CHIEF COMPLAINT: Intermittent claudication

PRESENT ILLNESS: This 70-year-old gentleman is status post an
aortobifemoral bypass in the distant past for aneurysm with
occlusive disease. He has developed bilateral superficial
femoral artery occlusions with severe disabling claudication.
The left side was treated with an angioplasty. The right side
is not amenable to catheter-based intervention. Arteriography
showed reconstitution of an above-knee popliteal artery with
3-vessel runoff below the knee.

MEDICAL HISTORY: AAA with illiac artery aneurysms treated with an aortobifemoral
graft [**2089**].
Bilat carotid endarterectomies
CAD - coronary angioplasty and stenting [**2103**]
CABG (LIMA to LAD, SVG to diagonal, SVG to OM, sequential
SVG to AM/PDA)[**2089**]
Hyperlipidemia
HTN
AODM
Cerebral hemorrhage mid [**2085**]??????s
Prior CVA

MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: Plavix 75', Folate-B6-B12, Gabapentin 1200', Glimepiride 1
mg', Lopressor 50', Simvastatin 80', Sitagliptin 100', ASA 81,
Niacin, Omega FA, Vit E 400'.

ALLERGIES: Penicillins

PHYSICAL EXAM: Please See H&P

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Patient is married with 8 children.
Lives with: Wife
Occupation: [**Name2 (NI) **] fitter - retired
ETOH: Rare
Tobacco: denies
Atherosclerosis of native arteries of the extremities with intermittent claudication,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Aortocoronary bypass status,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits
Ath ext ntv at w claudct,Crnry athrscl natve vssl,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Aortocoronary bypass,Hx TIA/stroke w/o resid
Admission Date:  [**2105-1-13**]              Discharge Date:   [**2105-1-16**]

Date of Birth:  [**2034-7-2**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 2597**]
Chief Complaint:
Intermittent claudication

Major Surgical or Invasive Procedure:
Right femoral to above-knee popliteal artery
bypass with an 8-mm PTFE graft


History of Present Illness:
This 70-year-old gentleman is status post an
aortobifemoral bypass in the distant past for aneurysm with
occlusive disease. He has developed bilateral superficial
femoral artery occlusions with severe disabling claudication.
The left side was treated with an angioplasty. The right side
is not amenable to catheter-based intervention. Arteriography
showed reconstitution of an above-knee popliteal artery with
3-vessel runoff below the knee.


Past Medical History:
AAA with illiac artery aneurysms treated with an aortobifemoral
graft [**2089**].
Bilat carotid endarterectomies
CAD - coronary angioplasty and stenting [**2103**]
CABG (LIMA to LAD, SVG to diagonal, SVG to OM, sequential
SVG to AM/PDA)[**2089**]
Hyperlipidemia
HTN
AODM
Cerebral hemorrhage mid [**2085**]??????s
Prior CVA


Social History:
Patient is married with 8 children.
Lives with: Wife
Occupation: [**Name2 (NI) **] fitter - retired
ETOH: Rare
Tobacco: denies


Family History:
non contributory

Physical Exam:
Please See H&P

Pertinent Results:
[**2105-1-13**] 06:51PM   GLUCOSE-153* UREA N-19 CREAT-1.1 SODIUM-137
POTASSIUM-4.4 CHLORIDE-106 TOTAL CO2-21* ANION GAP-14
[**2105-1-13**] 06:51PM   estGFR-Using this
[**2105-1-13**] 06:51PM   ALT(SGPT)-32 AST(SGOT)-50* ALK PHOS-40
[**2105-1-13**] 06:51PM   CK-MB-2 cTropnT-<0.01
[**2105-1-13**] 06:51PM   CALCIUM-8.6 PHOSPHATE-4.1 MAGNESIUM-1.9
[**2105-1-13**] 06:51PM   HGB-11.9* HCT-35.4*
[**2105-1-13**] 06:51PM   PLT SMR-VERY LOW PLT COUNT-50*
[**2105-1-13**] 06:51PM   PT-14.3* PTT-30.9 INR(PT)-1.2*
[**2105-1-13**] 05:25PM   TYPE-ART PO2-203* PCO2-43 PH-7.34* TOTAL
CO2-24 BASE XS--2
[**2105-1-13**] 05:25PM   GLUCOSE-137* LACTATE-1.9 NA+-136 K+-4.1
CL--105
[**2105-1-13**] 05:25PM   HGB-12.8* calcHCT-38
[**2105-1-13**] 05:25PM   freeCa-1.15
[**2105-1-13**] 03:46PM   TYPE-ART PO2-101 PCO2-32* PH-7.45 TOTAL
CO2-23 BASE XS-0
[**2105-1-13**] 03:46PM   GLUCOSE-143* LACTATE-1.6 NA+-138 K+-3.9
CL--107
[**2105-1-13**] 03:46PM   HGB-14.2 calcHCT-43
[**2105-1-13**] 03:46PM   freeCa-1.23

Brief Hospital Course:
This 70-year-old gentleman is status post an aortobifemoral
bypass in the distant past for aneurysm with occlusive disease.
He has developed bilateral superficial
femoral artery occlusions with severe disabling claudication.
The left side was treated with an angioplasty. The right side is
not amenable to catheter-based intervention. Arteriography
showed reconstitution of an above-knee popliteal artery with
3-vessel runoff below the knee. Patient was admitted for Right
femoral to above-knee popliteal artery bypass with an 8-mm PTFE
graft.

Post-op patient was noted to be doing well with minimal pain and
stable hct.

POD1: Patient continued to do well had a small hematoma at his
groin site. DP and PT pulsed were dopplerable bilat.

POD 2: Foley was removed. Patient voided appropriately. Patient
was started on Plavix and tolerated a regular diet.

POD 3: Patient was seen by  PT and cleared for home without
services.


Medications on Admission:
[**Last Name (un) 1724**]: Plavix 75', Folate-B6-B12, Gabapentin 1200', Glimepiride 1
mg', Lopressor 50', Simvastatin 80', Sitagliptin 100', ASA 81,
Niacin, Omega FA, Vit E 400'.

Discharge Medications:
1. Oxycodone 5 mg Capsule Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain for 10 days.
Disp:*30 Tablet(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO twice
a day: otc - while on pain medication.
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
Disp:*30 Tablet, Chewable(s)* Refills:*2*
5. Vytorin 10-40 10-40 mg Tablet Sig: One (1) Tablet PO at
bedtime: home med.
6. Nortriptyline 25 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime): home med.
7. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily):
home med.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
8. Glimepiride 2 mg Tablet Sig: One (1) Tablet PO at bedtime:
home med.
9. Januvia 100 mg Tablet Sig: One (1) Tablet PO once a day: home
med.


Discharge Disposition:
Home

Discharge Diagnosis:
Intermittent claudication with right
superficial femoral artery occlusion.


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


Discharge Instructions:
Division of Vascular and Endovascular Surgery
Lower Extremity Bypass Surgery Discharge Instructions

What to expect when you go home:
1. It is normal to feel tired, this will last for 4-6 weeks
??????	You should get up out of bed every day and gradually increase
your activity each day
??????	Unless you were told not to bear any weight on operative foot:
you may walk and you may go up and down stairs
??????	Increase your activities as you can tolerate- do not do too
much right away!

2. It is normal to have swelling of the leg you were operated
on:
??????	Elevate your leg above the level of your heart (use [**2-26**]
pillows or a recliner) every 2-3 hours throughout the day and at
night
??????	Avoid prolonged periods of standing or sitting without your
legs elevated

3. It is normal to have a decreased appetite, your appetite will
return with time
??????	You will probably lose your taste for food and lose some
weight
??????	Eat small frequent meals
??????	It is important to eat nutritious food options (high fiber,
lean meats, vegetables/fruits, low fat, low cholesterol) to
maintain your strength and assist in wound healing
??????	To avoid constipation: eat a high fiber diet and use stool
softener while taking pain medication

What activities you can and cannot do:
??????	No driving until post-op visit and you are no longer taking
pain medications
??????	Unless you were told not to bear any weight on operative foot:

??????	You should get up every day, get dressed and walk
??????	You should gradually increase your activity
??????	You may up and down stairs, go outside and/or ride in a car
??????	Increase your activities as you can tolerate- do not do too
much right away!
??????	No heavy lifting, pushing or pulling (greater than 5 pounds)
until your post op visit
??????	You may shower (unless you have stitches or foot incisions) no
direct spray on incision, let the soapy water run over incision,
rinse and pat dry
??????	Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing
over the area that is draining, as needed
??????	Take all the medications you were taking before surgery,
unless otherwise directed
??????	Take one full strength (325mg) enteric coated aspirin daily,
unless otherwise directed
??????	Call and schedule an appointment to be seen in 2 weeks for
staple/suture removal

What to report to office:
??????	Redness that extends away from your incision
??????	A sudden increase in pain that is not controlled with pain
medication
??????	A sudden change in the ability to move or use your leg or the
ability to feel your leg
??????	Temperature greater than 100.5F for 24 hours
??????	Bleeding, new or increased drainage from incision or white,
yellow or green drainage from incisions


Followup Instructions:
Provider: [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2604**], MD Phone:[**Telephone/Fax (1) 1237**]
Date/Time:[**2105-1-29**] 12:40
{'Atherosclerosis of native arteries of the extremities with intermittent claudication,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Aortocoronary bypass status,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}


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: Intermittent claudication

PRESENT ILLNESS: This 70-year-old gentleman is status post an
aortobifemoral bypass in the distant past for aneurysm with
occlusive disease. He has developed bilateral superficial
femoral artery occlusions with severe disabling claudication.
The left side was treated with an angioplasty. The right side
is not amenable to catheter-based intervention. Arteriography
showed reconstitution of an above-knee popliteal artery with
3-vessel runoff below the knee.

MEDICAL HISTORY: AAA with illiac artery aneurysms treated with an aortobifemoral
graft [**2089**].
Bilat carotid endarterectomies
CAD - coronary angioplasty and stenting [**2103**]
CABG (LIMA to LAD, SVG to diagonal, SVG to OM, sequential
SVG to AM/PDA)[**2089**]
Hyperlipidemia
HTN
AODM
Cerebral hemorrhage mid [**2085**]??????s
Prior CVA

MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: Plavix 75', Folate-B6-B12, Gabapentin 1200', Glimepiride 1
mg', Lopressor 50', Simvastatin 80', Sitagliptin 100', ASA 81,
Niacin, Omega FA, Vit E 400'.

ALLERGIES: Penicillins

PHYSICAL EXAM: Please See H&P

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Patient is married with 8 children.
Lives with: Wife
Occupation: [**Name2 (NI) **] fitter - retired
ETOH: Rare
Tobacco: denies 

### Response:
{'Atherosclerosis of native arteries of the extremities with intermittent claudication,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Aortocoronary bypass status,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}
