CHIEF COMPLAINT: Ischemic, chronic right heel ulcer.

PRESENT ILLNESS: 

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: Intravenous  contrast  dye  causes  nausea  and
vomiting.
Augmentin causes a rash.
Demerol causes a rash.
Irritation from silk/ribbon tape.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Other complications due to other vascular device, implant, and graft,Ulcer of heel and midfoot,Chronic airway obstruction, not elsewhere classified,Atherosclerosis of native arteries of the extremities with ulceration,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status
Comp-oth vasc dev/graft,Ulcer of heel & midfoot,Chr airway obstruct NEC,Ath ext ntv art ulcrtion,DMI wo cmp nt st uncntrl,Hypertension NOS,Pure hypercholesterolem,Crnry athrscl natve vssl,Aortocoronary bypass
Service:  Vascular Surgery     Discharge Date:  [**2120-7-25**]

Date of Birth:   [**2074-6-22**]         Sex:  F

Surgeon:  [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 19472**]

CHIEF COMPLAINT:  Ischemic, chronic right heel ulcer.

HISTORY  OF  PRESENT  ILLNESS:   The patient is a 46-year-old
white  female  with type I diabetes, coronary artery disease,
end  stage  renal  disease,  status  post renal transplant in
[**9-/2117**],  status  post left below the knee amputation, status
post right distal popliteal to anterior tibial artery bypass,
status post right common femoral to popliteal anterior tibial
left  arm  vein  graft.   She has been followed by Dr. [**Last Name (STitle) **],
Podiatry,  since  [**6-/2119**]  for  a  chronic right plantar heel
ulcer.    The patient has had multiple Apligraf applications.
The wound has gotten small but still has not healed.

The  patient  was  referred back to Dr. [**Last Name (STitle) **].  The patient
underwent  an  outpatient  arteriogram  on  [**2120-7-15**]  which
showed  a  stenosis  in  her  distal  right  vein graft.  The
patient was scheduled for revision of her right vein graft.

PAST  MEDICAL  HISTORY:  Coronary artery disease:  Myocardial
infarction, coronary artery bypass graft.
Type   I   diabetes   since   age   12;  with  triopathy  and
gastroparesis.
Cerebrovascular accident times two.
End  stage  renal  disease,  status  post renal transplant in
09/[**2117**].
Hypertension.
Hypercholesterolemia.
Anemia.
Peripheral vascular disease.

PAST SURGICAL HISTORY:  Coronary  artery  bypass  graft times
three in [**7-/2116**] by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] at [**Hospital1 190**].
Left lower extremity bypass graft in [**2112**].
Left below the knee amputation in [**1-/2117**] by Dr. [**Last Name (STitle) **].
Jump  graft  from  right  common  femoral artery to popliteal
anterior  tibial  vein graft with left arm vein on [**2118-12-2**]
by Dr. [**Last Name (STitle) **].
Hand surgery.
Renal transplant in 09/[**2117**].

FAMILY   HISTORY:      The   patient's   family   history  is
noncontributory.

SOCIAL  HISTORY:  The patient lives with her husband.  She is
a  current  cigarette  smoking  with an 80-pack-year history.
She  ambulates  with  a left lower extremity prosthesis and a
boot for her right leg prescribed by the Podiatry Service.

ALLERGIES:    Intravenous  contrast  dye  causes  nausea  and
vomiting.
Augmentin causes a rash.
Demerol causes a rash.
Irritation from silk/ribbon tape.

PHYSICAL EXAMINATION:  Vital signs:  The patient was afebrile
with  stable  vital  signs.  Her heart had a regular rate and
rhythm.    Her lungs were clear bilaterally.  Her abdomen was
benign.    The  right  foot had a deep plantar heel ulcer.  A
pedal pulse was not palpable.  Left below the knee amputation
incision  was  well  healed.  Neurological exam:  The patient
was alert and oriented times three; nonfocal.

LABORATORY  DATA:   On [**2120-7-16**], white blood count was 9.2,
hemoglobin  12.9, hematocrit 39.2, platelets 274,000.  Sodium
140,  potassium  3.9,  chloride  103,  bicarbonate 32, BUN 7,
creatinine 0.6, glucose 46.  Chest x-ray on [**2120-7-16**] showed
no  acute pulmonary disease.  Electrocardiogram on [**2120-7-8**]
showed  a  normal  sinus  rhythm  at  a rate of 67.  Interval
improvement  in  anterolateral  ischemia  seen since previous
tracing of [**2120-7-6**].

MEDICATIONS:   Her medications on admission were levofloxacin
500 mg p.o. q.day, prednisone 5 mg p.o. q.d., tacrolimus 2 mg
p.o.  q.12 hours, CellCept [**Pager number **] mg b.i.d., Bactrim one tablet
p.o.  q.d.,  glargine 25 units subcutaneously q.h.s., regular
insulin  sliding  scale q.i.d., metoprolol 50 mg p.o. b.i.d.,
aspirin  325  mg  p.o.  q.d.,  famotidine  20 mg p.o. b.i.d.,
paroxetine  20  mg  p.o.  q.d.,  alprazolam 1 mg p.o. b.i.d.,
Colace  100  mg p.o. b.i.d., Senna p.r.n., morphine sustained
release  30  mg  p.o.  b.i.d.,  MSIR  15  mg p.o. q.4-6 hours
p.r.n., .................... 400 mg p.o. q.4 hours, Lactulose
30 mg p.o. q.8 hours p.r.n., nitroglycerin p.r.n.

HOSPITAL COURSE:  The patient was admitted to the hospital on
[**2120-7-22**]  following an uneventful jump graft from the right
femoral  to  below the knee popliteal vein graft to the right
below  the knee to anterior tibial vein graft using right arm
basilic  vein.    At  the  end  of surgery, the patient had a
Doppler  signal  at  the  right  anterior tibial and dorsalis
pedis.

The  patient  received  Kefzol  perioperatively.    The Renal
Transplant   Service   followed   the   patient   during  her
hospitalization.    They  recommended  holding  the patient's
metoprolol perioperatively while on bed rest if the patient's
systolic  blood  pressure  was  low.    Target systolic blood
pressure was greater than 110.  The patient reported that her
average   blood   pressure  was  in  the  90/60  range.    On
postoperative  day  three,  the  patient's blood pressure was
87/39.      The  patient  appeared  sedated  but  was  easily
arousible.    She  stated  that when she was on bed rest, her
blood pressure was frequently in that range.  The patient was
asymptomatic.

The  Podiatry  Service  was consulted to adjust the patient's
right  leg  boot in order to off load as much weight from her
right heel as possible.  This was done on [**2120-7-25**], and the
patient can be full weight bearing on the right.

At  the  time  of  dictation, the patient's right arm and leg
incisions  are  clean,  dry,  and intact.  Her right dorsalis
pedis  pulse is dopplerable.  Her right plantar heel ulcer is
deep  but  clean.  Her right elbow ulceration is stable.  The
patient  will  continue  to  have  Adaptic and a dry, sterile
dressing  applied  to  her  right foot and right elbow ulcers
q.d.    She may have a dry, sterile dressing to her right arm
and leg incisions p.r.n.

The  patient will follow-up with Dr. [**Last Name (STitle) **] in the office in
about  two  weeks  for  surgical  staple  removal.   She will
continue   on   levofloxacin  for  her  plantar  ulcer  until
follow-up with Dr. [**Last Name (STitle) **] and then per further instructions.

DISCHARGE MEDICATIONS:
Prednisone 5 mg p.o. q.d.
Bactrim  single strength one tablet p.o. q.Monday, Wednesday,
Friday.
Tacrolimus 2 mg p.o. b.i.d.
Mycophenolate mofetil 1000 mg p.o. b.i.d.
Metoprolol 50 mg p.o. b.i.d.
Paxil 20 mg p.o. q.d.
Pepcid 20 mg p.o. b.i.d.
Aspirin 325 mg p.o. q.d.
Colace 100 mg p.o. b.i.d.
Lactulose 30 mg p.o. q.8 hours p.r.n. constipation.
Senna one tablet p.o. b.i.d. p.r.n.
Neurontin 400 mg p.o. q.6 hours.
Alprazolam 1 mg p.o. b.i.d. p.r.n.
Morphine sulfate sustained release 30 mg p.o. q.12 hours.
MSIR 15 mg p.o. q.4-6 hours p.r.n.
Nitroglycerin sublingual 0.3 mg p.r.n. chest pain.
Glargine 25 mg p.o. q.h.s.
Regular insulin sliding scale q.i.d.

CONDITION AT DISCHARGE:  Satisfactory.

DISPOSITION:  Home with [**Hospital6 407**] services.

PRIMARY DIAGNOSIS:
Ischemic  right  chronic  plantar heel ulcer and distal right
vein graft stenosis.
Jump  graft  from right femoral popliteal vein graft to right
popliteal  anterior tibial vein graft using right arm basilic
vein on [**2120-7-22**].

SECONDARY DIAGNOSIS:
Type I diabetes with triopathy and gastroparesis.
End stage renal disease, status post renal transplant.
Coronary artery disease.
Status post cerebrovascular accident times two.
Hypertension.
Hypercholesterolemia.






                          [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 19472**]

Dictated By:[**Last Name (NamePattern1) 3954**]

MEDQUIST36

D:  [**2120-7-25**]  15:52
T:  [**2120-7-25**]  16:04
JOB#:  [**Job Number 26639**]
{'Other complications due to other vascular device, implant, and graft,Ulcer of heel and midfoot,Chronic airway obstruction, not elsewhere classified,Atherosclerosis of native arteries of the extremities with ulceration,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass 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: Ischemic, chronic right heel ulcer.

PRESENT ILLNESS: 

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: Intravenous  contrast  dye  causes  nausea  and
vomiting.
Augmentin causes a rash.
Demerol causes a rash.
Irritation from silk/ribbon tape.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Other complications due to other vascular device, implant, and graft,Ulcer of heel and midfoot,Chronic airway obstruction, not elsewhere classified,Atherosclerosis of native arteries of the extremities with ulceration,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status'}
