Mallory Hubbard, PA - 05/15/2025 8:55 AM CDTFormatting of this note is different from the original.Inpatient Discharge SummaryBRIEF OVERVIEWAdmitting Provider: William Cavanaugh Chapman, MDDischarge Provider: Chapman, William Cavanaugh, MDPrimary Care Physician at Discharge: Beard, Kelsey Michelle, NP 618-463-0689 Admission Date: 5/14/2025 Discharge Date: 5/15/2025Admission Location: Barnes Jewish HospitalHospital Problems/Diagnoses:Principal Problem: Metastatic colon cancer to liver (HCC)Active Problems: Metastasis to liver (HCC)Resolved Problems:No resolved hospital problems.DETAILS OF HOSPITAL STAYPresenting Problem/History of Present Illness:Mr. Alexander R Towell is a 49 y.o. male with history of metastatic colorectal cancer the liver. Presenting for surgical consultation accompanied by his girlfriend, Kimberly. He was diagnosed with sigmoid colon cancer status post laparoscopic sigmoid colectomy in 12/29/2021. He was recurrence free until three years later, his recurrence was in the terminal ileum status post right hemicolectomy in 7/1/2024, pathology notable for ileal adenocarcinoma. Last colonoscopy was 2 months ago which was normal. He was first seen in our clinic and reviewed at liver multidisciplinary conference in 10/2024. > Findings: PET (july)- 4 areas of FDG uptake in the liver, very focal. 2 in left hemiliver 1 near segment 7 + 1 near the dome. MRI (aug)- treatment response with smaller lesions, only see 3 lesions. Pelvic disease is treated. >

Plan: Consider left lateral resection versus ablationHospital Course:The patient was taken to the OR on 5/14 for a robotic segment 2 resection (small wedge). For details of the operation, please see the OP note in Epic.Surgeons and Role: * Chapman, William Cavanaugh, MD - Primary>Post operative pain controlled with PO pain mediations.>Foley catheter was removed without incident.>No surgical drain utilized. PT/OT evaluated while inpatient and recommend home.The patient was discharged home in stable condition on 5/15.Scripts: Oxycodone 5mg #15, robaxinFollow-up:No future appointments. > surgical follow up in 2 weeks, appointment has been requestedTest Results Pending at Discharge:Pending Labs Order Current Status Surgical pathology In process Operative Procedures Performed:Procedure(s):XI LIVER RESECTION - LAPAROSCOPIC ROBOTIC ASSISTED, TAP BlockDischarge DetailsPhysical Exam at Discharge:Discharge Condition: goodPulse: 60Resp: 17BP: 121/80Temp: 36.5 °C (97.7 °F)Weight: 97.9 kg (215 lb 14.4 oz)Pertinent Exam Findings at Discharge: dermabond CDIDischarge Disposition:Patient will be discharged to:home Code Status at Discharge: FULLDischarge Instructions:Instructions For Hepatobiliary Surgery Patients: Call 911 or go to your local emergency room if: You have bleeding from your incision that worries you. You have chest pain. You feel like you can’t catch your breath. You faint or pass out. Call Your Doctor If: You have a fever of 101.5 F degrees or higher. It is hard for you to urinate. You have nausea, vomiting or diarrhea. If you have bright red blood or bad smelling drainage from your incision sites. You have any questions about your medications. You have belly pain that is getting worse. Your incision is red or swollen. Your eyes appear yellow; you have clay-colored stool, dark urine, and/or persistent itching. These can be a signs of a problem with your liver. If you are sent home with a drain, call if there is a sudden change in your abdominal drain output or color. If you need to talk with a doctor after regular hours or on weekends; please call your doctor’s office. The voicemail will give you directions on how to reach the on call doctor for an emergency. Do NOT leave a message on the voice mail. These messages will not be heard until the next business day. Office of Dr. Chapman: (314) 362-2538Diet:Regular Diet as toleratedActivity:You may perform activities as you feel up to it. Do NOT lift anything over 10 pounds for 6 weeks. This includes babies and pets.Do NOT drive while taking narcotic pain medicine. It is very important to stay active. Take several short walks each day.Care Instructions:You may take showers. Pat wounds dry. Do not rub.Keep your incision site dry and clean. Do NOT take tub baths, go swimming or use a hot tub until approved by your doctor. It is normal to feel very tired for several weeks after surgery. It’s ok to rest as needed.Follow Up:You will need to follow up with your Primary Care Doctor in 1-2 weeks. It is VERY important to let your doctor know if any changes were made to your medications while you were in the hospital.Discharge Medications:Current Medications TAKE these medications acetaminophen 500 mg capsuleTake 2 capsules (1,000 mg total) by mouth every 6 (six) hours as needed for painFor: painaspirin 325 mgTake 1 tablet (325 mg total) by mouth every 6 (six) hours as needed for pain or headachesFor: paincyanocobalamin 100 mcg tabletTake 1 tablet (100 mcg total) by mouth early morning before breakfastFor: prevention of vitamin B12 deficiencyCommonly known as: Vitamin B-12docusate sodium 100 mg capsuleTake 1 capsule (100 mg total) by mouth 2 (two) times a day as needed for constipationFor: constipationCommonly known as: COLACEfluticasone propionate 50 mcg/actuation nasal sprayAdminister 1 spray into each nostril daily as needed for rhinitisFor: inflammation of the nose due to an allergyCommonly known as: FLONASEiron bisgly,ps-FA-B-C#12-succ 65 mg-65 mg -1,000 mcg (24) tabletTake 1 tablet by mouth 3 (three) times a weekFor: anemia from inadequate ironlevothyroxine 112 mcg tabletTake 1 tablet (112 mcg total) by mouth early morning before breakfastFor: a condition with low thyroid hormone levelsCommonly known as: SYNTHROIDloperamide 2 mg tabletTake 1 tablet (2 mg total) by mouth 4 (four) times a day as needed for diarrheaFor: diarrhea caused by chemotherapyCommonly known as: IMODIUM A-DLORazepam 0.5 mg tabletTake 1 tablet (0.5 mg total) by mouth every 8 (eight) hours as needed for anxietyFor: anxiousCommonly known as: ATIVANmethocarbamoL 500 mg tabletTake 1 tablet (500 mg total) by mouth 3 (three) times a day as needed for muscle spasmsCommonly known as: ROBAXINmultivitamin with minerals tabletTake 1 tablet by mouth daily with dinnerFor: treatment to prevent mineral deficiency, treatment to prevent vitamin deficiencyomega-3 fatty acids-fish oil 300-1,000 mg capsuleTake 2 capsules (2 g total) by mouth daily with dinnerFor: supplementSUMAtriptan 50 mg tabletTake 1 tablet (50 mg total) by mouth once as needed for migraineFor: a migraine headacheCommonly known as: IMITREXzolpidem 5 mg tabletTake 1 tablet (5 mg total) by mouth nightly as needed for sleepFor: difficulty falling asleepCommonly known as: AMBIENOutpatient Follow-Up:Cosigned by William Chapman, MD at 05/15/2025 12:23 PM CDTElectronically signed by Mallory Hubbard, PA at 05/15/2025 8:56 AM CDTElectronically signed by William Chapman, MD at 05/15/2025 12:23 PM CDTdocumented in this encounter