CHIEF COMPLAINT: neck and right arm pain

PRESENT ILLNESS: [**Known firstname **] [**Known lastname **] is a generally healthy man, 63 years old, who
presented with a prolonged and progressive syndrome of neck and
right arm pain.  He subsequently
developed difficulties with balance, as well as dexterity. He
was found to have spinal stenosis.  He was diagnosed with
cervical myelopathy, as well as right-sided C6 radiculopathy. He
underwent a multi modal course of conservative care,
without relief.  His symptoms are progressive.  Due to the
severity of his symptoms, the non-refractory nature of the
syndrome, and failure of conservative care, he has elected to
undergo surgical treatment.

MEDICAL HISTORY: HTN
Hyperlipidemia
DM II
CAD, prior MI
Cardiomyopathy
Sleep Apnea--on CPAP
Cardiac Risk Factors: Diabetes, Dyslipidemia, Hypertension
Cardiac History: No history of CABG
Percutaneous coronary intervention: None
Pacemaker/ICD: None

MEDICATION ON ADMISSION: amolodipine 10 daily, carvedilol 37.5 [**Hospital1 **], fluoxetine 20 [**Hospital1 **],
fluticasone nasal spray, furosemide 40 qAM, hydralazine 25 [**Hospital1 **],
lantus 40 units [**Hospital1 **], novolog SS TID, lisinopril 40 qAM,
metformin 1000 [**Hospital1 **], potassium 20meq, simvastatin 40 qhs, xalatan
eye gtts, MVI, ASA 81, stool softener, benadryl, tyenol

ALLERGIES: Vicodin / Morphine / Percocet / Adhesive Tape

PHYSICAL EXAM: NAD
Head and Neck:  left sided anterior neck incision c/d/i with
steri-strips in place
B/L UE's:  SILT and motor intact C5-T1
2+ radial pulses
B/L Le's:  SILT and motor intact L2-S1
2+ DP pulses

FAMILY HISTORY: There is a family history of coronary artery disease (father and
mother with coronary disease in their 70's, brother with CAD in
his 50's, sister with CAD in her 60's). No history of sudden
death.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. He is married, lives
with his wife, and has a business selling [**Location (un) **] seed.
Cervical spondylosis with myelopathy,Other primary cardiomyopathies,Displacement of cervical intervertebral disc without myelopathy,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Old myocardial infarction,Coronary atherosclerosis of native coronary artery
Cerv spondyl w myelopath,Prim cardiomyopathy NEC,Cervical disc displacmnt,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Hypertension NOS,Obstructive sleep apnea,Old myocardial infarct,Crnry athrscl natve vssl
Admission Date:  [**2106-9-17**]              Discharge Date:   [**2106-9-19**]

Date of Birth:  [**2042-10-12**]             Sex:   M

Service: ORTHOPAEDICS

Allergies:
Vicodin / Morphine / Percocet / Adhesive Tape

Attending:[**Doctor Last Name 1350**]
Chief Complaint:
neck and right arm pain

Major Surgical or Invasive Procedure:
[**2106-9-17**] anterior cervical decompression and fusion C5-7


History of Present Illness:
[**Known firstname **] [**Known lastname **] is a generally healthy man, 63 years old, who
presented with a prolonged and progressive syndrome of neck and
right arm pain.  He subsequently
developed difficulties with balance, as well as dexterity. He
was found to have spinal stenosis.  He was diagnosed with
cervical myelopathy, as well as right-sided C6 radiculopathy. He
underwent a multi modal course of conservative care,
without relief.  His symptoms are progressive.  Due to the
severity of his symptoms, the non-refractory nature of the
syndrome, and failure of conservative care, he has elected to
undergo surgical treatment.

Past Medical History:
HTN
Hyperlipidemia
DM II
CAD, prior MI
Cardiomyopathy
Sleep Apnea--on CPAP
Cardiac Risk Factors: Diabetes, Dyslipidemia, Hypertension
Cardiac History: No history of CABG
Percutaneous coronary intervention: None
Pacemaker/ICD: None

Social History:
Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. He is married, lives
with his wife, and has a business selling [**Location (un) **] seed.


Family History:
There is a family history of coronary artery disease (father and
mother with coronary disease in their 70's, brother with CAD in
his 50's, sister with CAD in her 60's). No history of sudden
death.

Physical Exam:
NAD
Head and Neck:  left sided anterior neck incision c/d/i with
steri-strips in place
B/L UE's:  SILT and motor intact C5-T1
2+ radial pulses
B/L Le's:  SILT and motor intact L2-S1
2+ DP pulses

Pertinent Results:
[**2106-9-18**] 04:25AM BLOOD Hct-33.2*
[**2106-9-18**] 04:25AM BLOOD Glucose-290* UreaN-13 Creat-0.8 Na-139
K-4.4 Cl-105 HCO3-24 AnGap-14
[**2106-9-18**] 05:15PM BLOOD CK(CPK)-250
[**2106-9-18**] 05:15PM BLOOD CK-MB-4 cTropnT-<0.01

Brief Hospital Course:
Patient underwent above procedure.  For full details please see
the separately dictated operative note.  Post-operative pain was
controlled with IV followed by PO meds.  PT was consulted for
assistance with patient's care.  Peri-operative antibiotics were
utilized for 24 hrs. A hemovac drain was place intraoperatively
and was removed once output tapered down.

The patient progressed well post-operatively.  Diet was advanced
without complication.  The patient progressed with PT and was
cleared for discharge home.  The patient was discharged home,
tolerating regular diet and with pain well controlled on oral
medications.

Medications on Admission:
amolodipine 10 daily, carvedilol 37.5 [**Hospital1 **], fluoxetine 20 [**Hospital1 **],
fluticasone nasal spray, furosemide 40 qAM, hydralazine 25 [**Hospital1 **],
lantus 40 units [**Hospital1 **], novolog SS TID, lisinopril 40 qAM,
metformin 1000 [**Hospital1 **], potassium 20meq, simvastatin 40 qhs, xalatan
eye gtts, MVI, ASA 81, stool softener, benadryl, tyenol

Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. lisinopril 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
4. carvedilol 25 mg Tablet Sig: 1.5 Tablets PO BID (2 times a
day).
5. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. diazepam 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for spasm: do not drink alcohol, drive, or
operate machinery while taking this medication.
Disp:*30 Tablet(s)* Refills:*0*
7. senna 8.6 mg Capsule Sig: One (1) Tablet PO BID (2 times a
day).
8. bisacodyl 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) as
needed for constipation.
9. fluoxetine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. fluticasone 50 mcg/Actuation Spray, Suspension Sig: One (1)
Spray Nasal DAILY (Daily).
11. metformin 1,000 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
12. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. insulin aspart 100 unit/mL Cartridge Sig: One (1)
Subcutaneous twice a day: per home insulin regimen.
14. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every [**4-27**]
hours as needed for pain.
Disp:*29 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
cervical myelopathy


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


Discharge Instructions:
You have undergone the following operation: Anterior Cervical
Decompression and 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.

-	Swallowing: Difficulty swallowing is not uncommon after this
type of surgery. This should resolve over time.  Please take
small bites and eat slowly.  Removing the collar while eating
can be helpful ?????? however, please limit your movement of your
neck if you remove your collar while eating.

-	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 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 (oxycontin, oxycodone,
percocet) prescriptions to the pharmacy.   In addition, we are
only allowed to write for pain medications for 90 days from the
date of surgery.


Followup Instructions:
-Follow up:
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.
{'Cervical spondylosis with myelopathy,Other primary cardiomyopathies,Displacement of cervical intervertebral disc without myelopathy,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Old myocardial infarction,Coronary atherosclerosis of native coronary artery'}


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 and right arm pain

PRESENT ILLNESS: [**Known firstname **] [**Known lastname **] is a generally healthy man, 63 years old, who
presented with a prolonged and progressive syndrome of neck and
right arm pain.  He subsequently
developed difficulties with balance, as well as dexterity. He
was found to have spinal stenosis.  He was diagnosed with
cervical myelopathy, as well as right-sided C6 radiculopathy. He
underwent a multi modal course of conservative care,
without relief.  His symptoms are progressive.  Due to the
severity of his symptoms, the non-refractory nature of the
syndrome, and failure of conservative care, he has elected to
undergo surgical treatment.

MEDICAL HISTORY: HTN
Hyperlipidemia
DM II
CAD, prior MI
Cardiomyopathy
Sleep Apnea--on CPAP
Cardiac Risk Factors: Diabetes, Dyslipidemia, Hypertension
Cardiac History: No history of CABG
Percutaneous coronary intervention: None
Pacemaker/ICD: None

MEDICATION ON ADMISSION: amolodipine 10 daily, carvedilol 37.5 [**Hospital1 **], fluoxetine 20 [**Hospital1 **],
fluticasone nasal spray, furosemide 40 qAM, hydralazine 25 [**Hospital1 **],
lantus 40 units [**Hospital1 **], novolog SS TID, lisinopril 40 qAM,
metformin 1000 [**Hospital1 **], potassium 20meq, simvastatin 40 qhs, xalatan
eye gtts, MVI, ASA 81, stool softener, benadryl, tyenol

ALLERGIES: Vicodin / Morphine / Percocet / Adhesive Tape

PHYSICAL EXAM: NAD
Head and Neck:  left sided anterior neck incision c/d/i with
steri-strips in place
B/L UE's:  SILT and motor intact C5-T1
2+ radial pulses
B/L Le's:  SILT and motor intact L2-S1
2+ DP pulses

FAMILY HISTORY: There is a family history of coronary artery disease (father and
mother with coronary disease in their 70's, brother with CAD in
his 50's, sister with CAD in her 60's). No history of sudden
death.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. He is married, lives
with his wife, and has a business selling [**Location (un) **] seed. 

### Response:
{'Cervical spondylosis with myelopathy,Other primary cardiomyopathies,Displacement of cervical intervertebral disc without myelopathy,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Old myocardial infarction,Coronary atherosclerosis of native coronary artery'}
