LETTER

 

Date

 

Name

Address

City, State, Zip

 

Re: 

 

Dear Bob:

 

This is a followup letter to our brief discussion.  As a background, she has had 20 years of "nervous stomach," describing abdominal discomfort with certain foods and stress.  She would get relief intermittently with Donnatal, Di-Gel, and Maalox.  Additionally, she has been taking 8 Excedrin per day for approximately 20 years.

 

More recently for her shoulder problem, she was treated with prednisone, Naprosyn, Flexeril, Excedrin with codeine, Tylenol No. 3, Percodan, having been off all prednisone and Naprosyn for approximately 4 weeks.  However, despite being off those medications, she still describes some "indigestion" described as a midepigastric discomfort associated with mild nausea.  This discomfort is worse with food and with tight clothes.  She describes loss of appetite and basically being afraid to eat anything.  She has no visible bloating, vomiting, acid regurgitation, nocturnal symptoms, or dysphagia.  She does describe some improvement in the symptoms with soda crackers, creme de menthe, and liquid Maalox as well as belching.  She continues to take 8 Excedrin per day.

 

Her physical examination was remarkable for findings of a right pleural effusion, and her stool was hemoccult positive.

 

In view of her many years of dyspeptic symptoms, her recent multiple drug ingestion as well as the continued aspirin intake, one has to presume that her midepigastric discomfort and nausea are due to these multiple medications and the continued use of aspirin.  In view of this likelihood, it would seem most reasonable to treat her presumptively with Tagamet as well as taking her off regular aspirin and placing her on Ecotrin (the enteric-coated aspirin), which seems to have less gastroduodenal effects.  To this end we started her on Ecotrin, Tagamet, and should she have no improvement in her symptoms over the next several weeks, then endoscopy is recommended to evaluate the source of her pain.

 

Thank you, Bob, for asking me to see this patient, and should she have no improvement, I will keep you informed of the results of her endoscopy.

 

Sincerely,

_______________

 

 

LETTER

 

Date

 

Name

Address

City, State, Zip

 

Re:

 

Dear Ms. (blank):

 

I reviewed the set of records which you forwarded to me along with your letter.

 

Following the medical record review, I find that her right shoulder pain and neck pain began as a result of her work.  It is my impression that there were no other causes of her pain since the record fails to indicate causes other than the one connected with her job.  There is no prior history of similar symptoms.

The loading and unloading of the food containers and bags weighing up to 70 pounds, in an individual who is only 5 feet tall and weighs 108 pounds, is obviously an excessive effort and predisposes her to injury.

 

As long as the medical record fails to indicate any other prior injuries or any other accidents, one has to assume that all of her symptoms began as a result of a cervical disk herniation and that she has neurologic changes and that an EMG and MRI are indicated to complete her diagnostic studies.

 

Sincerely yours,

 

Name

 

 

 

THE WASHINGTON CLINIC

CHARTERED

5401 WESTERN AVE., N.W. · WASHINGTON, D.C. 20015 · (202) 244-9270

 

 

December 6, 2002

 

Policy Services

NCRIC, Inc.

1115 30th Street NW

Washington, DC 20007

 

 

Attention:  Underwriting

 

 

Dear Sirs:

 

This is to inform you that come February 1, 2003, I will cease practicing medicine in the District of Columbia and will join Rockville Internal Medicine Group in Maryland.  I will hold an office at 1201 Seven Locks Road, MD 20854, and at the Chevy Chase Building at 5530 Wisconsin Avenue, Chevy Chase, MD 20815.  I would appreciate continuing my NCRIC coverage in Maryland.  I am a rheumatologist.  I do not perform surgery, and I have never had a malpractice claim against me.  Please respond with a cost estimate of my coverage after February 1, 2003.

 

 

Sincerely yours,

 

 

 

___________________________

LAWRENCE H. SCHAINKER, M.D.

Department of Rheumatology

Washington Clinic Medical Center

 

D: 12/06/02

 

 

THE WASHINGTON CLINIC

CHARTERED

5401 WESTERN AVE., N.W. · WASHINGTON, D.C. 20015 · (202) 244-9270

 

 

December 2, 2002

 

To,

Lynn Soffer, M.D.

Associate Medical Director

Comprehensive Health Services Inc.

8229 Boone Boulevard, Suite 700

Vienna, VA 22182-2623

 

 

RE:                          JOSE VASQUEZ

SOCIAL SECURITY#:            584-52-2539

DATE OF VISIT:               12/02/02

 

 

Dear Dr. Soffer:

 

I have carefully reviewed the medical records of Mr. Jose Vasquez with respect to orthopaedic issues.  He is a 48-year-old gentleman who currently is receiving a 20% VA disability for recurrent neck problems and degenerative disc disease as well as 20% impairment for lumbar degenerative disc disease.  I have read the evaluations given by the VA Hospital and also have read the reports of the cervical and lumbar x‑rays and the lumbar MRI.

 

I feel that while Mr. Vasquez demonstrates evidence of degenerative disc disease, his functional capacity and range of motion are adequate.  Given the natural history of this condition, and its long-standing periods of freedom from symptoms, I would have to adjudge that he is fit to perform the duties of a Customs Inspector.  I do not feel that he, based on the findings today, is likely to experience sudden or subtle incapacitation by carrying out the tasks and duties of this position.

 

Thank you very much for allowing me to review these records.

 

 

Sincerely,

 

 

 

____________________

THOMAS F. RYAN, M.D.

D: 12/02/02

T: 12/03/02

TFR: edc