight 48-year-old woman from the Winnebago Indian tribe, reports weakness and numbness in her left foot along with increased thirst and urination. This paper will examine the possible diagnoses for these patients and discuss the rationale behind the treatment options for their respective conditions.

Case 1: R.H.

R.H. has been experiencing bloating, constipation, and infrequent and hard bowel movements for the past month. She also reports acid reflux and uses over-the-counter aluminum hydroxide tablets to alleviate the symptoms. Furthermore, she mentions using naproxen for arthritic pain and a decrease in exercise due to worsening arthritis. R.H.’s age, ethnicity, and symptoms point to potential medical conditions that need consideration.

One possible diagnosis for R.H.’s constipation is diet-related. R.H.’s age is a considerable factor as aging is associated with reduced colon motility and increased risk of constipation. Additionally, her change in exercise habits may contribute to the constipation. Decreased physical activity can lead to slower gastrointestinal transit, thereby causing infrequent bowel movements and hard stools. Furthermore, certain medications, such as naproxen, can cause constipation as a side effect. This potential medication-related cause should also be considered in R.H.’s case.

Another possible diagnosis for R.H.’s symptoms is gastroesophageal reflux disease (GERD). Her frequent heartburn, especially occurring predominantly at night, suggests GERD as a potential cause for her symptoms. The use of aluminum hydroxide tablets further supports this hypothesis. Aluminum hydroxide is an antacid that neutralizes the acid in the stomach, providing relief for heartburn symptoms.

Case 2: C.B.

C.B. presents with left foot weakness and numbness, increased thirst, and frequent nocturnal urination. She attributes her symptoms to warm weather and increased water consumption. However, her medical history, recent weight gain, and abnormal fasting blood sugar and cholesterol levels from three years ago indicate a potential underlying condition.

Given C.B.’s significant weight gain and abnormal blood sugar levels from three years ago, one possible diagnosis is type 2 diabetes mellitus. The weakness and numbness in C.B.’s left foot may be signs of peripheral neuropathy, a common complication of diabetes. Increased thirst and nocturnal urination, known as polydipsia and polyuria, respectively, can also be symptoms of uncontrolled diabetes. The weight gain and high cholesterol levels further highlight the importance of monitoring C.B.’s cardiovascular health, as diabetes and dyslipidemia are often interrelated conditions.


In conclusion, the case studies of R.H. and C.B. demonstrate different sets of symptoms and medical histories. For R.H., potential diagnoses for her symptoms include diet-related constipation and gastroesophageal reflux disease (GERD). On the other hand, C.B.’s symptoms and medical history suggest a possible diagnosis of type 2 diabetes mellitus. Further investigation and diagnostic tests can help confirm these diagnoses and guide appropriate management plans for both patients.