CHIEF COMPLAINT: Urinary retention

PRESENT ILLNESS: HPI: Mr. [**Known lastname **] is a 77 yo male with h/o PE s/p IVC filter
placement and prostate cancer diagnosed in [**2183**] with known mets
to his bone s/p XRT and chemo.  Pt presented this AM with "pain
all over" and acute urinary retention since [**96**]:30 pm last night.
 Pt complained of full body pain with pain localized to lower
back and legs, which was old and new low abdominal pain.  He was
unable to urinate overnight but voided about 200 cc of urine at
~4 AM this morning.  He denied dysuria or hematuria. He never
had urinary retention in the past and no recent difficulty
initiating urination.  He also noted difficulty walking [**12-22**] to
both weakness and pain. He does have LE weakness at baseline.
  In the ER the patient was noted to be in sinus tachycardia. A
foley was placed (per notes 200 cc of urine came out) and he was
given dilaudid with resolution of his pain.  He was seen by
neuro who recommended dexamethasone for possible cord
compression and he was given 10 mg IV. He had a CXR and abd
x-ray which were normal except for bony mets in the pelvis and
degenerative changes in the spine.  He also had an L-spine MRI
which was pre-liminarily negative for cord compression. Neuro
also recommended MRI of the C and T spines.  Prior to transfer
here CT of the T and C spines were done which showed
degenerative changes and spinal stenosis in c5-c6.  A head CT
was also done b/c the patient became confused in the ER.  No
evidence of bleed was noted.
 Of note two weeks ago pt was admitted to OSH after he slipped
out of bed and hit his head. Head CT at that time was negative.
Pt was also recently weaned off dexamethasone and his
granddaughter states that he usually gets full body aches after
he is weaned off the dexamethasone.
  Upon arrival to the floor pt was noted to be tachy to the 120s
and hypertensive. He initially complained of left sided chest
pain but became pain free without intervention.  EKG showed
sinus tachycardia.
.
ROS: Denies chills, sick contacts, nausea, vomiting, diarrhea,
constipation, incontinence, loss of sensation in extremities
+ fever to 100.5 per wife this AM
+ occ SOB with exertion and occ LE edema
+ transient CP for 10-15 mins in L side of chest

MEDICAL HISTORY: -DM
-anemia
-s/p PE after hip surgery with IVC filter in place
-Prostate CA diagnosed in [**2183**]. Treated with "hypothermia" at
that time and then radiation to the prostate in [**2185**].  He was on
hormone therapy after that.  He was later found to have a
"tumor" in his cervical spine and was treated with steroids and
radiation for that.  Per notes he has known bony mets to the
C/T/L spines.

MEDICATION ON ADMISSION: Lyrica 50 mg qd
NPH 8 units in AM and 8 units PM
Oxycodone 5 mg prn
Couamdin 2.5 mg daily until recheck next week.
Fentanyl patch 75 mcg q 72 hrs
"inhaler"
colace
iron
MVI
calcium
vitamin C
weaned of dexamethasone 2 mg [**Hospital1 **] on Saturday

ALLERGIES: Morphine

PHYSICAL EXAM: VS: T 100.9 in ER  HR 123  BP 172/73  RR 20  O2 sat 99% RA
Gen: well appearing, slightly confused male in NAD
HEENT: PERRL, anicteric, dry MM
Neck: supple, 9 cm JVP
Cardio: RRR, nl S1 S2, no m/r/g
Pulm: CTA b/l
Abd: slightly firm [**12-22**] to guarding but soft, mildly distended,
NT, +BS
Ext: 1+ PT pulses bilaterally, cool feet, no edema
Neuro: CN 2-12 intact
Reflexes: 1+ patellar and ankle reflexes
Sensation: intact in feet and hands
Muscle strength: [**3-23**] in b/l upper ext
Weakness in hamstrings b/l and [**1-22**] in knee flexion
[**3-23**] ankle dorsiflexion and plantar flexion
Back: no cervical or thoracic tenderness

FAMILY HISTORY: Daughter and sister with breast CA.

SOCIAL HISTORY: Denies ETOH,smoking or drugs
Lives with wife.
[**Name (NI) **] is a Jehovah's witness.
Secondary malignant neoplasm of bone and bone marrow,Retention of urine, unspecified,Thrombocytopenia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia in neoplastic disease,Tachycardia, unspecified,Hemiplegia, unspecified, affecting unspecified side,Personal history of venous thrombosis and embolism,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of prostate
Secondary malig neo bone,Retention urine NOS,Thrombocytopenia NOS,DMII wo cmp nt st uncntr,Anemia in neoplastic dis,Tachycardia NOS,Unsp hemiplga unspf side,Hx-ven thrombosis/embols,Hx of irradiation,Hx-prostatic malignancy
Admission Date:  [**2192-9-5**]              Discharge Date:   [**2192-9-7**]

Date of Birth:  [**2114-10-9**]             Sex:   M

Service: MEDICINE

Allergies:
Morphine

Attending:[**First Name3 (LF) 465**]
Chief Complaint:
Urinary retention

Major Surgical or Invasive Procedure:
None

History of Present Illness:
HPI: Mr. [**Known lastname **] is a 77 yo male with h/o PE s/p IVC filter
placement and prostate cancer diagnosed in [**2183**] with known mets
to his bone s/p XRT and chemo.  Pt presented this AM with "pain
all over" and acute urinary retention since [**96**]:30 pm last night.
 Pt complained of full body pain with pain localized to lower
back and legs, which was old and new low abdominal pain.  He was
unable to urinate overnight but voided about 200 cc of urine at
~4 AM this morning.  He denied dysuria or hematuria. He never
had urinary retention in the past and no recent difficulty
initiating urination.  He also noted difficulty walking [**12-22**] to
both weakness and pain. He does have LE weakness at baseline.
  In the ER the patient was noted to be in sinus tachycardia. A
foley was placed (per notes 200 cc of urine came out) and he was
given dilaudid with resolution of his pain.  He was seen by
neuro who recommended dexamethasone for possible cord
compression and he was given 10 mg IV. He had a CXR and abd
x-ray which were normal except for bony mets in the pelvis and
degenerative changes in the spine.  He also had an L-spine MRI
which was pre-liminarily negative for cord compression. Neuro
also recommended MRI of the C and T spines.  Prior to transfer
here CT of the T and C spines were done which showed
degenerative changes and spinal stenosis in c5-c6.  A head CT
was also done b/c the patient became confused in the ER.  No
evidence of bleed was noted.
 Of note two weeks ago pt was admitted to OSH after he slipped
out of bed and hit his head. Head CT at that time was negative.
Pt was also recently weaned off dexamethasone and his
granddaughter states that he usually gets full body aches after
he is weaned off the dexamethasone.
  Upon arrival to the floor pt was noted to be tachy to the 120s
and hypertensive. He initially complained of left sided chest
pain but became pain free without intervention.  EKG showed
sinus tachycardia.
.
ROS: Denies chills, sick contacts, nausea, vomiting, diarrhea,
constipation, incontinence, loss of sensation in extremities
+ fever to 100.5 per wife this AM
+ occ SOB with exertion and occ LE edema
+ transient CP for 10-15 mins in L side of chest


Past Medical History:
-DM
-anemia
-s/p PE after hip surgery with IVC filter in place
-Prostate CA diagnosed in [**2183**]. Treated with "hypothermia" at
that time and then radiation to the prostate in [**2185**].  He was on
hormone therapy after that.  He was later found to have a
"tumor" in his cervical spine and was treated with steroids and
radiation for that.  Per notes he has known bony mets to the
C/T/L spines.


Social History:
Denies ETOH,smoking or drugs
Lives with wife.
[**Name (NI) **] is a Jehovah's witness.


Family History:
Daughter and sister with breast CA.

Physical Exam:
VS: T 100.9 in ER  HR 123  BP 172/73  RR 20  O2 sat 99% RA
Gen: well appearing, slightly confused male in NAD
HEENT: PERRL, anicteric, dry MM
Neck: supple, 9 cm JVP
Cardio: RRR, nl S1 S2, no m/r/g
Pulm: CTA b/l
Abd: slightly firm [**12-22**] to guarding but soft, mildly distended,
NT, +BS
Ext: 1+ PT pulses bilaterally, cool feet, no edema
Neuro: CN 2-12 intact
Reflexes: 1+ patellar and ankle reflexes
Sensation: intact in feet and hands
Muscle strength: [**3-23**] in b/l upper ext
Weakness in hamstrings b/l and [**1-22**] in knee flexion
[**3-23**] ankle dorsiflexion and plantar flexion
Back: no cervical or thoracic tenderness


Pertinent Results:
[**2192-9-5**] 06:45PM   CK(CPK)-216*
[**2192-9-5**] 06:45PM   CK-MB-5 cTropnT-0.08*
[**2192-9-5**] 10:38AM   LACTATE-1.5
[**2192-9-5**] 10:10AM   GLUCOSE-141* UREA N-19 CREAT-0.8 SODIUM-133
POTASSIUM-4.9 CHLORIDE-97 TOTAL CO2-25 ANION GAP-16
[**2192-9-5**] 10:10AM   ALT(SGPT)-31 AST(SGOT)-79* ALK PHOS-218*
AMYLASE-172* TOT BILI-0.6
[**2192-9-5**] 10:10AM   LIPASE-21
[**2192-9-5**] 10:10AM   ALBUMIN-3.8
[**2192-9-5**] 10:10AM   WBC-6.4 RBC-3.87* HGB-12.5* HCT-35.9* MCV-93
MCH-32.3* MCHC-34.8 RDW-18.6*
[**2192-9-5**] 10:10AM   NEUTS-80.5* LYMPHS-16.5* MONOS-2.5 EOS-0.3
BASOS-0.2
[**2192-9-5**] 10:10AM   ANISOCYT-2+ MACROCYT-1+ MICROCYT-1+
[**2192-9-7**] 05:50AM BLOOD Plt Ct-127*
[**2192-9-7**] 05:50AM BLOOD ALT-26 AST-119* LD(LDH)-1558*
AlkPhos-272* Amylase-96 TotBili-0.5
[**2192-9-6**] 05:32PM BLOOD ALT-33 AST-252* LD(LDH)-2650*
CK(CPK)-302* AlkPhos-337* Amylase-118* TotBili-0.5
[**2192-9-6**] 03:45AM BLOOD ALT-34 AST-306* CK(CPK)-302* AlkPhos-386*
Amylase-141* TotBili-0.6
[**2192-9-6**] 05:32PM BLOOD CK-MB-8 cTropnT-0.06*
[**2192-9-6**] 03:45AM BLOOD PSA-328.4*
[**2192-9-6**] 03:45AM BLOOD TSH-0.61

Brief Hospital Course:
A/P:  77M with metastatic prostate cancer with known spine mets,
h/o DVT s/p IVC filter who presents with urinary retention,
abdominal pain, chest pain and tachycardia.
.
*Urinary Retention: Urinary retention in the setting of lower
extremity weakness and known spine mets was initially concerning
for cord compression. MRI of the L-spine did not show evidence
of cord compression or cauda equina compression.  Urinary
retention could also be [**12-22**] to autonomic dysfunction from DM but
the acute nature of this makes this unlikely. Pain medication
could be contributing but it does not appear pt took increased
doses of pain meds in the past 24 hrs.  Should also consider
worsening prostate dz, perhaps radiation prostatitis which could
be contributing.  Pt did not have preceeding sx prior to this
acute episode, however.
-Dexamethasone 4 mg PO dexamethasone q 6 hrs was continued for
diffuse spinal metastatic disease with some muscular weakness
potentially related.
-T and C spine MRI, no cord compression but diffuse metastatic
dz. Dr. [**Last Name (STitle) 23509**] aware and reports this is likely baseline. MRI
brain official dictation pending at discharge, but on discussion
with neuroradiology, no dural enhancement and normal MRI brain.
-spoke with Dr. [**Last Name (STitle) 770**] who will follow up next week. Appt made.

-Foley to stay in
-Pt has made decision not to pursue further chemotherapy or
aggressive Rx. He will meet with Dr. [**Last Name (STitle) 23509**] next week and
discuss further.
.
*Abdominal Pain: Pt had new abdominal pain that coincided with
urinary retention. Likely [**12-22**] to bladder distension as pain
improved after foley placed. Currently has benign abd exam and
no sx of N/V/diarrhea/constipation.  CT abd negative for acute
process.  Low abd pain not consistent with elevated LFTs. LFTs
improving, though abnormal. Abdominal exam completely benign on
discharge.

*Tachycardia: Pt presented with tachycardia, which could be [**12-22**]
to his diffuse pain. Resolved.
H/o PE, CP and tachycardia initially raised concern for PE,
though this was less likely in the setting of a therapeutic INR
and IVC filter.
-V/Q scan negative.
-cardiac enzymes not consistent with acute myocardial ischemia
and ECGs unchanged. TT is elevated at .06 but stable. As patient
is pursuing palliation at this time, will not pursue this
further.

*Initial Fever: w/u negative (bld cxs x2, urine cx, chest xray,
abd CT scan, spine MRI, brain MRI) and resolved by the time I
had met him without intervention.

.
*Chest pain: Pt describes transient chest pain on a regular
basis as an outpt and experienced CP here.  Resolved.No further
w/u is recommended based on pt's desire to pursue palliation.

*HTN:Stable
.
*Chronic Backpain: Backpain chronic and likely [**12-22**] to spinal
mets.
-cont home regimen fentanyl patch and lyrica
-prn oxycodone for breakthrough (also home regimen)
.
*Metastatic prostate cancer:
-f/u with oncologist as outpt
-Pt with desire to pursue palliation rather than further
aggressive therapy.
-[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10794**] met with pt. prior to d/c regarding support.
-I spoke at length with pt. and his wife to this regard and he
remained consistent and decisive about this decision.
-Although an LP was recommended to look for meningeal spread of
tumor to explain pt's ?weakness on limited neuro exam (see neuro
consultation note in OMR), this was not pursued due to pt's
desire not to pursue aggressive rx, elevated INR, and discussion
with pt's oncologist Dr. [**Last Name (STitle) 23509**].
*DM: Back to home regimen due to low bs on tightened control.
.
*h/o DVT s/p PE:  Pt is on coumadin as outpt and has IVC filter
in place.
-holding coumadin tonight due to increased INR 4.0.
-Pt will restart a decreased regimen at home and follow up next
week.
.
*Anemia: Unclear baseline but has h/o anemia. Stable.
-cont Fe and f/u further outpatient if warranted.
.
*FEN: diabetic, heart healthy diet
*Ppx: had bowel regimen, PPI due to steroids and coumadin.
*Comm: [**Name (NI) 16042**] witness/no blood transfusion.  discuss code
status with patient/family. contact PCP
*Dispo: home with home PT.

Medications on Admission:
Lyrica 50 mg qd
NPH 8 units in AM and 8 units PM
Oxycodone 5 mg prn
Couamdin 2.5 mg daily until recheck next week.
Fentanyl patch 75 mcg q 72 hrs
"inhaler"
colace
iron
MVI
calcium
vitamin C
weaned of dexamethasone 2 mg [**Hospital1 **] on Saturday


Discharge Medications:
1. Fentanyl 75 mcg/hr Patch 72HR Sig: One (1) Patch 72HR
Transdermal Q72H (every 72 hours).
2. Dexamethasone 2 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6
hours).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
5. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
6. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
7. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
8. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO BID (2 times a day).
9. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed for pain.
10. Pregabalin 25 mg Capsule Sig: Two (2) Capsule PO tid () as
needed for neuropathy.
11. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
12. Insulin NPH-Regular Human Rec  Subcutaneous
13. Warfarin 2.5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
14. Protonix 20 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Metastatic Prostate Cancer without cord compression
Urinary retention
Thrombocytopenia
Anemia
History thromboembolism with IVC filter


Discharge Condition:
Stable


Discharge Instructions:
Call Dr.[**Name (NI) 24775**] office [**Numeric Identifier 24776**]) if you have any
concerns following your discharge.
You will continue to have a foley catheter for your urine
collection, and this will be assessed by Dr. [**Last Name (STitle) 770**] next week.
Hold your coumadin tonight because your INR is high. Restart
your Coumadin tomorrow and follow up your INR next week at Dr. [**Name (NI) 24777**] office. You will also need to have your platelet
count checked (127) at time of discharge.

Followup Instructions:
Dr. [**Last Name (STitle) 770**] will see you next week Tues [**9-11**] at [**Hospital1 6933**].
at 8:30 AM


                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 472**]

Completed by:[**2192-9-11**]
{'Secondary malignant neoplasm of bone and bone marrow,Retention of urine, unspecified,Thrombocytopenia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia in neoplastic disease,Tachycardia, unspecified,Hemiplegia, unspecified, affecting unspecified side,Personal history of venous thrombosis and embolism,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of prostate'}


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: Urinary retention

PRESENT ILLNESS: HPI: Mr. [**Known lastname **] is a 77 yo male with h/o PE s/p IVC filter
placement and prostate cancer diagnosed in [**2183**] with known mets
to his bone s/p XRT and chemo.  Pt presented this AM with "pain
all over" and acute urinary retention since [**96**]:30 pm last night.
 Pt complained of full body pain with pain localized to lower
back and legs, which was old and new low abdominal pain.  He was
unable to urinate overnight but voided about 200 cc of urine at
~4 AM this morning.  He denied dysuria or hematuria. He never
had urinary retention in the past and no recent difficulty
initiating urination.  He also noted difficulty walking [**12-22**] to
both weakness and pain. He does have LE weakness at baseline.
  In the ER the patient was noted to be in sinus tachycardia. A
foley was placed (per notes 200 cc of urine came out) and he was
given dilaudid with resolution of his pain.  He was seen by
neuro who recommended dexamethasone for possible cord
compression and he was given 10 mg IV. He had a CXR and abd
x-ray which were normal except for bony mets in the pelvis and
degenerative changes in the spine.  He also had an L-spine MRI
which was pre-liminarily negative for cord compression. Neuro
also recommended MRI of the C and T spines.  Prior to transfer
here CT of the T and C spines were done which showed
degenerative changes and spinal stenosis in c5-c6.  A head CT
was also done b/c the patient became confused in the ER.  No
evidence of bleed was noted.
 Of note two weeks ago pt was admitted to OSH after he slipped
out of bed and hit his head. Head CT at that time was negative.
Pt was also recently weaned off dexamethasone and his
granddaughter states that he usually gets full body aches after
he is weaned off the dexamethasone.
  Upon arrival to the floor pt was noted to be tachy to the 120s
and hypertensive. He initially complained of left sided chest
pain but became pain free without intervention.  EKG showed
sinus tachycardia.
.
ROS: Denies chills, sick contacts, nausea, vomiting, diarrhea,
constipation, incontinence, loss of sensation in extremities
+ fever to 100.5 per wife this AM
+ occ SOB with exertion and occ LE edema
+ transient CP for 10-15 mins in L side of chest

MEDICAL HISTORY: -DM
-anemia
-s/p PE after hip surgery with IVC filter in place
-Prostate CA diagnosed in [**2183**]. Treated with "hypothermia" at
that time and then radiation to the prostate in [**2185**].  He was on
hormone therapy after that.  He was later found to have a
"tumor" in his cervical spine and was treated with steroids and
radiation for that.  Per notes he has known bony mets to the
C/T/L spines.

MEDICATION ON ADMISSION: Lyrica 50 mg qd
NPH 8 units in AM and 8 units PM
Oxycodone 5 mg prn
Couamdin 2.5 mg daily until recheck next week.
Fentanyl patch 75 mcg q 72 hrs
"inhaler"
colace
iron
MVI
calcium
vitamin C
weaned of dexamethasone 2 mg [**Hospital1 **] on Saturday

ALLERGIES: Morphine

PHYSICAL EXAM: VS: T 100.9 in ER  HR 123  BP 172/73  RR 20  O2 sat 99% RA
Gen: well appearing, slightly confused male in NAD
HEENT: PERRL, anicteric, dry MM
Neck: supple, 9 cm JVP
Cardio: RRR, nl S1 S2, no m/r/g
Pulm: CTA b/l
Abd: slightly firm [**12-22**] to guarding but soft, mildly distended,
NT, +BS
Ext: 1+ PT pulses bilaterally, cool feet, no edema
Neuro: CN 2-12 intact
Reflexes: 1+ patellar and ankle reflexes
Sensation: intact in feet and hands
Muscle strength: [**3-23**] in b/l upper ext
Weakness in hamstrings b/l and [**1-22**] in knee flexion
[**3-23**] ankle dorsiflexion and plantar flexion
Back: no cervical or thoracic tenderness

FAMILY HISTORY: Daughter and sister with breast CA.

SOCIAL HISTORY: Denies ETOH,smoking or drugs
Lives with wife.
[**Name (NI) **] is a Jehovah's witness. 

### Response:
{'Secondary malignant neoplasm of bone and bone marrow,Retention of urine, unspecified,Thrombocytopenia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia in neoplastic disease,Tachycardia, unspecified,Hemiplegia, unspecified, affecting unspecified side,Personal history of venous thrombosis and embolism,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of prostate'}
