CHIEF COMPLAINT: Increased [**First Name3 (LF) 15414**] output from midline incissional wound/VAC.

PRESENT ILLNESS: 50M with history of anal squamous ca treated w/ chemoradiation
and subsequent anal stricture requiring sigmoid colectomy, end
colostomy, non-healing mucous fistula. Pt underwent resiting of
his ostomy and closure of a parastomal/midline incisional hernia
in 5/[**2128**]. Shortly after pt was readmitted ([**2128-6-24**]) for fevers
and was found to have a perforated ostomy with midline wound
dehis and tracking fistula to ostomy. Pt underwent subsequent
abdominal washout and was discharged ([**7-10**]) on a methadone
taper. Mr. [**Known lastname 73917**] was readmitted on [**7-16**] for reduced ostomy output
and was treated with q48hr wound vac changes followed by
discharge in stable condition to rehabilitation. 24 hours later
Mr. [**Known lastname 73917**] returned to the general surgery service for closer
monitoring of the abdominal wound and evalutation of management
options. Of note, since initial colostomy placement, pt has had
chronic abdominal pain treated with many medications. This pain
has been exceedingly difficult to manage throughout numerous
hospitalizations and postoperative courses requiring very large
doses of narcotics on several occasions. At time of admission,
pt is on methadone taper (currently 30mg TID.

MEDICAL HISTORY: Anal SCC
Anal Atricture
Large Abdominal Hernia
Chronic
Abdominal Pain
Coronary Artery Disease
Peripheral [**Known lastname **] Disease
Obstructive Sleep Apnea
Hypertension
Hypercholesterolemia
Vitamin D Deficiency

MEDICATION ON ADMISSION: 1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2

ALLERGIES: Cymbalta / Morphine / Nortriptyline

PHYSICAL EXAM: T- 98.2  HR 85 BP 133/68  RR 18  Sat% 98% RA
Gen-AxOx3, NAD, pt ambulating >TID and tolerating regular diet
CV-RRR, No MRG
Pulm- CTABL
Abd- Soft, mildy distended, non-tender, midline incision C/D/I
with staples in place. Ostomy pink, functioning with
soft/semisoft [**Country 15414**] content.
Ext- no C/C/E

FAMILY HISTORY: Non-Contributory

SOCIAL HISTORY: Originally from [**Country 3400**] and lives with wife, no children quit
tobacco 2 months ago, previously 1 ppd x 2 years. No EtOH in 14
years
Persistent postoperative fistula,Other colostomy and enterostomy complication,Pulmonary collapse,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus,Other iatrogenic hypotension,Other acute postoperative pain,Obstructive sleep apnea (adult)(pediatric),Peripheral vascular disease, unspecified,Unspecified essential hypertension,Unspecified vitamin D deficiency,Anemia, unspecified
Persist postop fistula,Colstmy/enteros comp NEC,Pulmonary collapse,Abn react-external stoma,Hx-rectal & anal malign,Iatrogenc hypotnsion NEC,Acute postop pain NEC,Obstructive sleep apnea,Periph vascular dis NOS,Hypertension NOS,Vitamin D deficiency NOS,Anemia NOS
Admission Date:  [**2128-7-22**]              Discharge Date:   [**2128-8-9**]

Date of Birth:  [**2078-2-19**]             Sex:   M

Service: SURGERY

Allergies:
Cymbalta / Morphine / Nortriptyline

Attending:[**First Name3 (LF) 3376**]
Chief Complaint:
Increased [**First Name3 (LF) 15414**] output from midline incissional wound/VAC.

Major Surgical or Invasive Procedure:
Revision colostomy/colectomy and abdominal wound closure.

History of Present Illness:
50M with history of anal squamous ca treated w/ chemoradiation
and subsequent anal stricture requiring sigmoid colectomy, end
colostomy, non-healing mucous fistula. Pt underwent resiting of
his ostomy and closure of a parastomal/midline incisional hernia
in 5/[**2128**]. Shortly after pt was readmitted ([**2128-6-24**]) for fevers
and was found to have a perforated ostomy with midline wound
dehis and tracking fistula to ostomy. Pt underwent subsequent
abdominal washout and was discharged ([**7-10**]) on a methadone
taper. Mr. [**Known lastname 73917**] was readmitted on [**7-16**] for reduced ostomy output
and was treated with q48hr wound vac changes followed by
discharge in stable condition to rehabilitation. 24 hours later
Mr. [**Known lastname 73917**] returned to the general surgery service for closer
monitoring of the abdominal wound and evalutation of management
options. Of note, since initial colostomy placement, pt has had
chronic abdominal pain treated with many medications. This pain
has been exceedingly difficult to manage throughout numerous
hospitalizations and postoperative courses requiring very large
doses of narcotics on several occasions. At time of admission,
pt is on methadone taper (currently 30mg TID.

Past Medical History:
Anal SCC
Anal Atricture
Large Abdominal Hernia
Chronic
Abdominal Pain
Coronary Artery Disease
Peripheral [**Known lastname **] Disease
Obstructive Sleep Apnea
Hypertension
Hypercholesterolemia
Vitamin D Deficiency


Social History:
Originally from [**Country 3400**] and lives with wife, no children quit
tobacco 2 months ago, previously 1 ppd x 2 years. No EtOH in 14
years


Family History:
Non-Contributory

Physical Exam:
T- 98.2  HR 85 BP 133/68  RR 18  Sat% 98% RA
Gen-AxOx3, NAD, pt ambulating >TID and tolerating regular diet
CV-RRR, No MRG
Pulm- CTABL
Abd- Soft, mildy distended, non-tender, midline incision C/D/I
with staples in place. Ostomy pink, functioning with
soft/semisoft [**Country 15414**] content.
Ext- no C/C/E

Pertinent Results:
[**2128-8-6**] 05:45AM BLOOD WBC-10.1 RBC-3.35* Hgb-8.6* Hct-26.1*
MCV-78* MCH-25.7* MCHC-33.0 RDW-16.5* Plt Ct-463*
[**2128-8-5**] 06:14PM BLOOD Hct-28.2*#
[**2128-8-4**] 03:54AM BLOOD WBC-15.4* RBC-2.89* Hgb-7.3* Hct-23.1*
MCV-80* MCH-25.3* MCHC-31.6 RDW-17.1* Plt Ct-485*
[**2128-8-3**] 05:50PM BLOOD WBC-16.7* RBC-3.50* Hgb-8.6* Hct-27.9*
MCV-80* MCH-24.5* MCHC-30.7* RDW-16.5* Plt Ct-577*
[**2128-8-3**] 07:03AM BLOOD WBC-14.8* RBC-3.90* Hgb-9.6* Hct-30.8*
MCV-79* MCH-24.6* MCHC-31.1 RDW-16.8* Plt Ct-593*
[**2128-8-5**] 02:24AM BLOOD Neuts-76.6* Lymphs-17.6* Monos-5.3
Eos-0.4 Baso-0.1
[**2128-8-6**] 05:45AM BLOOD Plt Ct-463*
[**2128-8-6**] 05:45AM BLOOD PT-14.8* PTT-23.6 INR(PT)-1.3*
[**2128-8-5**] 02:24AM BLOOD Plt Ct-472*
[**2128-8-5**] 02:24AM BLOOD PT-14.7* PTT-23.4 INR(PT)-1.3*
[**2128-8-4**] 03:54AM BLOOD Plt Ct-485*
[**2128-8-4**] 03:54AM BLOOD PT-16.1* PTT-28.2 INR(PT)-1.4*
[**2128-8-3**] 05:50PM BLOOD Plt Ct-577*
[**2128-8-6**] 05:45AM BLOOD Glucose-100 UreaN-8 Creat-0.6 Na-138
K-3.6 Cl-101 HCO3-28 AnGap-13
[**2128-8-5**] 09:11AM BLOOD Na-140 K-3.6 Cl-100
[**2128-8-5**] 02:24AM BLOOD Glucose-90 UreaN-9 Creat-0.8 Na-138 K-3.8
Cl-102 HCO3-28 AnGap-12
[**2128-8-4**] 03:54AM BLOOD Glucose-100 UreaN-9 Creat-0.7 Na-137
K-4.2 Cl-103 HCO3-26 AnGap-12
[**2128-8-3**] 05:50PM BLOOD Glucose-125* UreaN-9 Creat-0.8 Na-140
K-4.7 Cl-102 HCO3-29 AnGap-14
[**2128-8-3**] 07:03AM BLOOD Glucose-198* UreaN-8 Creat-0.8 Na-137
K-4.9 Cl-101 HCO3-25 AnGap-16
[**2128-8-1**] 09:10AM BLOOD Glucose-112* UreaN-8 Creat-0.7 Na-137
K-4.4 Cl-98 HCO3-27 AnGap-16
[**2128-7-23**] 08:45PM BLOOD Glucose-131* UreaN-8 Creat-0.8 Na-137
K-4.5 Cl-98 HCO3-30 AnGap-14
[**2128-8-6**] 05:45AM BLOOD Calcium-8.5 Phos-4.8* Mg-1.7
[**2128-8-5**] 09:11AM BLOOD Mg-1.7
[**2128-8-5**] 02:24AM BLOOD Calcium-8.6 Phos-3.9 Mg-1.8
[**2128-8-4**] 03:54AM BLOOD Calcium-8.2* Phos-3.3 Mg-1.9
[**2128-8-3**] 05:50PM BLOOD Calcium-8.9 Phos-3.9 Mg-2.2
[**2128-8-3**] 07:03AM BLOOD Calcium-8.8 Phos-5.2* Mg-2.3
[**2128-8-2**] 09:20PM BLOOD Calcium-8.6 Phos-5.2* Mg-1.8
[**2128-8-1**] 09:10AM BLOOD Calcium-9.1 Phos-5.8*# Mg-2.1

Brief Hospital Course:
The patient was readmitted ([**7-22**]) to the inpatient unit from a
rehabilitation hospital as it was felt that there was a greater
amount of [**Month/Day (4) 15414**] in the patient's abdominal wound and was
therefore no longer appropriate for the facility. On admission
the patient was noted to have a wet to dry saline dressing
placed in the midline abdominal wound which was accumulateing a
moderate amount brown liquid [**Month/Day (4) 15414**]. A new VAC dressing was
placed with a white sponge dressing to the base of the wound
with a black sponge dressing to suction. It was decided that the
patient wound remain in house for close monitoring. On hospital
day four ([**7-25**]) the patient accumulated liquid [**Month/Day (4) 15414**] in the VAC
dressing. The VAC was subsequently changed on a roughly Q2day
cycle ([**7-22**], [**7-24**], [**7-26**], [**7-27**], [**7-30**], [**8-1**]). 30-60 minutes prior to
each VAC change the patient was medicated with 1-1.5mg ativan
and morning methadone done given high degree of anxiety and pain
the patient felt with wound examination. Gabapentin therapy was
also increased to 600mg three times daily to help with pts
anxiety/pain.

On hospital day 11 ([**8-1**]) the VAC dressing became compromised by
more solid/pasty [**Month/Year (2) 15414**] and required changing twice in the same
day.

On [**8-2**], patient was taken to the OR for an ostomy revision and
fistual take down. Post-operatively he was transferred to the
[**Hospital Unit Name 153**] for pain management. Chronic pain service was consulted
preoperatively to help establish a plan for the patient's
post-operative pain control. Post-op, Mr. [**Known lastname 73918**] pain was
managed on scheduled methadone (25mg IV Q3h), bupivicane
epidural, and ketamine drip but was changed (POD#1) to:
methadone PCA (1 mg bolus q10min, 1 mg basal rate), bupivicane
epidural, Gabapentin 600 mg tid, Ativan 0.5-1 mg q4h. Pt's pain
remained very well controlled for remainder of hospitalization.

Pt was weaned off the PCA and Epirdural and transitioned to oral
narcotic pain medication on [**2128-8-5**] and was transferred to the
floor on [**2128-8-6**]. Pt continued to do well on 900 mg gabapentin
TID, Ativan 1mg Q6h, methadone 20/25mg qam/qpm, with methadone
2.5mg Q4h PRN for breakthrough pain. He was tolerating a regular
diet and his ostomy was functioning well. Pt was able to get out
of bed to chair and ambulate for short periods.

[**2128-8-6**] - Pt was transfered to general surgery floor where he
continued to ambulate TID, was advanced to a regular diet, and
tolerate lower dose/frequency pain medications.

[**2128-8-7**] - Pt's ativan was decreased to 0.5 Q6h prn anxiety

The patient remained stable on the prescribed pain regimen and
had no acute issue the weekend prior to discharge. A physical
therapy consult was ordered and the patient was cleared for
home. After much reluctance from from the patient, and
collaboration between the surgical team, nursing, physical
therapy, case managment, and patient relatons, the patient was
discharged to home with visiting nursing for a home safety
evaluation.

Medications on Admission:
1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2

times a day).
4. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO TID (3
times a day).
5. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO every six (6) hours as needed for constipation.
6. Methadone 10 mg Tablet Sig: Two (2) Tablet PO TID (3 times a
day): Methadone to be tapered to 15mg TID on [**2128-7-25**] and to be
tapered by 5mg per dose every 3-4 days.
7. Clonidine 0.1 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly

Transdermal QSAT (every Saturday).
8. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

9. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day) as needed for BP.
10. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours) as needed for pain.
11. Ondansetron 4 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,

Rapid Dissolve PO Q8H (every 8 hours) as needed for nausea.
12. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO ONCE (Once) as
needed for dressing change for 1 doses.

Discharge Medications:
1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day) as needed for BP.
3. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for anxiety: Do not drink alcohol or drive a
car while taking this medication. DO not take if having
increased sedation. .
Disp:*30 Tablet(s)* Refills:*0*
4. Gabapentin 300 mg Capsule Sig: Three (3) Capsule PO TID (3
times a day).
Disp:*270 Capsule(s)* Refills:*0*
5. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Five (5) mL
PO twice a day as needed for constipation.
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
8. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO every [**4-27**]
hours as needed for pain: Do not exceed 4000mg per day.
9. Methadone 5 mg Tablet Sig: Four (4) Tablet PO once a day in
the morning: Do not consume alcohol or drive a car while taking
this medication. Decrease the dose by 2.5 mg every 3 days.
Disp:*44 Tablet(s)* Refills:*0*
10. Methadone 5 mg Tablet Sig: Five (5) Tablet PO QHS (once a
day (at bedtime)): Do not consume alcohol or drive a car while
taking this medication. Decrease your dose by 2.5 mg every 3
days until you follow-up with chronic pain. .
Disp:*65 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Perforated ostomy with dehiscence of midline abdominal wound and
fistula between ostomy and wound.


Discharge Condition:
Stable
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to the general surgery service from
rehabilitation center for increased [**Hospital 15414**] output from your
ostomy-wound fistula eventually requiring revision colostomy and
midline wound closure.

Please call your doctor or go to the emergency department if:
*You experience new chest pain, pressure, squeezing or
tightness.
*You develop new or worsening cough, shortness of breath, or
wheeze.
*You are vomiting and cannot keep down fluids or your
medications.
*You are getting dehydrated due to continued vomiting, diarrhea,
or other reasons.  Signs of dehydration include dry mouth, rapid
heartbeat, or feeling dizzy or faint when standing.
*You see blood or dark/black material when you vomit or have a
bowel movement.
*You experience burning when you urinate, have blood in your
urine, or experience an unusual discharge.
*Your pain is not improving within 12 hours or is not under
control within 24 hours.
*Your pain worsens or changes location.
*You have shaking chills, or fever greater than 101.5 degrees
Fahrenheit or 38 degrees Celsius.
*You develop any concerning symptoms.

General Discharge Instructions:
Please resume all regular home medications, unless specifically
advised not to take a particular medication.  Please take any
new medications as prescribed.
Please take the prescribed analgesic medications as needed.  You
may not drive or heavy machinery while taking narcotic analgesic
medications.  You may also take acetaminophen (Tylenol) as
directed, but do not exceed 4000 mg in one day.
Please get plenty of rest, continue to walk several times per
day, and drink adequate amounts of fluids.  Avoid strenuous
physical activity and refrain from heavy lifting greater than 10
lbs., until you follow-up with your surgeon, who will instruct
you further regarding activity restrictions.  Please also
follow-up with your primary care physician.

Incision Care:
*Please call your surgeon or go to the emergency department if
you have increased pain, swelling, redness, or drainage from the
incision site.
*Avoid swimming and baths until cleared by your surgeon.
*You may shower and wash incisions with a mild soap and warm
water.  Gently pat the area dry.
*Staples will be removed at your follow-up appointment.

Bulb Suction Drain Care:
*Please look at the drain site every day for signs of infection
(increased redness or pain, swelling, odor, yellow or bloody
discharge, warmth, and fever).
*Maintain the bulb on suction.
*Record the color, consistency, and amount of fluid in the
drain.  Call the surgeon, nurse practitioner, or VNA nurse if
the amount increases significantly or changes in character.
*Empty the drain frequently.
*You may shower and wash the drain site gently with warm, soapy
water.  You may also wash with half strength hydrogen peroxide
followed by saline rinse.
*Keep the insertion site clean and dry otherwise.  Place a drain
sponge for cleanliness.
*Avoid swimming, baths, and hot tubs.  Do not submerge yourself
in water.
*Attach the drain securely to your body to prevent pulling or
dislocation.

Monitoring Ostomy Output:
*Keep well hydrated.
*Replace fluid loss from ostomy daily.
*Avoid drinking only plain water.  Include gatorade and/or other
vitamin drinks to replace fluid.
*Try to maintain ostomy output between 500mL to 1500mL per day.
*If ostomy output exceeds 1 liter, take 4mg of Imodium, repeat
2mg with each episode of loose [**Hospital 15414**].  Do not exceed 16 mg in
one day. Call Dr. [**Last Name (STitle) 4488**] office with any issues.
Continue to care for your ostomy as instructed by the ostomy
nurses. You will see [**Doctor First Name **], Dr. [**Last Name (STitle) 4488**] [**Name (STitle) **] in the office for
staple/drain removal Monday of next week.

You will be sent home with prescriptions for our methadone. An
appointment has been made for you with the chronic pain clinic,
you will have enough medication to get you through to this time.
At your clinic appointment the will write you a new prescription
for methadone. You will be on a methadone taper as follows.

     Morning Dose      Evening Dose
7/19:  20 mg             25 mg
[**8-10**]:  20 mg             25 mg
[**8-11**]:  20 mg             25 mg
[**8-12**]:  17.5 mg           22.5 mg
[**8-13**]:  17.5 mg           22.5 mg
[**8-14**]:  17.5 mg           22.5 mg
[**8-15**]:  15 mg             20 mg
[**8-16**]:  15 mg             20 mg
[**8-17**]:  15 mg             20 mg
[**8-18**]:  12.5 mg           17.5 mg
[**8-19**]:  12.5 mg           17.5 mg
[**8-20**]:  12.5 mg           17.5 mg
[**8-21**]:  10 mg             15 mg
[**8-22**]:   10 mg             15 mg
[**8-23**]:   10 mg             15 mg
[**8-24**]:   7.5 mg            12.5 mg
[**8-25**]:   7.5 mg            12.5 mg

You will be given a prescription for the medication Ativan which
is helping you with pain and anxiety. Please take only when
needed.

Followup Instructions:
Please follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] office next monday
[**2128-8-9**] at 1330, call [**Telephone/Fax (1) 160**] with questions.

You have been scheduled an appointment with chronic pain
service:
Provider: [**Name10 (NameIs) 1089**] [**Name11 (NameIs) 1090**], MD Phone:[**Telephone/Fax (1) 1652**] Date/Time:[**2128-8-25**]
2:10

Primary Care Provider [**Name9 (PRE) **],[**Name9 (PRE) **] [**Name Initial (PRE) **]. [**Hospital3 **], Phone: [**Telephone/Fax (1) 8236**] call to make an appointment to be
seen.

** Primary Care provider would like [**Name Initial (PRE) **] call from the VNA when you
make your first home visit for an update**

You have been scheduled an appointment with pain psychology:
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Phone:[**Telephone/Fax (1) 1652**] Date/Time:[**2128-8-30**]
10:00



Completed by:[**2128-8-11**]
{'Persistent postoperative fistula,Other colostomy and enterostomy complication,Pulmonary collapse,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus,Other iatrogenic hypotension,Other acute postoperative pain,Obstructive sleep apnea (adult)(pediatric),Peripheral vascular disease, unspecified,Unspecified essential hypertension,Unspecified vitamin D deficiency,Anemia, unspecified'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: Increased [**First Name3 (LF) 15414**] output from midline incissional wound/VAC.

PRESENT ILLNESS: 50M with history of anal squamous ca treated w/ chemoradiation
and subsequent anal stricture requiring sigmoid colectomy, end
colostomy, non-healing mucous fistula. Pt underwent resiting of
his ostomy and closure of a parastomal/midline incisional hernia
in 5/[**2128**]. Shortly after pt was readmitted ([**2128-6-24**]) for fevers
and was found to have a perforated ostomy with midline wound
dehis and tracking fistula to ostomy. Pt underwent subsequent
abdominal washout and was discharged ([**7-10**]) on a methadone
taper. Mr. [**Known lastname 73917**] was readmitted on [**7-16**] for reduced ostomy output
and was treated with q48hr wound vac changes followed by
discharge in stable condition to rehabilitation. 24 hours later
Mr. [**Known lastname 73917**] returned to the general surgery service for closer
monitoring of the abdominal wound and evalutation of management
options. Of note, since initial colostomy placement, pt has had
chronic abdominal pain treated with many medications. This pain
has been exceedingly difficult to manage throughout numerous
hospitalizations and postoperative courses requiring very large
doses of narcotics on several occasions. At time of admission,
pt is on methadone taper (currently 30mg TID.

MEDICAL HISTORY: Anal SCC
Anal Atricture
Large Abdominal Hernia
Chronic
Abdominal Pain
Coronary Artery Disease
Peripheral [**Known lastname **] Disease
Obstructive Sleep Apnea
Hypertension
Hypercholesterolemia
Vitamin D Deficiency

MEDICATION ON ADMISSION: 1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2

ALLERGIES: Cymbalta / Morphine / Nortriptyline

PHYSICAL EXAM: T- 98.2  HR 85 BP 133/68  RR 18  Sat% 98% RA
Gen-AxOx3, NAD, pt ambulating >TID and tolerating regular diet
CV-RRR, No MRG
Pulm- CTABL
Abd- Soft, mildy distended, non-tender, midline incision C/D/I
with staples in place. Ostomy pink, functioning with
soft/semisoft [**Country 15414**] content.
Ext- no C/C/E

FAMILY HISTORY: Non-Contributory

SOCIAL HISTORY: Originally from [**Country 3400**] and lives with wife, no children quit
tobacco 2 months ago, previously 1 ppd x 2 years. No EtOH in 14
years 

### Response:
{'Persistent postoperative fistula,Other colostomy and enterostomy complication,Pulmonary collapse,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus,Other iatrogenic hypotension,Other acute postoperative pain,Obstructive sleep apnea (adult)(pediatric),Peripheral vascular disease, unspecified,Unspecified essential hypertension,Unspecified vitamin D deficiency,Anemia, unspecified'}
