Paper Writing Services was ts year gh school graduate, married and no cldren. He drinks one 4-ounce glass of red wine daily. He is a

Support with 1 journal no older than 5 years. “ I have chronic constipation, incomplete defecation and abdominal bloating” for past 2 years. M.C. a 46-year-old spanic female presents to the GI-Motility clinic for complaint of chronic constipation, incomplete defecation and abdominal bloating. She has pmhx of DM-type 2, IBS-Constipation, Tubular Adenoma. She also indicates that she has noticed that her symptoms are worsening for past 3 months. She has associated her symptoms with abdominal bloating, straining and incomplete defecation. She has tried Miralax one packet po daily for at least 8 weeks and it has not relieved her symptoms. Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, clls, pain or any other symptoms. Diabetes Mellitus, type 2 Constipation, chronic-IBS Penicillin She receives an annual flu shot. Last flu shot was ts year gh school graduate, married and no cldren. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago. Both parents are alive. Father has story of DM type 2, Tinea Pedis. mother alive and has story of atopic dermatitis, tinea corporis and tinea pedis. Constitutional: Negative for fever. Negative for clls. Respiratory: No Shortness of breath. No Orthopnea Cardiovascular: + 1 pitting leg edema. + Varicose veins. Skin: + rash crusted wte in feet and inter-digit in feet. Psycatric: No anxiety. No depression. Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored : Normocephalic/Atraumatic, PERRL, EOMI; No teeth loss seen. Gums no redness. : Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. : Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress. : Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. No edema. : No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. : No CVA tenderness bilaterally. GU exam deferred. : Slow gait but steady. No Kyphosis. : Normal affect. Cooperative. :: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal No new labs are needed. : may refer based on effect of medication therapy given for 2 weeks. : return to office in 8 weeks to reevaluate her symptoms.