EFTA02459432.pdf

From: jeffrey E. <jeevacation@gmail.com> Sent: Wednesday, June 29, 2016 4:52 PM To: MARK TRAMO Subject: Re: Jeffrey Epstein 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 EFTA_R1_01564504 EFTA02459432  On Wed, Jun 22, 2016 at 3:53 PM, MARK TRAMO <=mtramo@ucla.edu <mailto:mtramo@ucla.edu> &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 2 EFTA_R1_01564505 EFTA02459433  =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> 4)=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 3 EFTA_R1_01564506 EFTA02459434