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Clinical case

Patient 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).

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