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Letter to gp for referral to new neuro...please advise...
Dear Dr. Z:
I would like to request that you send a referral letter to Dr. B, **, *****, ******************** *********. I was previously under the care of Dr. *.*.W at the same clinic but due to the fact that Dr. W advised me to seek a second opinion, I was referred back to Dr. *.M. I last saw Dr. M on December 17, 2007 and was advised at that time that I would no longer be followed by Dr. M unless at her discretion and should I have any difficulty to follow up directly with you. I would appreciate it if you could put the following in your referral letter so that Dr. B will know what I have been dealing with for the past 22 months and I was told that if the details are included in your letter that I will be seen sooner by Dr. B.
I was diagnosed in 1993 with MS by Dr. *.*.W. My disease has been in remission and I have been under the care of Dr. *.M until October 2006. In October 2006, I had an “attack” of severe “ice pick” type pain in my right temple and “drooping” of my left eye lid. I was treated by Dr. M with IV Solumedrol with positive results. In February 2007 I had a relapse of symptoms similar to the symptoms I displayed in October 2006. At that time I was referred back to Dr. W in an emergency situation and diagnosed with Raeder’s Syndrome in February 2007. I was treated by Dr. W with IV Solumedrol and weaning prednisone as well as a wide variety of medications until November 2007 when he ordered an MRI and stated that the MRI was positive for MS and that I should seek a second opinion. I was referred back to Dr. M who stated that my MS is in-active.
In February of 2007, I was forced to leave my job due to a diagnosis of Paratrigeminal Neuralgia. Since that time I have had several symptoms that may be directly related to MS however they have not been followed up due to the fact that Dr. *.M has deemed my disease “in-active”.
The following is a list of the symptoms that I have had to date:
• Speech Difficulty – Stuttering, Slurring, difficulty retrieving words, strange words emitting from my mouth when distracted.
• Vision Problems – wavy distortion in peripheral vision of right eye, inability to make out shapes, inability to see clearly enough to drive in low light, seeing things that are not there from peripheral vision, vertical double vision, tadpole shaped white neon light “swims out of left peripheral vision.
• Intermittent Numbness and Tingling – left arm, left leg, persistent numbness in left side of face with intermittent numbness and tingling in left side of scalp.
• Balance difficulties which cause me to use a cane for my own safety.
• Unusual Fatigue
• Muscle Spasticity in legs
• Ice pick pain in feet
• Hearing exceptionally sensitive to high pitched sounds to the point of being very painful deep in my ears.
• Have been having a lot of paresthesias in the form of “smells that are not present”.
Since February 2007 I have seen a Rheumatologist and was diagnosed as having a low level of Vitamin D for which I now take supplements. I have undergone a neuro/psychological evaluation which resulted in a diagnosis of depression as well as difficulty with attention and concentration. It also showed moderate to severe impairment in the grip strength of my left hand and manual dexterity was mildly impaired in my right hand. As stated by the neuro/psychologist Dr. *.S, “Given her history of MS, pain and fatigue the etiology of her cognitive problems may be multifaceted.”
My problems with speech have not abated any and I am still having problems with my vision. The pain in my legs is still persistent and I have had no relief of the nerve pain in my feet.
I am currently on 20mg/Elavil daily and 300mg tid Tegretol and 20mg Citalopram daily. My sleep pattern has improved since I lowered my dose from 40mg to 20mg of Elavil but it is no longer helping to relieve the leg pain.
I am still suffering with the pain in my right and left temples and the drooping of my left eye and the numbness on the left side of my face. I have not been treated for this and during the last few weeks this pain has been persistent as has been the numbness in my face and the drooping left eye. In the past this was treated with IV Steroids but since I have not got a Neurologist to confer with I have not been able to get this treatment.
I would personally prefer to see Dr. B and after having a conversation with his office, they stated that changing Neurologists would not be a problem and it is something that is done regularly within the MS Clinic. There would be no problem with me seeing Dr. B as long as he has received a referral letter from my G.P. Seeing Dr. B would also be much easier for me as he is at the ********** ** ******* Hospital and I can either take a bus or taxi to an appointment whereas Dr. M is on 124th Street and I have a difficult time getting to appointments at her office as it is so far from home. I hope that you find this letter of some assistance to you when composing the letter for Dr. B. I would like to be able to pick up a copy of your referral letter to Dr. B sometime next week as I am sure you don’t want me to have to wait longer than I have to, to see Dr. B and have a follow up MRI.
I would like to request that you send a referral letter to Dr. B, **, *****, ******************** *********. I was previously under the care of Dr. *.*.W at the same clinic but due to the fact that Dr. W advised me to seek a second opinion, I was referred back to Dr. *.M. I last saw Dr. M on December 17, 2007 and was advised at that time that I would no longer be followed by Dr. M unless at her discretion and should I have any difficulty to follow up directly with you. I would appreciate it if you could put the following in your referral letter so that Dr. B will know what I have been dealing with for the past 22 months and I was told that if the details are included in your letter that I will be seen sooner by Dr. B.
I was diagnosed in 1993 with MS by Dr. *.*.W. My disease has been in remission and I have been under the care of Dr. *.M until October 2006. In October 2006, I had an “attack” of severe “ice pick” type pain in my right temple and “drooping” of my left eye lid. I was treated by Dr. M with IV Solumedrol with positive results. In February 2007 I had a relapse of symptoms similar to the symptoms I displayed in October 2006. At that time I was referred back to Dr. W in an emergency situation and diagnosed with Raeder’s Syndrome in February 2007. I was treated by Dr. W with IV Solumedrol and weaning prednisone as well as a wide variety of medications until November 2007 when he ordered an MRI and stated that the MRI was positive for MS and that I should seek a second opinion. I was referred back to Dr. M who stated that my MS is in-active.
In February of 2007, I was forced to leave my job due to a diagnosis of Paratrigeminal Neuralgia. Since that time I have had several symptoms that may be directly related to MS however they have not been followed up due to the fact that Dr. *.M has deemed my disease “in-active”.
The following is a list of the symptoms that I have had to date:
• Speech Difficulty – Stuttering, Slurring, difficulty retrieving words, strange words emitting from my mouth when distracted.
• Vision Problems – wavy distortion in peripheral vision of right eye, inability to make out shapes, inability to see clearly enough to drive in low light, seeing things that are not there from peripheral vision, vertical double vision, tadpole shaped white neon light “swims out of left peripheral vision.
• Intermittent Numbness and Tingling – left arm, left leg, persistent numbness in left side of face with intermittent numbness and tingling in left side of scalp.
• Balance difficulties which cause me to use a cane for my own safety.
• Unusual Fatigue
• Muscle Spasticity in legs
• Ice pick pain in feet
• Hearing exceptionally sensitive to high pitched sounds to the point of being very painful deep in my ears.
• Have been having a lot of paresthesias in the form of “smells that are not present”.
Since February 2007 I have seen a Rheumatologist and was diagnosed as having a low level of Vitamin D for which I now take supplements. I have undergone a neuro/psychological evaluation which resulted in a diagnosis of depression as well as difficulty with attention and concentration. It also showed moderate to severe impairment in the grip strength of my left hand and manual dexterity was mildly impaired in my right hand. As stated by the neuro/psychologist Dr. *.S, “Given her history of MS, pain and fatigue the etiology of her cognitive problems may be multifaceted.”
My problems with speech have not abated any and I am still having problems with my vision. The pain in my legs is still persistent and I have had no relief of the nerve pain in my feet.
I am currently on 20mg/Elavil daily and 300mg tid Tegretol and 20mg Citalopram daily. My sleep pattern has improved since I lowered my dose from 40mg to 20mg of Elavil but it is no longer helping to relieve the leg pain.
I am still suffering with the pain in my right and left temples and the drooping of my left eye and the numbness on the left side of my face. I have not been treated for this and during the last few weeks this pain has been persistent as has been the numbness in my face and the drooping left eye. In the past this was treated with IV Steroids but since I have not got a Neurologist to confer with I have not been able to get this treatment.
I would personally prefer to see Dr. B and after having a conversation with his office, they stated that changing Neurologists would not be a problem and it is something that is done regularly within the MS Clinic. There would be no problem with me seeing Dr. B as long as he has received a referral letter from my G.P. Seeing Dr. B would also be much easier for me as he is at the ********** ** ******* Hospital and I can either take a bus or taxi to an appointment whereas Dr. M is on 124th Street and I have a difficult time getting to appointments at her office as it is so far from home. I hope that you find this letter of some assistance to you when composing the letter for Dr. B. I would like to be able to pick up a copy of your referral letter to Dr. B sometime next week as I am sure you don’t want me to have to wait longer than I have to, to see Dr. B and have a follow up MRI.
Just to let you know that I have adjusted my letter and am sending it to you pm ok? I am not sure which one I will go with now and have recruited a few close friends to read them both and decide but I sure appreciate ALL THE HARD WORK you put into this! I need all the help I can get with this situation as you well know and I just want to thank you for your help.
Lots of Hugs,
Rena
Lots of Hugs,
Rena
Dear Dr. Z:
I respectfully request a referral letter for (Dr. B* So at the So Clinic). As you are aware, I was previously under the care of Dr. W at the above mentioned clinic wherein Dr. W. advised to seek a second opinion. After this time (WAS THIS THE 2ND OPINION - IF SO, CONSIDER STATING IT). I returned to Dr. M. on December 17, 2007 and was advised I would no longer need to be followed at that office and if I should have difficulty I was to follow up directly with you.
It would be greatly appreciated at this time, if you could please address the following details in your referral letter so Dr. B. will be aware of my persistent difficulties for past 22 months. I have been advised that if these historical details are included in this letter that I will have a greater chance of being examined by Dr. B as soon as possible.
Referral details:
Rena (lastname) was diagnosed in 1993 by Dr. W with Multiple Sclerosis. Rena lastname was informed by this Dr. that her disease was in “remission” and was placed under the care of Dr. M until October 2006.
In October 2006, patient describes an attack of severe ice pick type pain in her right temple and drooping of her left eye lid. She was subsequently treated by Dr. M, who prescribed IV Solumedrol. Ms. (lastname) received positive results from this treatment.
In February 2007 patient describes a return of symptoms similar to those in October 2006. At that time she was referred back to Dr. W in an emergent situation and subsequently diagnosed with Raeder’s Syndrome. Dr. W treated Ms. (lastname) with IV Solumedrol and weaning prednisone and a variety (RENA CONSIDER LISTING THE MEDS AND DELETE VARIETY,ETC) of medications until November 2007. Dr. W then ordered an MRI and advised Ms. (lastname) that the MRI was positive for Multiple Sclerosis and that she should seek a second opinion. Patient was then referred back to Dr. M who stated that her Multiple Sclerosis was in-active.
February of 2007, Ms. (lastname) left her workplace due to Paratrigeminal Neuralgia (who dx’d this? I would restructure the sentence to reflect this dx)
Ms. (lastname) was under the care of rheumatologist who is treating her for low level vitamin D. (RENA CONSIDER TAKING OUT THE VITAMIN D, AS I THINK IT'S NOT NECESSARY FOR THIS REFERRAL PURPOSES)
In 2008 Ms. (lastname) underwent a neuro/psychological evaluation which resulted in a diagnosis of depression as well as difficulty with attention and concentration. This evaluation also showed moderate to severe impairment in the grip strength of my left hand and manual dexterity was mildly impaired in my right hand. Dr. S neuro/psychologist stated, “Given her history of MS, pain and fatigue the etiology of her cognitive problems may be multifaceted.”
Currently, Ms. (lastname) is under my care, and experiences symptoms are felt to be directly related to her Multiple Sclerosis, however her Multiple Sclerosis in the past was treated solely with IV Solumedrol. Ms. (lastname) is not on disease modifying drugs, nor is she under the care of a Neurologist. (PLEASE STATE A STRONG SOURCE HERE REF. MS TREATMENT HERE - NEED A RECENT STAT. REGARDING THE MEDS. AND HOW MS IN NEVER IN-ACTIVE - JUST 2 SENTENCES. IT WILL MAKE THE MD LOOK GOOD AND UP ON HER FACTS, MAYBE SHE'LL APPRECIATE IT)
I am referring Ms. Rena (lastname) to you to for examination and treatment of Multiple Sclerosis and the associated reoccurring symptoms.
RENA, I’M NOT SO SURE YOU NEED THE CURRENT SYMPTOMS, BUT I WOULD BRING THEM TO THE NEUROLOGIST - CONSIDER CUTTING THESE OUT OF THE SUGGESTIONS FOR THE REFERRAL
Current symptoms:
• Speech difficulty: slurring, difficulty retrieving words, strange words emitting from my mouth when distracted
• Vision: wavy distortion in peripheral vision of right eye, inability to make out shapes, inability to see clearly enough to drive in low light, seeing things that are not there from peripheral vision, vertical double vision, tadpole shaped white neon light “swims out of left peripheral vision
• Intermittent Numbness and Tingling: left arm, left leg, persistent numbness in left side of face with intermittent numbness and tingling in left side of scalp
• Balance difficulties
• Fatigue
• Spasticity in legs
• Ice pick pain in feet
• Hearing sensitive to high pitched sounds with painful deep in my ears
• Paresthesias
I respectfully request a referral letter for (Dr. B* So at the So Clinic). As you are aware, I was previously under the care of Dr. W at the above mentioned clinic wherein Dr. W. advised to seek a second opinion. After this time (WAS THIS THE 2ND OPINION - IF SO, CONSIDER STATING IT). I returned to Dr. M. on December 17, 2007 and was advised I would no longer need to be followed at that office and if I should have difficulty I was to follow up directly with you.
It would be greatly appreciated at this time, if you could please address the following details in your referral letter so Dr. B. will be aware of my persistent difficulties for past 22 months. I have been advised that if these historical details are included in this letter that I will have a greater chance of being examined by Dr. B as soon as possible.
Referral details:
Rena (lastname) was diagnosed in 1993 by Dr. W with Multiple Sclerosis. Rena lastname was informed by this Dr. that her disease was in “remission” and was placed under the care of Dr. M until October 2006.
In October 2006, patient describes an attack of severe ice pick type pain in her right temple and drooping of her left eye lid. She was subsequently treated by Dr. M, who prescribed IV Solumedrol. Ms. (lastname) received positive results from this treatment.
In February 2007 patient describes a return of symptoms similar to those in October 2006. At that time she was referred back to Dr. W in an emergent situation and subsequently diagnosed with Raeder’s Syndrome. Dr. W treated Ms. (lastname) with IV Solumedrol and weaning prednisone and a variety (RENA CONSIDER LISTING THE MEDS AND DELETE VARIETY,ETC) of medications until November 2007. Dr. W then ordered an MRI and advised Ms. (lastname) that the MRI was positive for Multiple Sclerosis and that she should seek a second opinion. Patient was then referred back to Dr. M who stated that her Multiple Sclerosis was in-active.
February of 2007, Ms. (lastname) left her workplace due to Paratrigeminal Neuralgia (who dx’d this? I would restructure the sentence to reflect this dx)
Ms. (lastname) was under the care of rheumatologist who is treating her for low level vitamin D. (RENA CONSIDER TAKING OUT THE VITAMIN D, AS I THINK IT'S NOT NECESSARY FOR THIS REFERRAL PURPOSES)
In 2008 Ms. (lastname) underwent a neuro/psychological evaluation which resulted in a diagnosis of depression as well as difficulty with attention and concentration. This evaluation also showed moderate to severe impairment in the grip strength of my left hand and manual dexterity was mildly impaired in my right hand. Dr. S neuro/psychologist stated, “Given her history of MS, pain and fatigue the etiology of her cognitive problems may be multifaceted.”
Currently, Ms. (lastname) is under my care, and experiences symptoms are felt to be directly related to her Multiple Sclerosis, however her Multiple Sclerosis in the past was treated solely with IV Solumedrol. Ms. (lastname) is not on disease modifying drugs, nor is she under the care of a Neurologist. (PLEASE STATE A STRONG SOURCE HERE REF. MS TREATMENT HERE - NEED A RECENT STAT. REGARDING THE MEDS. AND HOW MS IN NEVER IN-ACTIVE - JUST 2 SENTENCES. IT WILL MAKE THE MD LOOK GOOD AND UP ON HER FACTS, MAYBE SHE'LL APPRECIATE IT)
I am referring Ms. Rena (lastname) to you to for examination and treatment of Multiple Sclerosis and the associated reoccurring symptoms.
RENA, I’M NOT SO SURE YOU NEED THE CURRENT SYMPTOMS, BUT I WOULD BRING THEM TO THE NEUROLOGIST - CONSIDER CUTTING THESE OUT OF THE SUGGESTIONS FOR THE REFERRAL
Current symptoms:
• Speech difficulty: slurring, difficulty retrieving words, strange words emitting from my mouth when distracted
• Vision: wavy distortion in peripheral vision of right eye, inability to make out shapes, inability to see clearly enough to drive in low light, seeing things that are not there from peripheral vision, vertical double vision, tadpole shaped white neon light “swims out of left peripheral vision
• Intermittent Numbness and Tingling: left arm, left leg, persistent numbness in left side of face with intermittent numbness and tingling in left side of scalp
• Balance difficulties
• Fatigue
• Spasticity in legs
• Ice pick pain in feet
• Hearing sensitive to high pitched sounds with painful deep in my ears
• Paresthesias
Rena,
Wouldn't it be so much easier if you just write -
Dr. X is a jerk and we can't agree on my treatment, so I need to move on to Dr. Y. Make it happen. Thanks.
I hope you're laughing.... you wrote a fine letter. I hope it does the trick for you because this has gone on too long.
Later, Lulu
Wouldn't it be so much easier if you just write -
Dr. X is a jerk and we can't agree on my treatment, so I need to move on to Dr. Y. Make it happen. Thanks.
I hope you're laughing.... you wrote a fine letter. I hope it does the trick for you because this has gone on too long.
Later, Lulu
I truly appreciate both of your comments and taking the time to read my letter. db...I am not sure about adding the part about not being prescribed the DMD's although I have an MS diagnosis. The reason I am thinking this way is that this gp is somehow under the thumb of Dr. M, the neuro that says my MS is in-active. My fear is that she will try to twist my words all around and she will say, that Dr. M stated in her letter that your disease is inactive and that is why you are not getting the DMD's". She will then state that because Dr. M has said your disease is inactive, you don't need to be seen by a neurologist. I feel that if I just leave that alone I will be better off with this gp. I am thinking that if she is going to send a letter to Dr. B. that I can always forward a copy of my letter with an addendum and add the information about DMD's and the desire to possibly be involved in the clinical trials at that time. I have to be very careful with this gp as she is in cahoots with the Neuro Dr. M and I don't trust either of them.
Kathy...thanks for your opinion honey and I hope you are feeling better soon honey!
Lots of Hugs for both of you!
Rena
Kathy...thanks for your opinion honey and I hope you are feeling better soon honey!
Lots of Hugs for both of you!
Rena
I think the letter is great, Rena. I'm glad that db is on the ball and could suggest some ideas that might help your case even more.
Sorry I haven't been around much; tired, pain, etc. I have been thinking about you and hoping you're doing OK. I've been kind of fuzzy-brained, but that doesn't mean I don't care.
Hugs,
Kathy
Sorry I haven't been around much; tired, pain, etc. I have been thinking about you and hoping you're doing OK. I've been kind of fuzzy-brained, but that doesn't mean I don't care.
Hugs,
Kathy
Nice work, Rena! You have thoroughly covered your history,current symptoms, and current meds. A couple of ideas to consider: in the last paragraph, where you request the referral to Dr. B and the reasons why you would like to see him, should you perhaps include your concern about not being prescribed DMD's despite having a definitive dx of MS? As I understand it, this is a major concern of yours and is part of your motivation to switch neuros. It might come across stronger if you were more explicit on this point.
Also, I thought you had previously expressed an interest in possibly joining a clinical trial if there was one that you'd be a candidate for? If so, you might want to add that as well, since your access to such trials would be greater if you saw Dr. B, who is a researcher who conducts such studies locally at * of * Hospital.
I can see you have put a lot of effort into this documentation and I truly hope it helps to move things along for you.
Also, I thought you had previously expressed an interest in possibly joining a clinical trial if there was one that you'd be a candidate for? If so, you might want to add that as well, since your access to such trials would be greater if you saw Dr. B, who is a researcher who conducts such studies locally at * of * Hospital.
I can see you have put a lot of effort into this documentation and I truly hope it helps to move things along for you.
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