CHIEF COMPLAINT: weight loss & unable to take POs.

PRESENT ILLNESS: 73 y.o. Female w/ stage IIIc papillary serous ovarian cancer s/p

MEDICAL HISTORY: PMH: HTN, depression, basal cell carcinoma, recurrent ovarian
cancer with peritoneal carcinomatosis, h/o TIA, cataracts
PSH: L CEA [**7-/2097**] ([**Doctor Last Name 1476**]); Ex lap, TAH-BSO, lymphadenectomy,
omentectomy, proctosigmoidectomy [**3-6**] ([**Doctor Last Name 2028**]); exploration of
wound dehisence w/ debridement and closure of fascia [**3-6**];
laparoscopic incisional hernia repair w/ mesh [**5-7**] ([**Doctor Last Name **]);
Ex lap, LOA, excision of infected mesh, appendectomy, drainage
of abscess, ileostomy/mucous fistula creation, closure with
vicryl mesh [**6-7**] ([**Doctor Last Name **]); delayed primary closure abdominal
wound [**6-7**] ([**Doctor Last Name **]

MEDICATION ON ADMISSION: 1. Bupropion HCl 100 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO QAM (once a day (in the morning)).
2. Citalopram 40 mg Tablet Sig: One (1) Tablet PO once a day.
3. 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*
4. Multivitamin,Tx-Minerals     Tablet Sig: One (1) Tablet PO
DAILY (Daily).
5. Omega-3 Fatty Acids Capsule Sig: One (1) Capsule PO BID
(2 times a day).
6. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
7. Avapro 75mg PO QOD

ALLERGIES: Shellfish / Carboplatin

PHYSICAL EXAM: VS:  99.4  144/78  71  18  100% ra.
GEN: AOx3, NAD, pleasant.
HEENT:  PERRLA. MMM. no LAD. JVP at 5cm.  neck supple.
Cards: RRR S1/S2 normal. no murmurs/gallops/rubs.
Pulm: No dullness to percussion, CTAB no crackles or wheezes
Abd: high pitched bowel sounds.  soft, tender to deep palpation,
ostomy in place, no rebound/guarding. neg HSM. neg [**Doctor Last Name 515**]
sign.
Extremities: wwp, no edema. DPs, PTs 2+ bilat.
Skin: no rashes or bruising
Neuro/Psych: CNs II-XII grossly intact, MAE.

FAMILY HISTORY: FAMILY HISTORY:  She denies any family history of cancer.

SOCIAL HISTORY: 30 pack-year h/o smoking, quit 9 years ago; social ETOH use;
Lives alone in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], 2 children, both live out of state but
very involved
Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Peritoneal abscess,Secondary malignant neoplasm of retroperitoneum and peritoneum,Other complications due to other vascular device, implant, and graft,Acute venous embolism and thrombosis of axillary veins,Other postoperative infection,Incisional hernia without mention of obstruction or gangrene,Peritoneal adhesions (postoperative) (postinfection),Loss of weight,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Personal history of malignant neoplasm of ovary,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of other malignant neoplasm of skin,Ileostomy status,Accidental cut, puncture, perforation or hemorrhage during surgical operation
Intestinal adhes w obstr,Peritoneal abscess,Sec mal neo peritoneum,Comp-oth vasc dev/graft,Ac emblsm axillary veins,Other postop infection,Incisional hernia,Peritoneal adhesions,Abnormal loss of weight,Hypertension NOS,Depressive disorder NEC,Hx of ovarian malignancy,Hx TIA/stroke w/o resid,Hx-skin malignancy NEC,Ileostomy status,Acc cut/hem in surgery
Admission Date:  [**2107-6-16**]              Discharge Date:   [**2107-7-20**]

Date of Birth:  [**2034-2-15**]             Sex:   F

Service: SURGERY

Allergies:
Shellfish / Carboplatin

Attending:[**First Name3 (LF) 1556**]
Chief Complaint:
  weight loss & unable to take POs.

Major Surgical or Invasive Procedure:
1. Exploratory laparotomy.
2. Lysis of adhesions.
3. Biopsy of peritoneal implant.
4. Suture repair of enterotomy (small intestine).
5. Repair of incisional hernia with mesh.
6. Small bowel bypass with (anastomosis x1)
7. PICC line right upper arm [**2107-6-21**]
8. PICC line left upper arm [**2107-6-30**]
7. CT guided drainage of pelvic fluid collection [**2107-7-7**]
8. CT guided drainage of second pelvic fluid collection [**2107-7-13**]


History of Present Illness:
73 y.o. Female w/ stage IIIc papillary serous ovarian cancer s/p

Paclitaxel, 6 cycles of Carboplatin/Gemcitabine, on cycle 6 of
Doxorubicin, h.o. SBO w/ necrotic ileum s/p ileostomy, multiple
abdominal surgery who is being admitted directly from clinic due
to concern about her rapid weight loss and inability to eat.
She had a recent 9 day admission to the hospital starting on
[**2107-5-28**].  Her CT scan at that time showed SBO with a transition
point within the left pelvis, extensive adhesions and decrease
in mesentery deposits compatible with treatment response.  She
was treated conservatively with bowel rest.  She was seen
received her 6th cycle of doxil on [**2107-6-9**].  She has continued
to have emesis despite restriction to a full liquid diet.  She
had a rapid 20 lb weight loss since her previous discharge and
has only been able to tolerate water for the past few days.
.
She reports that she feels nauseated after eating any food or
fluid and generally vomits a half an hour or so after eating.
She denies having any abdominal pain.  She reports passing gas
through her ostomy and having some output.  She has lost
approximately 15-20 lbs in the past 2 weeks.  She was able to
tolerate solids only for 2-3 days after her previous discharge.
She felt lightheaded earlier to day but that improved with IVF
in the clinic.
.
Review of Systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies chest pain or tightness, palpitations. Denies
cough, shortness of breath, or wheezes.  No recent change in
bladder habits. No dysuria. Denies arthralgias or myalgias.
Denies rashes.


Past Medical History:
PMH: HTN, depression, basal cell carcinoma, recurrent ovarian
cancer with peritoneal carcinomatosis, h/o TIA, cataracts
PSH: L CEA [**7-/2097**] ([**Doctor Last Name 1476**]); Ex lap, TAH-BSO, lymphadenectomy,
omentectomy, proctosigmoidectomy [**3-6**] ([**Doctor Last Name 2028**]); exploration of
wound dehisence w/ debridement and closure of fascia [**3-6**];
laparoscopic incisional hernia repair w/ mesh [**5-7**] ([**Doctor Last Name **]);
Ex lap, LOA, excision of infected mesh, appendectomy, drainage
of abscess, ileostomy/mucous fistula creation, closure with
vicryl mesh [**6-7**] ([**Doctor Last Name **]); delayed primary closure abdominal
wound [**6-7**] ([**Doctor Last Name **]

Social History:
30 pack-year h/o smoking, quit 9 years ago; social ETOH use;
Lives alone in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], 2 children, both live out of state but
very involved

Family History:
FAMILY HISTORY:  She denies any family history of cancer.


Physical Exam:
VS:  99.4  144/78  71  18  100% ra.
GEN: AOx3, NAD, pleasant.
HEENT:  PERRLA. MMM. no LAD. JVP at 5cm.  neck supple.
Cards: RRR S1/S2 normal. no murmurs/gallops/rubs.
Pulm: No dullness to percussion, CTAB no crackles or wheezes
Abd: high pitched bowel sounds.  soft, tender to deep palpation,
ostomy in place, no rebound/guarding. neg HSM. neg [**Doctor Last Name 515**]
sign.
Extremities: wwp, no edema. DPs, PTs 2+ bilat.
Skin: no rashes or bruising
Neuro/Psych: CNs II-XII grossly intact, MAE.


Pertinent Results:
[**2107-6-16**] 11:05AM   WBC-4.9 RBC-3.88* HGB-12.0 HCT-35.7* MCV-92
MCH-30.9 MCHC-33.7 RDW-14.3
[**2107-6-16**] 11:05AM   PLT COUNT-162
[**2107-6-16**] 11:05AM   ALBUMIN-3.9 MAGNESIUM-1.7
[**2107-6-16**] 11:05AM   ALT(SGPT)-20 AST(SGOT)-28 ALK PHOS-79 TOT
BILI-0.5
[**2107-6-16**] 11:05AM   UREA N-14 CREAT-1.0 SODIUM-136 POTASSIUM-4.3
CHLORIDE-100
[**2107-6-16**] CT Abd/ Pelvis : 1. Dilated small bowel proximally with
a probable transition point in the pelvis and relatively
decompressed distal small bowel and colon, compatible with small
bowel obstruction. No evidence of perforation.
  2. New areas of hypodensity in the left hepatic lobe may
represent focal fat deposition, although metastatic disease
cannot be fully excluded. MRI of the liver is recommended for
further evaluation. Otherwise, stable exam.

[**2107-7-5**] Abd CT : 1. Dilated loops of small bowel with air-fluid
levels and distal decompressed loops of small bowel with
transition region noted within the midline pelvis in region of
newly created small bowel anastomosis. This is concerning for
small-bowel obstruction but appears similar to prior exams and
should be correlated with clinical picture.
2. Large thin-rim-enhancing fluid collection within the midline
central
pelvis extending into the lower abdomen near new anastomotic
site. Underlying abscess is not excluded. The more inferior
pelvic component does appear amendable to image-guided
percutaneous drainage as indicated.
3. Interval increase in right pleural effusion with new left
pleural
effusion. Compressive atelectasis of the lower lobes. Small
amount of new
intra-abdominal ascites.
4. Status post repair of ventral hernia. Unchanged ileostomy and
parastomal hernia.

[**2107-7-12**] Abd CT : 1. Overall decrease in size of multiple
loculations of right lower quadrant abdominal fluid collection.
Marked decrease in size in the lowest collection which contains
the drain. An anteriorly located collection is not contiguous
with these loculations and is slightly increased in size.
2. Persistent bilateral pleural effusions, moderate on the
right, small on
the left.
3. Cholelithiasis without evidence of cholecystitis.
4. Small hiatal hernia.
5. Unchanged bilateral adrenal adenomas, as defined by MRI from
[**2104-3-30**].


[**2107-7-19**] Abd CT :  1. Interval decrease in thin rim-enhancing
fluid collection within the midline central pelvis extending
into the lower abdomen near the enteroenteric anastomotic site.
Interval removal of drain within the fluid collection
immediately adjacent to the anastomotic site and superior to the
bladder. Interval placement of new drain within the superior
pelvic component with decrease in size of fluid collection
compared to [**2107-7-12**].
2. Anteriorly located fluid collection does not appear
contiguous with these loculations and is stable in size and
appearance compared to [**2107-7-12**].
3. Dilated loops of proximal small bowel with distal
decompressed loops of
small bowel with transition point noted within the midline
pelvis within the region of the small bowel anastomosis. Oral
contrast is noted within the ileostomy. Findings are concerning
for partial small bowel obstruction, however, appears similar to
prior examinations and may represent chronic dilated small
bowel. Recommend clinical correlation.
4. Interval decrease in right-sided pleural effusion with
resolution of left pleural effusion. Adjacent compressive
atelectasis within the right lung base.
5. Unchanged ileostomy and parastomal hernia.
6. Unchanged bilateral adrenal nodules, previously characterized
as adenomas




Brief Hospital Course:
Ms. [**Known lastname **] is a 73 year ole female with stage IIIc papillary
serous ovarian cancer s/p Paclitaxel, 6 cycles of
Carboplatin/Gemcitabine, on cycle 6 of Doxorubicin; h/o SBO with
necrotic ileum s/p ileostomy, multiple abdominal surgeries who
was admitted for rapid weight loss and inability to eat in the
setting of chronic SBO seen on CT scan one month prior to
admission when the plan was conservative management with slow
advancement of diet.

She was admitted to the hospital on [**2107-6-16**], put on IV fluids
and made NPO.  She was then slowly advanced in diet but did not
tolerate it well and on [**2107-6-21**] was remade as NPO, had a PICC
line placed and was started on TPN for improvement of
nutritional status prior to surgery.

She was taken to the operating room on [**2107-6-27**].  An enterotomy
was performed in the distal ileum with a small intestine bypass
to relieve the obstruction.  Also, an incisional hernia was
repaired with a veritas bioprosthetic mesh.   The operation
proceeded without complication and she was transferred to the
floor after a short stay in the PACU.

She was continued NPO and with TPN post-surgery and observed for
return of bowel function.  On POD 4, bowel sounds became more
prominent and she observed gas in the ostomy bag.  She was
advanced to a clear liquid diet on POD 5 which she tolerated
well and to a full liquid diet on POD 6 and to a regular diet on
POD 7.  She tolerated all advances well.

On POD 4, her right arm was noted to be edematous and there was
increased resistance in flushing the PICC.  Right upper
extremity duplex was consistent with thrombotic occlusion of
right brachial vein and right axillary vein.  The PICC was
removed and replaced to the left arm.  A heparin drip was
started with serial PTTs.  Coumadin bridging was started on POD
6 (INR 1.3) and reached therapeutic levels (INR 2.1) on POD 8.
The heparin drip was then stopped.

While Ms. [**Known lastname 103423**] overall status appeared to be improving, she
complained of new lower abdominal pain on POD 8.  CT scan showed
a pelvic fluid collection and on POD 9, a pigtail catheter was
placed by IR to drain the fluid yielded 210 cc of brownish,
cream-colored serosanguinous fluid.  She was started on
cipro/flagyl therapy, was briefly switched to zosyn for
monotherapy, then switched back to ciprofloxacin after fluid
cultures grew e. coli sensitive to ciprofloxacin.  She was kept
NPO after the procedure and another advance of diet attempt was
started on POD 12 with sips to clears then full liquids by POD
15.

On POD 15 a repeat CT scan showed another fluid collection and a
small collection near the midline mesh.  A second pigtail
catheter was placed, draining 15 cc of fluid and 25 cc of fluid
was aspirated from the midline mesh area.

Following the procedure, she was advanced again to regular diet
which she tolerated well.  PO intake continued to increase
through POD 18, when TPN was cycled with 1/2 the usual volume
over 12 hours and it was discontinued on [**2107-7-16**].  She was
placed on calorie counts, given protein supplements and
continued on a regular diet which she tolerated well in small
amounts.

She had a repeat CT scan on [**2107-7-19**] to assess the fluid
collections which had markedly decreased.  There was scant
drainage from the tubes and they were removed on [**2107-7-16**] and
[**2107-7-20**] respectively without difficulty.  She will continue on
her course of Ciprofloxicin until [**2107-7-25**].

Mrs.[**Known lastname 103424**] INR has been in the range of 2.3-2.8 on 2 mg
daily. ( 2.8 on [**2107-7-20**] )
Her PICC line was removed on [**2107-7-20**] and she continues to try to
take small frequent meals with Carnation Instant Breakfast in
between.  Her ostomy is active and she is comfortable in doing
her ostomy care.

She was discharged to rehab on [**2107-7-20**] with the hopes of
increasing her strength and mobility so that she can return
home. She will follow up with Dr. [**Last Name (STitle) **] in 2 weeks and
Dr.[**Last Name (STitle) **], her Oncologist, after discharge from
rehab.


Medications on Admission:
1. Bupropion HCl 100 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO QAM (once a day (in the morning)).
2. Citalopram 40 mg Tablet Sig: One (1) Tablet PO once a day.
3. 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*
4. Multivitamin,Tx-Minerals     Tablet Sig: One (1) Tablet PO
DAILY (Daily).
5. Omega-3 Fatty Acids Capsule Sig: One (1) Capsule PO BID
(2 times a day).
6. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
7. Avapro 75mg PO QOD

Discharge Medications:
1. Bupropion HCl 100 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO DAILY (Daily).
2. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

3. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
4. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Omega-3 Fatty Acids     Capsule Sig: One (1) Capsule PO BID
(2 times a day).
6. Vitamin D-3 400 unit Tablet Sig: One (1) Tablet PO once a
day.
7. Irbesartan 150 mg Tablet Sig: 0.5 Tablet PO QOD ().
8. Irbesartan 150 mg Tablet Sig: 0.5 Tablet PO EVERY OTHER DAY
(Every Other Day).
9. Pyridoxine 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

10. Warfarin 2 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM.
11. Dronabinol 2.5 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
12. Megestrol 400 mg/10 mL (40 mg/mL) Suspension Sig: Ten (10)
ml PO BID (2 times a day).
13. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain not controlled by acetaminophen.
14. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours).
15. Cipro 500 mg Tablet Sig: One (1) Tablet PO twice a day: thru
[**2107-7-25**].
16. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO TID (3
times a day): hold sbp < 100  HR < 60
.
17. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for anxiety, nausea.


Discharge Disposition:
Extended Care

Facility:
[**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **] - [**Location (un) 538**]

Discharge Diagnosis:
1. Small bowel obstruction.
2. Incisional hernia.
3. Stage IIIc papillary serous ovarian cancer
4. DVT right axillary vein
5. Recurrent pelvic fluid collections


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
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.


Please call your doctor or return to the emergency room if you
have any of the following:

 * You experience new chest pain, pressure, squeezing or
 tightness.

* New or worsening cough or wheezing.

* If you are vomiting and cannot keep in 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 have shaking chills, or a fever greater than 101.5 (F)
 degrees or 38(C) degrees.

* Any serious change in your symptoms, or any new symptoms that
 concern you.

* Please resume all regular home medications and take any new
meds
 as ordered.
Activity:
No heavy lifting of items [**10-14**] 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) **] [**Last Name (NamePattern1) 9325**], MD Phone:[**Telephone/Fax (1) 3201**]
Date/Time:[**2107-8-5**] 1:45

Call Dr. [**Last Name (STitle) **] for a follow up appointment after
you are discharged from rehab.



Completed by:[**2107-7-20**]

Name:  [**Known lastname **],[**Known firstname 779**]                     Unit No:   [**Numeric Identifier 16718**]

Admission Date:  [**2107-6-16**]              Discharge Date:   [**2107-7-20**]

Date of Birth:  [**2034-2-15**]             Sex:   F

Service: SURGERY

Allergies:
Shellfish / Carboplatin

Attending:[**First Name3 (LF) 3524**]
Addendum:
Due to an INR of 2.8 on [**2107-7-20**] Mrs. [**Known lastname 10936**] should receive 1 mg
of Coumadin for the next few days so as not to exceed 2.5 INR.

Discharge Disposition:
Extended Care

Facility:
[**First Name4 (NamePattern1) 3008**] [**Last Name (NamePattern1) **] - [**Location (un) 164**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2207**] MD [**MD Number(1) 3525**]

Completed by:[**2107-7-20**]
{'Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Peritoneal abscess,Secondary malignant neoplasm of retroperitoneum and peritoneum,Other complications due to other vascular device, implant, and graft,Acute venous embolism and thrombosis of axillary veins,Other postoperative infection,Incisional hernia without mention of obstruction or gangrene,Peritoneal adhesions (postoperative) (postinfection),Loss of weight,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Personal history of malignant neoplasm of ovary,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of other malignant neoplasm of skin,Ileostomy status,Accidental cut, puncture, perforation or hemorrhage during surgical 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: weight loss & unable to take POs.

PRESENT ILLNESS: 73 y.o. Female w/ stage IIIc papillary serous ovarian cancer s/p

MEDICAL HISTORY: PMH: HTN, depression, basal cell carcinoma, recurrent ovarian
cancer with peritoneal carcinomatosis, h/o TIA, cataracts
PSH: L CEA [**7-/2097**] ([**Doctor Last Name 1476**]); Ex lap, TAH-BSO, lymphadenectomy,
omentectomy, proctosigmoidectomy [**3-6**] ([**Doctor Last Name 2028**]); exploration of
wound dehisence w/ debridement and closure of fascia [**3-6**];
laparoscopic incisional hernia repair w/ mesh [**5-7**] ([**Doctor Last Name **]);
Ex lap, LOA, excision of infected mesh, appendectomy, drainage
of abscess, ileostomy/mucous fistula creation, closure with
vicryl mesh [**6-7**] ([**Doctor Last Name **]); delayed primary closure abdominal
wound [**6-7**] ([**Doctor Last Name **]

MEDICATION ON ADMISSION: 1. Bupropion HCl 100 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO QAM (once a day (in the morning)).
2. Citalopram 40 mg Tablet Sig: One (1) Tablet PO once a day.
3. 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*
4. Multivitamin,Tx-Minerals     Tablet Sig: One (1) Tablet PO
DAILY (Daily).
5. Omega-3 Fatty Acids Capsule Sig: One (1) Capsule PO BID
(2 times a day).
6. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
7. Avapro 75mg PO QOD

ALLERGIES: Shellfish / Carboplatin

PHYSICAL EXAM: VS:  99.4  144/78  71  18  100% ra.
GEN: AOx3, NAD, pleasant.
HEENT:  PERRLA. MMM. no LAD. JVP at 5cm.  neck supple.
Cards: RRR S1/S2 normal. no murmurs/gallops/rubs.
Pulm: No dullness to percussion, CTAB no crackles or wheezes
Abd: high pitched bowel sounds.  soft, tender to deep palpation,
ostomy in place, no rebound/guarding. neg HSM. neg [**Doctor Last Name 515**]
sign.
Extremities: wwp, no edema. DPs, PTs 2+ bilat.
Skin: no rashes or bruising
Neuro/Psych: CNs II-XII grossly intact, MAE.

FAMILY HISTORY: FAMILY HISTORY:  She denies any family history of cancer.

SOCIAL HISTORY: 30 pack-year h/o smoking, quit 9 years ago; social ETOH use;
Lives alone in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], 2 children, both live out of state but
very involved 

### Response:
{'Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Peritoneal abscess,Secondary malignant neoplasm of retroperitoneum and peritoneum,Other complications due to other vascular device, implant, and graft,Acute venous embolism and thrombosis of axillary veins,Other postoperative infection,Incisional hernia without mention of obstruction or gangrene,Peritoneal adhesions (postoperative) (postinfection),Loss of weight,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Personal history of malignant neoplasm of ovary,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of other malignant neoplasm of skin,Ileostomy status,Accidental cut, puncture, perforation or hemorrhage during surgical operation'}
