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From: MARK TRAMO To: "jeffrey E." <jeevacation®gmail.com> Cc: Lesley Groff Subject: Re: Jeffrey Epstein Date: Wed, 29 Jun 2016 16:50:05 +0000 Attachments: LSSTxNEJM2008.pdf Hey JE - was just starting to type this and your email arrived...coincidence or clairvoyance? I. Saw your spine last night. The anterior-posterior diameter of a normal lumbar spinal canal varies between 15 and 27 mm. At that one bad level in your lumbar spine, the AP diameter measured 8 mm = severe stenosis, not a lot of room for all the right and left lower lumbar nerve roots and all 10 sacral nerve roots to fit through. No surprise you have Neurogenic Claudication. 2. It's great you responded to Medrol. Let's see how long it lasts. Side effects preclude taking it regularly. It doesn't change the mechanics of the problem: epidural compression of multiple nerve roots by bone and related hard tissues. 3. Your anatomy, failure to respond to more than a year of epidural injections (presumably 3 or more per year) and physical therapy (presumably done daily with a proper regimen), and >10-yr life expectancy favor surgical treatment, though I hesitate to opine strongly because I don't have all the data. If I examined you and found ANY myotomal weakness, dermatomal sensory loss, denervation on EMG, or conduction abnormalities on NCS or SEP, that would reinforce my impression 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't need anything approaching reconstructive surgery with multi-level fusion. 4. I'm attaching a NEJM paper you might find informative. I did a pubmed.org search and found some recent papers discussing minimally invasive lumbar decompression (MILD; the most recent from Iran!) and other techniques. I think you are best served by consulting an expert spine surgeon. One of the authors of the NEJM paper is down the block at ComellINYH/HSS (my old training ground): https://www.hss.edu/physicians_cammisa-frank.asp How is it possible that 2016 marks 30 yrs since being Chief Resident in Neurology there, Jeffrey? 5. I'm available most anytime today and tomorrow if you would like to chat - Best, Mark On Wed, Jun 29, 2016 at 9:10 AM, jeffrey E. <[email protected]> wrote: i took a medrol . pack, made a huge difference. not sure what that means On Wed, Jun 22, 2016 at 3:53 PM, MARK TRAMO < > wrote: Greetings, Lesley! - my permanent email address (like all H alums) is - my current active email address to which that email gets forwarded is - my cellphone is - the Institute website, which has an "EMail the Director" link, is http://www.BrainMusic.org - yes, I asked JE to send me a CD w/ MRI images when we spoke Sun EFTA00323084  - if he is willing and they are available, I would also like to review the reports/results of his electrophysiological studies, namely Nerve Conduction Studies (Electroneurography), needle EMG (Electromyography), and SSEPs (Somatosensory Evoked Potentials) - I'm also attaching a PDF of a manuscript-in-progress about the neural coding of tonal consonance and dissonance by auditory-nerve fibers, which we discussed over the phone Sunday - the Figures at the 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 Mark Tramo The Institute for Music & Brain Science 2220 Lynn Road, Suite 300 Thousand Oaks, CA 91360 tel fax Best, Mark On Wed, Jun 22, 2016 at 9:02 AM, Lesley Groff <1 > wrote: Hello Mark! I have been trying to reach you and then realized I was using an old email address! Jeffrey would like me to send you the MRI of his back...can you please let me know an address to send to as I believe it is on a CD... Thanks and hope you are well! Lesley Assistant to Jeffrey Epstein 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 please note The information contained in this communication is confidential, may be attorney-client privileged, may constitute inside information, and is intended only for the use of the addressee. It is the property of EFTA00323085  JEE Unauthorized use, disclosure or copying of this communication or any part thereof is strictly prohibited and may be unlawful. If you have received this communication in error, please notify us immediately by return e-mail or by e-mail to jea®gmail.com, and destroy this communication and all copies thereof, including all attachments. copyright -all rights reserved 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 EFTA00323086