CHIEF COMPLAINT: Inflammatory carcinoma of the left breast diagnosed [**2131-8-6**] s/p
neoadjuvant chemo and s/p left modified radical mastectomy on
[**2132-1-18**] now with left breast defect.

PRESENT ILLNESS: Mrs. [**First Name (STitle) **] is a 44-year-old Caucasian female with history of
inflammatory carcinoma of the left breast diagnosed [**2131-8-6**]. She
underwent neoadjuvant chemotherapy and then subsequently
underwent a left modified radical mastectomy on [**2132-1-18**].  At
the time of her mastectomy, she was found to have residual
invasive ductal carcinoma, 6.5 cm, grade 2, five of six nodes
positive for metastatic disease, the largest metastasis 0.9 cm
with extranodal extension. Patient was then placed on Zoladex
and monthly and tamoxifen for estrogen blockade as well as
Zometa to prevent bone loss.  She was encouraged to wait 6
months post mastectomy before considering reconstructive
options. She now presents for a desired delayed left breast
reconstruction.

MEDICAL HISTORY: Depression
Left breast cancer

MEDICATION ON ADMISSION: effexor 75 mg po daily
Ativan 0.5mg PRN
zolidex implanted
tamoxifen 20 mg daily
xometa yearly
viatamin C, B12 and calcium +D

ALLERGIES: Amoxicillin / Bactrim

PHYSICAL EXAM: Pre-procedure PE as per Anesthesia Record [**2132-9-15**]:
General: overweight woman in NAD
Mental/psych: cooperative, pleasant
Airway: as documented in detail on anesthesia record
Dental: good
Head/neck Range of motion: free range of motion
Heart: RRR
Lungs: clear to auscultation
Abdomen: soft, nontender, no bruits
Extremities: no edema, skin warm and dry
Other: R chest portacath, anicteric, neck supple

FAMILY HISTORY: negative for breast and ovarian cancer.

SOCIAL HISTORY: Ms. [**Known lastname 83070**] lives with her mother, brother, and sister.  She is a
substitute teacher in the [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] system.
Encounter for breast reconstruction following mastectomy,Secondary and unspecified malignant neoplasm of lymph nodes of axilla and upper limb,Personal history of malignant neoplasm of breast,Acquired absence of breast and nipple,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health
Brst reconst fol mastect,Mal neo lymph-axilla/arm,Hx of breast malignancy,Acq absnce breast/nipple,Hx antineoplastic chemo,Hx of irradiation
Admission Date:  [**2132-9-15**]              Discharge Date:   [**2132-9-18**]

Date of Birth:  [**2088-9-11**]             Sex:   F

Service: PLASTIC

Allergies:
Amoxicillin / Bactrim

Attending:[**First Name3 (LF) 16920**]
Chief Complaint:
Inflammatory carcinoma of the left breast diagnosed [**2131-8-6**] s/p
neoadjuvant chemo and s/p left modified radical mastectomy on
[**2132-1-18**] now with left breast defect.


Major Surgical or Invasive Procedure:
Left delayed [**Last Name (un) 5884**] flap breast reconstruction


History of Present Illness:
Mrs. [**First Name (STitle) **] is a 44-year-old Caucasian female with history of
inflammatory carcinoma of the left breast diagnosed [**2131-8-6**]. She
underwent neoadjuvant chemotherapy and then subsequently
underwent a left modified radical mastectomy on [**2132-1-18**].  At
the time of her mastectomy, she was found to have residual
invasive ductal carcinoma, 6.5 cm, grade 2, five of six nodes
positive for metastatic disease, the largest metastasis 0.9 cm
with extranodal extension. Patient was then placed on Zoladex
and monthly and tamoxifen for estrogen blockade as well as
Zometa to prevent bone loss.  She was encouraged to wait 6
months post mastectomy before considering reconstructive
options. She now presents for a desired delayed left breast
reconstruction.


Past Medical History:
Depression
Left breast cancer

Social History:
Ms. [**Known lastname 83070**] lives with her mother, brother, and sister.  She is a
substitute teacher in the [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] system.


Family History:
negative for breast and ovarian cancer.


Physical Exam:
Pre-procedure PE as per Anesthesia Record [**2132-9-15**]:
General: overweight woman in NAD
Mental/psych: cooperative, pleasant
Airway: as documented in detail on anesthesia record
Dental: good
Head/neck Range of motion: free range of motion
Heart: RRR
Lungs: clear to auscultation
Abdomen: soft, nontender, no bruits
Extremities: no edema, skin warm and dry
Other: R chest portacath, anicteric, neck supple

Pertinent Results:
[**2132-9-16**] 04:44AM BLOOD WBC-8.8# RBC-3.46* Hgb-10.5* Hct-32.1*
MCV-93 MCH-30.3 MCHC-32.7 RDW-14.0 Plt Ct-306

Brief Hospital Course:
The patient was admitted to the plastic surgery service on
[**2132-9-15**] and had a left breast [**Last Name (un) 5884**] flap reconstruction.  The
patient tolerated the procedure well.
.
Neuro: Post-operatively, the patient received Morphine PCA with
good effect and adequate pain control. When tolerating oral
intake, the patient was transitioned to Oxycodone with good pain
control reported.
.
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#2.
Intake and output were closely monitored.
.
ID: Post-operatively, the patient was started on IV cefazolin,
then switched to PO cefadroxil for discharge home. 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#4, 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 75 mg po daily
Ativan 0.5mg PRN
zolidex implanted
tamoxifen 20 mg daily
xometa yearly
viatamin C, B12 and calcium +D

Discharge Medications:
1. Aspirin 81 mg Tablet, Chewable Sig: 1.5 Tablet, Chewables PO
DAILY (Daily) for 30 days.
Disp:*45 Tablet, Chewable(s)* Refills:*0*
2. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain, HA, T>100 degrees: Do not exceed
4gms/4000mg of Tylenol per day.
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Venlafaxine 75 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO DAILY (Daily).
5. Cefadroxil 500 mg Capsule Sig: One (1) Capsule PO every
twelve (12) hours for 7 days.
Disp:*14 Capsule(s)* Refills:*0*
6. Tamoxifen 20 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home

Discharge Diagnosis:
Breast cancer


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


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 hydrogen peroxide.
3. Strip drain tubing, empty bulb(s), and record output(s) [**3-5**]
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 [**8-9**]
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:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 16921**], MD Phone:[**Telephone/Fax (1) 4649**]
Date/Time: [**2132-9-23**] 8:45
.
Provider: [**Name11 (NameIs) **] [**Name12 (NameIs) **], MD Phone:[**Telephone/Fax (1) 17898**]
Date/Time: [**2132-12-11**] 10:30
{'Encounter for breast reconstruction following mastectomy,Secondary and unspecified malignant neoplasm of lymph nodes of axilla and upper limb,Personal history of malignant neoplasm of breast,Acquired absence of breast and nipple,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health'}


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: Inflammatory carcinoma of the left breast diagnosed [**2131-8-6**] s/p
neoadjuvant chemo and s/p left modified radical mastectomy on
[**2132-1-18**] now with left breast defect.

PRESENT ILLNESS: Mrs. [**First Name (STitle) **] is a 44-year-old Caucasian female with history of
inflammatory carcinoma of the left breast diagnosed [**2131-8-6**]. She
underwent neoadjuvant chemotherapy and then subsequently
underwent a left modified radical mastectomy on [**2132-1-18**].  At
the time of her mastectomy, she was found to have residual
invasive ductal carcinoma, 6.5 cm, grade 2, five of six nodes
positive for metastatic disease, the largest metastasis 0.9 cm
with extranodal extension. Patient was then placed on Zoladex
and monthly and tamoxifen for estrogen blockade as well as
Zometa to prevent bone loss.  She was encouraged to wait 6
months post mastectomy before considering reconstructive
options. She now presents for a desired delayed left breast
reconstruction.

MEDICAL HISTORY: Depression
Left breast cancer

MEDICATION ON ADMISSION: effexor 75 mg po daily
Ativan 0.5mg PRN
zolidex implanted
tamoxifen 20 mg daily
xometa yearly
viatamin C, B12 and calcium +D

ALLERGIES: Amoxicillin / Bactrim

PHYSICAL EXAM: Pre-procedure PE as per Anesthesia Record [**2132-9-15**]:
General: overweight woman in NAD
Mental/psych: cooperative, pleasant
Airway: as documented in detail on anesthesia record
Dental: good
Head/neck Range of motion: free range of motion
Heart: RRR
Lungs: clear to auscultation
Abdomen: soft, nontender, no bruits
Extremities: no edema, skin warm and dry
Other: R chest portacath, anicteric, neck supple

FAMILY HISTORY: negative for breast and ovarian cancer.

SOCIAL HISTORY: Ms. [**Known lastname 83070**] lives with her mother, brother, and sister.  She is a
substitute teacher in the [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] system. 

### Response:
{'Encounter for breast reconstruction following mastectomy,Secondary and unspecified malignant neoplasm of lymph nodes of axilla and upper limb,Personal history of malignant neoplasm of breast,Acquired absence of breast and nipple,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health'}
