CHIEF COMPLAINT: Low Back Pain

PRESENT ILLNESS: [**Known firstname **] [**Known lastname 81322**] is a 66-year-old female who had the onset of back
pain associated with leg weakness, numbness, tingling and pain
caused difficulty with ambulation. The interfered with habits of
daily living as well as all activities requiring walking. She
was evaluated clinically and radiographically and found to have
a vertebra plana fracture of L2. An MRI demonstrated
infiltrative lesion within the vertebral body. Additionally, the
MRI demonstrated high-grade central and foraminal stenosis L2 on
the left. For these reasons in part, the patient elected to
undergo surgical treatment in the setting of high-grade
neurological compression and spinal instability.

MEDICAL HISTORY: 1. s/p recent L TKA c/b infection
2. chronic LLE lymphedema

MEDICATION ON ADMISSION: 1. Vicodin prn
2. MVI

ALLERGIES: Naprosyn

PHYSICAL EXAM: AVSS
Well appearing, obese, NAD, comfortable
BUE: SILT C5-T1 dermatomal distributions
BUE: [**5-21**] [**Doctor First Name **]/Tri/Bic/WE/WF/FF/IO
BUE: tone normal, negative [**Doctor Last Name 937**], 2+ symmetric DTR
bic/bra/tri
All fingers WWP, brisk capillary refill, 2+ distal pulses
BLE: SILT L1-S1 dermatomal distributions
BLE: [**5-21**] B TA/GS/[**Last Name (un) 938**]/FHL/Per, 4-/5 L IP/Qu/HS, [**5-21**] R IP/Qu/HS
BLE: tone normal, no clonus, toes downgoing, 2+ DTR knee/ankle
All toes WWP, brisk capillary refill, 2+ distal pulses

FAMILY HISTORY: N/C

SOCIAL HISTORY: Denies regular tobacco or EtOH use.
Pathologic fracture of vertebrae,Accidental puncture or laceration of dura during a procedure,Urinary tract infection, site not specified,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Kyphosis (acquired) (postural),Accidental cut, puncture, perforation or hemorrhage during surgical operation,Other lymphedema,Tachycardia, unspecified,Chronic ulcer of other specified sites,Obesity, unspecified,Other iatrogenic hypotension,Dermatomycosis, unspecified,Other malignant neoplasm without specification of site,Difficulty in walking
Path fx vertebrae,Accid punc/op lac dura,Urin tract infection NOS,Oth lymp unsp xtrndl org,Kyphosis NOS,Acc cut/hem in surgery,Other lymphedema,Tachycardia NOS,Chronic skin ulcer NEC,Obesity NOS,Iatrogenc hypotnsion NEC,Dermatomycosis NOS,Malignant neoplasm NOS,Difficulty in walking
Admission Date:  [**2182-3-7**]              Discharge Date:   [**2182-3-19**]

Date of Birth:  [**2116-1-28**]             Sex:   F

Service: ORTHOPAEDICS

Allergies:
Naprosyn

Attending:[**Doctor Last Name 1350**]
Chief Complaint:
Low Back Pain

Major Surgical or Invasive Procedure:
[**2182-3-7**]: L2 Transpedicular Corpectomy, Posterior Spinal
Instrumentation & Posterolateral Fusion T10-L5, Open L2 Biopsy,
ICBG


History of Present Illness:
[**Known firstname **] [**Known lastname 81322**] is a 66-year-old female who had the onset of back
pain associated with leg weakness, numbness, tingling and pain
caused difficulty with ambulation. The interfered with habits of
daily living as well as all activities requiring walking. She
was evaluated clinically and radiographically and found to have
a vertebra plana fracture of L2. An MRI demonstrated
infiltrative lesion within the vertebral body. Additionally, the
MRI demonstrated high-grade central and foraminal stenosis L2 on
the left. For these reasons in part, the patient elected to
undergo surgical treatment in the setting of high-grade
neurological compression and spinal instability.


Past Medical History:
1. s/p recent L TKA c/b infection
2. chronic LLE lymphedema

Social History:
Denies regular tobacco or EtOH use.

Family History:
N/C

Physical Exam:
AVSS
Well appearing, obese, NAD, comfortable
BUE: SILT C5-T1 dermatomal distributions
BUE: [**5-21**] [**Doctor First Name **]/Tri/Bic/WE/WF/FF/IO
BUE: tone normal, negative [**Doctor Last Name 937**], 2+ symmetric DTR
bic/bra/tri
All fingers WWP, brisk capillary refill, 2+ distal pulses
BLE: SILT L1-S1 dermatomal distributions
BLE: [**5-21**] B TA/GS/[**Last Name (un) 938**]/FHL/Per, 4-/5 L IP/Qu/HS, [**5-21**] R IP/Qu/HS
BLE: tone normal, no clonus, toes downgoing, 2+ DTR knee/ankle
All toes WWP, brisk capillary refill, 2+ distal pulses


Pertinent Results:
[**2182-3-7**] 09:53PM   WBC-9.2 HGB-9.5* HCT-27.8* PLT COUNT-357
[**2182-3-7**] 09:53PM   PT-14.0* PTT-28.8 INR(PT)-1.2*
[**2182-3-7**] 09:53PM   GLUCOSE-161* UREA N-13 CREAT-0.7 SODIUM-141
POTASSIUM-4.7 CHLORIDE-109* TOTAL CO2-25

[**2182-3-8**] 02:42AM Hct-29.3*
[**2182-3-8**] 09:56PM Hct-23.7*
[**2182-3-9**] 04:15AM Hct-25.5*
[**2182-3-10**] 05:46AM Hct-25.6*
[**2182-3-11**] 06:25AM Hct-26.7*
[**2182-3-12**] 06:28AM Hct-27.8*

Brief Hospital Course:
Ms. [**Known lastname 81322**] was admitted to the [**Hospital1 18**] Spine Surgery Service on
[**2182-3-7**] and taken to the Operating Room for the above
procedure performed by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1007**] in conjunctions with Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1352**]. Please refer to the dictated operative note for
further details. The surgery was very complicated. Due to the
patient's body habitus and extent of disease with considerable
tumor adherent to the dura, two dural tears with spinal fluid
leaks were encountered. These were repaired with the microscope.
The procedure duration was approximately 10.5 hours with EBL
2500cc. She received 3U PRBCs intraoperatively. A lumbar drain
was placed at the conclusion of the surgical procedure. She was
transferred to the SICU intubated postoperatively but in a
stable condition. On POD#1 she was extubated without incident
and was able to be transferred to the floor. She received 1U
PRBC for HCT 23 on POD#1. HCT bumped appropriately to HCT 25.5
after transfusion but she continued to be tachycardia and
slightly hypotensive. An additional 2U PRBCs were transfused.
Serial HCT were followed until stable. She received 6U RBCs
total during the hospital course.

TEDs/pnemoboots were used for postoperative DVT prophylaxis.
Initial postop pain was controlled with a PCA. Diet was advanced
as tolerated. The patient was gradually transitioned to oral
pain medication when tolerating PO diet. Oxycontin and Oxycodone
were used for oral pain control. A wound care consult was
obtained for assistance in managing a chin abrasion sustained
that developed postoperatively as well as several chronic pannus
ulcers. A CT Lspine was obtained on POD#4 and showed appropriate
pedicle screw position at all sites and acceptable spinal
alignment. Intravenous Ancef was continued for infection
prophylaxis while the lumbar drain was in place. On POD#5 the
lumbar drain was clamped and a HOB elevation trial was
performed. She did well without headache or other signs
concerning for continued dural leak. On POD#6 the lumbar drain
was removed and a purse-string suture was used to close the
drain hole to prevent fistula formation. The surgical wound
remained CDI throughout the hospitalization without erythema or
drainage.

After removal of the lumbar drain, physical therapy was
consulted for mobilization OOB. She was not braced
postoperatively. Foley was removed on POD#7. Xrays of the L
spine were obtained prior to discharge and confirmed appropriate
hardware position and spinal alignement. Hospital course was
otherwise unremarkable. Final pathology on her L2 biopsy was
still pending at the time of discharge. 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:
1. Vicodin prn
2. MVI

Discharge Medications:
1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
2. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
5. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
7. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).
8. Multivitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
9. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
10. Nystatin 100,000 unit/g Cream Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day) as needed for rash.
11. Ativan 1 mg Tablet Sig: One (1) Tablet PO every six (6)
hours as needed for spasms.
12. Oxycodone 15 mg Tablet Sig: One (1) Tablet PO Q3H (every 3
hours) as needed for pain.
13. Oxycodone 20 mg Tablet Sustained Release 12 hr Sig: One (1)
Tablet Sustained Release 12 hr PO Q12H (every 12 hours).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 105**] Northeast - [**Location (un) 701**]

Discharge Diagnosis:
L2 lesion


Discharge Condition:
Stable


Discharge Instructions:
You have undergone the following operation:

L2 Transpedicular Corpectomy, Posterior Spinal Instrumentation &
Posterolateral Fusion T10-L5

Immediately after the operation:
- Activity: You should not lift anything greater than 10 lbs.
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:
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 Limit any kind of lifting. No deep back bending.

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

- Brace: None

- Wound Care: 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. Do not get wound wet until cleared to do so at
follow up appointment. Do not soak the incision in a bath or
pool. Sutures stay in place until follow up. If the incision
starts draining at anytime cover it with a sterile dressing &
call the office.

- 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 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: You should not lift anything greater than 10 lbs.
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:
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 Limit any kind of lifting. No deep back bending.

- Brace: None
Treatments Frequency:
- Wound Care: 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. Do not get wound wet until cleared to do so at
follow up appointment. Do not soak the incision in a bath or
pool. Sutures stay in place until follow up. If the incision
starts draining at anytime cover it with a sterile dressing &
call the office.

Please call the office for fever>101.5 degrees Fahrenheit and/or
drainage from your wound.


Followup Instructions:
o Please Call the office ([**Telephone/Fax (1) 1228**]) and make an appointment
for 2 weeks after the day of your operation if this has not been
done already.
o At the 2-week visit we will check your incision, take baseline
X-rays and answer any questions.
o We will then see you at 6 weeks from the day of the operation.



Completed by:[**2182-3-15**]

Name:  [**Known lastname 13038**],[**Known firstname 3650**] L.                Unit No:   [**Numeric Identifier 13039**]

Admission Date:  [**2182-3-7**]              Discharge Date:   [**2182-3-19**]

Date of Birth:  [**2116-1-28**]             Sex:   F

Service: ORTHOPAEDICS

Allergies:
Naprosyn

Attending:[**Doctor Last Name 147**]
Addendum:
[**2182-3-17**]: BLE Lower Extremity U/S: NEGATIVE. Due to decreased
mobility, SC Heparin 5000U TID was started for DVT prophylaxis.
This will be continued until she is cleared by PT for discharge
to home from rehab.

[**2182-3-18**]: No events

[**2182-3-19**]: Foley removed. U/A sent which was positive. Started on 7
day course of ciprofloxacin for UTI. No other events.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2215**] Northeast - [**Location (un) 50**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 148**] MD [**MD Number(2) 149**]

Completed by:[**2182-3-19**]
{'Pathologic fracture of vertebrae,Accidental puncture or laceration of dura during a procedure,Urinary tract infection, site not specified,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Kyphosis (acquired) (postural),Accidental cut, puncture, perforation or hemorrhage during surgical operation,Other lymphedema,Tachycardia, unspecified,Chronic ulcer of other specified sites,Obesity, unspecified,Other iatrogenic hypotension,Dermatomycosis, unspecified,Other malignant neoplasm without specification of site,Difficulty in walking'}


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: Low Back Pain

PRESENT ILLNESS: [**Known firstname **] [**Known lastname 81322**] is a 66-year-old female who had the onset of back
pain associated with leg weakness, numbness, tingling and pain
caused difficulty with ambulation. The interfered with habits of
daily living as well as all activities requiring walking. She
was evaluated clinically and radiographically and found to have
a vertebra plana fracture of L2. An MRI demonstrated
infiltrative lesion within the vertebral body. Additionally, the
MRI demonstrated high-grade central and foraminal stenosis L2 on
the left. For these reasons in part, the patient elected to
undergo surgical treatment in the setting of high-grade
neurological compression and spinal instability.

MEDICAL HISTORY: 1. s/p recent L TKA c/b infection
2. chronic LLE lymphedema

MEDICATION ON ADMISSION: 1. Vicodin prn
2. MVI

ALLERGIES: Naprosyn

PHYSICAL EXAM: AVSS
Well appearing, obese, NAD, comfortable
BUE: SILT C5-T1 dermatomal distributions
BUE: [**5-21**] [**Doctor First Name **]/Tri/Bic/WE/WF/FF/IO
BUE: tone normal, negative [**Doctor Last Name 937**], 2+ symmetric DTR
bic/bra/tri
All fingers WWP, brisk capillary refill, 2+ distal pulses
BLE: SILT L1-S1 dermatomal distributions
BLE: [**5-21**] B TA/GS/[**Last Name (un) 938**]/FHL/Per, 4-/5 L IP/Qu/HS, [**5-21**] R IP/Qu/HS
BLE: tone normal, no clonus, toes downgoing, 2+ DTR knee/ankle
All toes WWP, brisk capillary refill, 2+ distal pulses

FAMILY HISTORY: N/C

SOCIAL HISTORY: Denies regular tobacco or EtOH use. 

### Response:
{'Pathologic fracture of vertebrae,Accidental puncture or laceration of dura during a procedure,Urinary tract infection, site not specified,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Kyphosis (acquired) (postural),Accidental cut, puncture, perforation or hemorrhage during surgical operation,Other lymphedema,Tachycardia, unspecified,Chronic ulcer of other specified sites,Obesity, unspecified,Other iatrogenic hypotension,Dermatomycosis, unspecified,Other malignant neoplasm without specification of site,Difficulty in walking'}
