So sharon patience 777020 past medical history elective right total knee replacement on late november or early december actually I can tell you can't I on the 11/26/2025 she had her right total knee replacement subsequent to the operation she was experiencing nausea and dizziness she had acute tenderness in the back of her knee and calf she had an ultrasound of the veins in her leg on the 12/24/2025 which showed demonstrating no ultrasound features of occlusive thrombus within the right fempop segment to below knee popliteal vein bifurcation iliac thrombosis was felt unlikely now presents with a swollen right calf and chest pain other past medical history previous dvt february 2025 tia 2024 small vessel disease august 2024 grade 2 hypertensive retinopathy 20 23 ischemic heart disease 2022 hypertension obesity rheumatoid arthritis appendectomy 1975 eczema gallstones 2002 with cholecystectomy 2003 total abdominal hysterectomy 2004 deep vein thrombosis 2004 myocardial perfusion scan 2005 no evidence of inducible ischemia or previous mi she's got diverticulitis she's got osteoarthritis family history of coronary heart disease got gastroenteral vascular ectasia she got gastritis and esophagitis back back in 2014 current medications lisinopril 10 mg once a day aspirin 75 mg once a day bisoprolol 2.5 mg once in the evening and bisoprolol 5 mg in the morning monomil xl 60 mg tablets once in the morning gtn spray 1 or 2 doses under the tongue as required atorvastatin 80 mg at night lansoprazole 30 mg 1 or 2 to be taken in the morning lacanidine 20 mg once per day she had a swollen and hot leg on christmas eve december 24 and had a course of antibiotics for that so other investigations so ct pulmonary angiogram good opacification of the pulmonary arteries no filling defect it's negative for pe chest x-ray clear lungs no pleural effusion full blood count hemoglobin 109 from 115 and preoperatively was a 132 back on the november 3 but then subsequently dropped at its lowest on the december 2 to 89 platelets 453 with low red cell counts 3.94 microcytosis mcv 81.1 and rdw 15.8 troponin of 7 creatinine of 93 sodium a 139 potassium 5.1 alp a 154 but remainder of lft is normal crp 31 which is decreasing from its peak in the perioperative. Of 247 on the 11/28/2025 urea 8.5 note that she had another chest x-ray on the 01/05/2026 peribronchial thickening hazy increased opacification in the perihilar regions bilaterally upper left diversion of blood and subtle curly b lines in the left hemithorax images suggest to have heart failure d dimer 1.5 on the january 5 of note she attended the emergency department on the january 4 2 days ago with palpitations for 1 week chest discomfort known atrial fibrillation getting short of breath diagnosed with deep vein thrombosis plan from the orthopedic team for 28 days of rivaroxaban following knee replacement hello what's your name karen patience that's what I was looking for I'm rob I'm 1 of the medical registrars this is for me how are you yeah good I like to say brilliant I like to eat why not brilliant this here is really painful in your upper tummy just to the bottom of your breastbone I've got a hiatus hernia that I really think is that pain can you easily be so painful mhmm and I see you were in hospital recently having your knee replaced and how'd that go yeah I don't know why it's swollen but they've been I've done a clot in it yeah but then you had a scan which didn't show you how to clot did that scan I'm not hoping anybody on my scan no today I thought oh I haven't seen the 1 today blood to show it on on him my blood to show that there's it's a clot mhmm yeah the possibility of a clot so but yeah so very good test for the clot is it yeah so I'm not aware of that so you so you came in yesterday that's not right so you had in november or sorry in december you had this mhmm you had this knee done you were in hospital for to sick november november yeah and you were in hospital until early december yeah and then you came out yeah and then since then you were treated for an infection in the leg yeah is that right and then you were you had a scan looking for a dvt at that time well yeah and then you came back in yesterday saturday first and then we were having mhmm the sex drive in went home and become quite more at home mostly temperature and fever is low I was 48.4 I just this year I could've I shot the pain was just an extremely low pain in your way yeah you told me yeah but yeah so I just feel cold but yeah so I thought I'd been enough mhmm when I came back in I was not great this was yes the day before yesterday should say saturday saturday yeah I was on days now saturday and then I went home sunday morning and then I came back but yeah it was this morning I would say yeah yeah yeah no problem and this time it it's tummy discomfort that's the problem for you it was not so much the leg is that right yeah the legs painful because of the leg they're the sides of the leg and it's it's just a I've been explaining it's just a sharp sharp like someone's snapped around the calf I mean I've got brain torch only too but it says she's really average so just got a I've got a penis on the car and I'm done so that ain't what I can't this is what I thought I just yeah my partner both and I I just because I cell problem with it and it's still doing it it's like the pain is horrendous and there's a concern about the potential there was a concern about the potential for a clot on your lungs giving you a high blood test the potential to be a lung clot tested that so you had a scan which is normal I'm not sure you haven't got a clot on your chest is that monday's date the ct scan you had yeah yeah did you have a left scan today no no and how about what was your last year let's see if we noticed somebody's put a cane have you had any history of any sort of I can't see my words yeah oh I've just been yay very tender isn't it this feels like I was asking the explaining besides 1 of these it feels like a plate where I think we can't stretch and in terms of your tummy can I touch your tummy is that alright I've got a hernia on congrats back with your life sorry I wonder if he needs to just scan of your tummy to see what the cause of his tummy pain is might be a sensible thing to do what to think about that what is that 1 I'll do that for you I'll speak to my colleagues in the orthopaedic team about this painful leg to see whether there's anything that they want to add giving you out of fever possibly any wound infection is there I guess although the wound itself looks lovely yeah it's really nice it's really nice and you have got yes potential for infection at bottom of the scar I that was nice and nice it's a bit thing so it looks like it's just wide and hasn't been not broke out mhmm and in terms of this pain with your scabs you're not gonna the cause of that okay alright how old are those tests for you are are they on some painkillers in the meantime mhmm it's quite mhmm I went to check with them wanted to do a I have little bit and I wanted swallow it so I was eating it just like oh really sorry about that didn't want me to swallow it it was a struggling to go past mhmm and you want some blood thinners now is that right I'm going to a right spot yeah alright that's good okay I'll get it done I'll get those things sorted for you sounds awful no it's alright don't apologize it's not a problem do you live in a house flat house with anyone else my father my daughter just licks all night I don't either that's that's that do you drink or smoke no not with me no clean them in that's good allergic to anything yeah I can't have penicillin to stop my heart okay but I've just missed my headache yeah what gives you a headache what's the other thing what's what's other thing and I tried to get all my blood this time don't know what it is but it as soon as it's there it's come back up yeah yeah okay I'll get you something else it's just 44 you got a little drip in or anything yeah yeah great okay I apologize +1 27125 is fine okay you're feeling better sneezing on examination heart sounds soft pan systolic nonradiating murmur scattered bibasilar crevitations note 2 l oxygen requirement right leg very tender to touch wound on the anterior aspect of the right knee looking healthy with no evidence of dehiscence however profoundly tender to touch throughout the leg and feeling warm however no erythema left leg similarly warm abdominal examination profoundly tender in the left iliac fossa and in the epigastrium impression probable esophagitis however possibility of ischemia related to hiatus hernia or alternative abdominal pathology to be excluded with cross sectional imaging leg pain unclear if to be expected at this stage postoperatively and in the context of fever and borderline inflammatory markers orthopedic review so plan orthopedic team number 2 ct abdomen and pelvis + or - surgical discussion number 3 analgesia number 4 if orthopedic team do not feel joint infection as a possibility then for repeat dopplers to exclude the dvt given thrombosis history immobility not using a doac recent operation or puts patient at high risk with a die high d dimer number next blood swab given fever