CHIEF COMPLAINT: Back pain

PRESENT ILLNESS: Ms. [**Known lastname 13469**] has a long history of back pain due to scoliosis.  She
has attempted conservative therapy but continues to experience
back pain.  She now is electing to proceed with surgical
intervention.

MEDICAL HISTORY: Scoliosis
PM/SH:
HTN
depression/anxiety
chronic back pain on opioid therapy
Appy [**2115**]
chole [**2128**]
tubal ligation [**2102**]
rotator cuff [**2127**]
tonsils out as child

MEDICATION ON ADMISSION: diltiazem
alprazolam
escitalopram

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: A&O X 3; NAD
RRR
CTA B
Abd soft NT/ND
BUE- good strength at deltoid, biceps, triceps, wrist
flexion/extension, finger flexion/extension and intrinics;
sensation intact C5-T1 dermatomes; - [**Doctor Last Name 937**], reflexes
symmetric at biceps, triceps and brachioradialis
BLE- good strength at hip flexion/extension, knee
flexion/extension, ankle dorsiflexion and plantar flexion,
[**Last Name (un) 938**]/FHL; sensation intact L1-S1 dermatomes; - clonus, reflexes
symmetric at quads and Achilles

FAMILY HISTORY: N/C

SOCIAL HISTORY: Denies tobacco
Scoliosis [and kyphoscoliosis], idiopathic,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Opioid type dependence, continuous,Degeneration of thoracic or thoracolumbar intervertebral disc,Other acute postoperative pain,Leukocytosis, unspecified,Postprocedural fever,Unspecified essential hypertension,Other conditions of brain,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Late effects of unspecified accident,Dysthymic disorder
Idiopathic scoliosis,Hemorrhage complic proc,Ac posthemorrhag anemia,Opioid dependence-contin,Thoracic disc degen,Acute postop pain NEC,Leukocytosis NOS,Postprocedural fever,Hypertension NOS,Brain conditions NEC,Ocl crtd art wo infrct,Late eff accident NOS,Dysthymic disorder
Admission Date:  [**2131-3-5**]              Discharge Date:   [**2131-3-19**]

Date of Birth:  [**2071-7-31**]             Sex:   F

Service: ORTHOPAEDICS

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 3190**]
Chief Complaint:
Back pain

Major Surgical or Invasive Procedure:
Anterior/posterior fusion with instrumentation T3-S1

History of Present Illness:
Ms. [**Known lastname 13469**] has a long history of back pain due to scoliosis.  She
has attempted conservative therapy but continues to experience
back pain.  She now is electing to proceed with surgical
intervention.

Past Medical History:
Scoliosis
PM/SH:
HTN
depression/anxiety
chronic back pain on opioid therapy
Appy [**2115**]
chole [**2128**]
tubal ligation [**2102**]
rotator cuff [**2127**]
tonsils out as child


Social History:
Denies tobacco

Family History:
N/C

Physical Exam:
A&O X 3; NAD
RRR
CTA B
Abd soft NT/ND
BUE- good strength at deltoid, biceps, triceps, wrist
flexion/extension, finger flexion/extension and intrinics;
sensation intact C5-T1 dermatomes; - [**Doctor Last Name 937**], reflexes
symmetric at biceps, triceps and brachioradialis
BLE- good strength at hip flexion/extension, knee
flexion/extension, ankle dorsiflexion and plantar flexion,
[**Last Name (un) 938**]/FHL; sensation intact L1-S1 dermatomes; - clonus, reflexes
symmetric at quads and Achilles


Pertinent Results:
[**2131-3-19**] 04:30AM BLOOD WBC-11.9* RBC-3.09* Hgb-9.5* Hct-28.1*
MCV-91 MCH-30.8 MCHC-33.7 RDW-14.9 Plt Ct-1088*
[**2131-3-18**] 09:00AM BLOOD WBC-12.0* RBC-3.12* Hgb-9.6* Hct-28.2*
MCV-91 MCH-30.9 MCHC-34.1 RDW-14.8 Plt Ct-1019*
[**2131-3-17**] 04:57AM BLOOD WBC-14.1* RBC-3.01* Hgb-9.2* Hct-27.1*
MCV-90 MCH-30.4 MCHC-33.8 RDW-14.9 Plt Ct-806*
[**2131-3-16**] 09:05AM BLOOD WBC-16.1* RBC-3.01* Hgb-9.1* Hct-27.6*
MCV-92 MCH-30.4 MCHC-33.1 RDW-14.6 Plt Ct-672*
[**2131-3-15**] 05:05AM BLOOD WBC-16.5* RBC-3.07* Hgb-9.4* Hct-28.5*
MCV-93 MCH-30.6 MCHC-32.9 RDW-14.9 Plt Ct-652*
[**2131-3-14**] 09:38AM BLOOD WBC-16.0* RBC-3.25* Hgb-9.9* Hct-29.9*
MCV-92 MCH-30.5 MCHC-33.2 RDW-14.9 Plt Ct-537*
[**2131-3-13**] 07:35PM BLOOD WBC-14.6* RBC-3.25* Hgb-10.0* Hct-29.6*
MCV-91 MCH-30.6 MCHC-33.7 RDW-14.8 Plt Ct-502*
[**2131-3-13**] 05:30AM BLOOD WBC-14.7* RBC-3.27* Hgb-10.0* Hct-29.4*
MCV-90 MCH-30.8 MCHC-34.2 RDW-14.9 Plt Ct-517*
[**2131-3-12**] 04:20AM BLOOD WBC-11.5* RBC-3.25* Hgb-9.8* Hct-29.0*
MCV-89 MCH-30.1 MCHC-33.8 RDW-14.7 Plt Ct-357
[**2131-3-11**] 01:45AM BLOOD WBC-10.3 RBC-2.97* Hgb-9.2* Hct-26.3*
MCV-89 MCH-31.0 MCHC-35.0 RDW-14.8 Plt Ct-266
[**2131-3-10**] 09:46AM BLOOD WBC-9.4 RBC-3.18* Hgb-9.8* Hct-28.3*
MCV-89 MCH-30.8 MCHC-34.7 RDW-15.1 Plt Ct-226
[**2131-3-9**] 02:14PM BLOOD WBC-9.6 RBC-3.07* Hgb-9.5* Hct-26.9*
MCV-88 MCH-31.1 MCHC-35.5* RDW-15.3 Plt Ct-201
[**2131-3-16**] 09:05AM BLOOD Glucose-112* UreaN-5* Creat-0.4 Na-135
K-3.7 Cl-99 HCO3-29 AnGap-11
[**2131-3-12**] 04:20AM BLOOD Glucose-106* UreaN-6 Creat-0.4 Na-137
K-3.7 Cl-100 HCO3-31 AnGap-10
[**2131-3-11**] 01:45AM BLOOD Glucose-134* UreaN-6 Creat-0.3* Na-139
K-3.3 Cl-101 HCO3-32 AnGap-9
[**2131-3-10**] 02:12AM BLOOD Glucose-122* UreaN-9 Creat-0.3* Na-138
K-3.5 Cl-102 HCO3-33* AnGap-7*
[**2131-3-9**] 03:52AM BLOOD Glucose-100 UreaN-13 Creat-0.4 Na-141
K-3.7 Cl-106 HCO3-29 AnGap-10
[**2131-3-15**] 05:05AM BLOOD ALT-34 AST-26 LD(LDH)-336* AlkPhos-152*
TotBili-0.3
[**2131-3-16**] 09:05AM BLOOD Calcium-8.1* Phos-2.7 Mg-1.9
[**2131-3-11**] 01:32PM BLOOD Calcium-7.8* Phos-2.1* Mg-2.0
[**2131-3-10**] 02:12AM BLOOD Calcium-7.6* Phos-1.4* Mg-1.9
[**2131-3-13**] 07:35PM BLOOD CRP-217.6*

Brief Hospital Course:
Ms. [**Known lastname 13469**] was admitted to the [**Hospital1 18**] Spine Surgery Service on
[**2131-3-5**] and taken to the Operating Room for L3-S1 interbody
fusion through an anterior approach. Please refer to the
dictated operative note for further details. The surgery was
without complication and the patient was transferred to the PACU
in a stable condition. TEDs/pnemoboots were used for
postoperative DVT prophylaxis. Intravenous antibiotics were
given per standard protocol. Initial postop pain was controlled
with a PCA. On HD#2 she returned to the operating room for a
scheduled T11-L3 anterior fusion through a thoractomy. Please
refer to the dictated operative note for further details. The
second surgery was also without complication and the patient was
transferred to the PACU in a stable condition. Postoperative HCT
was stable. HD#3 she returned for a scheduled T4-S1 posterior
fusion. Postoperative hematocrit was low and she was transfused
multiple units of packed cells and platelets.  She was
transfered to the T/SICU from close monitoring.  Her chest tube
was removed POD2 from the third procedure.  A bupivicaine
epidural pain catheter placed at the time of the posterior
surgery remained in place until postop day one from the third
procedure. She was kept NPO until bowel function returned then
diet was advanced as tolerated.
She developed a persistently elevated white count and a medical
consult was obtained.  A thorough workup was conducted but
returned negative for a source.  She remained afebrile and on
HD#9 her leukocytosis decreased.
The patient was transitioned to oral pain medication when
tolerating PO diet. Foley was removed on POD#3 from the third
procedure. She was fitted with a lumbar warm-n-form brace for
comfort. Physical therapy was consulted for mobilization OOB to
ambulate. Hospital course was otherwise unremarkable. On the day
of discharge the patient was afebrile with stable vital signs,
comfortable on oral pain control and tolerating a regular diet.

Medications on Admission:
diltiazem
alprazolam
escitalopram

Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. gabapentin 300 mg Capsule Sig: Two (2) Capsule PO TID (3
times a day).
Disp:*180 Capsule(s)* Refills:*2*
3. diltiazem HCl 240 mg Capsule, Extended Release Sig: One (1)
Capsule, Extended Release PO DAILY (Daily).
4. morphine 30 mg Tablet Extended Release Sig: One (1) Tablet
Extended Release PO Q8H (every 8 hours).
Disp:*90 Tablet Extended Release(s)* Refills:*0*
5. cyclobenzaprine 10 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
Disp:*90 Tablet(s)* Refills:*2*
6. hydromorphone 2 mg Tablet Sig: 2-4 Tablets PO Q4H (every 4
hours) as needed for PRN Pain.
Disp:*100 Tablet(s)* Refills:*0*
7. alprazolam 0.25 mg Tablet Sig: Two (2) Tablet PO TID (3 times
a day) as needed for anxiety.
8. escitalopram 10 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).


Discharge Disposition:
Home with Service

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
Scoliosis
Acute post-op blood loss anemia


Discharge Condition:
Good

Discharge Instructions:
You have undergone the following operation: ANTERIOR/Lateral/
POSTERIOR Thoracolumbar Decompression With 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 or stand
more than ~45 minutes without getting up and walking around.



-Rehabilitation/ Physical Therapy:

o2-3 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.


oLimit any kind of lifting.



-Diet: Eat a normal healthy diet. You may have some constipation
after surgery. You have been given medication to help with this
issue.



-Brace: You have been given a brace. This brace is to be worn
for comfort when you are walking. You may take it off when
sitting in a chair or while lying in bed.



-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. Cover it with a sterile dressing. Call the
office.



-You should resume taking your normal home medications. No
NSAIDs.



-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 or fax narcotic
prescriptions (oxycontin, oxycodone, percocet) to your 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 and/or drainage from your wound.


Physical Therapy:
 Activity:  Activity as tolerated
 Thoracic lumbar spine:   when OOB
TLSO when OOB

Treatment Frequency:
Please continue to change the dressings daily with dry, sterile
gauze.

Followup Instructions:
With Dr. [**Last Name (STitle) 363**] in 10 days


Completed by:[**2131-3-22**]
{'Scoliosis [and kyphoscoliosis], idiopathic,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Opioid type dependence, continuous,Degeneration of thoracic or thoracolumbar intervertebral disc,Other acute postoperative pain,Leukocytosis, unspecified,Postprocedural fever,Unspecified essential hypertension,Other conditions of brain,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Late effects of unspecified accident,Dysthymic disorder'}


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: Back pain

PRESENT ILLNESS: Ms. [**Known lastname 13469**] has a long history of back pain due to scoliosis.  She
has attempted conservative therapy but continues to experience
back pain.  She now is electing to proceed with surgical
intervention.

MEDICAL HISTORY: Scoliosis
PM/SH:
HTN
depression/anxiety
chronic back pain on opioid therapy
Appy [**2115**]
chole [**2128**]
tubal ligation [**2102**]
rotator cuff [**2127**]
tonsils out as child

MEDICATION ON ADMISSION: diltiazem
alprazolam
escitalopram

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: A&O X 3; NAD
RRR
CTA B
Abd soft NT/ND
BUE- good strength at deltoid, biceps, triceps, wrist
flexion/extension, finger flexion/extension and intrinics;
sensation intact C5-T1 dermatomes; - [**Doctor Last Name 937**], reflexes
symmetric at biceps, triceps and brachioradialis
BLE- good strength at hip flexion/extension, knee
flexion/extension, ankle dorsiflexion and plantar flexion,
[**Last Name (un) 938**]/FHL; sensation intact L1-S1 dermatomes; - clonus, reflexes
symmetric at quads and Achilles

FAMILY HISTORY: N/C

SOCIAL HISTORY: Denies tobacco 

### Response:
{'Scoliosis [and kyphoscoliosis], idiopathic,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Opioid type dependence, continuous,Degeneration of thoracic or thoracolumbar intervertebral disc,Other acute postoperative pain,Leukocytosis, unspecified,Postprocedural fever,Unspecified essential hypertension,Other conditions of brain,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Late effects of unspecified accident,Dysthymic disorder'}
