<table><tr><th>From:</th><th>jeffrey E. &lt;jeevacation@gmail.com&gt;</th></tr><tr><td>Sent:</td><td>Wednesday, June 29, 2016 4:52 PM</td></tr><tr><td>To:</td><td>MARK TRAMO</td></tr><tr><td>Subject:</td><td>Re: Jeffrey Epstein</td></tr></table>

I never had an epidural shot. never, i w=s hoping to try,

On Wed, Jun 29, 2016 at 12:50 PM, MARK TRAMO &=████████████████████████████████████ wrote:

Hey J= - was just starting to type this and your email arrived...coincidence or =lairvoyance?

1. Saw your spine last night. The anterior=posterior diameter of a normal lumbar spinal canal varies between 15 and 2= mm. At that one bad level in your lumbar spine, the AP diameter measured = mm = severe stenosis, not a lot of room for all the right and left lowe= lumbar nerve roots and all 10 sacral nerve roots to fit through. No surpr=se you have Neurogenic Claudication.

2. It&=39;s great you responded to Medrol. Let's see how long it lasts. Side =ffects preclude taking it regularly. It doesn't change the mechanics o= the problem: epidural compression of multiple nerve roots by bone and rel=ted hard tissues.

3. Your anatomy, failure to res=ond to more than a year of epidural injections (presumably 3 or more per y=ar) and physical therapy (presumably done daily with a proper regimen), an= >10-yr life expectancy favor surgical treatment, though I hesitate to =pine strongly because I don't have all the data. If I examined you and=found ANY myotomal weakness, dermatomal sensory loss, denervation on EMG, =r conduction abnormalities on NCS or SEP, that would reinforce my impressi=n that you need surgery. I can't opine about the type of surgery other=than to say your severe stenosis involves only one level, so you shouldn&#=9;t need anything approaching reconstructive surgery with multi-level fusi=n.

4. I'm attaching a NEJM paper you mi=ht find informative. I did a pubmed.org <http://pubmed.org> search and found some recent papers discussing minimally =nvasive lumbar decompression (MILD; the most recent from Iran!) and other =echniques. I think you are best served by consulting an expert spine surge=n. One of the authors of the NEJM paper is down the block at Cornell/NYH/H=S (my old training ground): https://www.hss.edu/physicians_cammis=- frank.asp <https://www.hss.edu/physicians=cammisa-frank.asp> How is it possible that 2016 marks 30 yrs since being =hief Resident in Neurology there, Jeffrey?

	=. I'm available most anytime today and tomorrow if you would like to c=at - <tel:310-913-7879>

Best,
Mark
=div class="gmail_extra">

On Wed, Jun 29, 2=16 at 9:10 AM, jeffrey E. <jeevacation@gmail.com <mailto:jeevacat=on@gmail.com» wrote=

i took a medrol . pack= made a huge difference. not sur= what that means

&g=; wrote:

Greetin=s, Lesley!

- my permanent email address (like all H alu=s) is mtramo@=ost.harvard.edu <mailto:mtramo@post.harvard.edu> - my current active email address to which t=at email gets forwarded is mtramo@ucla.edu <mailto:mtramo@ucla.edu> - my cellphone is 310-913.7879 <tel:310.91=-7879> http://www.Brai=Music.org <http://www.BrainMusic.org>

- yes, I asked JE to send me a CD w/ =RI images when we spoke Sun - if he is willing and they are avai=able, I would also like to review the reports/results of his electrophysio=ogical studies, namely Nerve Conduction Studies (Electroneurography), need=e EMG (Electromyography), and SSEPs (Somatosensory Evoked Potentials)

- I'm also attaching a PDF of a manuscript-in-prog=ess about the neural coding of tonal consonance and dissonance by auditory=nerve fibers, which we discussed over the phone Sunday - the Figures at th= end tell the computational part of the results I tried to relate verbally=- the equations and graphs communicate so much better!

- my mailing address for the MR images:

Dr M=rk Tramo
The Institute for Music & Brain Science
2=20 Lynn Road, Suite 300
Thousand Oaks, CA 91360
tel 805-495=6702 <tel:805.495.6702>
fax 805-495-6195 <tel:805-495-6195>

Best,
Mark

On Wed, Jun 22, 2016 at 9:02 AM, Lesley Groff <le=ley.jee@gmail.com
<mailto:lesley.jee@gmail.com> > wrote:

=ello Mark! I have been trying to reach you and then realized I was u=ing an old email
address! Jeffrey would like me to send you the MRI =f his back...can you please let me know an address to send to as I
b=lieve it is on a CD...

Thanks and hope you are well!

Lesley
Assistant to Jeffrey Epstein

=ark Jude Tramo, MD PhD Dept of Neurology, David Geffen School of Medic=ne at UCLA Dept of Musicology, UCLA Herb Alpert School of Music<=div> Director, The Institute for Music & Brain Science C=-Director, University of California Multi-Campus Music Research Initiative=(UC MERCI)

mtramo@ucla.edu <mailto:mtramo@ucla.edu>

http://www.BrainMusic.org
http://merci.ucsd=edu <http://merci.ucsd.edu>

=A0 please note

The information contained i= this communication is confidential, may be attorney-client privileged,=may constitute inside information, and is intended only for the use =f the addressee. It is the property of JEE

Unauthorized use, disclos=re or copying of this communication or any part thereof is strictly pro=ibited and may be unlawful. If you have received this communication =n error, please notify us immediately by return e-mail or by e-mail to =a href="mailto:jeevacation@gmail.com"

target="_blank">jeevacation@gmai=.com, and
destroy this communication and all copies thereof,
inc=uding all attachments. copyright -all rights reserved