CHIEF COMPLAINT: Bunion and hammertoe deformity R foot

PRESENT ILLNESS: 57 DM F known well to podiatry service seen routinely for care
of charcot foot L and for recurrent ulceration and infection of
R 2nd toe.  Pt has been undergoing conservative care for 2nd toe
and given the extent of deformity of the toe with severe bunion,
it was decided to take Pt to OR for hammertoe and bunion
correction.

MEDICAL HISTORY: 1. CHF (Diastolic pMIBI [**3-19**] Mild [**Last Name (LF) **], [**First Name3 (LF) **]=57%)
2. Aortic Valve Insufficiency
3. Bleeding diathesis with neg prior workup which has previously
responded to ddAVP. Pt is followed by Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
of Heme/Onc
4. OSA on bipap at home
5. Insulin Dependent DM complicated by Charcot foot and
peripheral neuropathy.
6. PVD with multiple foot ulcers
7. Hashimoto's Thyroiditis
8. Asthma
9. Anemia
10. IBS
11. Hepatitis C
12. MRSA in past
13. Cataracts
14. Macular degeneration
15. Osteoarthritis
16. Bladder spasms
17. Stress urinary incontinence
18. Fibromyalgia
19. Anxiety
20. Major Depression
21. s/p tonsilletcomy and adenoidectomy
22. s/p c-section with significant post partum bleeding
23. s/p bladder suspension complicated by post op bleeding
24. s/p hernia repair

MEDICATION ON ADMISSION: Alprazolam 0.5', Amitriptyline 150', ASA 81', Desmopressin 1
spray NU PRN, ditropan 10', furosemide 80', levothyroxine
125mcg', Lyrica 50mg, Metoprolol XL 100', Lyrica 50''',
Montelukast 10', Nexium 40', KCL 10', Simvastatin 20', Ultram
100 q4hr, Venlafaxine XR 150'

ALLERGIES: Tape / Provera / Antibiotic / Verapamil / Heparin Agents /
Codeine / Dicloxacillin

PHYSICAL EXAM: GEN: NAD, AAOx3
HEENT: nasal BIPAP, PERRLA, EOMI
CV: RRR, S1, S2
Chest: CTA with mild wheezes
Abd: NT, ND +BS
Ext: Severe R 2nd hammertoe and bunion deformity. Superficial
ulceration dorsal 2nd toe at PIPJ with mild surrounding redness.
No active drainage. Generalized 1+ b/l LE edema. All incisions
completely healed on L foot s/p Charcot recon. No other open
lesions. Pt w/ palpable DP and dopplerable PT R foot with
decreased protective sensation plantarly.

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Married. Lives with husband.  Daughter is HCP.
Bunion,Infection (chronic) of amputation stump,Ulcer of other part of foot,Atherosclerosis of native arteries of the extremities with gangrene,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Acute osteomyelitis, ankle and foot,Diastolic heart failure, unspecified,Other hammer toe (acquired),Arthropathy associated with neurological disorders,Major depressive affective disorder, single episode, unspecified,Anxiety state, unspecified,Heart valve replaced by other means
Bunion,Infection amputat stump,Ulcer other part of foot,Ath ext ntv art gngrene,Pseudomonas infect NOS,Ac osteomyelitis-ankle,Diastolc hrt failure NOS,Other hammer toe,Arthropathy w nerve dis,Depress psychosis-unspec,Anxiety state NOS,Heart valve replac NEC
Admission Date:  [**2124-7-18**]              Discharge Date:   [**2124-8-2**]

Date of Birth:  [**2067-1-6**]             Sex:   F

Service: PODIATRY

Allergies:
Tape / Provera / Antibiotic / Verapamil / Heparin Agents /
Codeine / Dicloxacillin

Attending:[**First Name3 (LF) 3821**]
Chief Complaint:
Bunion and hammertoe deformity R foot

Major Surgical or Invasive Procedure:
Bunionectomy and 2nd toe hammertoe repair R foot


History of Present Illness:
57 DM F known well to podiatry service seen routinely for care
of charcot foot L and for recurrent ulceration and infection of
R 2nd toe.  Pt has been undergoing conservative care for 2nd toe
and given the extent of deformity of the toe with severe bunion,
it was decided to take Pt to OR for hammertoe and bunion
correction.

Past Medical History:
1. CHF (Diastolic pMIBI [**3-19**] Mild [**Last Name (LF) **], [**First Name3 (LF) **]=57%)
2. Aortic Valve Insufficiency
3. Bleeding diathesis with neg prior workup which has previously
responded to ddAVP. Pt is followed by Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
of Heme/Onc
4. OSA on bipap at home
5. Insulin Dependent DM complicated by Charcot foot and
peripheral neuropathy.
6. PVD with multiple foot ulcers
7. Hashimoto's Thyroiditis
8. Asthma
9. Anemia
10. IBS
11. Hepatitis C
12. MRSA in past
13. Cataracts
14. Macular degeneration
15. Osteoarthritis
16. Bladder spasms
17. Stress urinary incontinence
18. Fibromyalgia
19. Anxiety
20. Major Depression
21. s/p tonsilletcomy and adenoidectomy
22. s/p c-section with significant post partum bleeding
23. s/p bladder suspension complicated by post op bleeding
24. s/p hernia repair

Social History:
Married. Lives with husband.  Daughter is HCP.


Family History:
Non-contributory.

Physical Exam:
GEN: NAD, AAOx3
HEENT: nasal BIPAP, PERRLA, EOMI
CV: RRR, S1, S2
Chest: CTA with mild wheezes
Abd: NT, ND +BS
Ext: Severe R 2nd hammertoe and bunion deformity. Superficial
ulceration dorsal 2nd toe at PIPJ with mild surrounding redness.
No active drainage. Generalized 1+ b/l LE edema. All incisions
completely healed on L foot s/p Charcot recon. No other open
lesions. Pt w/ palpable DP and dopplerable PT R foot with
decreased protective sensation plantarly.

Pertinent Results:
[**2124-7-22**] 10:12 am SWAB      Source: R 2nd toe:
_________________________________________________________
                             ENTEROCOCCUS SP.
                             |          STAPHYLOCOCCUS,
COAGULASE NEGATIVE
                             |          |          PSEUDOMONAS
AERUGINOSA
                             |          |          |
AMPICILLIN------------   <=2 S
CEFEPIME--------------                           2 S
CEFTAZIDIME-----------                           4 S
CIPROFLOXACIN---------                      <=0.25 S
CLINDAMYCIN-----------              =>8 R
ERYTHROMYCIN----------              =>8 R
GENTAMICIN------------                8 I      <=1 S
IMIPENEM--------------                         <=1 S
LEVOFLOXACIN----------              =>8 R
MEROPENEM-------------                      <=0.25 S
OXACILLIN-------------              =>4 R
PENICILLIN------------     4 S    =>0.5 R
PIPERACILLIN----------                         <=4 S
PIPERACILLIN/TAZO-----                         <=4 S
RIFAMPIN--------------            <=0.5 S
TETRACYCLINE----------              <=1 S
TOBRAMYCIN------------                         <=1 S
VANCOMYCIN------------   <=1 S        2 S

   ANAEROBIC CULTURE (Final [**2124-7-26**]):    NO ANAEROBES ISOLATED.


[**Date range (1) 44486**]  BLOOD CULTURE: No growth

[**2124-7-18**] Pathology Tissue: BONE FIRST METATARSAL,
A. Bone, 1st right metatarsal (A):
Bone with some reparative changes; cartilage with some
degenerative changes.
B. Skin, right 2nd toe (B):
Skin with ulceration, granulation tissue, fibrosis, chronic
inflammation, and fibrinopurulent exudate.
C. Bone, 2nd toe (C):
Bone with some reparative changes; no significant acute
inflammation noted.
Cartilage with degenerative changes

CHEST (PORTABLE AP)  [**2124-7-19**]: A single upright portable film of
the chest on [**7-19**] at 2051 hours. Sternal sutures are in place
from previous surgery, the diaphragm is high bilaterally which
is presumably due to position and a poor inspiratory effort. The
heart is enlarged to the left thoracic margin, unchanged since
[**Month (only) 205**]. There now appears to be some increased density at the left
base consistent with atelectasis or infiltrate

UNILAT LOWER EXT VEINS  [**2124-7-19**]: No evidence of deep venous
thrombosis in the left lower extremity

CHEST (PA & LAT)  [**2124-7-22**]: Resolving left lower lobe opacity,
likely atelectasis

FOOT AP,LAT & OBL RIGHT  [**2124-7-29**]: Post-op films following
amputation of the right second toe at the metatarsophalangeal
joint.


Brief Hospital Course:
[**7-18**]: Pt was admitted same day for correction of severe hammertoe
and bunion deformity of R foot. Pt tolerated the procedure well
without any complications (see op note for details). Pt w/
undiagnosed bleeding disorder and instructions were given from
Pt's Heme/Onc physician for perioperative medications/recs
including pre and post op DDAVP (desmopressin). Postoperatively,
R 2nd digit was noted to be mildly dusky but still warm with
adequate CRT with pin intact. Pt [**Name (NI) 20851**]
[**7-19**]: POD1; Low grade temps, VSS; R 2nd toe continued to be dusky
but warm, pin still in tact. Dsgs clean and dry. c/o L calf
pain. Venous ultrasound neg for DVT.
[**7-20**]: Temp spike o/n to 101.9 w/ c/o nausea and chills. EKG w/ no
changes and portable CXR w/atelectesis, LLL effusion. White
count bump to 12.9. Incisions still dry, sutures in tact to R
foot but 2nd toe remaining dusky so pin was pulled without
incident. IS was encourage and Pt was also pan cultured and
foley d/c'd. Cipro was added for broadened coverage.  Pt
evaluated and cleared by PT for TDWB through heel.
[**7-21**]: Cont w/ low grade fevers, VSS. Continued bibasilar crackles
though improving. R 2nd toe cont to be warm but color worsening
with white count increasing to 14.  Med consulted for fever who
rec switching to levo and flagyl for questionnable PNA. Also
believe toe is source. ? ECHO if fevers cont. Pt w/ h/o
neurogenic bladder s/o mult bladder suspensions but with urinary
incontinence since foley removed. Bladder scanned showing
>400ccs. Urology curbsided and believed cause likely [**12-17**]
overflow and recommended replace foley until day of discharge
and at that time trial void her and get post void residual. [**Month (only) 116**]
need foley on discharge if doesn't improved
[**7-22**]: (POD4) Pt still spiking fevers to 101.3 while VSS. To date
all Ucx, UA, Bcx were negative but toe worsening in color.
Sutures along dorsal 2nd toe were removed at bedside revealing
necrotic base; Wcx were taken. Lesion flushed and packed open.
White count improving.
[**7-23**]: Cont low grade temps but white count improving. Remaining
sutures prox to 2nd toe removed [**12-17**] incrased drainage and packed
w/ betadine; [**Last Name (un) **] consulted for irregular blood glucose
levels. Medicine unconvinced of any clear signs of PNA but would
cont to monitor for endocarditis/graft infection. Pt made NPO
after MN for possible OR debridment vs amputation next day.
[**7-24**]: OR for open 2nd toe amp. Pt tolerated procedure well (see
op note for details). Postoperatively, Pt doing well still with
low grade temps but white count completely resolved.
[**7-25**]: (POD 7,1) Afebrile o/n w/ VSS. Amp site clean, red and
granular with appropriate bleeding. Cont Abx and NWB RLE.
[**2130-7-27**]: Cont [**Month/Day/Year 20851**]; Amp site clean and granular. 2U PRBC infused
for low Hct with appropriate bump.  Bedside wcx growing pseudo,
coag(-) staph and enterococcus. Cultures from sterile intraop
tissue growing coag (-) staph and enterococcus and GNR. Pt made
NPO for amp closure next day.
[**7-28**]: OR for R 2nd toe amp closure (see op note for details). Pt
tolerated procedure well with uncomplicated postop; [**Month/Year (2) 20851**].
[**2033-7-29**]: (POD12,6,2): Pt [**Name (NI) 20851**] over weekend with no events.
Incisions cont to look clean and dry with sutures in tact and no
active drainage for clinical signs of infection. Levo changed to
cipro for better gram(-) coverage.
[**2035-7-31**]: [**Month/Day/Year 20851**] with normal white count. Wcx growing entero (pan
sensitive), GNR, CNS ([**Last Name (un) 36**] to vanc). PT reconsulted for NWB RLE
who was cleared to go home w/ PT services. Incisions cont to be
clean and dry with redness and swelling improving.  Found to
have preulcerative lesions along distal achilles tendon of RLE
[**12-17**] having leg elevated on pillows. No signs of infection; began
wet-to-dry dsgs and applied mulitpodus splint.
[**8-2**]: Cont to be [**Month/Year (2) 20851**] without white count. Pt was discharged
home w/ VNA and PT services on 3 weeks of Linezolid and Cipro to
follow up with Dr. [**Last Name (STitle) **] in 1 week.

Medications on Admission:
Alprazolam 0.5', Amitriptyline 150', ASA 81', Desmopressin 1
spray NU PRN, ditropan 10', furosemide 80', levothyroxine
125mcg', Lyrica 50mg, Metoprolol XL 100', Lyrica 50''',
Montelukast 10', Nexium 40', KCL 10', Simvastatin 20', Ultram
100 q4hr, Venlafaxine XR 150'


Discharge Medications:
1. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours
as needed.
Disp:*30 Tablet(s)* Refills:*0*
2. Cipro 500 mg Tablet Sig: One (1) Tablet PO twice a day for 2
weeks.
Disp:*28 Tablet(s)* Refills:*0*
3. Linezolid 600 mg Tablet Sig: One (1) Tablet PO twice a day
for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*
4. Linezolid 600 mg Tablet Sig: One (1) Tablet PO twice a day
for 1 weeks.
Disp:*14 Tablet(s)* Refills:*0*
5. Ultram 50 mg Tablet Sig: 1-2 Tablets PO q6 hr as needed for
pain.
Disp:*50 Tablet(s)* Refills:*0*
6. Amitriptyline 50 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime).
7. Venlafaxine 75 mg Capsule, Sust. Release 24 hr Sig: Two (2)
Capsule, Sust. Release 24 hr PO DAILY (Daily).
8. Furosemide 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

9. Levoxyl 175 mcg Tablet Sig: One (1) Tablet PO daily ().
10. Lyrica 50 mg Capsule Sig: One (1) Capsule PO tid ().
11. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
12. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. Morphine 15 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for breakthrough pain.
14. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO BID (2 times a
day).
15. Esomeprazole Magnesium 20 mg Capsule, Delayed Release(E.C.)
Sig: Two (2) Capsule, Delayed Release(E.C.) PO qd ().
16. Oxybutynin Chloride 10 mg Tab,Sust Rel Osmotic Push 24hr
Sig: One (1) Tab,Sust Rel Osmotic Push 24hr PO daily ().
17. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed.
18. Vancomycin 1000 mg IV Q 12H
19. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours).
20. HYDROmorphone (Dilaudid) 1 mg IV Q6H:PRN breakthrough


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] home health

Discharge Diagnosis:
Bunion and 2nd hammertoe deformity R foot


Discharge Condition:
Stable


Discharge Instructions:
Please resume all prehospital medications.  You were prescribed
2  antibiotics and a pain medication, please take both as
directed.

You are to remain non-weightbearing on your right foot in
surgical shoe and crutches.

Please keep your dressing clean and dry at all times, also
keeping your foot elevated to prevent swelling.  You will have
daily dsg changes performed by visiting nurses.

Please call your doctor to go to the ED for any increase in pain
not managed by pain medication.  Any drainage through your
dressing, nauseas, vomiting, fevers greater than 101.5, chills,
nightsweats

Followup Instructions:
Please call [**Telephone/Fax (1) 543**] to schedule an appointment to see Dr.
[**Last Name (STitle) **] in one week.


                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 722**] DPM 48-125

Completed by:[**2124-8-2**]
{'Bunion,Infection (chronic) of amputation stump,Ulcer of other part of foot,Atherosclerosis of native arteries of the extremities with gangrene,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Acute osteomyelitis, ankle and foot,Diastolic heart failure, unspecified,Other hammer toe (acquired),Arthropathy associated with neurological disorders,Major depressive affective disorder, single episode, unspecified,Anxiety state, unspecified,Heart valve replaced by other means'}


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: Bunion and hammertoe deformity R foot

PRESENT ILLNESS: 57 DM F known well to podiatry service seen routinely for care
of charcot foot L and for recurrent ulceration and infection of
R 2nd toe.  Pt has been undergoing conservative care for 2nd toe
and given the extent of deformity of the toe with severe bunion,
it was decided to take Pt to OR for hammertoe and bunion
correction.

MEDICAL HISTORY: 1. CHF (Diastolic pMIBI [**3-19**] Mild [**Last Name (LF) **], [**First Name3 (LF) **]=57%)
2. Aortic Valve Insufficiency
3. Bleeding diathesis with neg prior workup which has previously
responded to ddAVP. Pt is followed by Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
of Heme/Onc
4. OSA on bipap at home
5. Insulin Dependent DM complicated by Charcot foot and
peripheral neuropathy.
6. PVD with multiple foot ulcers
7. Hashimoto's Thyroiditis
8. Asthma
9. Anemia
10. IBS
11. Hepatitis C
12. MRSA in past
13. Cataracts
14. Macular degeneration
15. Osteoarthritis
16. Bladder spasms
17. Stress urinary incontinence
18. Fibromyalgia
19. Anxiety
20. Major Depression
21. s/p tonsilletcomy and adenoidectomy
22. s/p c-section with significant post partum bleeding
23. s/p bladder suspension complicated by post op bleeding
24. s/p hernia repair

MEDICATION ON ADMISSION: Alprazolam 0.5', Amitriptyline 150', ASA 81', Desmopressin 1
spray NU PRN, ditropan 10', furosemide 80', levothyroxine
125mcg', Lyrica 50mg, Metoprolol XL 100', Lyrica 50''',
Montelukast 10', Nexium 40', KCL 10', Simvastatin 20', Ultram
100 q4hr, Venlafaxine XR 150'

ALLERGIES: Tape / Provera / Antibiotic / Verapamil / Heparin Agents /
Codeine / Dicloxacillin

PHYSICAL EXAM: GEN: NAD, AAOx3
HEENT: nasal BIPAP, PERRLA, EOMI
CV: RRR, S1, S2
Chest: CTA with mild wheezes
Abd: NT, ND +BS
Ext: Severe R 2nd hammertoe and bunion deformity. Superficial
ulceration dorsal 2nd toe at PIPJ with mild surrounding redness.
No active drainage. Generalized 1+ b/l LE edema. All incisions
completely healed on L foot s/p Charcot recon. No other open
lesions. Pt w/ palpable DP and dopplerable PT R foot with
decreased protective sensation plantarly.

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Married. Lives with husband.  Daughter is HCP. 

### Response:
{'Bunion,Infection (chronic) of amputation stump,Ulcer of other part of foot,Atherosclerosis of native arteries of the extremities with gangrene,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Acute osteomyelitis, ankle and foot,Diastolic heart failure, unspecified,Other hammer toe (acquired),Arthropathy associated with neurological disorders,Major depressive affective disorder, single episode, unspecified,Anxiety state, unspecified,Heart valve replaced by other means'}
