CHIEF COMPLAINT: back pain

PRESENT ILLNESS: 66 year old male with known metastatic thyroid CA to spine,
brain, ribs presented to Dr.[**Name (NI) 6767**] office for routine follow-up
today. The patient has back pain but no numbness or tingling.
The
pain in his back is more of a dull ache and is not nearly as
painful as the pain he had in his neck prior to the cyberknife
treatment he had at C1 in [**Month (only) 958**] of this year. He has not had any
urinary incontinence but did notice stool staining in his
underwear twice this week when he woke up in the morning. He has
had controlled bowel movements since then and reports no loss of
sensation in the groin or buttock region.

MEDICAL HISTORY: Metastatic Thyroid Ca
HTN
Atrial Fibrillation
Pulmonary Embolus [**1-28**] - Anticoagulated with coumadin; has
two small lesions on MRI head c/w mets but not contraindications

MEDICATION ON ADMISSION: AMIODARONE - 200 mg Tablet - 1 Tablet(s) by mouth once a day
ATENOLOL - 25 mg Tablet - 1 Tablet(s) by mouth once a day
ENOXAPARIN [LOVENOX]- 40 mg/0.4 mL Syringe
GABAPENTIN - 300 mg Capsule - 1 Capsule(s) by mouth twice a day
LEVOTHYROXINE - 200 mcg Tablet - 1 Tablet(s) by mouth once a day
LEVOTHYROXINE - 25 mcg Tablet - 0.5 (One half) Tablet(s) by
                mouth Mon, Wed, Fri
OXYCODONE [OXYCONTIN] - 40 mg Tablet SustSR 12 hr - 1 Tablet(s)
                        by mouth three times a day
DOCUSATE SODIUM - 100 mg - 1 Capsule(s) by mouth twice a day

ALLERGIES: Iodine; Iodine Containing

PHYSICAL EXAM: PHYSICAL EXAM:
T:98.2  BP:125/60    HR:54    RR:16       O2Sats:95% RA
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRL        EOMs-intact
Neck: In cervical collar. Surgical incision well-healed.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Spine: No point tenderness.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Motor:
      D    B     T    FE   FF    IP    Q     AT    [**Last Name (un) 938**]    G
R     5    5     5    5    5     5     5     5     5      5
L     5    5     5    5    5     5     5     5     5      5

FAMILY HISTORY: Mother with h/o emphysema.

SOCIAL HISTORY: Lives with wife.  [**Name (NI) 1403**] part time in real estate building and
development and is still currently working.  Retired from full
time work in [**2157-9-22**].
Smoked approximately 30 years ago (quit in [**2126**])
EtOH: drinks 1 glass wine/day
Secondary malignant neoplasm of bone and bone marrow,Pneumonia due to Pseudomonas,Myelopathy in other diseases classified elsewhere,Secondary malignant neoplasm of lung,Acute posthemorrhagic anemia,Blood in stool,Delirium due to conditions classified elsewhere,Unspecified pleural effusion,Unspecified protein-calorie malnutrition,Ulcer of anus and rectum,Disruption of external operation (surgical) wound,Thrombocytopenia, unspecified,Atrial fibrillation,Personal history of malignant neoplasm of thyroid,Other specified disorders of skin,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Other postablative hypothyroidism,Hip joint replacement,Herpes simplex without mention of complication,Obstructive sleep apnea (adult)(pediatric),Other iatrogenic hypotension,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Secondary malig neo bone,Pseudomonal pneumonia,Myelopathy in oth dis,Secondary malig neo lung,Ac posthemorrhag anemia,Blood in stool,Delirium d/t other cond,Pleural effusion NOS,Protein-cal malnutr NOS,Rectal & anal ulcer,Disrup-external op wound,Thrombocytopenia NOS,Atrial fibrillation,Hx of thyroid malignancy,Skin disorders NEC,Hypertension NOS,Hx-ven thrombosis/embols,Long-term use anticoagul,Postablat hypothyr NEC,Joint replaced hip,Herpes simplex NOS,Obstructive sleep apnea,Iatrogenc hypotnsion NEC,Abn react-procedure NEC
Admission Date:  [**2160-8-1**]              Discharge Date:   [**2160-9-8**]

Date of Birth:  [**2093-10-4**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Iodine; Iodine Containing

Attending:[**First Name3 (LF) 2724**]
Chief Complaint:
back pain

Major Surgical or Invasive Procedure:
Resection of T5 tumor, lateral extra cavitary T9 vertebrectomy,
and posterior instrumented fusion from T2-T11.

Left-sided thoracentesis

tracheotomy

Peg placement


History of Present Illness:
66 year old male with known metastatic thyroid CA to spine,
brain, ribs presented to Dr.[**Name (NI) 6767**] office for routine follow-up
today. The patient has back pain but no numbness or tingling.
The
pain in his back is more of a dull ache and is not nearly as
painful as the pain he had in his neck prior to the cyberknife
treatment he had at C1 in [**Month (only) 958**] of this year. He has not had any
urinary incontinence but did notice stool staining in his
underwear twice this week when he woke up in the morning. He has
had controlled bowel movements since then and reports no loss of
sensation in the groin or buttock region.

The patient noticed that his right leg felt slightly weaker
recently, but he had a right hip replacement and attributed the
weakness to that surgery.  The patient had an MRI of the
thoracic
spine which showed a new large lesion almost completely
occluding
the canal. Dr. [**Last Name (STitle) 724**] sent him to the ER for neurosurgical
evaluation.


Past Medical History:
Metastatic Thyroid Ca
HTN
Atrial Fibrillation
Pulmonary Embolus [**1-28**] - Anticoagulated with coumadin; has
two small lesions on MRI head c/w mets but not contraindications

to anticoag.
Hypothyroidism

Social History:
Lives with wife.  [**Name (NI) 1403**] part time in real estate building and
development and is still currently working.  Retired from full
time work in [**2157-9-22**].
Smoked approximately 30 years ago (quit in [**2126**])
EtOH: drinks 1 glass wine/day


Family History:
Mother with h/o emphysema.

Physical Exam:
PHYSICAL EXAM:
T:98.2  BP:125/60    HR:54    RR:16       O2Sats:95% RA
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRL        EOMs-intact
Neck: In cervical collar. Surgical incision well-healed.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Spine: No point tenderness.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Motor:
      D    B     T    FE   FF    IP    Q     AT    [**Last Name (un) 938**]    G
R     5    5     5    5    5     5     5     5     5      5
L     5    5     5    5    5     5     5     5     5      5

Sensation: Intact to light touch bilaterally. No sensory loss in
thoracic region or in legs.

Reflexes: Pa  Ac
Right     2+  1+
Left      3+  1+

Toes downgoing bilaterally
No clonus


Pertinent Results:
MRI of the thoracic and lumbar spine. [**2160-8-1**]

IMPRESSION: Bony metastatic disease involving the T4, T5, T9,
and T10
vertebrae. Spinous process metastasis at T5 indents the spinal
cord and
results in 50% narrowing of the spinal canal with slight
indentation on the spinal cord. Epidural metastasis on the right
side of the spinal canal at T9 level displaces the spinal cord
to the left side and results in slightly more than 50% narrowing
of the spinal canal with moderate cord compression. Other
changes as described above.

IMPRESSION: Bony metastasis to right pedicle and body of the L1
and superior portion of L2 vertebra as described above. No
evidence of epidural mass or spinal cord compression.

BONE SCAN. [**8-4**]

IMPRESSION: 1. Osseous metastasis in multiple levels of the
thoracic and lumbar spine as described above. Uptake in some
vertebrae might be related to degenerative changes but a
differentiation cannot be made on the base of this study. 2.
Osseous metastasis involving multiple bilateral ribs. 3. Osseous
metastasis involving bilateral distal femora. 4. Increased
uptake surrounding the femoral component of the right hip
prosthesis in the right acetabulum likely related to
post-operative changes. However, residual underlying metastasis
cannot be ruled out completely.







[**2160-9-8**] 05:30AM BLOOD WBC-7.3 RBC-3.72* Hgb-10.8* Hct-32.0*
MCV-86 MCH-29.0 MCHC-33.7 RDW-17.3* Plt Ct-74*
[**2160-9-2**] 06:15AM BLOOD Hypochr-NORMAL Anisocy-OCCASIONAL
Poiklo-NORMAL Macrocy-OCCASIONAL Microcy-NORMAL
Polychr-OCCASIONAL
[**2160-9-8**] 05:30AM BLOOD Plt Ct-74*
[**2160-9-8**] 05:30AM BLOOD Glucose-115* UreaN-17 Creat-0.6 Na-131*
K-4.5 Cl-97 HCO3-27 AnGap-12
[**2160-9-4**] 04:02AM BLOOD ALT-65* AST-22 AlkPhos-59 TotBili-0.5
[**2160-9-3**] 02:10AM BLOOD proBNP-1249*
[**2160-9-8**] 05:30AM BLOOD Calcium-8.2* Phos-2.5* Mg-2.2
[**2160-8-18**] 03:18PM BLOOD Hapto-165
[**2160-8-14**] 04:02AM BLOOD Homocys-7.8
[**2160-8-14**] 02:49PM BLOOD Ammonia-<6
[**2160-8-14**] 02:49PM BLOOD T4-4.7 T3-24*
[**2160-8-15**] 12:05PM BLOOD Cortsol-20.7*
[**2160-8-24**] 02:44AM BLOOD Digoxin-1.0

Brief Hospital Course:
The patient was admitted to the neurological surgery service on
[**8-1**] for treatment.  On admission, he was started on
dexamethasone, maintained on levonox fo prior history of
pulmonary embolism and maintained in a TLSO.  In preparation for
surgery on [**8-4**], a medicine consultation was obtained for
surgical risk stratification. CT exam also showed a T9
destructive lesion.  Also, bone scan showed evidience of mets at
multiple levels of the thoracic and lumbar spine, ribs, and
femurs.

On [**8-5**] he had an embolization by Dr. [**First Name (STitle) **] and on [**8-7**] he had
T1-T12 Fusion.
On [**8-8**] he had good strength but was not following commands. He
received 2u PRBC and his repeat HCT was 28.9 On [**8-10**] Sputum Cx
sent. SVT w/[**Month/Year (2) 5509**] so a dilt drip was started. One drain was
removed.

On [**8-12**] bilateral pleural effusions were tapped by IR and on the
following day the 2nd drain out was removed and he was
extubated.  On [**8-14**] he was re-intubated. The next day his mental
status improved, was following some commands and went to the OR
for trach/peg. He tolerated the procedure well and was
transitioned to a trach mask on [**8-16**].

On [**8-18**] he had A-fib with rapid rate and was on esmolol drip.
Staples were removed that day. The esmolol was turned off on
[**8-19**] and he was transferred to the step down unit. The patient
had drainage from the JP site so a chest CT was obtained which
did not show pleural or thoracic fistula. On [**8-21**] he was in
a-fib again with [**Month/Day (4) 5509**] and was sent back to the ICU. Cardiology
was consulted to help manage his heart rate/rhythm. He converted
to sinus rhythm while in the ICU.

The patient had drainage from his JP site on [**8-24**] that was
purulent, tan, thick material. On [**8-25**] thoracics was consulted
and they determined that there was no indication for surgery
since the pleural effusions were improved. It appeared that the
drainage was only from the JP site and not from the previous
thoracentesis site. The JP site was still leaking but the
drainage was thin and yellowish. Dr. [**Last Name (STitle) 548**] placed new sutures
over the area and by the next day ([**8-26**]) the site was completely
dry the sutures need to stay in place until [**9-12**]

On [**8-24**] a sputum culture came bac positive for pseudomonas so
Zosyn was started. ID was consulted and agreed that this should
be continued for 7 days. The drainage from the JP site grew out
proteus for which Zosyn was also appropriate. Mr. [**Known lastname 20598**] was
treated for HSV 1 infection on his lips with acyclovir as well.

He was transferred to step down unit again on [**8-26**] but then to
the MICU on [**8-28**] for lower GI bleed and melena. Pt was transfused
1 U prbcs and underwent a colonoscopy which showed:Polyp in the
ascending colon, Diverticulosis of the left > right, Ulcers in
the distal rectum (biopsy. Recommendations from GI were:
Follow-up pathology results. Hold anticoagulation for now and
avoid rectal tubes.
He was transferred to the MICU service on two different
occassions due to a GI bleed and atrial fibrillation.

Brief MICU course:

# Afib with [**Month/Day (4) 5509**].  Has had intermittent Afib in past, on amio for
rhythm control as well as metoprolol.  Metoprolol just restarted
today.  Precipitant now unclear - hypovolemia, hypervolemia,
infection/sepsis, PE, other pulmonary disease, hyperthyroidism.
Appears slightly dry on exam (crackles asymmetric).  Getting T4
replacement though not currently, appears to have been lost
during transfer (last [**8-21**]).  Has been on dilt gtt in past
during admit.  Did not respond to 10 IV dilt and 10 IV
lopressor.  BP holding >90.  BP responsive to 500 cc bolus.
Initially on esmolol gtt, now d/c??????d and getting Metoprolol PO.
Echo showed no effusion, EF 55%, leaflets normal but limited
study.  On readmission to MICU, his TSH was found to be 15.
There was concern for PE given the patient's history, but LENIs
were negative.  Pt had another episode of rapid rates to 180s on
the morning of [**9-3**] which transiently decreased with lopressor
and resolved after 750 mL NS bolus.  Amiodarone was returned to
former dosing of 200 mg [**Hospital1 **].
.
#Hypothyroidism.  Current transfer meds did not include
levothyroxine and apparently this med had been held since
transfer on [**8-21**] (not reordered in transfer orders). Continued
Synthroid at home dosing plus 200mcg daily. Will need close f/u
of TSH in coming days and weeks to correctly dose levothyroxine.

# Hypoxemia.  After transfer to the MICU, was requiring more O2
than prior transfer (50% TM at the time, now 70-100%).  Desat to
80s on [**9-2**], improved after Atrovent neb.  Over remainder of
stay requred 50-70% FiO2 on trach mask.  There was intially
concern for infiltrate on his CXR, so his Zosyn was continued
until [**2160-9-4**].  An intial BNP 1727, which decreased to 1200s the
next day.  Given concern for PE,  LENIs were performed and were
negative.

- Also tried to wean sedating meds including neuroleptics and
pain meds.
.
#Metastatic papillary CA: S/p recent T1-T12 palliative
decompression and fusion on [**2160-8-7**] with known brain, bone and
soft tissue mets.

-No active treatment for now, long-term plan of care per
Neurosurgery
.
# LGIB: In the setting of anticoagulation with Lovenox (60mg
[**Hospital1 **]) for a history of PE in the past.  3 unit PRBC transfusion
but now stable.  Ulcers on colonoscopy, bx showed no evidence of
malignancy, but acute and chronic inflammation consistent with
ulcer. Pt has been continued on [**Hospital1 **] PPI as per GI recs.  Daily
Hcts have been stable in MICU.
.
# Pseudomonas VAP: Pt with Pseudomonas in sputum from [**8-25**] and on
Zosyn since [**8-23**]. 10 day course extended until [**9-4**] given
hypoxemia and concern for infiltrate on CXR.  Added vanc/cipro
[**2160-8-31**],  d/c'd cipro [**2160-9-2**].  Vancomycin was d/c'd on [**9-3**]
when the sputum culture from [**9-1**] failed to show any growth.

# Delirium: Pt with history of delirium that began this
admission. Previously had been working. requires frequent
reorientation. Has been getting zyprexa prn, however attempting
to decrease amount of sedation.
.
# Leukocytosis: Stable in the 10K range.

.
# h/o PE: Pt with history of DVT/PE in [**2159-1-22**]. On
anticoag at therapeutic dosing earlier during admit (when had
GIB); also with history of hemoptysis presumably from lung mets;
also known brain mets. Given his recent GI bleed and hemoptysis
we decided to use heparin sq only

#Thrombocytopenia: Plt count recovering from nadir of 38LK -->
89K, now 74K
Unclear if thrombocytopenia was medication related. Stable.
.

#Prophy: Pneumoboots, PPI.#
.
#Code: FULL
.
Goals of care when speaking with Mrs [**Known lastname 20598**] is to get Mr
[**Known lastname 20598**] home with services if possible. We discussed possible
Hospice but she does not want to consider that option at this
point.

On discharge Mr [**Known lastname 20598**] was awake, alert, orientated x3
comfortable with full strenght in his lower extremities, his
wound was healing no erthyema. He had low grade temps 99 range
he had full work up given his complicated medical history. His
UA and CXR were negative for infection, blood cultures are
pending. He continues to receive tube feeds but has also passed
a swallow test for ground food. His trach can be down sized.

Medications on Admission:
AMIODARONE - 200 mg Tablet - 1 Tablet(s) by mouth once a day
ATENOLOL - 25 mg Tablet - 1 Tablet(s) by mouth once a day
ENOXAPARIN [LOVENOX]- 40 mg/0.4 mL Syringe
GABAPENTIN - 300 mg Capsule - 1 Capsule(s) by mouth twice a day
LEVOTHYROXINE - 200 mcg Tablet - 1 Tablet(s) by mouth once a day
LEVOTHYROXINE - 25 mcg Tablet - 0.5 (One half) Tablet(s) by
                mouth Mon, Wed, Fri
OXYCODONE [OXYCONTIN] - 40 mg Tablet SustSR 12 hr - 1 Tablet(s)
                        by mouth three times a day
DOCUSATE SODIUM - 100 mg - 1 Capsule(s) by mouth twice a day


Discharge Medications:
1. Acetaminophen 325 mg Tablet [**Known lastname **]: 1-2 Tablets PO Q6H (every 6
hours) as needed.
2. Heparin (Porcine) 5,000 unit/mL Solution [**Known lastname **]: One (1)
Injection TID (3 times a day).
3. Senna 8.6 mg Tablet [**Known lastname **]: One (1) Tablet PO BID (2 times a
day) as needed.
4. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) [**Known lastname **]: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
5. Docusate Sodium 50 mg/5 mL Liquid [**Known lastname **]: One (1)  PO BID (2
times a day).
6. Gabapentin 250 mg/5 mL Solution [**Known lastname **]: One (1)  PO BID (2 times
a day).
7. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
8. Olanzapine 5 mg Tablet, Rapid Dissolve [**Last Name (STitle) **]: One (1) Tablet,
Rapid Dissolve PO QHS (once a day (at bedtime)).
9. Mupirocin Calcium 2 % Cream [**Last Name (STitle) **]: One (1) Appl Topical [**Hospital1 **] (2
times a day).
10. Ipratropium Bromide 17 mcg/Actuation Aerosol [**Hospital1 **]: Six (6)
Puff Inhalation QID (4 times a day) as needed for wheeze or
shortness of breath.
11. Amiodarone 200 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times
a day).
12. Levothyroxine 100 mcg Tablet [**Hospital1 **]: Two (2) Tablet PO DAILY
(Daily).
13. Metoprolol Tartrate 25 mg Tablet [**Hospital1 **]: 0.5 Tablet PO TID (3
times a day).
14. Oxycodone 5 mg/5 mL Solution [**Hospital1 **]: One (1)  PO Q3H (every 3
hours) as needed for pain.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
Metastatic thyroid cancer to spine
HSV 1 infection on lips
Pseudomonas infection in sputum
Intermittent a-fib with rapid ventricular rate


Discharge Condition:
Neurologically stable


Discharge Instructions:
DISCHARGE INSTRUCTIONS FOR SPINE CASES

??????        Do not smoke
??????        Keep wound clean / No tub baths or pools until seen in
follow up.
??????        No pulling up, lifting> 10 lbs., excessive bending or
twisting for two weeks.
??????        Limit your use of stairs to 2-3 times per day
??????        Have a family member check your incision daily for
signs of infection
??????        Wear cervical collar as instructed
??????        You may shower briefly without the collar unless
instructed otherwise
??????        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. unless directed by your
doctor
??????        Increase your intake of fluids and fiber as pain
medicine (narcotics) can cause constipation
??????        Clearance to drive and return to work will be addressed
at your post-operative office visit

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING:

??????        Pain that is continually increasing or not relieved by
pain medicine
??????        Any weakness, numbness, tingling in your extremities
??????        Any signs of infection at the wound site: redness,
swelling, tenderness, drainage
??????        Fever greater than or equal to 101?????? F
??????        Any change in your bowel or bladder habits

Followup Instructions:
PLEASE CALL [**Telephone/Fax (1) **] TO SCHEDULE AN APPOINTMENT WITH DR.
[**Last Name (STitle) **] TO BE SEEN IN 4 WEEKS.
Have you drain sutures in the back removed on [**9-12**] you may do
that at rehab



Completed by:[**2160-9-8**]
{'Secondary malignant neoplasm of bone and bone marrow,Pneumonia due to Pseudomonas,Myelopathy in other diseases classified elsewhere,Secondary malignant neoplasm of lung,Acute posthemorrhagic anemia,Blood in stool,Delirium due to conditions classified elsewhere,Unspecified pleural effusion,Unspecified protein-calorie malnutrition,Ulcer of anus and rectum,Disruption of external operation (surgical) wound,Thrombocytopenia, unspecified,Atrial fibrillation,Personal history of malignant neoplasm of thyroid,Other specified disorders of skin,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Other postablative hypothyroidism,Hip joint replacement,Herpes simplex without mention of complication,Obstructive sleep apnea (adult)(pediatric),Other iatrogenic hypotension,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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: 66 year old male with known metastatic thyroid CA to spine,
brain, ribs presented to Dr.[**Name (NI) 6767**] office for routine follow-up
today. The patient has back pain but no numbness or tingling.
The
pain in his back is more of a dull ache and is not nearly as
painful as the pain he had in his neck prior to the cyberknife
treatment he had at C1 in [**Month (only) 958**] of this year. He has not had any
urinary incontinence but did notice stool staining in his
underwear twice this week when he woke up in the morning. He has
had controlled bowel movements since then and reports no loss of
sensation in the groin or buttock region.

MEDICAL HISTORY: Metastatic Thyroid Ca
HTN
Atrial Fibrillation
Pulmonary Embolus [**1-28**] - Anticoagulated with coumadin; has
two small lesions on MRI head c/w mets but not contraindications

MEDICATION ON ADMISSION: AMIODARONE - 200 mg Tablet - 1 Tablet(s) by mouth once a day
ATENOLOL - 25 mg Tablet - 1 Tablet(s) by mouth once a day
ENOXAPARIN [LOVENOX]- 40 mg/0.4 mL Syringe
GABAPENTIN - 300 mg Capsule - 1 Capsule(s) by mouth twice a day
LEVOTHYROXINE - 200 mcg Tablet - 1 Tablet(s) by mouth once a day
LEVOTHYROXINE - 25 mcg Tablet - 0.5 (One half) Tablet(s) by
                mouth Mon, Wed, Fri
OXYCODONE [OXYCONTIN] - 40 mg Tablet SustSR 12 hr - 1 Tablet(s)
                        by mouth three times a day
DOCUSATE SODIUM - 100 mg - 1 Capsule(s) by mouth twice a day

ALLERGIES: Iodine; Iodine Containing

PHYSICAL EXAM: PHYSICAL EXAM:
T:98.2  BP:125/60    HR:54    RR:16       O2Sats:95% RA
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRL        EOMs-intact
Neck: In cervical collar. Surgical incision well-healed.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Spine: No point tenderness.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Motor:
      D    B     T    FE   FF    IP    Q     AT    [**Last Name (un) 938**]    G
R     5    5     5    5    5     5     5     5     5      5
L     5    5     5    5    5     5     5     5     5      5

FAMILY HISTORY: Mother with h/o emphysema.

SOCIAL HISTORY: Lives with wife.  [**Name (NI) 1403**] part time in real estate building and
development and is still currently working.  Retired from full
time work in [**2157-9-22**].
Smoked approximately 30 years ago (quit in [**2126**])
EtOH: drinks 1 glass wine/day 

### Response:
{'Secondary malignant neoplasm of bone and bone marrow,Pneumonia due to Pseudomonas,Myelopathy in other diseases classified elsewhere,Secondary malignant neoplasm of lung,Acute posthemorrhagic anemia,Blood in stool,Delirium due to conditions classified elsewhere,Unspecified pleural effusion,Unspecified protein-calorie malnutrition,Ulcer of anus and rectum,Disruption of external operation (surgical) wound,Thrombocytopenia, unspecified,Atrial fibrillation,Personal history of malignant neoplasm of thyroid,Other specified disorders of skin,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Other postablative hypothyroidism,Hip joint replacement,Herpes simplex without mention of complication,Obstructive sleep apnea (adult)(pediatric),Other iatrogenic hypotension,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
