CHIEF COMPLAINT: Bilateral foot ulcers and rest pain

PRESENT ILLNESS: 70 year-old female with a history of LLE claudication who
presented in [**11-17**] with ischemic and gangrenous 1st left toe.
She underwent a right femoral patch angioplasty with Dacron,
right to left femoral bypass with 8-mm PTFE graft and left
superficial femoral artery profunda endarterectomies.  She
presented in [**12-19**] with a wound dehiscence for which she was
treated with ciprofloxacin.  She returns today for pre-operative
workup for bilateral lower extremity angio tomorrow.  Currently
she feels well, but continues to have claudication in her left
calf while walking with numbness and burning in her left foot.
The ulcers on the tips of her left toes have continued to heal
daily.

MEDICAL HISTORY: - CAD s/p stent to 70% RCA lesion in [**2116**]; no CP, cath was done
in preparation of LE revascularization.
- Hypertension
- h/o syncope since childhood -> +syncope "hundreds of times"
- Seizure disorder (dx [**2112**]) (usual sxs are syncope w/ vomiting,
incontinence).  Last episode in summer [**2116**].  Followed by Dr.
[**First Name (STitle) **] at [**Hospital 1474**] hospital ([**Telephone/Fax (1) 28219**]).  Seizure free since
starting Keppra.
- PVD/claudication --> s/p R femoral patch angioplasty with
Dacron, R -> L femoral bypass with 8-mm PTFE graft, and L
superficial femoral artery profunda endarterectomies ([**11-17**]).
- Carotid artery disease (40-59% of the right ICA, 60-69% of the
left ICA by carotid duplex on [**2117-8-23**])
- H/o head trauma: Fractured skull (age 14 mos) after falling
out of a
second story window; hit on the head with an axe @ age 9.
- Rheumatoid arthritis
- Osteopenia
- Glaucoma
- Macular degeneration
- Cataract surgery, left eye
- Raynaud's phenomenon
- COPD/Emphysema
- s/p cholecystectomy
- s/p appendectomy
- Pernicious anemia

MEDICATION ON ADMISSION: metoprolol 25'', plavix 75', keppra 500'', celebrex 100',
prednisone 5', crestor 10', ASA 325', xalatan 1 drop left eye
QHS

ALLERGIES: Tape / Morphine

PHYSICAL EXAM: ON ADMISSION:
Vitals: 97.7  86  146/68  18  94% ROOM AIR
Gen: NAD
CV: RRR
Lung: CTAB
Abd: soft, obese, ND, NT, NABS
Ext: Palpable DP bilaterally, non-palpable PT, bilateral toes
hyperemic, left toe with healing ulcers.
.
ON DISCHARGE:
Vitals:  97.0  76  140/66  18  97% ROOM AIR
Gen: NAD
CV: RRR
Lung: CTAB
Abd: soft, obese, ND, NT, NABS
Ext: Palpable DP bilaterally, non-palpable PT, left toe with
healing ulcers improving, both feet warm.

FAMILY HISTORY: Mother w/ "angina" and h/o melanoma

SOCIAL HISTORY: Lives with her daughter.  H/o tobacco use (quit [**2109**]) - 30 pack
year hx.  Denies EtOH or drug use.
Atherosclerosis of autologous vein bypass graft of the extremities,Other convulsions,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Rheumatoid arthritis,Unspecified glaucoma,Macular degeneration (senile), unspecified,Percutaneous transluminal coronary angioplasty status
Ath ext autologs bps gft,Convulsions NEC,Chr airway obstruct NEC,Crnry athrscl natve vssl,Hypertension NOS,Rheumatoid arthritis,Glaucoma NOS,Macular degeneration NOS,Status-post ptca
Admission Date:  [**2118-5-16**]              Discharge Date:   [**2118-5-24**]

Date of Birth:  [**2047-9-27**]             Sex:   F

Service: SURGERY

Allergies:
Tape / Morphine

Attending:[**First Name3 (LF) 1781**]
Chief Complaint:
Bilateral foot ulcers and rest pain

Major Surgical or Invasive Procedure:
[**2118-5-17**] Diagnostic abdominal aortogram, pelvic arteriogram,
bilateral lower extremity runoffs, brachial arterial puncture
with third order catheterization.
[**2118-5-19**] Revision femoral-femoral bypass graft, right common
femoral endarterectomy and patch angioplasty.


History of Present Illness:
70 year-old female with a history of LLE claudication who
presented in [**11-17**] with ischemic and gangrenous 1st left toe.
She underwent a right femoral patch angioplasty with Dacron,
right to left femoral bypass with 8-mm PTFE graft and left
superficial femoral artery profunda endarterectomies.  She
presented in [**12-19**] with a wound dehiscence for which she was
treated with ciprofloxacin.  She returns today for pre-operative
workup for bilateral lower extremity angio tomorrow.  Currently
she feels well, but continues to have claudication in her left
calf while walking with numbness and burning in her left foot.
The ulcers on the tips of her left toes have continued to heal
daily.

Past Medical History:
- CAD s/p stent to 70% RCA lesion in [**2116**]; no CP, cath was done
in preparation of LE revascularization.
- Hypertension
- h/o syncope since childhood -> +syncope "hundreds of times"
- Seizure disorder (dx [**2112**]) (usual sxs are syncope w/ vomiting,
incontinence).  Last episode in summer [**2116**].  Followed by Dr.
[**First Name (STitle) **] at [**Hospital 1474**] hospital ([**Telephone/Fax (1) 28219**]).  Seizure free since
starting Keppra.
- PVD/claudication --> s/p R femoral patch angioplasty with
Dacron, R -> L femoral bypass with 8-mm PTFE graft, and L
superficial femoral artery profunda endarterectomies ([**11-17**]).
- Carotid artery disease (40-59% of the right ICA, 60-69% of the
left ICA by carotid duplex on [**2117-8-23**])
- H/o head trauma: Fractured skull (age 14 mos) after falling
out of a
second story window; hit on the head with an axe @ age 9.
- Rheumatoid arthritis
- Osteopenia
- Glaucoma
- Macular degeneration
- Cataract surgery, left eye
- Raynaud's phenomenon
- COPD/Emphysema
- s/p cholecystectomy
- s/p appendectomy
- Pernicious anemia


Social History:
Lives with her daughter.  H/o tobacco use (quit [**2109**]) - 30 pack
year hx.  Denies EtOH or drug use.


Family History:
Mother w/ "angina" and h/o melanoma

Physical Exam:
ON ADMISSION:
Vitals: 97.7  86  146/68  18  94% ROOM AIR
Gen: NAD
CV: RRR
Lung: CTAB
Abd: soft, obese, ND, NT, NABS
Ext: Palpable DP bilaterally, non-palpable PT, bilateral toes
hyperemic, left toe with healing ulcers.
.
ON DISCHARGE:
Vitals:  97.0  76  140/66  18  97% ROOM AIR
Gen: NAD
CV: RRR
Lung: CTAB
Abd: soft, obese, ND, NT, NABS
Ext: Palpable DP bilaterally, non-palpable PT, left toe with
healing ulcers improving, both feet warm.

Pertinent Results:
ON ADMISSION:
[**2118-5-16**] 07:00PM BLOOD WBC-7.9 RBC-3.57* Hgb-10.9* Hct-32.6*
MCV-91 MCH-30.5 MCHC-33.4 RDW-14.6 Plt Ct-316
[**2118-5-16**] 07:00PM BLOOD PT-11.7 PTT-22.5 INR(PT)-1.0
[**2118-5-16**] 07:00PM BLOOD Glucose-80 UreaN-20 Creat-0.9 Na-140
K-3.7 Cl-104 HCO3-27 AnGap-13
[**2118-5-16**] 07:00PM BLOOD Calcium-9.1 Phos-3.4 Mg-2.4
.
ON DISCHARGE
[**2118-5-21**] 09:45AM BLOOD WBC-10.2 RBC-3.63* Hgb-11.3* Hct-32.5*
MCV-90 MCH-31.2 MCHC-34.9 RDW-15.5 Plt Ct-211
[**2118-5-21**] 09:45AM BLOOD Glucose-139* UreaN-20 Creat-1.0 Na-144
K-3.9 Cl-106 HCO3-23 AnGap-19
[**2118-5-21**] 09:45AM BLOOD Calcium-9.0 Phos-3.7 Mg-2.3
.
RADIOLOGY  Final Report
CHEST (PRE-OP PA & LAT)  [**2118-5-18**] 12:06 PM
CHEST (PRE-OP PA & LAT)
Reason: ISCHEMIA BILATERAL LEGS
[**Hospital 93**] MEDICAL CONDITION:
70 year old woman with PVD
REASON FOR THIS EXAMINATION:
preop RT leg bypass
EXAMINATION: Peripheral vascular disease. Preop right leg
bypass.
IMPRESSION: PA and lateral chest compared to [**2117-11-25**]:
Lungs are mildly hyperinflated. Reticulation seen best in the
central right lung probably bronchiectasis. More pronounced
oligemia in the right upper lobe could be due to emphysema.
Irregular opacities at the apices of both lungs, particularly
the left, most likely scars, but a prior radiograph should be
obtained to confirm that this is not a new finding and therefore
requiring additional evaluation.
Heart is normal size. A very small pericardial effusion is
probably present. Pulmonary vascularity and hilar and
mediastinal vessels are normal. No pleural effusion.
.
RADIOLOGY  Final Report
CHEST (PORTABLE AP)  [**2118-5-19**] 12:11 PM
CHEST (PORTABLE AP)
Reason: SOB
[**Hospital 93**] MEDICAL CONDITION:
70 year old woman with
REASON FOR THIS EXAMINATION:
SOB
INDICATION: Shortness of breath.
CHEST, ONE VIEW: Comparison with [**2118-5-18**]. Cardiac,
mediastinal, and hilar contours are unchanged. Diffuse reticular
interstitial opacities are unchanged. Scarring at both lung
apices is unchanged. No pleural effusion or pneumothorax. No
focal consolidations. Osseous structures are also probably
unchanged on this poorly penetrated film.
IMPRESSION:
1. No acute cardiopulmonary abnormality.
2. Diffuse reticular interstitial opacities suggest interstitial
disease. HRCT may be useful for further characterization.


Brief Hospital Course:
The patient was admitted to Dr.[**Name (NI) 7257**] Vascular Surgery
Service on [**2118-5-16**].  She underwent a diagnostic abdominal
aortogram, pelvic arteriogram, bilateral lower extremity
runoffs, brachial arterial puncture with third order
catheterization on [**2118-5-17**]. For details of the operation, please
refer to the operative report.  She did well post-angiogram and
was raken to the operating room on [**2118-5-19**], where she underwent a
revision femoral-femoral bypass graft, right common femoral
endarterectomy and patch angioplasty.  For details of the
operation, please refer to the operative report.  Her
postoperative course was relatively uncomplicated.  She had a
temperature to 101.3 on POD 1 attributed to atelectasis.  She
was placed on a steroid taper immediately post-operatively and
was transitioned to PO medications.  She was deemed stable for
discharge on POD 4.  Her foley catheter was removed without
complications.  She was evaluated by physical therapy and
cleared for home.  She continued to tolerate a regular diet and
remained afebrile.  She will follow-up with Dr. [**Last Name (STitle) **].

Medications on Admission:
metoprolol 25'', plavix 75', keppra 500'', celebrex 100',
prednisone 5', crestor 10', ASA 325', xalatan 1 drop left eye
QHS

Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
4. RESUME ALL PREVIOUS HOME MEDICATIONS
5. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
6. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
7. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
8. Rosuvastatin 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
9. Celecoxib 100 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
10. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution Sig: One (1)
 Inhalation Q6H (every 6 hours).
11. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
12. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4-6H
(every 4 to 6 hours) as needed.
13. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).



Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] VNA- [**Location (un) 5087**]

Discharge Diagnosis:
Bilateral foot ulcers and rest pain.


Discharge Condition:
Stable


Discharge Instructions:
What to expect when you go home:
1. It is normal to feel tired, this will last for 4-6 weeks
??????	You should get up out of bed every day and gradually increase
your activity each day
??????	Unless you were told not to bear any weight on operative foot:
you may walk and you may go up and down stairs
??????	Increase your activities as you can tolerate- do not do too
much right away!

2. It is normal to have swelling of the leg you were operated
on:
??????	Elevate your leg above the level of your heart (use [**1-15**]
pillows or a recliner) every 2-3 hours throughout the day and at
night
??????	Avoid prolonged periods of standing or sitting without your
legs elevated

3. It is normal to have a decreased appetite, your appetite will
return with time
??????	You will probably lose your taste for food and lose some
weight
??????	Eat small frequent meals
??????	It is important to eat nutritious food options (high fiber,
lean meats, vegetables/fruits, low fat, low cholesterol) to
maintain your strength and assist in wound healing
??????	To avoid constipation: eat a high fiber diet and use stool
softener while taking pain medication

What activities you can and cannot do:
??????	No driving until post-op visit and you are no longer taking
pain medications
??????	Unless you were told not to bear any weight on operative foot:

??????	You should get up every day, get dressed and walk
??????	You should gradually increase your activity
??????	You may up and down stairs, go outside and/or ride in a car
??????	Increase your activities as you can tolerate- do not do too
much right away!
??????	No heavy lifting, pushing or pulling (greater than 5 pounds)
until your post op visit
??????	You may shower (unless you have stitches or foot incisions) no
direct spray on incision, let the soapy water run over incision,
rinse and pat dry
??????	Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing
over the area that is draining, as needed
??????	Take all the medications you were taking before surgery,
unless otherwise directed
??????	Take one full strength (325mg) enteric coated aspirin daily,
unless otherwise directed
??????	Call and schedule an appointment to be seen in 2 weeks for
staple/suture removal

What to report to office:
??????	Redness that extends away from your incision
??????	A sudden increase in pain that is not controlled with pain
medication
??????	A sudden change in the ability to move or use your leg or the
ability to feel your leg
??????	Temperature greater than 100.5F for 24 hours
??????	Bleeding, new or increased drainage from incision or white,
yellow or green drainage from incisions

Followup Instructions:
Scheduled Appointments :
Provider [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3310**], MD Phone:[**Telephone/Fax (1) 2226**]
Date/Time:[**2118-9-28**] 11:00
.
Appointments to be made:
Please call Dr. [**Last Name (STitle) **] at ([**Telephone/Fax (1) 1798**] to schedule a
follow-up appointment in [**12-14**] weeks.



Completed by:[**2118-5-24**]
{'Atherosclerosis of autologous vein bypass graft of the extremities,Other convulsions,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Rheumatoid arthritis,Unspecified glaucoma,Macular degeneration (senile), unspecified,Percutaneous transluminal coronary angioplasty status'}


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: Bilateral foot ulcers and rest pain

PRESENT ILLNESS: 70 year-old female with a history of LLE claudication who
presented in [**11-17**] with ischemic and gangrenous 1st left toe.
She underwent a right femoral patch angioplasty with Dacron,
right to left femoral bypass with 8-mm PTFE graft and left
superficial femoral artery profunda endarterectomies.  She
presented in [**12-19**] with a wound dehiscence for which she was
treated with ciprofloxacin.  She returns today for pre-operative
workup for bilateral lower extremity angio tomorrow.  Currently
she feels well, but continues to have claudication in her left
calf while walking with numbness and burning in her left foot.
The ulcers on the tips of her left toes have continued to heal
daily.

MEDICAL HISTORY: - CAD s/p stent to 70% RCA lesion in [**2116**]; no CP, cath was done
in preparation of LE revascularization.
- Hypertension
- h/o syncope since childhood -> +syncope "hundreds of times"
- Seizure disorder (dx [**2112**]) (usual sxs are syncope w/ vomiting,
incontinence).  Last episode in summer [**2116**].  Followed by Dr.
[**First Name (STitle) **] at [**Hospital 1474**] hospital ([**Telephone/Fax (1) 28219**]).  Seizure free since
starting Keppra.
- PVD/claudication --> s/p R femoral patch angioplasty with
Dacron, R -> L femoral bypass with 8-mm PTFE graft, and L
superficial femoral artery profunda endarterectomies ([**11-17**]).
- Carotid artery disease (40-59% of the right ICA, 60-69% of the
left ICA by carotid duplex on [**2117-8-23**])
- H/o head trauma: Fractured skull (age 14 mos) after falling
out of a
second story window; hit on the head with an axe @ age 9.
- Rheumatoid arthritis
- Osteopenia
- Glaucoma
- Macular degeneration
- Cataract surgery, left eye
- Raynaud's phenomenon
- COPD/Emphysema
- s/p cholecystectomy
- s/p appendectomy
- Pernicious anemia

MEDICATION ON ADMISSION: metoprolol 25'', plavix 75', keppra 500'', celebrex 100',
prednisone 5', crestor 10', ASA 325', xalatan 1 drop left eye
QHS

ALLERGIES: Tape / Morphine

PHYSICAL EXAM: ON ADMISSION:
Vitals: 97.7  86  146/68  18  94% ROOM AIR
Gen: NAD
CV: RRR
Lung: CTAB
Abd: soft, obese, ND, NT, NABS
Ext: Palpable DP bilaterally, non-palpable PT, bilateral toes
hyperemic, left toe with healing ulcers.
.
ON DISCHARGE:
Vitals:  97.0  76  140/66  18  97% ROOM AIR
Gen: NAD
CV: RRR
Lung: CTAB
Abd: soft, obese, ND, NT, NABS
Ext: Palpable DP bilaterally, non-palpable PT, left toe with
healing ulcers improving, both feet warm.

FAMILY HISTORY: Mother w/ "angina" and h/o melanoma

SOCIAL HISTORY: Lives with her daughter.  H/o tobacco use (quit [**2109**]) - 30 pack
year hx.  Denies EtOH or drug use. 

### Response:
{'Atherosclerosis of autologous vein bypass graft of the extremities,Other convulsions,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Rheumatoid arthritis,Unspecified glaucoma,Macular degeneration (senile), unspecified,Percutaneous transluminal coronary angioplasty status'}
