CHIEF COMPLAINT: intractable low back pain and R hip pain

PRESENT ILLNESS: Mr. [**Known lastname 17562**] is a 43 year old man with renal cell carcinoma
metastatic to the R sacral ala s/p IL2 and Cyberknife therapy on
the sacrum. Since [**Month (only) **] he developed numbness to the R toes,
which progressed to numbness up to the calf and some
dysesthesia. He was started on Neurontin without significant
benefit. Finally on [**10-20**] he underwent pelvic MRI which showed
progression of the sacral lesion. He had developed intractable
low back pain that seemed to be positional as well as right
lower extremity radiculopathy in an S1 distribution.

MEDICAL HISTORY: 1.  History of recurrent kidney stones dating as far back as
[**2146-2-19**].
2.  History of asymptomatic bradycardia which was thoroughly
evaluated by cardiology and no therapy was indicated.  Of note,
during anesthesia for his nephrectomy, he required atropine
treatment for bradycardia.
3.  GERD.
4.  Degenerative disc disease in the C-spine region.

MEDICATION ON ADMISSION: tylenol, prevacid, oxycodone, neurontin,zoloft

ALLERGIES: Codeine / Iodine / Glucocorticoids,Systemic Classifier /
Dilaudid

PHYSICAL EXAM: AOx3. Follows commands. Speech intact. Face symetric. No drift.
PERRLA. EOMI. Sensation intact in all four extremities. Moving
all extremities with full strength.

FAMILY HISTORY: nc

SOCIAL HISTORY: never smoked, [**12-27**] beer/month
married,kids
Secondary malignant neoplasm of bone and bone marrow,Acute posthemorrhagic anemia,Personal history of malignant neoplasm of kidney,Esophageal reflux,Degeneration of cervical intervertebral disc,Arthropathy, unspecified, shoulder region,Neoplasm related pain (acute) (chronic)
Secondary malig neo bone,Ac posthemorrhag anemia,Hx of kidney malignancy,Esophageal reflux,Cervical disc degen,Arthropathy NOS-shlder,Neoplasm related pain
Admission Date:  [**2150-1-29**]              Discharge Date:   [**2150-2-7**]

Date of Birth:  [**2106-4-22**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Codeine / Iodine / Glucocorticoids,Systemic Classifier /
Dilaudid

Attending:[**First Name3 (LF) 2724**]
Chief Complaint:
intractable low back pain and R hip pain

Major Surgical or Invasive Procedure:
[**2150-1-29**] PARTIAL SACRECTOMY
[**2150-2-2**] INSTRUMENTED SACRAL RECONSTRUCTION


History of Present Illness:
Mr. [**Known lastname 17562**] is a 43 year old man with renal cell carcinoma
metastatic to the R sacral ala s/p IL2 and Cyberknife therapy on
the sacrum. Since [**Month (only) **] he developed numbness to the R toes,
which progressed to numbness up to the calf and some
dysesthesia. He was started on Neurontin without significant
benefit. Finally on [**10-20**] he underwent pelvic MRI which showed
progression of the sacral lesion. He had developed intractable
low back pain that seemed to be positional as well as right
lower extremity radiculopathy in an S1 distribution.

Past Medical History:
1.  History of recurrent kidney stones dating as far back as
[**2146-2-19**].
2.  History of asymptomatic bradycardia which was thoroughly
evaluated by cardiology and no therapy was indicated.  Of note,
during anesthesia for his nephrectomy, he required atropine
treatment for bradycardia.
3.  GERD.
4.  Degenerative disc disease in the C-spine region.


Social History:
never smoked, [**12-27**] beer/month
married,kids

Family History:
nc

Physical Exam:
AOx3. Follows commands. Speech intact. Face symetric. No drift.
PERRLA. EOMI. Sensation intact in all four extremities. Moving
all extremities with full strength.

Pertinent Results:
MRI lumbar spine [**10-20**]
1. Large right sacroiliac lytic lesion expanding the right
sacral ala, with
narrowing abutting the right neural foramen at L5-S1.
Questionable expansion
into the right neural foramen, and if is present, probably
minimal.
2. Multilevel degenerative changes in the lumbar spine, worst at
level L4-L5.
3. Cystic lesions in the right kidney, incompletely
characterized.


Brief Hospital Course:
Pt was admitted and brought to OR for partial sacrectomy under
general anesthesia.  He had EBL of 14liters and received
replacement.  He remained intubated and was brought to TICU
postop and kept at flat bedrest until return to OR for fusion.
he was extubated the next morning.  Pain medication was
titrated.  Initially post op he had weakness of his right
plantar and dorsiflexors but was full strength by POD#2.  His
hematocrit was followed and he received transfusions with goal
of >25 by return to OR for fusion. He was transferred to the
floor in stable condition on [**1-31**]. On the evening of [**2-1**] he was
kept NPO and started on IVF in preparation for the OR on [**2-2**].
On [**2-2**] he returned to the OR for L4-S1 fusion with placement of
ileal screws and sacral reconstruction. He tolerated this
procedure well with no complication. Post operatively he was
transferred to the ICU for continued monitoring. On post op exam
he was doing well. His strength was full and his incisions were
clean and dry. He was started on a morphine PCA for pain control
with relief. On [**2-3**] he was transferred to the floor in stable
condition. His PCA was discontinued and he was started on
oxycontin 30mg q12 and the pain managment team was consulted for
help in controlling his pain. Recommendations per the pain team
were to titrate the long acting oxycontin based on his PRN pain
medication needs.  He was transfused 2 units of PRBCs on [**2-4**]
for a HCT of 24.  Post transfusion HCT was 27.8.  When his pain
was adequately controlled he began working with Physical Therapy
and workup was started on his right shoulder pain that included
an x ray. R shoulder x ray showed no fracture and was consistent
with arthritic changes. His shoulder pain did improve over his
stay and will follow up with his PCP for further workup as
needed. On [**2-5**] his oxycontin was increased to 40mg [**Hospital1 **] per pain
team recomendations. He was able to get OOB and obtain his
upright L spine x rays on [**2-6**] and these showed good placement
of surgical hardware.

He was discharged home on [**2-7**] with a PT order.


Medications on Admission:
tylenol, prevacid, oxycodone, neurontin,zoloft

Discharge Medications:
1. oxycodone 10 mg Tablet Sustained Release 12 hr [**Month/Year (2) **]: Four (4)
Tablet Sustained Release 12 hr PO twice a day.
Disp:*240 Tablet Sustained Release 12 hr(s)* Refills:*0*
2. acetaminophen 325 mg Tablet [**Month/Year (2) **]: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain or fever.
3. gabapentin 300 mg Capsule [**Month/Year (2) **]: Two (2) Capsule PO BID (2
times a day).
4. docusate sodium 100 mg Capsule [**Month/Year (2) **]: One (1) Capsule PO BID (2
times a day).
5. sertraline 50 mg Tablet [**Month/Year (2) **]: One (1) Tablet PO DAILY (Daily).

6. senna 8.6 mg Tablet [**Month/Year (2) **]: 1-2 Tablets PO BID (2 times a day).

7. bisacodyl 5 mg Tablet, Delayed Release (E.C.) [**Month/Year (2) **]: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
8. Valium 5 mg Tablet [**Month/Year (2) **]: One (1) Tablet PO every eight (8)
hours as needed for Spasm.
Disp:*90 Tablet(s)* Refills:*0*
9. lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
10. oxycodone 10 mg Tablet [**Last Name (STitle) **]: 1-2 Tablets PO every four (4)
hours as needed for pain.
Disp:*120 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 82643**] ME Home Health

Discharge Diagnosis:
Metastatic renal cell carcinoma


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


Discharge Instructions:
??????        Do not smoke
??????        Keep wound clean / No tub baths or pools until seen in
follow up/ remove dressing POD#2   / begin daily showers POD#4
??????        If you have steri-strips in place ?????? keep dry x 72
hours.  Do not pull them off. They will fall off on their own or
be taken off in the office
??????        No pulling up, lifting> 10 lbs., excessive bending or
twisting for two weeks then increase as tolerated.
??????        Limit your use of stairs to 2-3 times per day
??????        Have a family member check your incision daily for
signs of infection
??????        Take pain medication as instructed; you may find it
best if taken in the a.m. when you wake for morning stiffness
and before bed for sleeping discomfort
??????        Do not take any anti-inflammatory medications such as
Motrin, Advil, aspirin, Ibuprofen etc. for 3 months to promote
fusion.
??????        Increase your intake of fluids and fiber as pain
medicine (narcotics) can cause constipation

Followup Instructions:
PLEASE RETURN TO THE OFFICE 10 DAYS FOR REMOVAL OF YOUR
STAPLES/SUTURES. Please call to make this appointment.

PLEASE CALL [**Telephone/Fax (1) **] TO SCHEDULE AN APPOINTMENT WITH DR.
[**Last Name (STitle) **] TO BE SEEN IN 6 WEEKS.
YOU WILL NEED XRAYS PRIOR TO YOUR APPOINTMENT



Completed by:[**2150-2-7**]
{'Secondary malignant neoplasm of bone and bone marrow,Acute posthemorrhagic anemia,Personal history of malignant neoplasm of kidney,Esophageal reflux,Degeneration of cervical intervertebral disc,Arthropathy, unspecified, shoulder region,Neoplasm related pain (acute) (chronic)'}


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: intractable low back pain and R hip pain

PRESENT ILLNESS: Mr. [**Known lastname 17562**] is a 43 year old man with renal cell carcinoma
metastatic to the R sacral ala s/p IL2 and Cyberknife therapy on
the sacrum. Since [**Month (only) **] he developed numbness to the R toes,
which progressed to numbness up to the calf and some
dysesthesia. He was started on Neurontin without significant
benefit. Finally on [**10-20**] he underwent pelvic MRI which showed
progression of the sacral lesion. He had developed intractable
low back pain that seemed to be positional as well as right
lower extremity radiculopathy in an S1 distribution.

MEDICAL HISTORY: 1.  History of recurrent kidney stones dating as far back as
[**2146-2-19**].
2.  History of asymptomatic bradycardia which was thoroughly
evaluated by cardiology and no therapy was indicated.  Of note,
during anesthesia for his nephrectomy, he required atropine
treatment for bradycardia.
3.  GERD.
4.  Degenerative disc disease in the C-spine region.

MEDICATION ON ADMISSION: tylenol, prevacid, oxycodone, neurontin,zoloft

ALLERGIES: Codeine / Iodine / Glucocorticoids,Systemic Classifier /
Dilaudid

PHYSICAL EXAM: AOx3. Follows commands. Speech intact. Face symetric. No drift.
PERRLA. EOMI. Sensation intact in all four extremities. Moving
all extremities with full strength.

FAMILY HISTORY: nc

SOCIAL HISTORY: never smoked, [**12-27**] beer/month
married,kids 

### Response:
{'Secondary malignant neoplasm of bone and bone marrow,Acute posthemorrhagic anemia,Personal history of malignant neoplasm of kidney,Esophageal reflux,Degeneration of cervical intervertebral disc,Arthropathy, unspecified, shoulder region,Neoplasm related pain (acute) (chronic)'}
