47. Belly Dancer

L. is 42, divorced without children. She presented with abdominal pain. There was no associated gastrointestinal symptoms, no urologic issues, but her current menses, tho light, had been ongoing for 3 weeks. At our first visit, the exam and her membership in a belly-dancing troupe suggested a "soft-tissue" injury, that is, a problem associated with trauma to muscles, tendons or ligaments.

Over the next three weeks, we proceeded through a number of blood and radiology testing, the final an abdominal CT scan; all normal. At our last visit, I decided to start over with a history and exam.

When asked about stress factors, she describe multiple sources:
1. Work difficulties: called to task for being slow when from her perspective, she is just doing her job ("courtesy bagger" at Safeway). She worries that she is being set up to be fired so that she can be replaced by a lower wage (less senior) new employee.
2. Estrangement from family; her father died last year and her sisters didn't even tell her about it.
3. Financial difficulties.
She finally acknowedged that her current pain may be associated with one day when she had push a large number of grocery carts from the parking lot to the front of the store, a sudden stop jamming the cart handles against her abdomen. She has not returned, and has not answered by follow-up calls.