CHIEF COMPLAINT: Neck pain

PRESENT ILLNESS: This is a patient with a history of metastatic breast cancer to
her cervicothoracic junction.  She was seen at an outside
institution by a spine specialist who did not recommend any
further intervention.  She has muscle spasms and scapular pain.
She is in a cervicothoracic brace since [**Month (only) 547**] or since early
[**Month (only) 116**].

MEDICAL HISTORY: see HPI

MEDICATION ON ADMISSION: lisinopril, folic acid, Crestor,
calcium, multivitamin, Arimidex, Exgeva, Ativan, and Tegretol.

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: see HPI

FAMILY HISTORY: See HPI

SOCIAL HISTORY: see HPI
Pathologic fracture of vertebrae,Secondary malignant neoplasm of bone and bone marrow,Other disorders of neurohypophysis,Orthostatic hypotension,Personal history of malignant neoplasm of breast,Hip joint replacement,Trigeminal neuralgia,Unspecified essential hypertension,Pure hypercholesterolemia,Neoplasm related pain (acute) (chronic)
Path fx vertebrae,Secondary malig neo bone,Neurohypophysis dis NEC,Orthostatic hypotension,Hx of breast malignancy,Joint replaced hip,Trigeminal neuralgia,Hypertension NOS,Pure hypercholesterolem,Neoplasm related pain
Admission Date:  [**2123-12-7**]              Discharge Date:   [**2123-12-20**]

Date of Birth:  [**2057-3-6**]             Sex:   F

Service: ORTHOPAEDICS

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 3645**]
Chief Complaint:
Neck pain

Major Surgical or Invasive Procedure:
1. Open treatment of pathologic fracture dislocation C7,
    T1, T2, T3.
2. Posterior arthrodesis C4-T6.
3. Posterior instrumentation T4-T6.
4. Application of allograft.
5. Left iliac crest bone graft, morselized.


History of Present Illness:
This is a patient with a history of metastatic breast cancer to
her cervicothoracic junction.  She was seen at an outside
institution by a spine specialist who did not recommend any
further intervention.  She has muscle spasms and scapular pain.
She is in a cervicothoracic brace since [**Month (only) 547**] or since early
[**Month (only) 116**].

Her past medical history is diagnosis of breast cancer in [**2112**]
with lumpectomy, chemo and radiation, not BRCA 1 or 2.  She was
diagnosed with spinal metastases in [**2123**] and had radiation.

Her other medical problems are hypertension and high
cholesterol.
 No other significant medical issues.

Her medications included lisinopril, folic acid, Crestor,
calcium, multivitamin, Arimidex, Exgeva, Ativan, and Tegretol.

She has no known drug allergies.

She has a husband and two children.  She does not smoke.  She is
currently not working.

Review of systems is negative.  However, she is 5 feet 4 inches,
147 pounds with systolic blood pressure 172/105, pulse 89.  No
chest pain, headaches, nausea, or vomiting.

Notes were reviewed from MCCM from [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 9969**] from
[**2123-8-6**].
 It is noted that she was using Duragesic patches at that time.
She remains neurologically intact.  She was on Femara at that
point.

A PET scan done on [**2123-6-22**] shows extensive metastases, no
visceral metastases.  She was on hormonal therapy as well as
Exgeva.  Studies were reviewed.  PET scan done from [**2123-5-25**]
done at [**Hospital 1727**] Medical Center, department of radiology shows
markedly improved appearance since the last exam _____ vast
majority of previously recent osseous lesions no longer
demonstrating hypermetabolism with residual uptake destructive
lesions in T1-T2.

The images were reviewed.  Unfortunately, the cervicothoracic
junction is a cutoff point for the thoracic and no other
cervical
study, no good overlap study is noted.

On physical examination, she appears to be tolerating her brace
well.  She is neurologically intact in upper and lower
extremities.  No spasticity.  No atrophy.  Distal pulses intact.

Fine hand motor function is intact.  Gait is within normal
limits.

In brief, this is a patient with multiple osseous metastases
from
breast cancer status post radiation to her spine as well as
hormonal therapy.  I recommended a new CT of her cervicothoracic
junction and follow up with me.  The goal of the reconstruction
would be to free her from her brace.  I do think her life
expectancy is significant enough to consider surgical
stabilization given the remaining option, which would be to
leave
her in a brace indefinitely.

Past Medical History:
see HPI

Social History:
see HPI

Family History:
See HPI

Physical Exam:
see HPI

Pertinent Results:
[**2123-12-7**] 09:02PM   GLUCOSE-170* UREA N-13 CREAT-0.5 SODIUM-130*
POTASSIUM-3.7 CHLORIDE-97 TOTAL CO2-22 ANION GAP-15
[**2123-12-7**] 09:02PM   CALCIUM-8.0* PHOSPHATE-3.3 MAGNESIUM-1.3*
[**2123-12-7**] 09:02PM   WBC-7.0 RBC-3.07* HGB-10.3* HCT-28.9* MCV-94
MCH-33.5* MCHC-35.5* RDW-12.5
[**2123-12-7**] 01:25PM   WBC-5.3 RBC-3.71* HGB-12.5 HCT-34.7* MCV-94
MCH-33.7* MCHC-35.9* RDW-12.5
[**2123-12-7**] 01:25PM   PLT COUNT-192

Brief Hospital Course:
Patient was admitted to the [**Hospital1 18**] Spine Surgery Service and
taken to the Operating Room for the above procedure.  Refer to
the dictated operative note for further details.  The surgery
was without complication and the patient was transferred to the
ICU in a stable condition.  After a 24 hours observation in ICU
the patient was transferred to the floor. TEDs/pnemoboots were
used for postoperative DVT prophylaxis.  Intravenous antibiotics
were continued for 24hrs postop per standard protocol. Initial
postop pain was controlled with a PCA.  Diet was advanced as
tolerated.  The patient was transitioned to oral pain medication
when tolerating PO diet.  Foley was removed on POD#2.  Physical
therapy was consulted for mobilization OOB to ambulate.  She had
significant episodes of orthostatic hypotension on PT. [**Hospital 91413**]
medical consult was sought, who suggested restriction of free
fluid intake due a suspicion on SIADH. Over a period of one week
this improved and patient is able to move the chair without
symptoms of dizziness of hypotension. Hospital course was
otherwise unremarkable.  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:
lisinopril, folic acid, Crestor,
calcium, multivitamin, Arimidex, Exgeva, Ativan, and Tegretol.


Discharge Medications:
1. carbamazepine 100 mg Tablet, Chewable Sig: One (1) Tablet,
Chewable PO QID (4 times a day).
2. rosuvastatin 5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
3. anastrozole 1 mg Tablet Sig: One (1) Tablet PO daily at 5 pm
().
4. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
5. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
6. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
7. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*180 Tablet(s)* Refills:*0*
11. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) as needed for fever or pain.
12. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*90 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 979**] - [**Location (un) 24402**], ME

Discharge Diagnosis:
1. Metastatic breast cancer.
2. Pathologic fracture with instability and dislocation at
    C7, T1, T2, T3.
3. Status post radiation


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.

Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
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.

-      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.

-      Follow up:
o   Please Call the office and make an appointment for 2 weeks
after the day of your discharge 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.

Please call the office if you have a fever>101.5 degrees
Fahrenheit, drainage from your wound, or have any questions.

Physical Therapy:
see discharge instructions
Treatments Frequency:
see discharge instructions

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 89824**], MD Phone:[**Telephone/Fax (1) 3736**]
{'Pathologic fracture of vertebrae,Secondary malignant neoplasm of bone and bone marrow,Other disorders of neurohypophysis,Orthostatic hypotension,Personal history of malignant neoplasm of breast,Hip joint replacement,Trigeminal neuralgia,Unspecified essential hypertension,Pure hypercholesterolemia,Neoplasm related pain (acute) (chronic)'}


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 pain

PRESENT ILLNESS: This is a patient with a history of metastatic breast cancer to
her cervicothoracic junction.  She was seen at an outside
institution by a spine specialist who did not recommend any
further intervention.  She has muscle spasms and scapular pain.
She is in a cervicothoracic brace since [**Month (only) 547**] or since early
[**Month (only) 116**].

MEDICAL HISTORY: see HPI

MEDICATION ON ADMISSION: lisinopril, folic acid, Crestor,
calcium, multivitamin, Arimidex, Exgeva, Ativan, and Tegretol.

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: see HPI

FAMILY HISTORY: See HPI

SOCIAL HISTORY: see HPI 

### Response:
{'Pathologic fracture of vertebrae,Secondary malignant neoplasm of bone and bone marrow,Other disorders of neurohypophysis,Orthostatic hypotension,Personal history of malignant neoplasm of breast,Hip joint replacement,Trigeminal neuralgia,Unspecified essential hypertension,Pure hypercholesterolemia,Neoplasm related pain (acute) (chronic)'}
