This is a good summary of my medical problems over the years…

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Attn: The Office of Dr. B:

Please accept this referral on behalf of my patient, Tara ***** ******, who has contacted your office for an appointment the week of August 12th.

Tara has been my patient since November 2005, and from the beginning her case has been ongoing and complex. Right before I met Tara on November 1, 2005, she had bacteremia, yet her white cell blood count was only 6.7 and she failed to develop a fever. This is one instant of numerous regarding her atypical presentation, making an ongoing clinical evaluation extremely important.

I’ve seen Tara approximately every other week for the past eight years. She has responded positively to IVIG therapy at 50 grams a dose, as well as ongoing antibiotic therapy.

Tara’s health problems date back to when she was born, and she has seen numerous specialists and physicians for assistance regarding her ongoing health problems. Tara’s case is fascinating while it is frustrating, as she fails to often ‘look sick’ yet has disease processes ongoing, later documented by surgery or culture while having a normal CBC.

Tara has been diagnosed with the following diseases and conditions:

* primary immune deficiency, impaired response to the pneumococcal vaccine * CVID
* low t-cells
* low nk cells
* brain lesions consistent with multiple sclerosis
* positive ANA
* cyclical neutropenia
* abnormal electrical activity in her temporal lobe
* bacteremia
* multiple positive nasal, anal, blood and urine cultures
* multiple abnormal Pap smears
* multiple elevated d-dimers
* polyps in her uterus, nasal, colon
* bronchitis, pneumonia, sinus infections
* bartonella infection
* vasculitis
* severe chest pain with an elevated troponin level
* multiple skin infections, notably staph
* low IL-6 levels
* tonsils, appendix and gallbladder removed
* inflammation of her esophagus

Another prime example of Tara’s atypical presentation, was when she developed chronic pain in her upper right abdomen. She complained for months yet numerous imaging studies came back normal. Tara had over twenty ultrasounds, ct scans, as well as an MRI of her abdomen. Multiple radiologists determined there was nothing wrong, yet she insisted she was in pain. Eventually she consulted surgeon Dr. Moses Fallas, who preformed exploratory surgery in April 2007, and he found chronic cholecystitis.

It was a surprise to many physicians and radiologists, many of whom believed she was just having MS like phantom pain.

Tara’s case challenges our notion of how to approach the practice of medicine, as many times ‘the evidence’ has later been proven to be wrong in her case. We have found the best way to assist her over the years is just to listen–she has demonstrated a strong sensitivity with her body, and has proven herself not to be embellishing or just looking for attention.

It is breathtaking how healthy Tara looks, and it is often misleading due to the severity of her health problems. I’ve learned to just close my eyes and listen to her share her symptoms, as she often looks healthy even as she needs medical assistance.

Tara has thousands of pages of medical records, so please do not hesitate to contact my office when you need documentation.

I hope that Tara is able to find the medical support that she needs. I believe she can live a long life if she has access to the necessary medical care. She is dynamic, engaging and intelligent, and often acts strong even when she is suffering in pain.

Please feel free to contact me if you have any further questions.

Regards,

Dr. Jeffrey Sherman, MD