To: Jeffrey Epstein[jeevacation@gmail.com]
Cc: ███████████████████████████████████
From: MARK TRAMO
Sent: Sun 6/24/2018 7:54:10 PM
Subject: To JEE: Physical Medicine & Rehabilitation (a.k.a. Physiatry) referral

Hi Jeffrey - To recapitulate the first part of today's Skype meeting:

I. Ask the surgeon who recommended the minimally invasive procedure for a referral to an HSS Physiatry attending he has worked with and trusts. Just tell him you would like to try a course of rehabilitation therapy first and, if ineffective, follow-up with him about the surgical procedure he recommended. It's always a good idea to bring the disc with your most recent LS spine MR images and Radiology Report with you to all related appointments, including the new physiatrist, new physical therapist, and the surgeon (even if he has seen it before). It may be possible to have the physical therapist set up whatever equipment s/he and you need in your home - they usually treat pts three times per week; in any case, it's important to do the recommended regimen daily, especially now while deciding about effectiveness of rehab vs. going for surgery.

2. Tell both the surgeon and the physiatrist your experience re: contradicting recommendations from two physical therapists.

3. Ask the surgeon and physiatrist to order and direct your physical therapy program (independently). Get a copy of their referral/order and see if they jibe. If ou'd like ou could scan their orders and email them to or fax them to me at marked "urgent".

4. That said, the previous, successful treatment of your herniated disc (probably also at the same lumbar level) sounded like a very nice approach ;-)

Yours,

Mark

Mark Jude Tramo, MD PhD

Dept of Neurology, David Geffen School of Medicine at UCLA

Dept of Musicology, UCLA Herb Alpert School of Music

Director, The Institute for Music & Brain Science

Co-Director, University of California Multi-Campus Music Research Initiative (UC MERCI)

http://www.BrainMusic.org
http://merci.ucsd.edu