Hey folks, just a quick reminder that this episode is not meant to be used for medical advice, just good old-fashioned education.

All patient information has been modified to protect their identity and the views expressed in our podcast do not necessarily reflect the opinion of our employers.

Hi, team. Welcome back. I am so excited to see you all. How are you doing? How are the fish in California?

They're wet. Jack and I went fishing over the weekend. It was a blast. I tried not to think about all the freshwater associated diseases while we're out there, but Jack kept me pretty grounded, which was good.

Yeah, it's always good to have a non-ID friend on your fishing trip to, you know, keep things light,

all that stuff. Yeah, it was a good time. I was, it was, it was so fun that even though the fact that I fell on the river and we caught no fish, both of those things happened, and still came back with a huge smile on my face. I was talking to my, to my parents about it that night. And they were like, oh, how was fishing? I was like, you know, we didn't catch anything. I fell on the river, but it was one of the best

Saturdays I've had in a long time. And they were like, wow, that's really surprising and I'm

really happy for you. Thank you. Dan, don't sell yourself short. You almost caught a fish.

Almost, almost. And it almost was really big. So good stuff, good stuff. Okay. Well, I've got a great case today,

excited to share it with you all. I feel like oftentimes as a hospitalist, I see a patient at one

point in their medical journey, but I wanted to start out a little bit

before the patient got to the hospital. So this is a case of a 32-year-old female. No significant

past medical history did have a chalisectomy in the past, who presented to urgent care with a

two-day history of bilateral, left greater than

right, calf swelling with pain, and some mild shortness of breath. She had also noted some weight

loss and irritability over the past month, but wasn't really sure how much weight she had lost.

Didn't notice any fevers, frequent heart palpitations, P&D, orthopnia,

daytime somulents, cold intolerance, hair loss, constipation, dry skin, or other symptoms.

The only current medications were ibuprofen, which she just took occasionally over the counter,

and then oral contraceptive. She denied alcohol use, tobacco use, or any other substance use.

The vital sign showed a blood pressure of 145 over 84, a pulse of 133 was afebrile with a normal temperature,

respiratory rate was 18, and the oxygen saturation was 99% on ambient air. On exam,

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