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{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M51_F4.jpg"}},{"insert":"\n\n"},{"insert":"Joan describes a 2-year history of recurrent loose stools, intermittent abdominal pain, and bloating. The stools were malodorous, bulky, and difficult to flush down. There was no blood or mucus in the stool. Nor was there pain on defecation or tenesmus. She denies experiencing fever, nausea, vomiting, or easy satiety. Her bowel habits were completely normal before this.\n\n\u0022Recently, I\u0027ve started to become tired very easily. I just don\u0027t seem to have enough energy to get through the day,\u0022 she says and continues, \u0022oh and I\u0027ve lost weight, like a good amount. I\u0027ve had to adjust the seams on most of my outfits about 3 times since this started.\u0022\n\nJoan does not recall any of her relatives having similar complaints. A quick perusal of her medical records shows that she has seen two other doctors regarding her complaints. The last physician diagnosed her with irritable bowel syndrome.\n\nOn cue, she speaks up. \u0022The last time I saw a doctor, I was told that I had irritable bowel syndrome. I\u0027m not comfortable with this diagnosis though, and I thought that I should have a second opinion.\u0022\n"}]}