WOODSON C. MERRELL, M.D.

WOODSON C. MERRELL, M.D. 44 EAST 67th STREET NEW YORK, NEW YORK 10065 Telephone: (212) 535-1012 Fax: (212) 535-1172 Date: March 8, 2010 Patient: Jeffrey Epstein (Email: • Check in with your parathyroid specialist for routine follow up; we will send you a copy of this (and all) labs. Your numbers are, PTH 68.9 (normal less than 65) and calcium 10.4 (normal less than 10.2) • Increase niaspan 750mg to 1, twice per day and recheck cholesterol and triglycerides in 1 month • Be very careful of refined carbohydrates, due to high normal hemoglobin A1C • Your uric acid is slightly elevated; this comes mainly from animal proteins • Follow up with urologist for blood in the urine, for probably cystoscopy; especially with family history of bladder tumors • Due to elevated homocysteine, take B12; 1000mcg sublingually (under the tongue), 1 per day • Because of high homocysteine and absence of both MTHFR C6 folic acid enzymes, begin (folinic acid form of folic acid) FolaPro by Metagenics; 1 per day • Avoid extra vitamin D intake due to normal level (42) and high calcium • I don't believe I mentioned it today; heavy metals (mercury, lead, and arsenic) are all normal • Everything else is normal except pending estradiol and testosterone ; they should be back Wednesday or Thursday this week • Do you want copies of your final lab reports? • Follow up in 1 month to recheck cholesterol, triglycerides, uric acid, urine (cytology), hemoglobin A1C , and muscle enzyme (CK) • We can send you faxed or PDF of blood requisition to do these (fasting - nothing to eat or drink except water past midnight) blood tests in Florida • Follow up with me one week after doing above blood tests; telephone or in person All supplements are available at Willner Chemists 100 Park Avenue NYC, NY 10017 EFTA00727374