CHIEF COMPLAINT: Patient admitted for ventral hernia repair and panniculectomy

PRESENT ILLNESS: 55-year-old male with a
history of having open bypass surgery in [**2133**].  He had a maximum
weight of 540 pounds.  Currently, his weight is 410 pounds and
he
has a height of 6 feet 3.  His current body mass index is 51.2
and he presents for combination procedure with you regarding a
hernia repair and abdominal wall closure with panniculectomy.
He
has also history of several suture sinuses that are seen in the
midline incision that is a vertical midline incision.  He does
have a history of excoriation and open wounds that are seen in
the area.

MEDICAL HISTORY: PMH:
Hypertension
Hyperlipidemia
Atrial fibrillation, on coumadin
Obstructive Sleep Apnea (on CPAP of 10 with 2 liters of
oxygen)Lower extremity venous stasis with recurrent cellulitis
Osteoarthritis of back and lower extremity joints

MEDICATION ON ADMISSION: hydrochlorothiazide, Coumadin, atenolol,
lisinopril.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Examination:  He is alert and oriented in no apparent
distress, fully ambulatory, fully conversant.  He has a weight
of
410 pounds.  He has a height of 6 feet 3.  He has a current BMI
of 51.2.  Physical examination of the abdomen reveals a slightly
widened midline vertical scar.  His umbilicus is in place.  He
does have several small areas of suture sinuses that are seen,
medial aspect of the superior portion of the incision as well as
inferior portion of the incision.  When probed these wounds
appear not to extend to the abdominal fascia.  He has pigmentary
changes of the lower portion of the pannus and he has a midline
hernia that is fully palpated ventrally.  Neurologically,
cranial
nerves are intact to gross examination.

FAMILY HISTORY: Family history is noted for father deceased age 68 of MI and
obesity and mother deceased age 72 from stroke. His son
underwent [**Name2 (NI) 33554**] gastric bypass for morbid obesity through
[**Hospital1 18**] Program in [**2132**].

SOCIAL HISTORY: He is married living with his wife. [**Name (NI) **] has a business involved
in medical transportation. He is former Olympic-style wrestler
in the old Soviet [**Hospital1 1281**]. He was former one pack cigarettes daily
stopping in [**9-/2131**], no recreational drugs, occasional alcohol
on weekends.
Incisional hernia without mention of obstruction or gangrene,Acute kidney failure, unspecified,Paralytic ileus,Peritoneal adhesions (postoperative) (postinfection),Morbid obesity,Bariatric surgery status,Atrial fibrillation,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other and unspecified hyperlipidemia,Venous (peripheral) insufficiency, unspecified,Osteoarthrosis involving, or with mention of more than one site, but not specified as generalized, multiple sites,Scar conditions and fibrosis of skin,Long-term (current) use of anticoagulants
Incisional hernia,Acute kidney failure NOS,Paralytic ileus,Peritoneal adhesions,Morbid obesity,Bariatric surgery status,Atrial fibrillation,Obstructive sleep apnea,Hypertension NOS,Abn react-surg proc NEC,Hyperlipidemia NEC/NOS,Venous insufficiency NOS,Osteoarthrosis-mult site,Scar & fibrosis of skin,Long-term use anticoagul
Admission Date:  [**2136-3-29**]              Discharge Date:   [**2136-4-4**]

Date of Birth:  [**2081-1-2**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 301**]
Chief Complaint:
Patient admitted for ventral hernia repair and panniculectomy

Major Surgical or Invasive Procedure:
Status Post:
1. Incisional hernia repair.
2. Excision of scar.
3. Abdominal exploration.
4. Bilateral component separation for closure of ventral
    hernia.
5. Panniculectomy.


History of Present Illness:
55-year-old male with a
history of having open bypass surgery in [**2133**].  He had a maximum
weight of 540 pounds.  Currently, his weight is 410 pounds and
he
has a height of 6 feet 3.  His current body mass index is 51.2
and he presents for combination procedure with you regarding a
hernia repair and abdominal wall closure with panniculectomy.
He
has also history of several suture sinuses that are seen in the
midline incision that is a vertical midline incision.  He does
have a history of excoriation and open wounds that are seen in
the area.


Past Medical History:
PMH:
Hypertension
Hyperlipidemia
Atrial fibrillation, on coumadin
Obstructive Sleep Apnea (on CPAP of 10 with 2 liters of
oxygen)Lower extremity venous stasis with recurrent cellulitis
Osteoarthritis of back and lower extremity joints

Social History:
He is married living with his wife. [**Name (NI) **] has a business involved
in medical transportation. He is former Olympic-style wrestler
in the old Soviet [**Hospital1 1281**]. He was former one pack cigarettes daily
stopping in [**9-/2131**], no recreational drugs, occasional alcohol
on weekends.


Family History:
Family history is noted for father deceased age 68 of MI and
obesity and mother deceased age 72 from stroke. His son
underwent [**Name2 (NI) 33554**] gastric bypass for morbid obesity through
[**Hospital1 18**] Program in [**2132**].

Physical Exam:
Physical Examination:  He is alert and oriented in no apparent
distress, fully ambulatory, fully conversant.  He has a weight
of
410 pounds.  He has a height of 6 feet 3.  He has a current BMI
of 51.2.  Physical examination of the abdomen reveals a slightly
widened midline vertical scar.  His umbilicus is in place.  He
does have several small areas of suture sinuses that are seen,
medial aspect of the superior portion of the incision as well as
inferior portion of the incision.  When probed these wounds
appear not to extend to the abdominal fascia.  He has pigmentary
changes of the lower portion of the pannus and he has a midline
hernia that is fully palpated ventrally.  Neurologically,
cranial
nerves are intact to gross examination.


Pertinent Results:
[**2136-3-30**] 04:16AM BLOOD WBC-13.9*# RBC-5.07 Hgb-15.8 Hct-47.8
MCV-94 MCH-31.3 MCHC-33.1 RDW-14.2 Plt Ct-289
[**2136-3-31**] 01:10PM BLOOD WBC-13.2* RBC-3.62* Hgb-11.7* Hct-33.9*
MCV-94 MCH-32.4* MCHC-34.6 RDW-13.8 Plt Ct-227
[**2136-4-4**] 07:15AM BLOOD WBC-7.1 RBC-3.45* Hgb-10.9* Hct-31.6*
MCV-92 MCH-31.5 MCHC-34.3 RDW-15.1 Plt Ct-255
[**2136-3-30**] 04:16AM BLOOD Plt Ct-289
[**2136-4-2**] 07:55AM BLOOD PT-14.2* PTT-24.0 INR(PT)-1.2*
[**2136-4-4**] 07:15AM BLOOD PT-17.5* PTT-25.6 INR(PT)-1.6*
[**2136-3-30**] 04:16AM BLOOD Glucose-123* UreaN-29* Creat-1.9* Na-136
K-5.8* Cl-104 HCO3-21* AnGap-17
[**2136-4-4**] 07:15AM BLOOD Glucose-104 UreaN-17 Creat-1.1 Na-137
K-3.8 Cl-102 HCO3-29 AnGap-10
[**2136-3-30**] 04:16AM BLOOD Calcium-7.3* Phos-5.4*# Mg-1.7
[**2136-4-4**] 07:15AM BLOOD Calcium-7.9* Phos-3.1# Mg-1.9
[**2136-3-29**] 11:57AM BLOOD Glucose-93 Lactate-1.9 Na-138 K-4.8
Cl-99*
[**2136-3-29**] 05:42PM BLOOD Lactate-1.6 Na-133* K-5.2 Cl-101
[**2136-3-29**] 11:57AM BLOOD Hgb-16.2 calcHCT-49
[**2136-3-29**] 05:42PM BLOOD Hgb-17.1 calcHCT-51

Brief Hospital Course:
Patient admitted for ventral hernia repair and panniculectomy.
He tolerated the procedure very well without complications.
Postoperatively his labs were followed closely. His pain was
well controlled with pca and then transitioned to oral
narcotics.

He was discharged from the hospital with follow up with Dr.
[**Last Name (STitle) **] and Dr. [**First Name (STitle) **] and with his primary care to follow his
coumadin dosing.

Medications on Admission:
hydrochlorothiazide, Coumadin, atenolol,
lisinopril.


Discharge Medications:
1. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
2. Warfarin 5 mg Tablet Sig: 7.5 mg PO Once Daily at 4 PM:
Please schedule an appointment with your docotor to have your
INR checked within 1 week.
Disp:*30 tablets* Refills:*0*
3. Hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO
DAILY (Daily).
4. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
5. Duricef 500 mg Capsule Sig: One (1) Capsule PO twice a day
for 2 weeks: take while drains are in place.
Disp:*28 Capsule(s)* Refills:*0*
6. Colace 50 mg/5 mL Liquid Sig: Ten (10) mL PO twice a day:
take while using narcotics for pain control to help prevent
constipation.
Disp:*300 mL* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Ventral Hernia


Discharge Condition:
hemodynamically stable, tolerating oral intake, ambulating in
[**Doctor Last Name **], pain controlled with oral regimen, voiding without issue,
tolerating a normal diet.


Discharge Instructions:
You are being discharged on medications to treat the pain from
your operation. These medications will make you drowsy and
impair your ability to drive a motor vehicle or operate
machinery safely. You MUST  refrain from such activities while
taking these medications.


Please call your doctor or return to the emergency room if you
have any of the following:

 * You experience new chest pain, pressure, squeezing or
 tightness.

* New or worsening cough or wheezing.

* If you are vomiting and cannot keep in fluids or your
 medications.

* You are getting dehydrated due to continued vomiting,
 diarrhea or other reasons. Signs of dehydration include dry
 mouth, rapid heartbeat or feeling dizzy or faint when standing.

* You see blood or dark/black material when you vomit or have a
 bowel movement.


* You have shaking chills, or a fever greater than 101.5 (F)
 degrees or 38(C) degrees.

* Any serious change in your symptoms, or any new symptoms that
 concern you.

* Please resume all regular home medications and take any new
meds
 as ordered.
Activity:
No heavy lifting of items [**9-6**] pounds for 6 weeks. You may
resume moderate
exercise at your discretion, no abdominal exercises.

Wound Care:
You may shower, no tub baths or swimming.
If there is clear drainage from your incisions, cover with
clean, dry gauze.
Your steri-strips will fall off on their own. Please remove any
remaining strips 7-10 days after surgery.
Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.

You should continue to wear your abdominal binder at all times
until follow up with Dr. [**First Name (STitle) **].


Followup Instructions:
Provider: [**Name10 (NameIs) 357**] see Dr. [**Last Name (STitle) **] in two weeks, call [**Telephone/Fax (1) 2723**]
to make an appointment.
Provider: [**First Name11 (Name Pattern1) 2053**] [**Last Name (NamePattern1) 6751**], MD Phone:[**Telephone/Fax (1) 6742**]
Date/Time:[**2136-4-6**] 1:00
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 304**], MD Phone:[**Telephone/Fax (1) 305**]
Date/Time:[**2136-7-4**] 11:15
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 8021**], RD,LDN Phone:[**Telephone/Fax (1) 305**]
Date/Time:[**2136-7-4**] 11:30

Please make an appointment to see your primary care provider
[**Name Initial (PRE) 176**] 1 week to have you INR checked and coumadin dosing
adjusted.



Completed by:[**2136-4-5**]
{'Incisional hernia without mention of obstruction or gangrene,Acute kidney failure, unspecified,Paralytic ileus,Peritoneal adhesions (postoperative) (postinfection),Morbid obesity,Bariatric surgery status,Atrial fibrillation,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other and unspecified hyperlipidemia,Venous (peripheral) insufficiency, unspecified,Osteoarthrosis involving, or with mention of more than one site, but not specified as generalized, multiple sites,Scar conditions and fibrosis of skin,Long-term (current) use of anticoagulants'}


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: Patient admitted for ventral hernia repair and panniculectomy

PRESENT ILLNESS: 55-year-old male with a
history of having open bypass surgery in [**2133**].  He had a maximum
weight of 540 pounds.  Currently, his weight is 410 pounds and
he
has a height of 6 feet 3.  His current body mass index is 51.2
and he presents for combination procedure with you regarding a
hernia repair and abdominal wall closure with panniculectomy.
He
has also history of several suture sinuses that are seen in the
midline incision that is a vertical midline incision.  He does
have a history of excoriation and open wounds that are seen in
the area.

MEDICAL HISTORY: PMH:
Hypertension
Hyperlipidemia
Atrial fibrillation, on coumadin
Obstructive Sleep Apnea (on CPAP of 10 with 2 liters of
oxygen)Lower extremity venous stasis with recurrent cellulitis
Osteoarthritis of back and lower extremity joints

MEDICATION ON ADMISSION: hydrochlorothiazide, Coumadin, atenolol,
lisinopril.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Examination:  He is alert and oriented in no apparent
distress, fully ambulatory, fully conversant.  He has a weight
of
410 pounds.  He has a height of 6 feet 3.  He has a current BMI
of 51.2.  Physical examination of the abdomen reveals a slightly
widened midline vertical scar.  His umbilicus is in place.  He
does have several small areas of suture sinuses that are seen,
medial aspect of the superior portion of the incision as well as
inferior portion of the incision.  When probed these wounds
appear not to extend to the abdominal fascia.  He has pigmentary
changes of the lower portion of the pannus and he has a midline
hernia that is fully palpated ventrally.  Neurologically,
cranial
nerves are intact to gross examination.

FAMILY HISTORY: Family history is noted for father deceased age 68 of MI and
obesity and mother deceased age 72 from stroke. His son
underwent [**Name2 (NI) 33554**] gastric bypass for morbid obesity through
[**Hospital1 18**] Program in [**2132**].

SOCIAL HISTORY: He is married living with his wife. [**Name (NI) **] has a business involved
in medical transportation. He is former Olympic-style wrestler
in the old Soviet [**Hospital1 1281**]. He was former one pack cigarettes daily
stopping in [**9-/2131**], no recreational drugs, occasional alcohol
on weekends. 

### Response:
{'Incisional hernia without mention of obstruction or gangrene,Acute kidney failure, unspecified,Paralytic ileus,Peritoneal adhesions (postoperative) (postinfection),Morbid obesity,Bariatric surgery status,Atrial fibrillation,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other and unspecified hyperlipidemia,Venous (peripheral) insufficiency, unspecified,Osteoarthrosis involving, or with mention of more than one site, but not specified as generalized, multiple sites,Scar conditions and fibrosis of skin,Long-term (current) use of anticoagulants'}
