CHIEF COMPLAINT: admitted for charcot joint reconstruction

PRESENT ILLNESS: 56yo F with a hx of unclear bleeding diathesis, as well as
diastolic CHF and DM complicated by charcot foot deformity was
admitted on [**2123-4-5**] and underwent reconstruction of L charcot
foot on [**2123-4-10**]. The delay between the time of admission and OR
was secondary to swelling of the LLE believed to be secondary to
her Charcot deformity. She was intubated for the OR on [**4-10**] for
a total of 5 hours. At the recommendation of the heme/onc
service, the pt was given ddAVP 30mcg/kg IV prior to OR for her
bleeding diathesis. During the op, the pt was given 2units PRBCs
and 3 liters of LR with a significant amount of blood loss
intraoperatively per the podiatry resident est. 750 cc + and
urine output of 400cc/5 hours intra-operatively (for net of
positive of over 3.5 liters positive).

MEDICAL HISTORY: 1. CHF (Diastolic pMIBI [**3-20**] Mild [**Last Name (LF) **], [**First Name3 (LF) **]=57%)
2. Aortic Valve Insufficiency
3. Bleeding diathesis with neg prior workup which has previously
responded to ddAVP. Pt is followed by Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
of Heme/Onc
4. OSA on bipap at home
5. Insulin Dependent DM complicated by Charcot foot and
peripheral neuropathy.
6. PVD with multiple foot ulcers
7. Hashimoto's Thyroiditis
8. Asthma
9. Anemia
10. IBS
11. Hepatitis C
12. MRSA in past
13. Cataracts
14. Macular degeneration
15. Osteoarthritis
16. Bladder spasms
17. Stress urinary incontinence
18. Fibromyalgia
19. Anxiety
20. Major Depression
21. s/p tonsilletcomy and adenoidectomy
22. s/p c-section with significant post partum bleeding
23. s/p bladder suspension complicated by post op bleeding
24. s/p hernia repair

MEDICATION ON ADMISSION: 1. Atenolol 50mg QPM
2. Diovan 80mg QAM
3. Lasix 100mg [**Hospital1 **]
4. Lantus 80unts QPM with HISS
5. Levoxyl 0.175mcg QAM
6. ddAVP NS PRN
7. Singulair 10mg QAM
8. Combivent IH PRN
9. Ciproflaxacin 500mg [**Hospital1 **] ([**2123-3-29**] -)
10. Clindamycin 300mg TID ([**2123-3-29**] - )
11. Ditropan XL 10mg QAM
12. Effexor 150mg QAM
13. Flexeril 10mg TID/PRN
14. Amitriptyline 150mg QHS
15. Neurontin 600mg [**Hospital1 **]
16. Nexium 40mg QAM
17. Niferex capsule 1-2 times daily
18. Potassium 10-20mg QPM
19. Ultram 100mg PRN
20. Xanax 0.5mg QHS and PRN
21. Mireda IUD with Progesterone

ALLERGIES: Tape / Provera / Antibiotic / Verapamil / Heparin Agents

PHYSICAL EXAM: Tc=101.8 P= 86 BP=108/48 RR=20 88-100% on nasal BIPAP
.
GEN: Initially, mild-moderate respiratory distress with
accessory SCM use bilaterally, AOX2 (thought she was at [**Hospital 107**]
Hospital in [**Hospital1 1559**], MA)
HEENT: 12 cm JVP, nasal BIPAP, PERRLA
CV: RRR, S1, S2
Chest: Bilateral diffuse rhonchi with mild expiratory wheezes
Abd: NT, ND +BS
Ext: LLE in tight ACE wrap s/p left charcot reconstruction

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Married. Lives with husband.  Daughter is HCP.
Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Acute diastolic heart failure,Unspecified viral hepatitis C without hepatic coma,Ulcer of other part of foot,Acute posthemorrhagic anemia,Acute kidney failure, unspecified,Arthropathy associated with neurological disorders,Unspecified hemorrhagic conditions,Long-term (current) use of insulin,Hallux valgus (acquired),Other chest pain,Obesity, unspecified
DMII neuro nt st uncntrl,Ac diastolic hrt failure,Hpt C w/o hepat coma NOS,Ulcer other part of foot,Ac posthemorrhag anemia,Acute kidney failure NOS,Arthropathy w nerve dis,Hemorrhagic cond NOS,Long-term use of insulin,Hallux valgus,Chest pain NEC,Obesity NOS
Admission Date:  [**2123-4-5**]              Discharge Date:   [**2123-4-19**]

Date of Birth:  [**2067-1-6**]             Sex:   F

Service: MEDICINE

Allergies:
Tape / Provera / Antibiotic / Verapamil / Heparin Agents

Attending:[**First Name3 (LF) 2145**]
Chief Complaint:
admitted for charcot joint reconstruction

Major Surgical or Invasive Procedure:
surgical reconstruction/repair of charcot joint


History of Present Illness:
56yo F with a hx of unclear bleeding diathesis, as well as
diastolic CHF and DM complicated by charcot foot deformity was
admitted on [**2123-4-5**] and underwent reconstruction of L charcot
foot on [**2123-4-10**]. The delay between the time of admission and OR
was secondary to swelling of the LLE believed to be secondary to
her Charcot deformity. She was intubated for the OR on [**4-10**] for
a total of 5 hours. At the recommendation of the heme/onc
service, the pt was given ddAVP 30mcg/kg IV prior to OR for her
bleeding diathesis. During the op, the pt was given 2units PRBCs
and 3 liters of LR with a significant amount of blood loss
intraoperatively per the podiatry resident est. 750 cc + and
urine output of 400cc/5 hours intra-operatively (for net of
positive of over 3.5 liters positive).

Post op, the patient complained of left sided upper anterior
chest pain without radiation which was reproducible with
palpation and felt to be secondary to a device placed in the
exact location of her pain used to prop her during the
procedure. She was given morphine with relief of pain. At the
time, her HR was 70, BP: 160/60, SaO2: 100% (but unclear amount
of supplemental oxygen, RN nursing notes her SaO2 to be 98% on
3L at time of acceptance from PACU). Her CV exam was RRR, S1,
S2, no m/r/g and lung exam was CTA bilaterally. No JVP or LE
edema was mentioned on exam.

Subsequently the pt was given lasix 40mg IV x1 over night for
her positive fluid status. A CXR was obtained at that time which
confirmed pulmonary edema on [**2123-4-10**].


Past Medical History:
1. CHF (Diastolic pMIBI [**3-20**] Mild [**Last Name (LF) **], [**First Name3 (LF) **]=57%)
2. Aortic Valve Insufficiency
3. Bleeding diathesis with neg prior workup which has previously
responded to ddAVP. Pt is followed by Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
of Heme/Onc
4. OSA on bipap at home
5. Insulin Dependent DM complicated by Charcot foot and
peripheral neuropathy.
6. PVD with multiple foot ulcers
7. Hashimoto's Thyroiditis
8. Asthma
9. Anemia
10. IBS
11. Hepatitis C
12. MRSA in past
13. Cataracts
14. Macular degeneration
15. Osteoarthritis
16. Bladder spasms
17. Stress urinary incontinence
18. Fibromyalgia
19. Anxiety
20. Major Depression
21. s/p tonsilletcomy and adenoidectomy
22. s/p c-section with significant post partum bleeding
23. s/p bladder suspension complicated by post op bleeding
24. s/p hernia repair

Social History:
Married. Lives with husband.  Daughter is HCP.


Family History:
Non-contributory.

Physical Exam:
Tc=101.8 P= 86 BP=108/48 RR=20 88-100% on nasal BIPAP
.
GEN: Initially, mild-moderate respiratory distress with
accessory SCM use bilaterally, AOX2 (thought she was at [**Hospital 107**]
Hospital in [**Hospital1 1559**], MA)
HEENT: 12 cm JVP, nasal BIPAP, PERRLA
CV: RRR, S1, S2
Chest: Bilateral diffuse rhonchi with mild expiratory wheezes
Abd: NT, ND +BS
Ext: LLE in tight ACE wrap s/p left charcot reconstruction


Pertinent Results:
Foot and ankle films [**4-5**]: Extensive neuropathic changes with
paraspinous of the foot and extensive soft tissue swelling.
.
ECG [**2123-4-6**]: NSR at 70, left [**Hospital1 **] axis, Q in III, no ST changes,
TW flatteningn in L, TWI in V2 to v3, poor R wave progression.
.
CT lower extrem [**4-6**]: Extensive Charcot changes throughout the
left hindfoot, with rocker- bottom deformity, without
significant change from the radiograph dated [**2123-2-25**], and
[**2123-4-5**].
.
Left LENI [**4-6**]: No evidence of DVT within the left lower
extremity from the popliteal vein through the common femoral
vein.
.
[**4-10**] CXR: Lung volumes are lower today and borderline pulmonary
edema is new. Moderate cardiomegaly is stable. What is most
noteworthy is interval widening of the mediastinum, particularly
in the right lower paratracheal region. Since there is no
contralateral tracheal shift to suggest the mass effect
generally seen from hematoma. I suspect this is due to vascular
overload alone. I suggest careful followup following diuresis to
exclude conditions such as aortic dissection and if central
venous line was placed or attempted in the interim, mediastinal
hematoma. The esophagus is distended with air above the level of
the carina and could be the cause of pain.
.
ECG [**2123-4-10**]: NSR at 80, leftward axis, Q in III, no ST changes,
TW flattening in III, TWI in V2 to v4, poor R wave progression.

.
[**4-11**] CXR: Lung volumes remain low, but pulmonary vascular
congestion has improved since [**4-10**]. Mediastinal veins remain
dilated. The heart is moderately enlarged. There is no
appreciable pleural effusion or indication of pneumothorax.
.
[**4-12**] Foot and ankle films: Limited secondary to overlying cast.
The patient is status post subtalar and first ray fusion as
described above.
.
[**4-17**] CXR: Upper lungs are clear. Mild cardiomegaly is stable.
Consolidation at the left lung base has worsened since [**4-10**],
stable since [**4-12**], and less pronounced opacification at the
right lung base has worsened since [**4-12**]. Findings are
consistent with atelectasis but pneumonia cannot be excluded.
There is no pleural effusion or pneumothorax.
.
[**4-18**] CXR: 1. Slight interval improvement in left lower lobe
consolidation.
2. Improvement in opacity at the right lung base which may
partly be due to differences in patient rotation.


Brief Hospital Course:
The patient was initially admitted to the Podiatry service:

**PODIATRY COURSE**
POD #1, the pt was found to have a low grade temp of 100.4 with
HR: 76, BP: 112/60 and RR: 20 with SaO2: 97% on 3L. Her lung
exam was significant for crackles at bases bilaterally. Her
ins/outs were as follows: IVF: 380 and PO: 240 for total of: 630
and Outs: 1350. She was given another dose of ddAVP 30mg IV x1
as well as lasix 60mg IV x1. During the course of the day, she
did not diurese appropriately, and continued to have crackles at
her bases bilaterally resulting in another dose of lasix 120mg
IV x1 at noon. On [**2123-4-11**], despite diuresis with lasix, her
urine output remained low at 40 cc/hr. Her creatinine rose from
0.9 to 1.2.

As this did not result in much improvement a med consult was
called for evaluation for diuresis. Medical consult recommended
transfer to medicine on [**4-11**] but at the time of evaluation, she
was felt to be in respiratory distress. The MICU was called for
further evaluation.

An ABG and stat CXR were obtained at that time around 4 pm.
Initial ABG on BIPAP with O2 sats of 94% was:

7.43/46/32/53 on BIPAP, sat 94%.

Repeat ABG [**11-16**] an hour later on the same settings of BIPAP was
as follows:

7.45/42/30/68, lactate 1.1

CXR on [**2123-4-11**] was consistent with pulmonary edema.

**MICU COURSE**
The patient was then transferred to the MICU for further
evaluation. Her O2 sats dropped to 88% and her nasal BIPAP was
tightened and readjusted. An ABG with O2 sats of 88% was
improved at:

7.53/33/198/28/198

Her O2 sat rose with adjustment of her BIPAP to 100%. The
patient was given 5 mg metolaxone and 60 mg IV lasix in the MICU
and put out 190 cc of urine.  She diuresed well overnight and
was 1.5 L negative during her 18 hours in the MICU.  In the
morning her hematocrit had continued to slowly trend down to 24,
and she received 1 U PRBC followed by lasix and metolazone.  She
was called out to the floor the morning after arrival in the
MICU.

**FLOOR COURSE**
...
On the floor, the patient was diuresed with further improvement
in her oxygenation.  Once she was at her baseline in terms of
pulmonary status, her home regimen of PO lasix was restarted.
Her blood pressure was well-controlled.  Following her
transfusion of PRBC in the MICU, her hematocrit remained stable
and began to improve.  Vancomycin and unasyn were continued
post-op and discontinued on discharge.  The podiatry service
continued to follow the patient, and they discontinued her JP
drain and placed a bivalve cast prior to discharge.  She will
follow up with podiatry 2 weeks after discharge.  The patient
will continue to be followed by [**Date Range 1978**] as an outpatient, and
the need for ddAVP should be discussed carefully in the future
given that the patient developed volume load and CHF after
receiving ddAVP peri-op on this admission.

Medications on Admission:
1. Atenolol 50mg QPM
2. Diovan 80mg QAM
3. Lasix 100mg [**Hospital1 **]
4. Lantus 80unts QPM with HISS
5. Levoxyl 0.175mcg QAM
6. ddAVP NS PRN
7. Singulair 10mg QAM
8. Combivent IH PRN
9. Ciproflaxacin 500mg [**Hospital1 **] ([**2123-3-29**] -)
10. Clindamycin 300mg TID ([**2123-3-29**] - )
11. Ditropan XL 10mg QAM
12. Effexor 150mg QAM
13. Flexeril 10mg TID/PRN
14. Amitriptyline 150mg QHS
15. Neurontin 600mg [**Hospital1 **]
16. Nexium 40mg QAM
17. Niferex capsule 1-2 times daily
18. Potassium 10-20mg QPM
19. Ultram 100mg PRN
20. Xanax 0.5mg QHS and PRN
21. Mireda IUD with Progesterone


Discharge Medications:
1. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Alprazolam 0.25 mg Tablet Sig: Two (2) Tablet PO QHS (once a
day (at bedtime)).
3. Alprazolam 0.25 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day) as needed for anxiety.
4. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO BID (2
times a day).
6. Venlafaxine 75 mg Capsule, Sust. Release 24HR Sig: Two (2)
Capsule, Sust. Release 24HR PO DAILY (Daily).
7. Cyclobenzaprine 10 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) as needed.
8. Oxybutynin Chloride 10 mg Tab, Sust Release Osmotic Push Sig:
One (1) Tab, Sust Release Osmotic Push PO qd (): Please hold
until patient urinating well after foley has been removed.
9. Valsartan 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. Furosemide 40 mg Tablet Sig: 2.5 Tablets PO BID (2 times a
day).
11. Amitriptyline 50 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime).
12. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

13. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**11-16**]
Puffs Inhalation Q6H (every 6 hours) as needed.
14. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
15. Tramadol 50 mg Tablet Sig: Two (2) Tablet PO Q4-8H () as
needed.
16. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
17. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
18. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed.
19. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
20. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
DAILY (Daily) as needed.
21. Calcium Carbonate 500 mg/5 mL Suspension Sig: Ten (10) ML PO
QID (4 times a day) as needed.
22. Morphine 15 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4
to 6 hours) as needed.
23. Compazine 10 mg Tablet Sig: One (1) Tablet PO every [**2-18**]
hours as needed for nausea.
24. Foley removal
Please discontinue foley when patient arrives at rehab


Discharge Disposition:
Extended Care

Facility:
Masonic Home

Discharge Diagnosis:
Primary Diagnoses:
Charcot joint s/p surgical reconstruction
diastolic congestive heart failure
bleeding diathesis with prior negative workup
anemia, secondary to blood loss
.
Secondary Diagnoses:
diabetes mellitus
peripheral vascular disease
depression


Discharge Condition:
good


Discharge Instructions:
If you experience fever, chills, shortness of breath, or
worsening pain, redness, or drainage from your surgical site,
please call your doctor or return to the emergency room for
evaluation.
.
Please take all medications as prescribed.
.
Please attend all follow up appointments.

Followup Instructions:
You should make an appointment to follow up with Dr. [**Last Name (STitle) 44484**] of
Podiatric Surgery within 2 weeks after discharge from the
hospital.  You can call [**Telephone/Fax (1) 543**] for an appointment.
.
You also have the following appointments already scheduled:
Provider: [**Name10 (NameIs) 7801**],[**First Name7 (NamePattern1) 177**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]/ONCOLOGY-CC9
Date/Time:[**2123-6-21**] 10:00
Provider: [**Name10 (NameIs) 475**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 474**], M.D. Phone:[**Telephone/Fax (1) 1989**]
Date/Time:[**2123-8-20**] 11:00


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 2158**]

Completed by:[**2123-4-19**]
{'Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Acute diastolic heart failure,Unspecified viral hepatitis C without hepatic coma,Ulcer of other part of foot,Acute posthemorrhagic anemia,Acute kidney failure, unspecified,Arthropathy associated with neurological disorders,Unspecified hemorrhagic conditions,Long-term (current) use of insulin,Hallux valgus (acquired),Other chest pain,Obesity, unspecified'}


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: admitted for charcot joint reconstruction

PRESENT ILLNESS: 56yo F with a hx of unclear bleeding diathesis, as well as
diastolic CHF and DM complicated by charcot foot deformity was
admitted on [**2123-4-5**] and underwent reconstruction of L charcot
foot on [**2123-4-10**]. The delay between the time of admission and OR
was secondary to swelling of the LLE believed to be secondary to
her Charcot deformity. She was intubated for the OR on [**4-10**] for
a total of 5 hours. At the recommendation of the heme/onc
service, the pt was given ddAVP 30mcg/kg IV prior to OR for her
bleeding diathesis. During the op, the pt was given 2units PRBCs
and 3 liters of LR with a significant amount of blood loss
intraoperatively per the podiatry resident est. 750 cc + and
urine output of 400cc/5 hours intra-operatively (for net of
positive of over 3.5 liters positive).

MEDICAL HISTORY: 1. CHF (Diastolic pMIBI [**3-20**] Mild [**Last Name (LF) **], [**First Name3 (LF) **]=57%)
2. Aortic Valve Insufficiency
3. Bleeding diathesis with neg prior workup which has previously
responded to ddAVP. Pt is followed by Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
of Heme/Onc
4. OSA on bipap at home
5. Insulin Dependent DM complicated by Charcot foot and
peripheral neuropathy.
6. PVD with multiple foot ulcers
7. Hashimoto's Thyroiditis
8. Asthma
9. Anemia
10. IBS
11. Hepatitis C
12. MRSA in past
13. Cataracts
14. Macular degeneration
15. Osteoarthritis
16. Bladder spasms
17. Stress urinary incontinence
18. Fibromyalgia
19. Anxiety
20. Major Depression
21. s/p tonsilletcomy and adenoidectomy
22. s/p c-section with significant post partum bleeding
23. s/p bladder suspension complicated by post op bleeding
24. s/p hernia repair

MEDICATION ON ADMISSION: 1. Atenolol 50mg QPM
2. Diovan 80mg QAM
3. Lasix 100mg [**Hospital1 **]
4. Lantus 80unts QPM with HISS
5. Levoxyl 0.175mcg QAM
6. ddAVP NS PRN
7. Singulair 10mg QAM
8. Combivent IH PRN
9. Ciproflaxacin 500mg [**Hospital1 **] ([**2123-3-29**] -)
10. Clindamycin 300mg TID ([**2123-3-29**] - )
11. Ditropan XL 10mg QAM
12. Effexor 150mg QAM
13. Flexeril 10mg TID/PRN
14. Amitriptyline 150mg QHS
15. Neurontin 600mg [**Hospital1 **]
16. Nexium 40mg QAM
17. Niferex capsule 1-2 times daily
18. Potassium 10-20mg QPM
19. Ultram 100mg PRN
20. Xanax 0.5mg QHS and PRN
21. Mireda IUD with Progesterone

ALLERGIES: Tape / Provera / Antibiotic / Verapamil / Heparin Agents

PHYSICAL EXAM: Tc=101.8 P= 86 BP=108/48 RR=20 88-100% on nasal BIPAP
.
GEN: Initially, mild-moderate respiratory distress with
accessory SCM use bilaterally, AOX2 (thought she was at [**Hospital 107**]
Hospital in [**Hospital1 1559**], MA)
HEENT: 12 cm JVP, nasal BIPAP, PERRLA
CV: RRR, S1, S2
Chest: Bilateral diffuse rhonchi with mild expiratory wheezes
Abd: NT, ND +BS
Ext: LLE in tight ACE wrap s/p left charcot reconstruction

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Married. Lives with husband.  Daughter is HCP. 

### Response:
{'Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Acute diastolic heart failure,Unspecified viral hepatitis C without hepatic coma,Ulcer of other part of foot,Acute posthemorrhagic anemia,Acute kidney failure, unspecified,Arthropathy associated with neurological disorders,Unspecified hemorrhagic conditions,Long-term (current) use of insulin,Hallux valgus (acquired),Other chest pain,Obesity, unspecified'}
