CHIEF COMPLAINT: Ischemic left heel ulcer.

PRESENT ILLNESS: This is a 56-year-old white male
with diabetes, hypertension, hepatitis C, and a history of
intravenous drug abuse who has been followed by Dr. [**Last Name (STitle) **]
of Podiatry for a left heel ulcer which developed several
weeks prior to admission.  The patient was referred to Dr.
[**Last Name (STitle) **] for further evaluation and treatment.

MEDICAL HISTORY: 1.  Diabetes.
2.  Hypertension.
3.  Hepatitis C.
4.  History of intravenous drug abuse.

MEDICATION ON ADMISSION: 1.  NPH insulin 12 units subcutaneously q.a.m.
2.  NPH insulin 4 units subcutaneously at supper.
3.  Methadone 40 mg p.o. q.d.
4.  Cardizem-CD 240 mg p.o. q.d.
5.  Lasix 40 mg p.o. q.d.
6.  Tylenol p.o. as needed.
7.  Oxygen via nasal cannula as needed.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history was noncontributory.

SOCIAL HISTORY: The patient lives at the Greenery in [**Location (un) 9101**]
for the previous seven years.  He is a cigarette smoker.  He
does not drink alcohol.  He has a history of intravenous drug
abuse.  He has been using a cane and/or wheelchair for
mobility.
Atherosclerosis of native arteries of the extremities with ulceration,Chronic hepatitis C without mention of hepatic coma,Opioid type dependence, continuous,Ulcer of heel and midfoot,Unspecified essential hypertension,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Gastroparesis
Ath ext ntv art ulcrtion,Chrnc hpt C wo hpat coma,Opioid dependence-contin,Ulcer of heel & midfoot,Hypertension NOS,DMII neuro nt st uncntrl,Neuropathy in diabetes,Gastroparesis
Admission Date:  [**2117-1-26**]       Discharge Date:  [**2117-2-2**]

Date of Birth:   [**2050-7-29**]       Sex:  M

Service:  Vascular Surgery

CHIEF COMPLAINT:  Ischemic left heel ulcer.

HISTORY OF PRESENT ILLNESS:  This is a 56-year-old white male
with diabetes, hypertension, hepatitis C, and a history of
intravenous drug abuse who has been followed by Dr. [**Last Name (STitle) **]
of Podiatry for a left heel ulcer which developed several
weeks prior to admission.  The patient was referred to Dr.
[**Last Name (STitle) **] for further evaluation and treatment.

PAST MEDICAL HISTORY:
1.  Diabetes.
2.  Hypertension.
3.  Hepatitis C.
4.  History of intravenous drug abuse.

PAST SURGICAL HISTORY:
1.  Cholecystectomy.
2.  Bilateral fifth toe amputation.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:
1.  NPH insulin 12 units subcutaneously q.a.m.
2.  NPH insulin 4 units subcutaneously at supper.
3.  Methadone 40 mg p.o. q.d.
4.  Cardizem-CD 240 mg p.o. q.d.
5.  Lasix 40 mg p.o. q.d.
6.  Tylenol p.o. as needed.
7.  Oxygen via nasal cannula as needed.

FAMILY HISTORY:  Family history was noncontributory.

SOCIAL HISTORY:  The patient lives at the Greenery in [**Location (un) 9101**]
for the previous seven years.  He is a cigarette smoker.  He
does not drink alcohol.  He has a history of intravenous drug
abuse.  He has been using a cane and/or wheelchair for
mobility.

PHYSICAL EXAMINATION ON PRESENTATION:  General physical
examination revealed an alert and cooperative white male in
no acute distress.  Heart examination revealed a regular rate
and rhythm without murmurs.  The lungs were clear
bilaterally.  The abdomen was soft and nontender.
Extremities revealed left heel ulceration was present.  Pulse
examination revealed femoral pulse was palpable bilaterally.
Neurologic examination was nonfocal.  Pulses had dopplerable
signals bilaterally.  Neurologic examination was nonfocal.

PERTINENT LABORATORY VALUES ON PRESENTATION:  Admission
laboratories from [**2117-1-26**] revealed white blood cell
count was 14.9, hemoglobin was 10.2, hematocrit was 33.4, and
platelets were 324,000.  Sodium was 138, potassium was 5.1,
chloride was 106, bicarbonate was 24, blood urea nitrogen was
29, creatinine was 1.6, and blood glucose was 106.
Urinalysis on [**2117-1-27**] was negative.  A culture of the
left heel ulcer from [**2117-1-19**] showed
methicillin-resistant Staphylococcus aureus, moderate growth.

PERTINENT RADIOLOGY/IMAGING:  A chest x-ray showed no acute
pulmonary disease.

Electrocardiogram revealed intermittent sinus rhythm at a
rate of 46, ectopic atrial focus was present.

HOSPITAL COURSE:   The patient was admitted to the hospital
on [**2117-1-26**].  He was placed on the Mucomyst protocol and
hydrated prior to angiogram in the cardiac catheterization
laboratory on [**2117-1-27**].

The Cardiology Service was consulted for preoperative
clearance.  An echocardiogram on [**2117-1-28**] showed normal
left ventricular wall thickness and cavity size.  The left
ventricular systolic function was normal with an left
ventricular ejection fraction of greater than 55%.  The
patient was cleared for surgery.

Mavik was recommended for better blood pressure control.  T
his was started on [**2117-1-28**].  Approximately three hours
after the first dose, the patient's systolic blood pressure
dropped to 80.  The patient's only complaint was nausea.  The
patient was transferred to Surgical Intensive Care Unit for
close monitoring.  A dopamine drip was used to manage his
systolic blood pressure.  Cardiac isoenzymes were cycled and
were negative.  It was determined that a larger dose of Mavik
was given than recommended.  The patient's blood pressure
returned to baseline.  The patient was scheduled for surgery.

On [**2117-1-29**], the patient underwent an uneventful left
superficial femoral artery endarterectomy with a Dacron
patch.  At the end of surgery, the patient had a dopplerable
left dorsalis pedis and posterior tibialis pulse.  He
received 2 units of packed red blood cells intraoperatively.
The patient received several doses of Kefzol perioperatively.

The patient was started on Lopressor; per postoperative beta
blocker protocol.

Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], the patient's endocrinologist, followed the
patient for diabetic management.

Physical Therapy evaluated the patient for full weightbearing
ambulation on his left foot using a healing sandal.  The
patient will continue to wear a multipoultice splint on his
left leg when he is not ambulating.

At the time of discharge, the patient's left thigh incision
was intact.  There was minimal serosanguineous drainage from
the incision.  His left heel ulcer is clean and without
erythema.  He will continue to have normal saline,
wet-to-dry, dressing changes t.i.d.  His incision will be
swabbed with a Betadine stick q.d.  The patient had
dopplerable signals at his pedal pulses bilaterally.

The patient was to follow up with Dr. [**Last Name (STitle) **] in the office
for staple removal in 10 days.

MEDICATIONS ON DISCHARGE:
 1.  Methadone 40 mg p.o. q.d.
 2.  NPH insulin 12 units subcutaneously q.a.m.
 3.  NPH insulin 4 units subcutaneously at supper.
 4.  Regular insulin sliding-scale q.i.d.
 5.  Cardizem-CD 240 mg p.o. q.d.
 6.  Lopressor 12.5 mg p.o. b.i.d.
 7.  Lasix 40 mg p.o. q.d.
 8.  Ecotrin 325 mg p.o. q.d.
 9.  Heparin 5000 units subcutaneously b.i.d.
10.  Sucralfate 1 g p.o. q.i.d.
11.  Reglan 10 mg p.o. a.c. and q.h.s.
12.  Ranitidine 150 mg p.o. b.i.d.
13.  Calcium carbonate 500 mg p.o. q.i.d. as needed.
14.  Percocet one to two tablets p.o. q.4h. as needed.
15.  Tylenol 325 mg to 650 mg p.o. q.4h. as needed.
16.  Oxygen via nasal cannula (to maintain oxygen saturations
of greater than 92%).

CONDITION AT DISCHARGE:  Condition on discharge was
satisfactory.

DISCHARGE STATUS:  Return to [**Hospital3 28512**] Home in
[**Location (un) 9101**].

DISCHARGE DIAGNOSES:
1.  Ischemic left heel ulcer.
2.  Left superficial femoral artery endarterectomy with
Dacron patch on [**2117-1-29**].

SECONDARY DIAGNOSES:
1.  Diabetes.
2.  Gastroparesis.
3.  Hypertension.
4.  Hepatitis C.
5.  Methicillin-resistant Staphylococcus aureus (left heel).
6.  History of intravenous drug abuse.





                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 19472**]

Dictated By:[**Last Name (NamePattern1) 3954**]
MEDQUIST36

D:  [**2117-2-2**]  10:12
T:  [**2117-2-2**]  10:23
JOB#:  [**Job Number 28513**]
{'Atherosclerosis of native arteries of the extremities with ulceration,Chronic hepatitis C without mention of hepatic coma,Opioid type dependence, continuous,Ulcer of heel and midfoot,Unspecified essential hypertension,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Gastroparesis'}


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: Ischemic left heel ulcer.

PRESENT ILLNESS: This is a 56-year-old white male
with diabetes, hypertension, hepatitis C, and a history of
intravenous drug abuse who has been followed by Dr. [**Last Name (STitle) **]
of Podiatry for a left heel ulcer which developed several
weeks prior to admission.  The patient was referred to Dr.
[**Last Name (STitle) **] for further evaluation and treatment.

MEDICAL HISTORY: 1.  Diabetes.
2.  Hypertension.
3.  Hepatitis C.
4.  History of intravenous drug abuse.

MEDICATION ON ADMISSION: 1.  NPH insulin 12 units subcutaneously q.a.m.
2.  NPH insulin 4 units subcutaneously at supper.
3.  Methadone 40 mg p.o. q.d.
4.  Cardizem-CD 240 mg p.o. q.d.
5.  Lasix 40 mg p.o. q.d.
6.  Tylenol p.o. as needed.
7.  Oxygen via nasal cannula as needed.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history was noncontributory.

SOCIAL HISTORY: The patient lives at the Greenery in [**Location (un) 9101**]
for the previous seven years.  He is a cigarette smoker.  He
does not drink alcohol.  He has a history of intravenous drug
abuse.  He has been using a cane and/or wheelchair for
mobility. 

### Response:
{'Atherosclerosis of native arteries of the extremities with ulceration,Chronic hepatitis C without mention of hepatic coma,Opioid type dependence, continuous,Ulcer of heel and midfoot,Unspecified essential hypertension,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Gastroparesis'}
