CHIEF COMPLAINT: Stage III A nonsmall cell lung cancer.

PRESENT ILLNESS: Ms. [**Known lastname 22867**] is a 64-year-old female with a history of stage IIIA
non small cell lung cancer diagnosed in [**2116**] at which time she
underwent neoadjuvant chemotherapy with carboplatin and Taxol,
surgery and then subsequent chemo and radiation.  She was doing
well until [**2124-6-5**] when an irregular lesion was found in her
right lower lobe on CT scan.  Core needle biopsy revealed it to
be
bronchioalveolar type carcinoma.  On her scan at that time there
was also two other areas of ground-glass opacities in the left
upper lobe raising the possibility of multifocal disease. On
[**2124-6-14**], she underwent a reoperative
thoracotomy, pulmonary lysis of adhesions and right lower lobe
wedge resection.  Pathology revealed a 3.5 cm well
differentiated adenocarcinoma that was originally identified as
a pT2 N0 Mx lesion, but within the same wedge, a 1-cm satellite
nodule of adenocarcinoma peripheral to the dominant mass was
identified and therefore she was deemed T4.  She subsequently
received Gemzar
and Avastin for a total of eight cycles for presumptive adjuvant
therapy.  She reports that she did not complete all the Avastin
given some visual changes she was having given her previous
history of stroke.  After this time she underwent surveillance
CT scans and most recently had a PET scan in [**2126-7-7**] which
revealed a new nodular abnormality with increased activity in
the right lower lobe.  She is being admitted for a Right
completion pneumonectomy.

MEDICAL HISTORY: NSCLC stage IIIA s/p neoadjuvant chemo
Open Right upper Lobectomy '[**16**] s/p chemo/radiation
Right lower lobe wedge in [**2124**] for tumor recurrence
Hypertension
Cerebral vascular accident x 2 on coumadin
GERD
Gout/Arthritis

MEDICATION ON ADMISSION: Coumadin 4 daily, except thursday 2 mg,  folate 1 mg daily,
fosamax 70 qweekly, MVI, KCl 20meq [**Hospital1 **],  zocor 20 daily, ziac
10/6.25 daily, caltrate, senna, colace

ALLERGIES: Versed

PHYSICAL EXAM: VS: 99.5 97.3 HR(90's - 110's) 110/70 18 96RA FS 97-150
Gen: NAD, AAOx4
Card: irreg irreg, SEM
Lungs: no breath sounds on R; CTA on L
Abd: +BS, soft, nt/nd
wound: c/d/i
ext: no c/c/e

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Married Lives in [**State 531**].
60 pack-years, quit 16 years ago.
ETOH wine with dinner
Malignant neoplasm of lower lobe, bronchus or lung,Diseases of tricuspid valve,Unspecified disease of pericardium,Atrial fibrillation,Unspecified essential hypertension,Anemia, unspecified,Mitral valve disorders,Other chronic pulmonary heart diseases,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Esophageal reflux,Gout, unspecified,Personal history of irradiation, presenting hazards to health,Long-term (current) use of anticoagulants,Personal history of tobacco use
Mal neo lower lobe lung,Tricuspid valve disease,Pericardial disease NOS,Atrial fibrillation,Hypertension NOS,Anemia NOS,Mitral valve disorder,Chr pulmon heart dis NEC,Hx TIA/stroke w/o resid,Esophageal reflux,Gout NOS,Hx of irradiation,Long-term use anticoagul,History of tobacco use
Admission Date:  [**2126-9-18**]              Discharge Date:   [**2126-10-6**]

Date of Birth:  [**2061-11-13**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Versed

Attending:[**First Name3 (LF) 2969**]
Chief Complaint:
Stage III A nonsmall cell lung cancer.

Major Surgical or Invasive Procedure:
[**2126-9-18**] Completion Right pneumonectomy with serratus flap


History of Present Illness:
Ms. [**Known lastname 22867**] is a 64-year-old female with a history of stage IIIA
non small cell lung cancer diagnosed in [**2116**] at which time she
underwent neoadjuvant chemotherapy with carboplatin and Taxol,
surgery and then subsequent chemo and radiation.  She was doing
well until [**2124-6-5**] when an irregular lesion was found in her
right lower lobe on CT scan.  Core needle biopsy revealed it to
be
bronchioalveolar type carcinoma.  On her scan at that time there
was also two other areas of ground-glass opacities in the left
upper lobe raising the possibility of multifocal disease. On
[**2124-6-14**], she underwent a reoperative
thoracotomy, pulmonary lysis of adhesions and right lower lobe
wedge resection.  Pathology revealed a 3.5 cm well
differentiated adenocarcinoma that was originally identified as
a pT2 N0 Mx lesion, but within the same wedge, a 1-cm satellite
nodule of adenocarcinoma peripheral to the dominant mass was
identified and therefore she was deemed T4.  She subsequently
received Gemzar
and Avastin for a total of eight cycles for presumptive adjuvant
therapy.  She reports that she did not complete all the Avastin
given some visual changes she was having given her previous
history of stroke.  After this time she underwent surveillance
CT scans and most recently had a PET scan in [**2126-7-7**] which
revealed a new nodular abnormality with increased activity in
the right lower lobe.  She is being admitted for a Right
completion pneumonectomy.


Past Medical History:
NSCLC stage IIIA s/p neoadjuvant chemo
Open Right upper Lobectomy '[**16**] s/p chemo/radiation
Right lower lobe wedge in [**2124**] for tumor recurrence
Hypertension
Cerebral vascular accident x 2 on coumadin
GERD
Gout/Arthritis

Social History:
Married Lives in [**State 531**].
60 pack-years, quit 16 years ago.
ETOH wine with dinner

Family History:
non-contributory

Physical Exam:
VS: 99.5 97.3 HR(90's - 110's) 110/70 18 96RA FS 97-150
Gen: NAD, AAOx4
Card: irreg irreg, SEM
Lungs: no breath sounds on R; CTA on L
Abd: +BS, soft, nt/nd
wound: c/d/i
ext: no c/c/e

Pertinent Results:
[**2126-9-24**]: Echocardiogram: The left atrium is mildly dilated.
There is mild symmetric left ventricular hypertrophy. The left
ventricular cavity size is normal. There is mild regional left
ventricular systolic dysfunction with mid lateral and inferior
hypokinesis. Right ventricular chamber size and free wall motion
are normal. The aortic valve leaflets are mildly thickened.
There is no aortic valve stenosis. No aortic regurgitation is
seen. The mitral valve leaflets are mildly thickened. An
eccentric, laterally directed jet of moderate to severe (3+)
mitral regurgitation is seen. Severe [4+] tricuspid
regurgitation is seen. There is moderate pulmonary artery
systolic hypertension. There is a small pericardial effusion.

[**2126-10-1**] CHEST, PA AND LATERAL
Since yesterday, filling of the right pleural cavity with fluid
progressed.  Subcutaneous emphysema on the right slightly
decreased. Central catheter ends in mid SVC. Tiny atelectasis in
the left with tiny pleural effusions are unchanged. No other
change.

[**2126-9-24**] IMPRESSION:
1. Negative examination for pulmonary embolism.
2. Status post right pneumonectomy with multiple air-fluid
levels raising the concern for a fistula between the right
bronchial stump and the right
pneumonectomy space.
3. The hyperdense material in the right pneumonectomy space and
the right
extrathoracic collection are concerning for hemoraghe in the
right
pneumonectomy and extra thoracic hematoma.
4. Extensive subcutaneous emphysema underneath the right breast
tissue and
adjacent to the right lateral chest wall.
5. Small left pleural effusion.

[**2126-10-3**] WBC-8.3 RBC-3.69* Hgb-10.9* Hct-32.9* Plt Ct-761*
[**2126-9-17**] WBC-5.3 RBC-4.20# Hgb-12.6# Hct-38.4# Plt Ct-275
[**2126-10-4**] PT-24.4* INR(PT)-2.4*
[**2126-10-2**] Glucose-93 UreaN-10 Creat-0.4 Na-137 K-4.4 Cl-101
HCO3-30 AnGap-10
[**2126-9-17**] Glucose-98 UreaN-16 Creat-0.6 Na-139 K-4.0 Cl-100
HCO3-30 AnGap-13
[**2126-9-23**] TSH-9.3*
[**2126-10-4**] Digoxin-0.6*

Brief Hospital Course:
Mrs. [**Last Name (STitle) 22868**] was admitted on [**2126-9-18**] for Completion Right
pneumonectomy with serratus flap. She was extubated in the
operating room and transferred to the SICU
for further management.   Her pain was well controlled with a
Dilaudid/Bupivicane epidural managed by the acute pain service.
The chest-tube remained clamped and the foley was to gravity.
She remained hemodynamically stable, oxygen saturations were
100% on 3 Liters via nasal cannula and her electrolytes were
repleted. She was started on IV lopressor for tachycardia.  On
POD #1 she was transfused with 1 unit PRBC for a Hct of 24. The
chest-tube was removed. Her diet was advanced as tolerated, she
transferred to the floor.  On POD #2 she was followed by serial
chest x-rays which remained stable.  On POD #3 she developed
atrial fibrillation with a RVR of 130-140's. The beta-blocker
was increased, amiodarone drip was started and her electrolytes
were repleted, and her cardiac enzymes were negative. Her TSH
was mildly elevated in the immediate postoperative state.  She
was transfused with 1 unit of PRBC for a Hct of 23 to a Hct of
25.  The epidural was removed and she was converted to PO pain
medications. On POD #4 she remained in rapid atrial
fibrillation.  Cardiology was consulted who recommended stopping
amiodarone, increasing beta-blockers and starting diltiazem.  On
POD #5 she remained in atrial fibrillation, DOE and still
requiring 02 at 4L via nasal cannula for a saturation of 96%. An
echocardiogram revealed mild LVH. mild regional LV systolic
dysfunction, lateral and inferior hypokinesis. No AS or AR.
Moderate to severe (3+) MR, Severe [4+] TR. moderate PA systolic
HTN and  a small pericardial effusion.  She was ruled out for
Pulmonary Embolism by CT.  Her coumadin was restarted. On POD #6
her heart rate was better controlled with PO/IV diltiazem, and
lopressor.  On POD #[**8-13**] her IV diltiazem was titrated down.  Her
atrial fibrillation remained 80-100's.  On POD #9 she was weaned
from the diltiazem drip.  Her blood pressure remained stable.
The foley was removed and she voided without difficulty. On POD
#10 her heart rate increased and she was started on digoxin with
better rate control. Her coumadin was held for an elevated INR.
On POD #12 cardiology recommended to continue the diltiazem 60
Q6h, lopressor 100 mg [**Hospital1 **], and digoxin 0.125 daily.  She was
seen by Physical Therapy.  On POD #13 she developed episodes of
bradycardia with pauses in the 30's.  Her digoxin level was 0.6.
 Cardiology recommended decreasing the diltiazem and
beta-blockers.  She was started on ACE for afterload reduction.
She was transfused to a HCT of 30.  On POD #14 her heart rate
increased her meds were adjusted to maintain a heart rate in the
100's. She was continued on her coumadin with goal INR of
2.0-3.0. On POD#15-18, her coumadin was adjusted daily to
maintain INR at goal - she received 1mg daily. Her atrial
fibrillation with RVR continued with HR at times spiking above
140's. She continued to be asymptomatic. Cardiology continued to
follow and give recommendations.
At discharge, the patient's heart medications are as follows:
Metoprolol 62.5mg PO TID
Diltiazem 45mg PO TID
Captopril 12.5mg PO TID
Digoxin 0.125mg PO Qdaily

She will take 1mg of coumadin on [**10-6**], the date of discharge,
and 1mg on [**10-7**]. She will be followed by cardiology for coumadin
maintenance and appropriate lab studies.

Cardiology is planning to contact her on [**10-8**] for further
instructions, regarding her coumadin levels and INR testing, as
well as when to follow up for cardioversion. She and her husband
will be staying in the Holiday Inn on [**Location (un) **], and so will be
close to [**Hospital1 18**] for follow up.

She will follow up with Dr. [**Last Name (STitle) **] in his clinic in a week.

On [**10-6**], the patient and her husband, the nursing staff, and the
thoracic surgery team felt that it was appropriate to discharge
her with close follow-up. She is being discharge stable, in good
condition.

Medications on Admission:
Coumadin 4 daily, except thursday 2 mg,  folate 1 mg daily,
fosamax 70 qweekly, MVI, KCl 20meq [**Hospital1 **],  zocor 20 daily, ziac
10/6.25 daily, caltrate, senna, colace

Discharge Medications:
1. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*70 Tablet(s)* Refills:*0*
5. 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*
6. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
7. Warfarin 1 mg Tablet Sig: One (1) Tablet PO at bedtime: take
1 tablet on [**10-6**] and 1 tablet on [**10-7**]; will call with further
instructions on [**10-8**]; goal INR 2.0 - 3.0.
Disp:*30 Tablet(s)* Refills:*2*
8. Levalbuterol Tartrate 45 mcg/Actuation HFA Aerosol Inhaler
Sig: One (1)  Inhalation q6h PRN as needed for shortness of
breath or wheezing.
Disp:*1 MDI* Refills:*1*
9. Klor-Con 20 mEq Packet Sig: Two (2)  PO once a day.
10. Fosamax 70 mg Tablet Sig: One (1) Tablet PO once a week.
11. caltrate
take as before
12. centrum silver
take as before
13. fiber
take as before
14. Senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day.
15. Captopril 12.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
Disp:*90 Tablet(s)* Refills:*2*
16. Diltiazem HCl 30 mg Tablet Sig: 1.5 Tablets PO TID (3 times
a day).
Disp:*135 Tablet(s)* Refills:*2*
17. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
18. Metoprolol Tartrate 25 mg Tablet Sig: 2.5 Tablets PO TID (3
times a day).
Disp:*225 Tablet(s)* Refills:*2*
19. Ativan 0.5 mg Tablet Sig: 0.5 tablet Tablet PO qhs prn as
needed for insomnia for 10 days.
Disp:*10 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
NSCLC stage IIIA s/p neoadjuvant chemo
Open Right upper Lobectomy '[**16**] s/p chemo/radiation
Right lower lobe wedge in [**2124**] for tumor recurrence
Hypertension
CVA
GERD
Gout


Discharge Condition:
Stable


Discharge Instructions:
Call Dr.[**Doctor Last Name 4738**] office [**Telephone/Fax (1) 4741**] if you experience: Fever >
101 or chills, Increased cough or shortness of breath, chest
pain, if your incision develops drainage, if you cough up blood,
experience plapitations or have any lightheadedness, nausea of
vomiting.
You may shower.
No swimming or tub bathing for 6 weeks
No driving while taking narcotics.  Continue stool softners with
narcotics.
Cardiology will contact you on Tuesday about your coumadin labs
and dosing, as well as your cardioversion which will take place
2 weeks after this discharge.
If you do not receive a call from cardiology by Tuesday
afternoon, please call the hospital and page cardiology or
[**First Name8 (NamePattern2) 3692**] [**Last Name (NamePattern1) **], the cardiology PA. If you are not able to contact
cardiology, please call the cardiothoracic at [**Telephone/Fax (1) 4741**].

Followup Instructions:
Please call the office of Dr. [**Last Name (STitle) **], [**Telephone/Fax (1) 4741**], to schedule
a follow up appointment for a week after your discharge. This
will be at the [**Hospital Ward Name 517**] [**Hospital Ward Name 121**] building, [**Location (un) 453**] [**Hospital1 **],
Chest Disease Center.
Please report to the [**Hospital Ward Name 517**] Clinical Center [**Location (un) **]
Radiology Department 30 minutes before your appointment for a
Chest X-Ray
Follow-up with your cardiologist - you will be contact[**Name (NI) **] with
these instructions, as above.
Follow-up with your PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] [**Numeric Identifier 22869**]



Completed by:[**2126-10-6**]
{'Malignant neoplasm of lower lobe, bronchus or lung,Diseases of tricuspid valve,Unspecified disease of pericardium,Atrial fibrillation,Unspecified essential hypertension,Anemia, unspecified,Mitral valve disorders,Other chronic pulmonary heart diseases,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Esophageal reflux,Gout, unspecified,Personal history of irradiation, presenting hazards to health,Long-term (current) use of anticoagulants,Personal history of tobacco use'}


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: Stage III A nonsmall cell lung cancer.

PRESENT ILLNESS: Ms. [**Known lastname 22867**] is a 64-year-old female with a history of stage IIIA
non small cell lung cancer diagnosed in [**2116**] at which time she
underwent neoadjuvant chemotherapy with carboplatin and Taxol,
surgery and then subsequent chemo and radiation.  She was doing
well until [**2124-6-5**] when an irregular lesion was found in her
right lower lobe on CT scan.  Core needle biopsy revealed it to
be
bronchioalveolar type carcinoma.  On her scan at that time there
was also two other areas of ground-glass opacities in the left
upper lobe raising the possibility of multifocal disease. On
[**2124-6-14**], she underwent a reoperative
thoracotomy, pulmonary lysis of adhesions and right lower lobe
wedge resection.  Pathology revealed a 3.5 cm well
differentiated adenocarcinoma that was originally identified as
a pT2 N0 Mx lesion, but within the same wedge, a 1-cm satellite
nodule of adenocarcinoma peripheral to the dominant mass was
identified and therefore she was deemed T4.  She subsequently
received Gemzar
and Avastin for a total of eight cycles for presumptive adjuvant
therapy.  She reports that she did not complete all the Avastin
given some visual changes she was having given her previous
history of stroke.  After this time she underwent surveillance
CT scans and most recently had a PET scan in [**2126-7-7**] which
revealed a new nodular abnormality with increased activity in
the right lower lobe.  She is being admitted for a Right
completion pneumonectomy.

MEDICAL HISTORY: NSCLC stage IIIA s/p neoadjuvant chemo
Open Right upper Lobectomy '[**16**] s/p chemo/radiation
Right lower lobe wedge in [**2124**] for tumor recurrence
Hypertension
Cerebral vascular accident x 2 on coumadin
GERD
Gout/Arthritis

MEDICATION ON ADMISSION: Coumadin 4 daily, except thursday 2 mg,  folate 1 mg daily,
fosamax 70 qweekly, MVI, KCl 20meq [**Hospital1 **],  zocor 20 daily, ziac
10/6.25 daily, caltrate, senna, colace

ALLERGIES: Versed

PHYSICAL EXAM: VS: 99.5 97.3 HR(90's - 110's) 110/70 18 96RA FS 97-150
Gen: NAD, AAOx4
Card: irreg irreg, SEM
Lungs: no breath sounds on R; CTA on L
Abd: +BS, soft, nt/nd
wound: c/d/i
ext: no c/c/e

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Married Lives in [**State 531**].
60 pack-years, quit 16 years ago.
ETOH wine with dinner 

### Response:
{'Malignant neoplasm of lower lobe, bronchus or lung,Diseases of tricuspid valve,Unspecified disease of pericardium,Atrial fibrillation,Unspecified essential hypertension,Anemia, unspecified,Mitral valve disorders,Other chronic pulmonary heart diseases,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Esophageal reflux,Gout, unspecified,Personal history of irradiation, presenting hazards to health,Long-term (current) use of anticoagulants,Personal history of tobacco use'}
