WOODSON C. MERRELL, M.D.

WOODSON C. MERRELL, M.D. 44 EAST 67th STREET NEW YORK, NEW YORK 10065 Teleph Fax Date: September 22, 2011 Patient: Jeffrey Epstein (E: jeevacation®grnail.com) • See attached pdf of your recent labs, MRI, and Dr. Shimony's consultation notes • Contact your New Haven endocrinologist regarding elevated PTH (104: calcium normal) • Juicing is excellent; the only caveat is to be careful not to have many green vegetables as these contain oxalates which help form kidney stones • Because elevated homocysteine, and low folic acid in recent blood test, resume Folapro (MTHF) form of folic acid (Metagenics), one 800 mcg tablet daily • Use 1,000 mcg sublingual B12 daily • I gave you 5,000 mcg IM of folic acid today (+ IV B vitamins, Mg, Ca, C and glutathione) • It's fine to use an additional 50 mg Vitamin B-Complex daily. • Begin niacin treatment gradually (depending of degree of flushing and any other side effect, which is unlikely). You probably need to be on 1,000mg twice per day to get full triglyceride-lowering effect. • Recheck your blood test 1 month after being on this dose. • If your HDL cholesterol has not increased and triglycerides decreased significantly on the next blood test, you can also add high dose fish oil (given statin intolerance) • Let us know your schedule on your return to NYC in 2 weeks---to see a spine specialist * r Dr. Michael Neuwirth-10 Union Sq, NYC, NY 10003-3314 at Beth Israel Spine Institute): we will arrange this for you • Begin physical therapy rehabilitation for your lumbar spine stenosis, ideally guided by a spine specialist • Continue low back acupuncture, ideally twice per week • Whenever you have a flare of stenosis symptoms begin (5-7 days minimum) NSIAD therapy. This can be: o Celebrex 100mg 2x o Aleve (naproxen) 1 tablet 3 times/day or two tablets twice/day. o 2-3 Advil (ibuprofen) three times per day o If you take Ibuprofen or naproxen, take with food or antacid to protect stomach. • seeing urologist Dr. Harry Fisch- (944 Park Ave, NYC, NY 10028 regarding testosterone treatment • I will contact you if today's magnesium test is not normal • Continue other supplements and recommendations as per July 27th instructions sheet (see attached) • See me when you're in NY next to review above and do acupuncture. EFTA01106923 All supplements are available at: Willner Chemists 100 Park Avenue (41" Street) Life Science Pharmacy 144 Route 17M 0926 Pharmacist: Scott Berliner VitaHealth 1235 18, Avenue (between 66th & 6Th Street) New York, NY 10065 Pharmacist: David Restrepo EFTA01106924