CHIEF COMPLAINT: Patient admitted for weight reduction surgery.

PRESENT ILLNESS: [**Known firstname **] has class III morbid obesity with weight of 290.1 lbs as
of [**2132-10-15**] (her initial screen weight on [**2132-10-6**] was 286.9
lbs),
height of 64.5 inches and BMI of 49. Her previous weight loss
efforts have included 2 months of the [**Doctor Last Name 1729**] diet in [**2127**] and
[**2129**] losing 20 lbs, 4 months of prescription weight loss
medication Phentermine in [**2122**]-[**2123**] losing 47 lbs that she
regained after stopping medication in one year and 3 months of
Pondimin (Fenfluramine) in [**2112**] losing 20 lbs.

MEDICAL HISTORY: dyslipidemia, urinary stressincontinence, migraine headaches,
GERD, gallbladder disease and b/l knee and low back pain

MEDICATION ON ADMISSION: Midol PRN cramps; Tylenol ES, Aleve and Advil for knee and back
pain PRN; daily MV with minerals and Vitamin D 1000 U QD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Her blood pressure was 134/90, pulse 98 and O2 saturation 98%
room air. On physical examination [**Known firstname **] was casually dressed,
slightly anxious but in no distress. Skin was warm, moist, no
rashes. Sclerae were anicteric, conjunctiva clear, pupils were
equal round and reactive to light, fundi were normal, mucous
membranes were moist, tongue pink and the oropharynx was without
exudates or hyperemia. Trachea was in the midline and the neck
was supple without adenopathy, thyromegaly or carotid bruits.
Chest was symmetric and the lungs were clear to auscultation
bilaterally with good air movement. Cardiac exam was regular
rate
and rhythm, normal S1 and S2, no murmurs, rubs or gallops. The
abdomen was obese but soft and non-tender, non-distended with
normal bowel sounds, no masses, healed trocar scars, no hernias.
There was no spinal tenderness or flank pain. Lower extremities
were without edema, venous insufficiency or clubbing. There was
no joint swelling or joint inflammation. There were no focal
neurological deficits.

FAMILY HISTORY: Her family history is
noted for both parents living father age 74 with obesity; mother
in her 70s with cancer; aunt living in her 70s with diabetes and
grandmother deceased with diabetes.

SOCIAL HISTORY: She denied tobacco and recreational drug usage, has one bottle
of wine cooler twice a month and drinks 5-7 cups of coffee a
day.  She works as a manager for
[**Company 33655**] insurance company. She is married living with her
husband age 43 and they have 3 children ages 12, 17 and 20 years
old.
Morbid obesity,Iatrogenic pulmonary embolism and infarction,Cardiac complications, not elsewhere classified,Tachycardia, unspecified,Diaphragmatic hernia without mention of obstruction or gangrene,Other and unspecified hyperlipidemia,Esophageal reflux,Lumbago,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Pain in joint, lower leg,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Morbid obesity,Iatrogen pulm emb/infarc,Surg compl-heart,Tachycardia NOS,Diaphragmatic hernia,Hyperlipidemia NEC/NOS,Esophageal reflux,Lumbago,Migrne unsp wo ntrc mgrn,Joint pain-l/leg,Abn react-anastom/graft
Admission Date:  [**2133-3-3**]              Discharge Date:   [**2133-3-12**]

Date of Birth:  [**2089-4-15**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 301**]
Chief Complaint:
Patient admitted for weight reduction surgery.

Major Surgical or Invasive Procedure:
Status Post Laparoscopic Gastric Bypass

History of Present Illness:
[**Known firstname **] has class III morbid obesity with weight of 290.1 lbs as
of [**2132-10-15**] (her initial screen weight on [**2132-10-6**] was 286.9
lbs),
height of 64.5 inches and BMI of 49. Her previous weight loss
efforts have included 2 months of the [**Doctor Last Name 1729**] diet in [**2127**] and
[**2129**] losing 20 lbs, 4 months of prescription weight loss
medication Phentermine in [**2122**]-[**2123**] losing 47 lbs that she
regained after stopping medication in one year and 3 months of
Pondimin (Fenfluramine) in [**2112**] losing 20 lbs.

Past Medical History:
dyslipidemia, urinary stressincontinence, migraine headaches,
GERD, gallbladder disease and b/l knee and low back pain

Social History:
She denied tobacco and recreational drug usage, has one bottle
of wine cooler twice a month and drinks 5-7 cups of coffee a
day.  She works as a manager for
[**Company 33655**] insurance company. She is married living with her
husband age 43 and they have 3 children ages 12, 17 and 20 years
old.


Family History:
Her family history is
noted for both parents living father age 74 with obesity; mother
in her 70s with cancer; aunt living in her 70s with diabetes and
grandmother deceased with diabetes.

Physical Exam:
Her blood pressure was 134/90, pulse 98 and O2 saturation 98%
room air. On physical examination [**Known firstname **] was casually dressed,
slightly anxious but in no distress. Skin was warm, moist, no
rashes. Sclerae were anicteric, conjunctiva clear, pupils were
equal round and reactive to light, fundi were normal, mucous
membranes were moist, tongue pink and the oropharynx was without
exudates or hyperemia. Trachea was in the midline and the neck
was supple without adenopathy, thyromegaly or carotid bruits.
Chest was symmetric and the lungs were clear to auscultation
bilaterally with good air movement. Cardiac exam was regular
rate
and rhythm, normal S1 and S2, no murmurs, rubs or gallops. The
abdomen was obese but soft and non-tender, non-distended with
normal bowel sounds, no masses, healed trocar scars, no hernias.
There was no spinal tenderness or flank pain. Lower extremities
were without edema, venous insufficiency or clubbing. There was
no joint swelling or joint inflammation. There were no focal
neurological deficits.


Pertinent Results:
[**2133-3-5**] 10:21PM BLOOD PTT-38.4*
[**2133-3-6**] 04:10AM BLOOD WBC-13.8*# RBC-3.83* Hgb-11.8* Hct-32.8*
MCV-86 MCH-30.7 MCHC-35.8* RDW-13.9 Plt Ct-224
[**2133-3-6**] 04:10AM BLOOD Glucose-108* UreaN-7 Creat-0.6 Na-136
K-3.5 Cl-101 HCO3-25 AnGap-14
[**2133-3-5**] 01:42AM BLOOD Type-ART pO2-45* pCO2-34* pH-7.47*
calTCO2-25 Base XS-1 Intubat-NOT INTUBA Comment-COLLECTION
[**2133-3-5**] 01:42AM BLOOD freeCa-1.10*

[**2133-3-5**] CTA of Chest
Massive PE, including a saddle embolus, occluding right main
pulmonary artery
and multiple lobar, segmental and subsegmental right sided
emboli. Evidence
of right ventricular strain; right main pulmonary artery is
progressively
dilated on delayed scan.

[**2133-3-6**] Lower extremity Ultrasound
Compressible but echogenic left greater saphenous and common
femoral veins
with possible slight decrease of variability in the common
femoral veins
(compared with the right) is compatible with a more proximal
partially-occlusive thrombus.


Brief Hospital Course:
Patient admitted and underwent a laparoscopic gastric bypass on
[**2133-3-3**]. Postoperatively patient developed tachycardia and
intermittent drops in oxygen saturation. On postoperative day
one she underwent an upper gi study that confirmed no leak or
obstruction. A chest x-ray showed lung volumes relatively low,
a heart that is moderately enlarged, but no signs of
overhydration was seen and
Moderate retrocardiac atelectasis, but no evidence of pneumonia,
no pneumothorax. Patient was then given CT scan of chest. This
confirmed a Massive PE, including a saddle embolus, occluding
right main pulmonary artery and multiple lobar, segmental and
subsegmental right sided emboli. Patient was immediately started
on a heparin gtt and transfered to the intensive care unit for
close monitoring.

On postoperative day 3 patient had an ultrasound of her lower
extremities to rule out clot. This exam showed Compressible but
echogenic left greater saphenous and common femoral veins with
possible slight decrease of variability in the common femoral
veins (compared with the right) is compatible with a more
proximal
partially-occlusive thrombus.

Vascular service consulted. Recommends that INR be maintained
between 2.5 - 3. Coumadin to be continued for 6 months.

On Postoperative day 7 her heparin gtt was discontinued as her
INR was 3.5.

On postoperative day 9 her INR was 3.6.

We will discharge her home on coumadin 2.5mg daily with follow
up management by her primary care provider. [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] at
[**Telephone/Fax (1) 60008**]. I have spoken with Dr. [**Last Name (STitle) **] regarding [**Hospital 228**]
hospital course and follow up needs. Dr. [**Last Name (STitle) **] has agreed to
see [**Known firstname **] on Friday [**3-13**] and manage her coumadin regimen.

[**Known firstname **] has been given information regarding coumadin and it's
side effects. She will follow up with Dr. [**Last Name (STitle) **] in 2 weeks.


Medications on Admission:
Midol PRN cramps; Tylenol ES, Aleve and Advil for knee and back
pain PRN; daily MV with minerals and Vitamin D 1000 U QD

Discharge Medications:
1. Docusate Sodium 50 mg/5 mL Liquid Sig: Ten (10) ml PO BID (2
times a day).
Disp:*500 ml* Refills:*0*
2. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q4H (every 4 hours) as needed for pain.
Disp:*500 ml* Refills:*0*
3. Zantac 15 mg/mL Syrup Sig: Ten (10) ml PO twice a day.
Disp:*600 ml* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis: Obesity


Discharge Condition:
Stable


Discharge Instructions:
Discharge Instructions: Please call your surgeon or return to
the emergency department if you develop a fever greater than
101.5, chest pain, shortness of breath, severe abdominal pain,
pain unrelieved by your pain medication, severe nausea or
vomiting, severe abdominal bloating, inability to eat or drink,
foul smelling or colorful drainage from your incisions, redness
or swelling around your incisions, or any other symptoms which
are concerning to you.

Diet: Stay on Stage III diet until your follow up appointment.
Do not self advance
diet, do not drink out of a straw or chew gum.

Medication Instructions:
Resume your home medications, CRUSH ALL PILLS.
You will be starting some new medications:
1.  You are being discharged on medications to treat the pain
from your operation. These medications will make you drowsy and
impair your ability to drive a motor vehicle or operate
machinery safely. You MUST refrain from such activities while
taking these medications.
2. You should begin taking a chewable complete multivitamin with
minerals. No gummy vitamins.
3. You will be taking Zantac liquid 150 mg twice daily for one
month. This medicine prevents gastric reflux.
4. You should take a stool softener, Colace, twice daily for
constipation as needed, or until you resume a normal bowel
pattern.
5. You must not use NSAIDS (non-steroidal anti-inflammatory
drugs) Examples are Ibuprofen, Motrin, Aleve, Nuprin and
Naproxen. These agents will cause bleeding and ulcers in your
digestive system.

Activity:
No heavy lifting of items [**9-17**] pounds for 6 weeks. You may
resume moderate
exercise at your discretion, no abdominal exercises.

Wound Care:
You may shower, no tub baths or swimming.
If there is clear drainage from your incisions, cover with
clean, dry gauze.
Your steri-strips will fall off on their own. Please remove any
remaining strips 7-10 days after surgery.
Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.


Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 18800**], RD Phone:[**Telephone/Fax (1) 305**]
Date/Time:[**2133-3-18**] 3:30
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 304**], MD Phone:[**Telephone/Fax (1) 305**]
Date/Time:[**2133-3-18**] 4:00
Provider: [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 18800**], RD Phone:[**Telephone/Fax (1) 305**]
Date/Time:[**2133-4-24**] 9:00



Completed by:[**2133-3-12**]
{'Morbid obesity,Iatrogenic pulmonary embolism and infarction,Cardiac complications, not elsewhere classified,Tachycardia, unspecified,Diaphragmatic hernia without mention of obstruction or gangrene,Other and unspecified hyperlipidemia,Esophageal reflux,Lumbago,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Pain in joint, lower leg,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: Patient admitted for weight reduction surgery.

PRESENT ILLNESS: [**Known firstname **] has class III morbid obesity with weight of 290.1 lbs as
of [**2132-10-15**] (her initial screen weight on [**2132-10-6**] was 286.9
lbs),
height of 64.5 inches and BMI of 49. Her previous weight loss
efforts have included 2 months of the [**Doctor Last Name 1729**] diet in [**2127**] and
[**2129**] losing 20 lbs, 4 months of prescription weight loss
medication Phentermine in [**2122**]-[**2123**] losing 47 lbs that she
regained after stopping medication in one year and 3 months of
Pondimin (Fenfluramine) in [**2112**] losing 20 lbs.

MEDICAL HISTORY: dyslipidemia, urinary stressincontinence, migraine headaches,
GERD, gallbladder disease and b/l knee and low back pain

MEDICATION ON ADMISSION: Midol PRN cramps; Tylenol ES, Aleve and Advil for knee and back
pain PRN; daily MV with minerals and Vitamin D 1000 U QD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Her blood pressure was 134/90, pulse 98 and O2 saturation 98%
room air. On physical examination [**Known firstname **] was casually dressed,
slightly anxious but in no distress. Skin was warm, moist, no
rashes. Sclerae were anicteric, conjunctiva clear, pupils were
equal round and reactive to light, fundi were normal, mucous
membranes were moist, tongue pink and the oropharynx was without
exudates or hyperemia. Trachea was in the midline and the neck
was supple without adenopathy, thyromegaly or carotid bruits.
Chest was symmetric and the lungs were clear to auscultation
bilaterally with good air movement. Cardiac exam was regular
rate
and rhythm, normal S1 and S2, no murmurs, rubs or gallops. The
abdomen was obese but soft and non-tender, non-distended with
normal bowel sounds, no masses, healed trocar scars, no hernias.
There was no spinal tenderness or flank pain. Lower extremities
were without edema, venous insufficiency or clubbing. There was
no joint swelling or joint inflammation. There were no focal
neurological deficits.

FAMILY HISTORY: Her family history is
noted for both parents living father age 74 with obesity; mother
in her 70s with cancer; aunt living in her 70s with diabetes and
grandmother deceased with diabetes.

SOCIAL HISTORY: She denied tobacco and recreational drug usage, has one bottle
of wine cooler twice a month and drinks 5-7 cups of coffee a
day.  She works as a manager for
[**Company 33655**] insurance company. She is married living with her
husband age 43 and they have 3 children ages 12, 17 and 20 years
old. 

### Response:
{'Morbid obesity,Iatrogenic pulmonary embolism and infarction,Cardiac complications, not elsewhere classified,Tachycardia, unspecified,Diaphragmatic hernia without mention of obstruction or gangrene,Other and unspecified hyperlipidemia,Esophageal reflux,Lumbago,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Pain in joint, lower leg,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
