CHIEF COMPLAINT: TBM s/p Y-stent placement and removal in [**10/2197**], s/p stent
placement and removal in R mainstem bronchus in [**12/2198**] with
transient alleviation in symptoms

PRESENT ILLNESS: 71F with h/o TBM who has undergone stenting including Y stent
and RMB stent in [**2196**] and [**2198**] with transient alleviation in her
respiratory symptoms.  She has met with Dr. [**Last Name (STitle) **] in
clinic and has agreed to a surgical intervention.  On [**3-1**], the
patient underwent a bronchoscopy, right thoracotomy and
tracheoplasty with thoracic tracheoplasty with mesh, right main
stem bronchus/bronchus intermedius bronchoplasty with mesh, and
left main stem bronchus bronchoplasty with mesh.

MEDICAL HISTORY: Hypercholesterolemia
Pulmonary emboli x2 ('[**83**] and '[**87**]) requiring chronic
anticoagulation; first was unprovoked, treated with coumadin;
second occurred after coumadin was stopped but again, unprovoked
Crohn's/colitis
Hypothyroidism [**1-15**] Hashimoto's
Temporal arteritis (dx clinically last year), treated with
prednisone and MTX

MEDICATION ON ADMISSION: Benzonate 100"', Citalopram 40', Clonazepam 0.5 qhs, folic acid
1', Levothyroxine 100', Lovastatin 20', Methotrexate 15qwk,
Omeprazole 20", Prednisone 5', Warfarin 2.5 five days, 5 two
days

ALLERGIES: Imitrex / Ambien / Codeine / Oxycodone

PHYSICAL EXAM: At day of discharge:

FAMILY HISTORY: Her mother died at 62 of breast cancer. Her
father died at 62 of heart attack. Her sister is 71 and her
brother is 76, both are healthy. She has a 44-year-old daughter

SOCIAL HISTORY: She is a retired chemist, lives with her wife. She has 3 kids
and 3 grandkids.
Distant +tob (50years ago), does not drink and does not use any
drugs.
Other diseases of trachea and bronchus,Rhabdomyolysis,Pure hypercholesterolemia,Chronic lymphocytic thyroiditis
Trachea & bronch dis NEC,Rhabdomyolysis,Pure hypercholesterolem,Chr lymphocyt thyroidit
Admission Date:  [**2199-3-1**]              Discharge Date:   [**2199-3-6**]

Date of Birth:  [**2127-9-18**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Imitrex / Ambien / Codeine / Oxycodone

Attending:[**First Name3 (LF) 5790**]
Chief Complaint:
TBM s/p Y-stent placement and removal in [**10/2197**], s/p stent
placement and removal in R mainstem bronchus in [**12/2198**] with
transient alleviation in symptoms

Major Surgical or Invasive Procedure:
Appendectomy in [**2147**], R knee arthroscopy in [**2177**], Y stent
placement [**2196**], RMB stent placement [**2198**]

History of Present Illness:
71F with h/o TBM who has undergone stenting including Y stent
and RMB stent in [**2196**] and [**2198**] with transient alleviation in her
respiratory symptoms.  She has met with Dr. [**Last Name (STitle) **] in
clinic and has agreed to a surgical intervention.  On [**3-1**], the
patient underwent a bronchoscopy, right thoracotomy and
tracheoplasty with thoracic tracheoplasty with mesh, right main
stem bronchus/bronchus intermedius bronchoplasty with mesh, and
left main stem bronchus bronchoplasty with mesh.

Past Medical History:
Hypercholesterolemia
Pulmonary emboli x2 ('[**83**] and '[**87**]) requiring chronic
anticoagulation; first was unprovoked, treated with coumadin;
second occurred after coumadin was stopped but again, unprovoked
Crohn's/colitis
Hypothyroidism [**1-15**] Hashimoto's
Temporal arteritis (dx clinically last year), treated with
prednisone and MTX


Social History:
She is a retired chemist, lives with her wife. She has 3 kids
and 3 grandkids.
Distant +tob (50years ago), does not drink and does not use any
drugs.


Family History:
Her mother died at 62 of breast cancer. Her
father died at 62 of heart attack. Her sister is 71 and her
brother is 76, both are healthy. She has a 44-year-old daughter

and two sons age 42 and 38. She has three brothers with prostate

cancer and one son with type 1 diabetes.


Physical Exam:
At day of discharge:

99.4, 98.2, 61, 136/80, 18, 95 RA
NAD, A+OX3
RRR
CTAB
Soft, NT/ND
no c/c/e
Her right thoracotomy site appears c/d/i, no significant
erythema or fluctuance noted

Pertinent Results:
Admit Hct:  39
Discharge Hct: 35.3

Admit Cr: 1.0
Discharge Cr: 0.7

CPK trend: 1043->3285->3269->2830

Discharge INR: 1.4

CXR [**3-5**]: Right lung base remains elevated, due in part to small
pleural effusion and atelectasis in the middle lobe


Brief Hospital Course:
The patient underwent a tracheobronchoplasty by Dr. [**Last Name (STitle) **]
on [**3-1**].  The patient was monitored in the SICU from [**Date range (1) 8975**]
with no significant events.  She then transferred to the floor
on [**3-4**] PM and was discharged from the floor on [**3-6**].

Neuro: The patient was then started back on her Celexa once she
was tolerating clears.  She remained alert and oriented for her
entire hospital duration.  There were no significant events.

Pain: The patient's pain was controlled with an epidural
initially which was ultimately transitioned to IV dilaudid then
PO narcotics.  Her pain was well controlled with a PO regimen.

CV: She was placed on telemetry after her surgery.  She had no
events.

Resp: The patient had no respiratory issues after surgery.  She
was able to produce and clear her own secretions.  She was
transitioned to room air.  She continued on her nebs.  Her chest
tube was transitioned to water seal and she did not develop any
respiratory symptoms nor was there a PTX on CXR.  The chest tube
was ultimately taken out and the patient did well.  She
ambulated on room air without difficulties.

GI: Her diet was slowly transitioned to a regular diet which she
tolerated well.

Renal: Per labs she did have rhabdomyolosis secondary to
prolonged positioning from her operation but her Creatinine
remained normal throughout.  Her foley was discontinued after
her epidural was discontinued and she voided without
difficulties.

Heme: The patient started on her Coumadin once she was able to
tolerate clears.  At the time of discharge, her INR was 1.4.
She will continue on her coumadin and follow up with her PCP.
[**Name10 (NameIs) **] will not leave with Lovenox to bridge her coumadin per Dr.
[**Last Name (STitle) **].

ID: She remained afebrile during her hospital course.

Endo: She was restarted on her Levoxyl immediately after
surgery.  She will taper her Prednisone dose at home.  On
discharge she will take 2.5 mg of Prednisone daily for three
days and then stop.  In terms of her MTX she will not be on it
until she follows up with her rheumatologist.

Medications on Admission:
Benzonate 100"', Citalopram 40', Clonazepam 0.5 qhs, folic acid
1', Levothyroxine 100', Lovastatin 20', Methotrexate 15qwk,
Omeprazole 20", Prednisone 5', Warfarin 2.5 five days, 5 two
days

Discharge Medications:
1. Ipratropium Bromide 0.02 % Solution Sig: One (1) neb
Inhalation every eight (8) hours.
Disp:*90 vials* Refills:*2*
2. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1) neb Inhalation every eight (8) hours.
Disp:*90 nebs* Refills:*2*
3. Prednisone 5 mg Tablet Sig: half Tablet PO once a day: x 3
days then stop.
4. Omeprazole 20 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
5. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Coumadin 2.5 mg Tablet Sig: 1-2 Tablets PO at bedtime: take
2.5 mg po 3.24 and 3.25 and check INR Friday 3.26 and follow up
with Dr. [**Last Name (STitle) **] regarding dose.
7. Citalopram 40 mg Tablet Sig: One (1) Tablet PO once a day.
8. Clonazepam 0.5 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO at bedtime as needed for insomnia: be cautious
while on narcotics for pain- would avoid.
9. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO once a day.
10. Lovastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
11. Calcium Carbonate-Vitamin D3 500 mg(1,250mg) -400 unit
Tablet, Chewable Sig: One (1) Tablet, Chewable PO twice a day.
12. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
13. Dilaudid 2 mg Tablet Sig: 1-2 Tablets PO every four (4)
hours as needed for pain.
Disp:*75 Tablet(s)* Refills:*0*
14. home nebulizer equipment
dx: tracheobronchomalacia s/p tracheoplasty


Discharge Disposition:
Home

Discharge Diagnosis:
Tracheobronchomalacia
Hx of PE
Hx of colitis
Hx of temporal arteritis
Hashimoto's thyroiditis
Hyperlipidemia


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


Discharge Instructions:
- Call Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 2348**] if you have fevers greater
than 101.5, chills, shakes, shortness of breath, chest pain,
increasing amount of productive cough with difficult to manage
secretions, or any questions.
- No driving while taking narcotics.
- Take stool softeners to avoid constipation while on narcotics.
- Take nebulizers as instructed.
- No submerging in water x 3 weeks, but you may shower, then
remove right chest bandage and keep covered with bandaid until
healed.


Followup Instructions:
Follow up with Dr. [**Last Name (STitle) **] in 2 weeks with chest xray.
Please call [**Telephone/Fax (1) 2348**] to get the exact appointment date,
time, and location instruction. Remember to get your chest xray
30 minutes prior to your follow up.

Check you INR on Friday [**2199-3-8**] early in the am, and call Dr.
[**Last Name (STitle) **] to check on your coumadin dose for Friday night and
thereafter. Call if you have any problems with this.



Completed by:[**2199-3-6**]
{'Other diseases of trachea and bronchus,Rhabdomyolysis,Pure hypercholesterolemia,Chronic lymphocytic thyroiditis'}


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: TBM s/p Y-stent placement and removal in [**10/2197**], s/p stent
placement and removal in R mainstem bronchus in [**12/2198**] with
transient alleviation in symptoms

PRESENT ILLNESS: 71F with h/o TBM who has undergone stenting including Y stent
and RMB stent in [**2196**] and [**2198**] with transient alleviation in her
respiratory symptoms.  She has met with Dr. [**Last Name (STitle) **] in
clinic and has agreed to a surgical intervention.  On [**3-1**], the
patient underwent a bronchoscopy, right thoracotomy and
tracheoplasty with thoracic tracheoplasty with mesh, right main
stem bronchus/bronchus intermedius bronchoplasty with mesh, and
left main stem bronchus bronchoplasty with mesh.

MEDICAL HISTORY: Hypercholesterolemia
Pulmonary emboli x2 ('[**83**] and '[**87**]) requiring chronic
anticoagulation; first was unprovoked, treated with coumadin;
second occurred after coumadin was stopped but again, unprovoked
Crohn's/colitis
Hypothyroidism [**1-15**] Hashimoto's
Temporal arteritis (dx clinically last year), treated with
prednisone and MTX

MEDICATION ON ADMISSION: Benzonate 100"', Citalopram 40', Clonazepam 0.5 qhs, folic acid
1', Levothyroxine 100', Lovastatin 20', Methotrexate 15qwk,
Omeprazole 20", Prednisone 5', Warfarin 2.5 five days, 5 two
days

ALLERGIES: Imitrex / Ambien / Codeine / Oxycodone

PHYSICAL EXAM: At day of discharge:

FAMILY HISTORY: Her mother died at 62 of breast cancer. Her
father died at 62 of heart attack. Her sister is 71 and her
brother is 76, both are healthy. She has a 44-year-old daughter

SOCIAL HISTORY: She is a retired chemist, lives with her wife. She has 3 kids
and 3 grandkids.
Distant +tob (50years ago), does not drink and does not use any
drugs. 

### Response:
{'Other diseases of trachea and bronchus,Rhabdomyolysis,Pure hypercholesterolemia,Chronic lymphocytic thyroiditis'}
