CHIEF COMPLAINT: right breast cancer

PRESENT ILLNESS: The patient is a 63-year-old woman with a history of right
breast cancer who is interested in bilateral mastectomy and
reconstruction.  She is referred to me by Dr. [**Last Name (STitle) **] [**Name (STitle) 3459**].
Her primary care physician is [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] [**Name (STitle) 8682**].  She is
planning in genetic testing.  She has an umbilical hernia that
she is scheduled to have repaired in two weeks from now.  She is
a retired teacher.  She presents today with a friend.

MEDICAL HISTORY: PMH:  Arthritis, heart murmur.  Also includes mitral valve
prolapse.
SH:  She does not smoke or drink.
FH:  Breast cancer in mother and a maternal aunt, stroke,
depression, and heart disease.
PSH:  Includes an ovarian cyst resection and appendectomy.
MEDS:  Effexor and pravastatin.
ALL:  She is allergic to Percodan.

MEDICATION ON ADMISSION: Effexor and pravastatin

ALLERGIES: Percodan / simvastatin

PHYSICAL EXAM: PHYSICAL EXAMINATION:
VITAL SIGNS:  She is 5 feet tall, she is 126 pounds.
GENERAL:  She is a well-developed, well-nourished 63-year-old
woman in no apparent distress:  Alert and oriented x3 with
normal
mood and affect.
HEENT:  Extraocular motor function is normal.  Vision is normal.

FAMILY HISTORY: FH:  Breast cancer in mother and a maternal aunt, stroke,
depression, and heart disease.

SOCIAL HISTORY: SH:  She does not smoke or drink.
Malignant neoplasm of other specified sites of female breast,Secondary and unspecified malignant neoplasm of lymph nodes of axilla and upper limb,Umbilical hernia without mention of obstruction or gangrene,Pure hypercholesterolemia,Mitral valve disorders,Degeneration of intervertebral disc, site unspecified,Hypotension, unspecified
Malign neopl breast NEC,Mal neo lymph-axilla/arm,Umbilical hernia,Pure hypercholesterolem,Mitral valve disorder,Disc degeneration NOS,Hypotension NOS
Admission Date:  [**2195-11-25**]              Discharge Date:   [**2195-11-29**]

Date of Birth:  [**2132-9-21**]             Sex:   F

Service: PLASTIC

Allergies:
Percodan / simvastatin

Attending:[**First Name3 (LF) 5883**]
Chief Complaint:
right breast cancer

Major Surgical or Invasive Procedure:
1. Right immediate reconstruction of acquired absence of
    breast with deep inferior epigastric perforator flap
    reconstruction.
2. Harvest of right internal mammary artery and vein
    pedicle.
3. Right partial rib harvest.
4. Closure of the abdominal donor site


History of Present Illness:
The patient is a 63-year-old woman with a history of right
breast cancer who is interested in bilateral mastectomy and
reconstruction.  She is referred to me by Dr. [**Last Name (STitle) **] [**Name (STitle) 3459**].
Her primary care physician is [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] [**Name (STitle) 8682**].  She is
planning in genetic testing.  She has an umbilical hernia that
she is scheduled to have repaired in two weeks from now.  She is
a retired teacher.  She presents today with a friend.


Past Medical History:
PMH:  Arthritis, heart murmur.  Also includes mitral valve
prolapse.
SH:  She does not smoke or drink.
FH:  Breast cancer in mother and a maternal aunt, stroke,
depression, and heart disease.
PSH:  Includes an ovarian cyst resection and appendectomy.
MEDS:  Effexor and pravastatin.
ALL:  She is allergic to Percodan.


Social History:
SH:  She does not smoke or drink.


Family History:
FH:  Breast cancer in mother and a maternal aunt, stroke,
depression, and heart disease.


Physical Exam:
PHYSICAL EXAMINATION:
VITAL SIGNS:  She is 5 feet tall, she is 126 pounds.
GENERAL:  She is a well-developed, well-nourished 63-year-old
woman in no apparent distress:  Alert and oriented x3 with
normal
mood and affect.
HEENT:  Extraocular motor function is normal.  Vision is normal.

Nose midline.  Nasal septum is midline.  Inspection and
palpation
of skin reveals no evidence of any rashes, ulcer or lesions.  No
palpable lymph nodes in neck and axilla.  Her neck has full
range
of motion, supple, no evidence of thyromegaly.  Trachea is
midline.
BREASTS:  Her breast size is A cup.  She has grade 2 ptosis.
She
has pseudoptosis.  Her sternal notch to nipple distance on the
right side is 21.5, on the left side is 22.5.  Inframammary fold
to nipple distance on the right side is 5 cm, on the left side
is
5.5 cm.  She has two palpable masses in the superior aspect of
the breast.  There is no evidence of any tenderness, asymmetry.
ABDOMEN:  Soft, nontender.  She has no evidence of any masses.
She has a small umbilical hernia.  There is no evidence of any
hepatosplenomegaly, rash, intertrigo.  She has an infraumbilical
volume to create two A-cup size breasts.  She has a well-healed
lower midline incision from a previous ovarian cyst and
appendectomy.  Her Latissimus muscle is intact.  She has enough
gluteal volume to create a B cup size reconstruction.  There is
no evidence of any extremity varicosities.  Respiratory effort
is
normal with no intercostal retractions.  There is no evidence of
any peripheral edema, digital cyanosis, or lymphadenopathy.


Pertinent Results:
[**2195-11-26**] 03:15AM BLOOD WBC-8.5# RBC-2.83*# Hgb-8.3*# Hct-25.1*#
MCV-89 MCH-29.1 MCHC-32.8 RDW-13.7 Plt Ct-162
[**2195-11-26**] 03:15AM BLOOD Glucose-173* UreaN-12 Creat-0.6 Na-142
K-4.1 Cl-107 HCO3-30 AnGap-9
[**2195-11-26**] 03:15AM BLOOD Calcium-8.3* Phos-2.9 Mg-1.8

Brief Hospital Course:
The patient was admitted to the plastic surgery service on
[**2195-11-25**] and had a Right Breast Reconstruction with [**Last Name (un) 5884**] Flap.
The patient tolerated the procedure well.

Neuro: Post-operatively, the patient received Dilaudid IV/PCA
with good effect and adequate pain control. When tolerating oral
intake, the patient was transitioned to oral pain medications.

CV: The patient was stable from a cardiovascular standpoint;
vital signs were routinely monitored.

Pulmonary: The patient was stable from a pulmonary standpoint;
vital signs were routinely monitored.

GI/GU: Post-operatively, the patient was given IV fluids until
tolerating oral intake. Her diet was advanced when appropriate,
which was tolerated well. She was also started on a bowel
regimen to encourage bowel movement. Foley was removed on POD#1.
Intake and output were closely monitored.

ID: Post-operatively, the patient was started on IV cefazolin,
then switched to PO cephalexin on discharge. The patient's
temperature was closely watched for signs of infection.

Prophylaxis: The patient received subcutaneous heparin during
this stay, and was encouraged to get up and ambulate as early as
possible.

At the time of discharge on POD#, the patient was doing well,
afebrile with stable vital signs, tolerating a regular diet,
ambulating, voiding without assistance, and pain was well
controlled.


Medications on Admission:
  Effexor and pravastatin

Discharge Medications:
1. aspirin 81 mg Tablet, Chewable Sig: 1.5 Tablet, Chewables PO
DAILY (Daily).
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 2 weeks: continue while taking narcotic pain
medication.
3. venlafaxine 75 mg Capsule, Ext Release 24 hr Sig: Three (3)
Capsule, Ext Release 24 hr PO DAILY (Daily).
4. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO every six (6)
hours as needed for pain.
5. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain for 2 weeks: do not drive or drink
alcohol while taking this medication.
Disp:*84 Tablet(s)* Refills:*0*
6. Keflex 500 mg Capsule Sig: One (1) Capsule PO twice a day for
2 weeks.
Disp:*28 Capsule(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Right breast cancer


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
DISCHARGE INSTRUCTIONS:
Personal Care:
1. Remove dressings and discard. Dressings may be replaced as
needed. Use tape sparingly.
2. Clean around the drain site(s), where the tubing exits the
skin, with soap and water.
3. Strip drain tubing, empty bulb(s), and record output(s) [**1-8**]
times per day.
4. A written record of the daily output from each drain should
be brought to every follow-up appointment. your drains will be
removed as soon as possible when the daily output tapers off to
an acceptable amount.
5. DO NOT wear a bra for 3 weeks. You may wear a camisole for
comfort as desired.
6. You may shower daily with assistance as needed.
7. The Dermabond skin glue will begin to flake off in about [**6-14**]
days.
8. No pressure on your chest or abdomen
9. Okay to shower, but no baths until after directed by your
surgeon
.
Activity:
1. You may resume your regular diet.  Avoid caffeine and
chocolate.
2. DO NOT drive for 3 weeks.
3. Keep hips flexed at all times for 1 week, and then gradually
stand upright as tolerated.
4. DO NOT lift anything heavier than 5 pounds or engage in
strenuous activity for 6 weeks following surgery.
5. Please perform the occupational therapy exercises as
instructed.
.
Medications:
1. Resume your regular medications unless instructed otherwise
and take any new meds as ordered .
2. Take Aspirin, 120 mg by mouth once daily, for 30 days after
surgery.
3. You may take your prescribed pain medication for moderate to
severe pain.  You may switch to Tylenol or Extra Strength
Tylenol for mild pain as directed on the packaging.  Please note
that Percocet and Vicodin have Tylenol as an active ingredient
so do not take these meds with additional Tylenol.
4. Take prescription pain medications for pain not relieved by
tylenol.
5. Take your antibiotic as prescribed.
6. Take Colace, 100 mg by mouth 2 times per day, while taking
the prescription pain medication. You may use a different
over-the-counter stool softerner if you wish.
7. Do not drive or operate heavy machinery while taking any
narcotic pain medication. You may have constipation when taking
narcotic pain medications (oxycodone, percocet, vicodin,
hydrocodone, dilaudid, etc.); you should continue drinking
fluids, you may take stool softeners, and should eat foods that
are high in fiber.
.
Call the office IMMEDIATELY if you have any of the following:
1. Signs of infection: fever with chills, increased redness,
welling, warmth or tenderness at the surgical site, or unusual
drainage from the incision(s).
2. A large amount of bleeding from the incision(s) or drain(s).
3. Fever greater than 101.5 oF
4. Severe pain NOT relieved by your medication.
.
Return to the ER if:
* If you are vomiting and cannot keep in fluids or your
medications.
* If you have shaking chills, fever greater than 101.5 (F)
degrees or 38 (C) degrees, increased redness,swelling or
discharge from incision, chest pain, shortness of breath, or
anything else that is troubling you.
* Any serious change in your symptoms, or any new symptoms that
concern you.
.
DRAIN DISCHARGE INSTRUCTIONS
You are being discharged with drains in place. Drain care is a
clean procedure. Wash your hands thoroughly with soap and warm
water before performing drain care. Perform drainage care twice
a day. Try to empty the drain at the same time each day. Pull
the stopper out of the drainage bottle and empty the drainage
fluid into the measuring cup. Record the amount of drainage
fluid on the record sheet. Reestablish drain suction.

Followup Instructions:
Please call Dr.[**Last Name (STitle) 17650**] office at [**Telephone/Fax (1) 6331**] to schedule your
follow-up appointment upon discharge.



Completed by:[**2195-11-29**]

Admission Date: [**2195-11-25**]        Discharge Date: [**2195-11-29**]

Date of Birth:  [**2132-9-21**]        Sex:  F

Service:  PSU


ADDENDUM:
Please note that there is an additional diagnosis which is a
micrometastatic carcinoma involving 1 lymph node.  Please
document this as part of her discharge diagnosis.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], MD [**MD Number(2) 39103**]

Dictated By:[**Last Name (NamePattern4) 51569**]
MEDQUIST36
D:  [**2195-12-28**] 13:42:49
T:  [**2195-12-28**] 14:04:12
Job#:  [**Job Number 103611**]
{'Malignant neoplasm of other specified sites of female breast,Secondary and unspecified malignant neoplasm of lymph nodes of axilla and upper limb,Umbilical hernia without mention of obstruction or gangrene,Pure hypercholesterolemia,Mitral valve disorders,Degeneration of intervertebral disc, site unspecified,Hypotension, 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: right breast cancer

PRESENT ILLNESS: The patient is a 63-year-old woman with a history of right
breast cancer who is interested in bilateral mastectomy and
reconstruction.  She is referred to me by Dr. [**Last Name (STitle) **] [**Name (STitle) 3459**].
Her primary care physician is [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] [**Name (STitle) 8682**].  She is
planning in genetic testing.  She has an umbilical hernia that
she is scheduled to have repaired in two weeks from now.  She is
a retired teacher.  She presents today with a friend.

MEDICAL HISTORY: PMH:  Arthritis, heart murmur.  Also includes mitral valve
prolapse.
SH:  She does not smoke or drink.
FH:  Breast cancer in mother and a maternal aunt, stroke,
depression, and heart disease.
PSH:  Includes an ovarian cyst resection and appendectomy.
MEDS:  Effexor and pravastatin.
ALL:  She is allergic to Percodan.

MEDICATION ON ADMISSION: Effexor and pravastatin

ALLERGIES: Percodan / simvastatin

PHYSICAL EXAM: PHYSICAL EXAMINATION:
VITAL SIGNS:  She is 5 feet tall, she is 126 pounds.
GENERAL:  She is a well-developed, well-nourished 63-year-old
woman in no apparent distress:  Alert and oriented x3 with
normal
mood and affect.
HEENT:  Extraocular motor function is normal.  Vision is normal.

FAMILY HISTORY: FH:  Breast cancer in mother and a maternal aunt, stroke,
depression, and heart disease.

SOCIAL HISTORY: SH:  She does not smoke or drink. 

### Response:
{'Malignant neoplasm of other specified sites of female breast,Secondary and unspecified malignant neoplasm of lymph nodes of axilla and upper limb,Umbilical hernia without mention of obstruction or gangrene,Pure hypercholesterolemia,Mitral valve disorders,Degeneration of intervertebral disc, site unspecified,Hypotension, unspecified'}
