CHIEF COMPLAINT: Back Pain radiating down left leg

PRESENT ILLNESS: 60-year-old gentleman who presents with metastatic
melanoma. He has known metastases to the axilla, liver, hip, and

MEDICAL HISTORY: Melanoma diagnosed in [**2181**] with axillary lymph node involvement
with re-occurance in [**2182**]. Has received chemo/radiation and
other clinical trials. He currently has metatases to axilla,
liver, hip and vertebral body.

MEDICATION ON ADMISSION: Tylenol and Aleve

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Neurologic exam:
On examination, his motor strength was [**4-11**] in the iliopsoas
bilaterally. The quadriceps were graded [**3-12**] on the left and were

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Married, currently working, non smoker, 3 drinks per week.
Secondary malignant neoplasm of bone and bone marrow,Malignant neoplasm of liver, secondary,Precipitous drop in hematocrit,Personal history of malignant melanoma of skin,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health,Other iatrogenic hypotension,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Disturbance of skin sensation,Other acute postoperative pain
Secondary malig neo bone,Second malig neo liver,Drop, hematocrit, precip,Hx-malig skin melanoma,Hx antineoplastic chemo,Hx of irradiation,Iatrogenc hypotnsion NEC,Abn react-artif implant,Skin sensation disturb,Acute postop pain NEC
Admission Date:  [**2186-9-28**]              Discharge Date:   [**2186-10-3**]

Date of Birth:  [**2135-12-26**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2724**]
Chief Complaint:
Back Pain radiating down left leg

Major Surgical or Invasive Procedure:
L4-S1 Fusion


History of Present Illness:
60-year-old gentleman who presents with metastatic
melanoma. He has known metastases to the axilla, liver, hip, and

L4 vertebral body. There is suspicion on recent imaging that the

L4 lesion is progressing in spite of CyberKnife and systemic
chemotherapy. He reports severe low back pain. He also has pain
that radiates down the left lower extremity. He has been limping

at work. He does feel that the pain is better, walking and
sitting, and there is not a clear positional component

Past Medical History:
Melanoma diagnosed in [**2181**] with axillary lymph node involvement
with re-occurance in [**2182**]. Has received chemo/radiation and
other clinical trials. He currently has metatases to axilla,
liver, hip and vertebral body.

Social History:
Married, currently working, non smoker, 3 drinks per week.

Family History:
Noncontributory

Physical Exam:
Neurologic exam:
On examination, his motor strength was [**4-11**] in the iliopsoas
bilaterally. The quadriceps were graded [**3-12**] on the left and were

normal on the right. Dorsiflexion and plantar flexion were
normal bilaterally. His sensory examination was intact, although

there may have been some mild decreased appreciation of light
touch over the left knee. His back was flat and nontender. His
reflexes were normal and symmetric

Pertinent Results:
[**2186-10-2**] 06:25AM BLOOD WBC-6.6 RBC-3.43* Hgb-10.7* Hct-29.6*
MCV-86 MCH-31.2 MCHC-36.1* RDW-15.0 Plt Ct-131*
[**2186-10-2**] 06:25AM BLOOD Plt Ct-131*
[**2186-9-28**] 08:29PM BLOOD Neuts-92.9* Lymphs-4.7* Monos-2.2 Eos-0.1
Baso-0.2
[**2186-10-2**] 06:25AM BLOOD Glucose-103 UreaN-11 Creat-0.7 Na-139
K-3.9 Cl-104 HCO3-28 AnGap-11
[**2186-10-2**] 06:25AM BLOOD Calcium-8.4 Phos-2.5* Mg-2.1

Brief Hospital Course:
Mr [**Known lastname 64467**] [**Last Name (Titles) 1834**] a L4-S1 fusion without complication, he had
a wound drain in placed interoperatively. His neurologic exam
improved on a daily basis he progressed to full strength in his
left leg (which was weaker pre-op) his pain and numbness in his
left leg also improved. He did develop some right calf and thigh
pain and numbness, LENIs non invasive ultrasound was negative
for DVT. He required 4 units of PRBC due to high output of wound
drain. His crit on dc was 30.
On DC he was tolerating a regular diet, voiding without
difficulty. His neurological exam was full strenght in his lower
extremities with right leg complaints of numbness which has
improved in the last 24 hours. His standing films showed good
alignment of the hardware.

Medications on Admission:
Tylenol and Aleve

Discharge Medications:
1. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as
needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
2. Colace 100 mg Capsule Sig: [**12-9**] Capsules PO twice a day: Use
while taking percocet.
Disp:*40 Capsule(s)* Refills:*1*


Discharge Disposition:
Home

Discharge Diagnosis:
Metastatic Renal Cell


Discharge Condition:
Neurologically intact no deficits


Discharge Instructions:
??????	Do not smoke.
??????	Keep your wound(s) clean and dry you may shower now/ No tub
baths or pool swimming for two weeks from your date of surgery.
??????	No pulling up, lifting more than 10 lbs., or excessive bending
or twisting.
??????	Limit your use of stairs to 2-3 times per day.
??????	Have a friend or family member check your incision daily for
signs of infection.
??????	If you are required to wear one, wear your cervical collar or
back brace as instructed.
??????	You may shower briefly without the collar or back brace;
unless you have been instructed otherwise.
??????	Take your pain medication as instructed; you may find it best
if taken in the morning when you wake-up for morning stiffness,
and before bed for sleeping discomfort.
??????	Do not take any anti-inflammatory medications such as Motrin,
Advil, Aspirin, and Ibuprofen etc. unless directed by your
doctor.
??????	Increase your intake of fluids and fiber, as pain medicine
(narcotics) can cause constipation. We recommend taking an over
the counter stool softener, such as Docusate (Colace) while
taking narcotic pain medication.
??????	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, and drainage.
??????	Fever greater than or equal to 101?????? F.
??????	Any change in your bowel or bladder habits (such as loss of
bowl or urine control).


Followup Instructions:
Have your staples removed on Monday [**10-9**] please call
[**Telephone/Fax (1) 2992**] for an appointment. You will also need an
appointment in 6 weeks with Dr [**Last Name (STitle) 548**].
Dr[**Name (NI) 2845**] office is located at [**Last Name (NamePattern1) 439**] in the [**Hospital Unit Name 3269**] directly across from the ER



Completed by:[**2186-10-3**]
{'Secondary malignant neoplasm of bone and bone marrow,Malignant neoplasm of liver, secondary,Precipitous drop in hematocrit,Personal history of malignant melanoma of skin,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health,Other iatrogenic hypotension,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Disturbance of skin sensation,Other acute postoperative pain'}


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 radiating down left leg

PRESENT ILLNESS: 60-year-old gentleman who presents with metastatic
melanoma. He has known metastases to the axilla, liver, hip, and

MEDICAL HISTORY: Melanoma diagnosed in [**2181**] with axillary lymph node involvement
with re-occurance in [**2182**]. Has received chemo/radiation and
other clinical trials. He currently has metatases to axilla,
liver, hip and vertebral body.

MEDICATION ON ADMISSION: Tylenol and Aleve

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Neurologic exam:
On examination, his motor strength was [**4-11**] in the iliopsoas
bilaterally. The quadriceps were graded [**3-12**] on the left and were

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Married, currently working, non smoker, 3 drinks per week. 

### Response:
{'Secondary malignant neoplasm of bone and bone marrow,Malignant neoplasm of liver, secondary,Precipitous drop in hematocrit,Personal history of malignant melanoma of skin,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health,Other iatrogenic hypotension,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Disturbance of skin sensation,Other acute postoperative pain'}
