CHIEF COMPLAINT: pain

PRESENT ILLNESS: 54yo woman with history of non-secretory multiple myeloma.
Initially diagnosed with MGUS in [**2108**] after monoclonal spike
found on SPEP after presenting with fatigue.
She was in complete remission until [**2125**] when she presented with
pathologic fractures. She has since had numerous plasmocytomas
with six rounds of XRT directed at these
lesions. She underwent 5 pheresis sessions and cytoxan therapy
for an autologous stem cell transplant.  She underwent
chemotherapy with melphalan, then autologous stem cell
transplant in [**10-12**].  This was complicated by nausea, vomiting,
neutropenic fever, and pain.  Her post-transplant course has
been complicated by persistent nausea and vomiting.  Past
admissions for this complaint have been significant for negative
CT abdomen, EGD, and MRI of the head.  She has also had a past
episode of cord compression.

MEDICAL HISTORY: 1)	MGUS -> Multiple Myeloma:

MEDICATION ON ADMISSION: 

ALLERGIES: Tetracycline / Bactrim

PHYSICAL EXAM: Vitals:   99.5, 50, 100/60, 18, 98% RA

FAMILY HISTORY: One sister has h/o DCIS and had a removal of polyp seen on
colonoscopy.  Father had CABG at age 54 and s/p pacer but alive
at 87. Mother has recent dx of htn.  Father and sister had [**Name2 (NI) 10282**]
as children but without residual deformities. No other fam hx of
CA.

SOCIAL HISTORY: The patient smoked one pack of tobacco a day for 20 years but
quit 20 years ago. Reports occasional social use of alcohol. The
patient is now on disability but is a lawyer by profession and
was the chief of the national breast cancer coalition.
Multiple myeloma, without mention of having achieved remission,Bone marrow replaced by transplant,Pathologic fracture of vertebrae,Hyperosmolality and/or hypernatremia,Neoplasm of uncertain behavior of plasma cells,Anemia, unspecified
Mult mye w/o achv rmson,Trnspl status-bne marrow,Path fx vertebrae,Hyperosmolality,Plasmacytoma NOS,Anemia NOS
Admission Date:  [**2128-2-20**]              Discharge Date:   [**2128-3-23**]

Date of Birth:  [**2073-4-20**]             Sex:   F

Service: MEDICINE

Allergies:
Tetracycline / Bactrim

Attending:[**First Name3 (LF) 3913**]
Chief Complaint:
pain

Major Surgical or Invasive Procedure:
intrathecal catheter placement

History of Present Illness:
54yo woman with history of non-secretory multiple myeloma.
Initially diagnosed with MGUS in [**2108**] after monoclonal spike
found on SPEP after presenting with fatigue.
She was in complete remission until [**2125**] when she presented with
pathologic fractures. She has since had numerous plasmocytomas
with six rounds of XRT directed at these
lesions. She underwent 5 pheresis sessions and cytoxan therapy
for an autologous stem cell transplant.  She underwent
chemotherapy with melphalan, then autologous stem cell
transplant in [**10-12**].  This was complicated by nausea, vomiting,
neutropenic fever, and pain.  Her post-transplant course has
been complicated by persistent nausea and vomiting.  Past
admissions for this complaint have been significant for negative
CT abdomen, EGD, and MRI of the head.  She has also had a past
episode of cord compression.

	She now presents with 7-10 days of bilateral low back pain,
characterized as [**8-18**] in severity.  She does have some radiation
of pain down her right leg.  She also has some tingling and
numbness in her right lower leg/foot, which has been present for
months.  She denied any new onset of weakness, saddle
anesthesia, or bowel/bladder incontinence.
Of note, she does have a history of spinal cord compression
dating back to summer of [**2127**], which was treated with radiation.


	She has been in contact with Dr. [**First Name (STitle) 1557**] concerning this new
pain, and has had no relief with her fentanyl patch, oxycontin,
and dilaudid. Additionally, she was started on decadron 20mg,
tapered to 10mg, and now prednisone 200mg qD.

	In ED, vitals were 98.1, 55, 14, 107/62, and 100% RA.  She was
given 4mg of dilaudid, 3L of NS, and anzemet for nausea.

	Her review of systems was significant for anterior rib pain.
Also has known right chest plasmacytoma.  She has had interval
development of two new nodules on her anterior chest and lateral
left breast.  Also significant for nausea, no vomiting.
Otherwise negative for headache, cp/sob, abdominal pain, change
in bowel habits/melena.


Past Medical History:
1)	MGUS -> Multiple Myeloma:

-	MGUS diagnosed in 85
-	[**2125-5-9**] developed a pathologic fracture of her right eleventh
posterior rib, which was biopsied and ultimately felt to be
consistent with a four-centimeter plasmacytoma
-	 received XRT at NIH to this area
-	[**2125-7-9**] developed a left anterior rib fracture that was also
consistent with plasmacytoma; she received further radiation to
this area
-	[**2126-3-9**], the patient was started on thalidomide at 200 mg
p.o. q.d. and Decadron at 40 mg p.o. q.d. times four days,
bimonthly. She remained on this treatment for the next year with
several dosage adjustments due to peripheral neuropathy and
fatigue.
-	summer of [**2126**] thalidomide was decreased to 100 mg p.o. q.d.
as a result of peripheral neuropathy and fatigue
-	 [**2127-3-10**], the patient developed pain in her sacrum, and an
MRI of the sacral area revealed lesions in her sacrum as well as
a sacral fracture according to the patient. PET scan was
positive in multiple bony areas. The patient also received an
MRI of her left glenohumeral area, which confirmed a lytic
lesion. She went on to receive radiation therapy to her left
shoulder. She incurred increasing sacral pain and was evaluated
by Pain Clinic and placed on several narcotics inclusive of
OxyContin and MS Contin.
-	[**2127-6-9**], she sought evaluation in the EW at [**Location **] [**University/College 100728**]Hospital for increased pelvic pain. An MRI revealed
lesions in both proximal femurs with left femur, according to
the patient, exhibiting the more worrisome lesion. The patient
was also noted to have right hip involvement. She underwent rod
placements in both femurs as well as pins in both hips.
-	[**7-12**] MRI showed cord compression; patient received radiation
therapy, for six treatments to the LS spine. Her last treatment
was delivered on [**2127-7-18**]. On [**2127-7-11**], the patient received a
first treatment with Cytoxan at 1.5 gm/m. sq. as well as
Decadron 40 mg p.o. q.d. times four days. On [**2127-7-21**], she was
given a dose of Procrit and Neupogen.
-	started on Zometa back in [**2126-3-9**].
-	thalidomide and Decadron were discontinued in [**2127-3-10**].
-	 two cycles of Velcade from [**2127-3-10**] to [**2127-4-10**].

[**2118**]- anal fissure repair
[**2105**] ?????? h/o bacterial meningitis
[**2090**]- hospitalized for mono


Social History:
The patient smoked one pack of tobacco a day for 20 years but
quit 20 years ago. Reports occasional social use of alcohol. The
patient is now on disability but is a lawyer by profession and
was the chief of the national breast cancer coalition.

Family History:
One sister has h/o DCIS and had a removal of polyp seen on
colonoscopy.  Father had CABG at age 54 and s/p pacer but alive
at 87. Mother has recent dx of htn.  Father and sister had [**Name2 (NI) 10282**]
as children but without residual deformities. No other fam hx of
CA.

Physical Exam:
Vitals:   99.5, 50, 100/60, 18, 98% RA

Gen: alert, oriented, NAD
Heent: perrl, no oropharyngeal lesions.
Neck: supple, full range of motion
CV:  rrr, S1 and S2; no m/r/g
Resp: CTA bilaterally
Chest: subcutaneous nodules right breast, anterior chest, and
left lateral breast
Back: no focal spinal tenderness
Extr: no c/c/e
Neuro:  no deficits in cranial nn, sensation, strength in all
major mm groups
             Toes downgoing, DTR 2+ bilaterally, no clonus


Pertinent Results:
[**2128-2-20**] 01:10PM   GLUCOSE-100 UREA N-15 CREAT-0.5 SODIUM-140
POTASSIUM-3.4 CHLORIDE-104 TOTAL CO2-29 ANION GAP-10
[**2128-2-20**] 01:10PM   CALCIUM-9.0
[**2128-2-20**] 01:10PM   WBC-4.6 RBC-2.94* HGB-10.4* HCT-29.1* MCV-99*
MCH-35.5* MCHC-35.9* RDW-15.5
[**2128-2-20**] 01:10PM   NEUTS-76.9* LYMPHS-18.1 MONOS-4.2 EOS-0.7
BASOS-0.1
[**2128-2-20**] 01:10PM   MACROCYT-1+
[**2128-2-20**] 01:10PM   PLT COUNT-165
[**2128-2-20**] 01:10PM   PT-12.5 PTT-42.3* INR(PT)-1.0

Brief Hospital Course:
1. Multiple Myeloma, back pain

MRI was done that ruled out cord compression, but revealed an
extensive right paraspinal (T9-sacral) plasmacytoma that invaded
the spinal canal at multiple levels and caused displacement of
the
cord, but no frank cord compression.  She had very significant
pain that required ultimately placement of intrathecal
catheter(with
dilaudid/bupivacaine/clonidine), dilaudid drip, morphine pca, iv
ketamine
drip, flexeril, baclofen, neurontin, NSAIDS and her usual
fentanyl patch.

She was evaluated by radiation oncology, who reviewed her old
records from GWU and discerned that she could receive additional

radiation therapy to her spine.  She had to be intubated and
under
general anaesthesia in order to tolerate her radiation planning
and
several of her first radiation treatments.  The last few of her
radiation
treatments did not require this as her pain was better
controlled.

She was sent to the ICU twice during this course; once for pain
control/intensive
nursing after an especially explosive attack of pain, and again
for monitoring
when her pain regimen was increased.  Both stays were
unremarkable; no
respiratory depression or hypotension with increased regimen.

2. UTI

Pt's pain became refractory to all IV and intrathecal
opiates/benzo's.  Pentobarbital drip was started which brought
relief.  Pt and family decided to shift goals of care from
curative intent to comfort care.  Pt expired [**3-23**] at 0930.

Treated with levaquin.

Discharge Disposition:
Expired

Discharge Diagnosis:
expired

Discharge Condition:
expired

Discharge Instructions:
expired

Followup Instructions:
expired


Completed by:[**2128-3-24**]
{'Multiple myeloma, without mention of having achieved remission,Bone marrow replaced by transplant,Pathologic fracture of vertebrae,Hyperosmolality and/or hypernatremia,Neoplasm of uncertain behavior of plasma cells,Anemia, unspecified'}


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: pain

PRESENT ILLNESS: 54yo woman with history of non-secretory multiple myeloma.
Initially diagnosed with MGUS in [**2108**] after monoclonal spike
found on SPEP after presenting with fatigue.
She was in complete remission until [**2125**] when she presented with
pathologic fractures. She has since had numerous plasmocytomas
with six rounds of XRT directed at these
lesions. She underwent 5 pheresis sessions and cytoxan therapy
for an autologous stem cell transplant.  She underwent
chemotherapy with melphalan, then autologous stem cell
transplant in [**10-12**].  This was complicated by nausea, vomiting,
neutropenic fever, and pain.  Her post-transplant course has
been complicated by persistent nausea and vomiting.  Past
admissions for this complaint have been significant for negative
CT abdomen, EGD, and MRI of the head.  She has also had a past
episode of cord compression.

MEDICAL HISTORY: 1)	MGUS -> Multiple Myeloma:

MEDICATION ON ADMISSION: 

ALLERGIES: Tetracycline / Bactrim

PHYSICAL EXAM: Vitals:   99.5, 50, 100/60, 18, 98% RA

FAMILY HISTORY: One sister has h/o DCIS and had a removal of polyp seen on
colonoscopy.  Father had CABG at age 54 and s/p pacer but alive
at 87. Mother has recent dx of htn.  Father and sister had [**Name2 (NI) 10282**]
as children but without residual deformities. No other fam hx of
CA.

SOCIAL HISTORY: The patient smoked one pack of tobacco a day for 20 years but
quit 20 years ago. Reports occasional social use of alcohol. The
patient is now on disability but is a lawyer by profession and
was the chief of the national breast cancer coalition. 

### Response:
{'Multiple myeloma, without mention of having achieved remission,Bone marrow replaced by transplant,Pathologic fracture of vertebrae,Hyperosmolality and/or hypernatremia,Neoplasm of uncertain behavior of plasma cells,Anemia, unspecified'}
