CHIEF COMPLAINT: Neck Pain

PRESENT ILLNESS: 56yoF followed by Dr. [**Last Name (STitle) 1352**] and recommended for an occiput to
T2 revision posterior spinal fusion decompression for
pseudoarthrosis from occiput to C4 with hardware pullout in the
presence of significant right upper extremity weakness.
Initially did not want to have the surgical intervention.
However, she continued to have weakness, neck pain and right arm
pains so returned to Dr. [**Last Name (STitle) 1352**] to schedule the surgery.

MEDICAL HISTORY: 1.TLE s/p surgery - right temporoparietal resection [**2128**]. Has
minimal use of her LUE & LLE, is wheelchair-bound.
2.focal motor seizures.  Has sz approx once a month -> shaking
of her right arm, no loss of consciousness, but the sz affects
her tongue so she cannot speak.
3.VP shunt
4.depression
5.OCD
6.MRSA/VRE
7.HTN
8.chronic hyponatremia on Tegretol
9.COPD
10.neurogenic bladder
11.eating disorder (anorexia)
12.PUD
13.history of left hip removal.
14. history of chronic left lower extremity edema
15.  Right hip, fracture to the left, and fracture of the
lateral ischial ring on the right side.
16.  Left hip frequent dislocations status post left hip
replacement c/b MRSA inf currently without a left hip
17.  History of Methicillin resistant Staphylococcus aureus
growth in the left joint status post THR.
18. excision arthroplasty in [**2147**]
19. secondary hyperparathyroidism
20. iron deficiency anemia
21. Severe progressive cervical spondylosis s/p occiput to C4
fusion and C2-C3 lamanectomy [**2150**]

MEDICATION ON ADMISSION: 1. Oxybutynin Chloride 5 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
2. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
3. Risperidone 0.5 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
4. Risperidone 0.5 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime).
5. Calcium Carbonate 500 mg Tablet, Chewable Sig: Two (2)
Tablet, Chewable PO Q 12H (Every 12 Hours).
6. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Valium / Aspirin / Levofloxacin / Levaquin

PHYSICAL EXAM: Well appearing, very thin female
She has weakness primarily in her triceps and wrist flexion on
the right side.  Her deltoid is also [**3-9**].  Her biceps appears to
be [**4-8**] on that side as well as wrist extension.  Her interossei
are [**3-9**]. Her left upper and left lower extremities are baseline
with significant weakness.  Her right lower extremity has no
spasticity in it and has reasonable strength at 4/5 globally.
Her neck incision is clean, dry, and intact.  She has reasonable
range of motion.

FAMILY HISTORY: Pancreatic cancer in mother, who died in [**2147**]. Breast cancer in
grandfather, leukemia. [**Name2 (NI) **] known stroke, hypertension, diabetes,
or coronary artery disease.

SOCIAL HISTORY: The patient has been living at a long-term care facility)[**Location (un) 8220**]), but previously lived alone in an apartment in [**Location (un) 745**].
She was raised in [**Location (un) **].  She has a BA from [**Hospital1 74039**],
where she studied religion, American history, and religion.  She
[**Hospital1 **] EtOH or tobacco use. She uses a wheelchair to ambulate.
She has an aid for a few hours daily.
She works as a volunteer at [**Hospital1 **]. She [**Hospital1 **] any
ciggs/EtOH.
Other mechanical complication of other internal orthopedic device, implant, and graft,Cervical spondylosis with myelopathy,Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy,Hyposmolality and/or hyponatremia,Unspecified protein-calorie malnutrition,Anorexia nervosa,Neurogenic bladder NOS,Depressive disorder, not elsewhere classified,Chronic airway obstruction, not elsewhere classified,Other and unspecified anticonvulsants causing adverse effects in therapeutic use,Unspecified essential hypertension,Obsessive-compulsive disorders
Mech com orth dev NEC,Cerv spondyl w myelopath,Part epil w/o intr epil,Hyposmolality,Protein-cal malnutr NOS,Anorexia nervosa,Neurogenic bladder NOS,Depressive disorder NEC,Chr airway obstruct NEC,Adv eff antconvl NEC/NOS,Hypertension NOS,Obsessive-compulsive dis
Admission Date:  [**2155-1-21**]              Discharge Date:   [**2155-1-24**]

Date of Birth:  [**2098-10-28**]             Sex:   F

Service: ORTHOPAEDICS

Allergies:
Valium / Aspirin / Levofloxacin / Levaquin

Attending:[**First Name3 (LF) 3645**]
Chief Complaint:
Neck Pain

Major Surgical or Invasive Procedure:
[**1-21**]: Revision Posterior Cervical Spine Fusion


History of Present Illness:
56yoF followed by Dr. [**Last Name (STitle) 1352**] and recommended for an occiput to
T2 revision posterior spinal fusion decompression for
pseudoarthrosis from occiput to C4 with hardware pullout in the
presence of significant right upper extremity weakness.
Initially did not want to have the surgical intervention.
However, she continued to have weakness, neck pain and right arm
pains so returned to Dr. [**Last Name (STitle) 1352**] to schedule the surgery.


Past Medical History:
1.TLE s/p surgery - right temporoparietal resection [**2128**]. Has
minimal use of her LUE & LLE, is wheelchair-bound.
2.focal motor seizures.  Has sz approx once a month -> shaking
of her right arm, no loss of consciousness, but the sz affects
her tongue so she cannot speak.
3.VP shunt
4.depression
5.OCD
6.MRSA/VRE
7.HTN
8.chronic hyponatremia on Tegretol
9.COPD
10.neurogenic bladder
11.eating disorder (anorexia)
12.PUD
13.history of left hip removal.
14. history of chronic left lower extremity edema
15.  Right hip, fracture to the left, and fracture of the
lateral ischial ring on the right side.
16.  Left hip frequent dislocations status post left hip
replacement c/b MRSA inf currently without a left hip
17.  History of Methicillin resistant Staphylococcus aureus
growth in the left joint status post THR.
18. excision arthroplasty in [**2147**]
19. secondary hyperparathyroidism
20. iron deficiency anemia
21. Severe progressive cervical spondylosis s/p occiput to C4
fusion and C2-C3 lamanectomy [**2150**]

Social History:
The patient has been living at a long-term care facility)[**Location (un) 8220**]), but previously lived alone in an apartment in [**Location (un) 745**].
She was raised in [**Location (un) **].  She has a BA from [**Hospital1 74039**],
where she studied religion, American history, and religion.  She
[**Hospital1 **] EtOH or tobacco use. She uses a wheelchair to ambulate.
She has an aid for a few hours daily.
She works as a volunteer at [**Hospital1 **]. She [**Hospital1 **] any
ciggs/EtOH.


Family History:
Pancreatic cancer in mother, who died in [**2147**]. Breast cancer in
grandfather, leukemia. [**Name2 (NI) **] known stroke, hypertension, diabetes,
or coronary artery disease.

Physical Exam:
Well appearing, very thin female
She has weakness primarily in her triceps and wrist flexion on
the right side.  Her deltoid is also [**3-9**].  Her biceps appears to
be [**4-8**] on that side as well as wrist extension.  Her interossei
are [**3-9**]. Her left upper and left lower extremities are baseline
with significant weakness.  Her right lower extremity has no
spasticity in it and has reasonable strength at 4/5 globally.
Her neck incision is clean, dry, and intact.  She has reasonable
range of motion.

Pertinent Results:
[**2155-1-21**] 09:00PM   HCT-31.5*
[**2155-1-21**] 04:47PM   HGB-8.6* calcHCT-26
[**2155-1-21**] 03:45PM   HGB-10.4* calcHCT-31
[**2155-1-21**] 01:55PM   HGB-11.3* calcHCT-34

Brief Hospital Course:
Ms [**Known lastname 102960**] was admitted to the Orthopaedic Spine service under
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1352**]. She was taken to the operating room on
[**2155-1-21**] where the above procedure was performed. The surgery
was without complication and she received 2U PRBCs
intraoperatively for an EBL 600cc. For further details please
refer to Dr.[**Doctor Last Name 6493**] dictated operative note. She was placed
in a rigid c-collar after surgery. Postoperatively she remained
intubated in the PACU overnight for monitoring. The next morning
she was extubated and transferred to the floor in a stable
condition. There was no immediate change in her BUE neurologic
condition following surgery.
Postop pain was controlled with Vicodin and IV Morphine as
needed. She was mobilized OOB with PT. Foley was discontinued on
POD#3. Nutrition was consulted to maximize her healing potential
in the setting of severe anorexia nervosa. The decision was made
to start TPN which she received via central line throughout her
hospital stay. She also had an oral diet with Boost for
supplementation but refused to increase her baseline caloric
oral intake. Central line and TPN were discontinued on the
morning of discharge. Her hospital stay was otherwise
unremarkable.

Medications on Admission:
1. Oxybutynin Chloride 5 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
2. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
3. Risperidone 0.5 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
4. Risperidone 0.5 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime).
5. Calcium Carbonate 500 mg Tablet, Chewable Sig: Two (2)
Tablet, Chewable PO Q 12H (Every 12 Hours).
6. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Phenobarbital 30 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
8. Phenobarbital 30 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
9. Venlafaxine 75 mg Capsule, Sust. Release 24 hr Sig: Four (4)
Capsule, Sust. Release 24 hr PO DAILY (Daily).
10. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**12-6**]
Drops Ophthalmic PRN (as needed).
11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
12. Demeclocycline 150 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
13. Carbamazepine 200 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
14. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets
PO Q4H (every 4 hours) as needed.
Disp:*90 Tablet(s)* Refills:*0*


Discharge Medications:
1. Oxybutynin Chloride 5 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
2. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
3. Risperidone 0.5 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
4. Risperidone 0.5 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime).
5. Calcium Carbonate 500 mg Tablet, Chewable Sig: Two (2)
Tablet, Chewable PO Q 12H (Every 12 Hours).
6. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Phenobarbital 30 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
8. Phenobarbital 30 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
9. Venlafaxine 75 mg Capsule, Sust. Release 24 hr Sig: Four (4)
Capsule, Sust. Release 24 hr PO DAILY (Daily).
10. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**12-6**]
Drops Ophthalmic PRN (as needed).
11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
12. Demeclocycline 150 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
13. Carbamazepine 200 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
14. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets
PO Q4H (every 4 hours) as needed.
Disp:*90 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
Golden Liviing Center

Discharge Diagnosis:
C2-3 anterolisthesis


Discharge Condition:
Stable


Discharge Instructions:
You have undergone the following operation: Revision Posterior
Cervical Fusion

Immediately after the operation:
-	Activity: You should not lift anything greater than 10 lbs for
2 weeks. You will be more comfortable if you do not sit in a car
or chair for more than ~45 minutes without getting up and
walking around.

-	Rehabilitation/ Physical Therapy:
o	2-3 times a day you should go for a walk for 15-30 minutes as
part of your recovery.  You can walk as much as you can
tolerate.
o	Isometric Extension Exercise in the collar: 2x/day x 10 times
perform extension exercises as instructed.

-	Cervical Collar / Neck Brace: You need to wear the brace at
all times until your follow-up appointment which should be in 2
weeks.  You may remove the collar to take a shower.  Limit your
motion of your neck while the collar is off. Place the collar
back on your neck immediately after the shower.

-	Wound Care: Remove the dressing in 2 days.  If the incision is
draining cover it with a new sterile dressing.  If it is dry
then you can leave the incision open to the air.  Once the
incision is completely dry (usually 2-3 days after the
operation) you may take a shower. Do not soak the incision in a
bath or pool.  If the incision starts draining at anytime after
surgery, do not get the incision wet. Call the office at that
time. If you have an incision on your hip please follow the same
instructions in terms of wound care.

-	You should resume taking your normal home medications.

-	You have also been given Additional Medications to control
your pain. Please allow 72 hours for refill of narcotic
prescriptions, so please plan ahead.  You can either have them
mailed to your home or pick them up at the clinic located on
[**Hospital Ward Name 23**] 2.  We are not allowed to call in narcotic prescriptions
(oxycontin, oxycodone, percocet) to the pharmacy.  In addition,
we are only allowed to write for pain medications for 90 days
from the date of surgery.

Please call the office if you have a fever>101.5 degrees
Fahrenheit, drainage from your wound, or have any questions.

Physical Therapy:
Immediately after the operation:
-	Activity: You should not lift anything greater than 10 lbs for
2 weeks. You will be more comfortable if you do not sit in a car
or chair for more than ~45 minutes without getting up and
walking around.

-	Rehabilitation/ Physical Therapy:
o	2-3 times a day you should go for a walk for 15-30 minutes as
part of your recovery.  You can walk as much as you can
tolerate.
o	Isometric Extension Exercise in the collar: 2x/day x 10 times
perform extension exercises as instructed.

-	Cervical Collar / Neck Brace: You need to wear the brace at
all times until your follow-up appointment which should be in 2
weeks.  You may remove the collar to take a shower.  Limit your
motion of your neck while the collar is off. Place the collar
back on your neck immediately after the shower.

Treatments Frequency:
-	Wound Care: Remove the dressing in 2 days.  If the incision is
draining cover it with a new sterile dressing.  If it is dry
then you can leave the incision open to the air.  Once the
incision is completely dry (usually 2-3 days after the
operation) you may take a shower. Do not soak the incision in a
bath or pool.  If the incision starts draining at anytime after
surgery, do not get the incision wet. Call the office at that
time. If you have an incision on your hip please follow the same
instructions in terms of wound care.


Followup Instructions:
oPlease Call the office and make an appointment for 2 weeks
after the day of your operation if this has not been done
already.
oAt the 2-week visit we will check your incision, take baseline
x rays and answer any questions.
oWe will then see you at 6 weeks from the day of the operation.
At that time we will most likely obtain Flexion/Extension X-rays
and often able to place you in a soft collar which you will wean
out of over 1 week.



Completed by:[**2155-1-24**]
{'Other mechanical complication of other internal orthopedic device, implant, and graft,Cervical spondylosis with myelopathy,Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy,Hyposmolality and/or hyponatremia,Unspecified protein-calorie malnutrition,Anorexia nervosa,Neurogenic bladder NOS,Depressive disorder, not elsewhere classified,Chronic airway obstruction, not elsewhere classified,Other and unspecified anticonvulsants causing adverse effects in therapeutic use,Unspecified essential hypertension,Obsessive-compulsive disorders'}


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: Neck Pain

PRESENT ILLNESS: 56yoF followed by Dr. [**Last Name (STitle) 1352**] and recommended for an occiput to
T2 revision posterior spinal fusion decompression for
pseudoarthrosis from occiput to C4 with hardware pullout in the
presence of significant right upper extremity weakness.
Initially did not want to have the surgical intervention.
However, she continued to have weakness, neck pain and right arm
pains so returned to Dr. [**Last Name (STitle) 1352**] to schedule the surgery.

MEDICAL HISTORY: 1.TLE s/p surgery - right temporoparietal resection [**2128**]. Has
minimal use of her LUE & LLE, is wheelchair-bound.
2.focal motor seizures.  Has sz approx once a month -> shaking
of her right arm, no loss of consciousness, but the sz affects
her tongue so she cannot speak.
3.VP shunt
4.depression
5.OCD
6.MRSA/VRE
7.HTN
8.chronic hyponatremia on Tegretol
9.COPD
10.neurogenic bladder
11.eating disorder (anorexia)
12.PUD
13.history of left hip removal.
14. history of chronic left lower extremity edema
15.  Right hip, fracture to the left, and fracture of the
lateral ischial ring on the right side.
16.  Left hip frequent dislocations status post left hip
replacement c/b MRSA inf currently without a left hip
17.  History of Methicillin resistant Staphylococcus aureus
growth in the left joint status post THR.
18. excision arthroplasty in [**2147**]
19. secondary hyperparathyroidism
20. iron deficiency anemia
21. Severe progressive cervical spondylosis s/p occiput to C4
fusion and C2-C3 lamanectomy [**2150**]

MEDICATION ON ADMISSION: 1. Oxybutynin Chloride 5 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
2. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
3. Risperidone 0.5 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
4. Risperidone 0.5 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime).
5. Calcium Carbonate 500 mg Tablet, Chewable Sig: Two (2)
Tablet, Chewable PO Q 12H (Every 12 Hours).
6. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Valium / Aspirin / Levofloxacin / Levaquin

PHYSICAL EXAM: Well appearing, very thin female
She has weakness primarily in her triceps and wrist flexion on
the right side.  Her deltoid is also [**3-9**].  Her biceps appears to
be [**4-8**] on that side as well as wrist extension.  Her interossei
are [**3-9**]. Her left upper and left lower extremities are baseline
with significant weakness.  Her right lower extremity has no
spasticity in it and has reasonable strength at 4/5 globally.
Her neck incision is clean, dry, and intact.  She has reasonable
range of motion.

FAMILY HISTORY: Pancreatic cancer in mother, who died in [**2147**]. Breast cancer in
grandfather, leukemia. [**Name2 (NI) **] known stroke, hypertension, diabetes,
or coronary artery disease.

SOCIAL HISTORY: The patient has been living at a long-term care facility)[**Location (un) 8220**]), but previously lived alone in an apartment in [**Location (un) 745**].
She was raised in [**Location (un) **].  She has a BA from [**Hospital1 74039**],
where she studied religion, American history, and religion.  She
[**Hospital1 **] EtOH or tobacco use. She uses a wheelchair to ambulate.
She has an aid for a few hours daily.
She works as a volunteer at [**Hospital1 **]. She [**Hospital1 **] any
ciggs/EtOH. 

### Response:
{'Other mechanical complication of other internal orthopedic device, implant, and graft,Cervical spondylosis with myelopathy,Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy,Hyposmolality and/or hyponatremia,Unspecified protein-calorie malnutrition,Anorexia nervosa,Neurogenic bladder NOS,Depressive disorder, not elsewhere classified,Chronic airway obstruction, not elsewhere classified,Other and unspecified anticonvulsants causing adverse effects in therapeutic use,Unspecified essential hypertension,Obsessive-compulsive disorders'}
