Letters for Disability 3

April 2, 2008

Re: Mena Williams

To Whom It May Concern:

Ms. Williams, a pleasant and articulate 41-year old woman, has been a patient at Lyme Resource Medical, P.C., since June 5, 2007, when she presented with symptoms including (but not limited to) severe insomnia, abdominal pain, joint pain, leg pain, heart palpitations, neurocognitive deficits, extreme fatigue and depression. A copy of her complete Lyme symptoms check list has been attached.

Blood work from LabCorp in June 2007 revealed a low CD57 of 36 (normal range 60-360), reflecting suppressed immune function as reflected in natural killer cell activity. This finding is common among chronic Lyme patients. A copy of the lab report is enclosed.

Ms. Williams had previously been diagnosed with Borreliosis (Lyme disease) in 2003 by Dr. Joseph Burruscano, and had been seen by many other physicians and specialists prior to her first visit to our practice. The diagnosis was confirmed in December of 2003 by positive Lyme IgG and IgM Western blot from Igenex, Inc. (copies enclosed). Her increasingly severe symptoms resulted in her stopping work as a research biochemist in December of 2005.

Post-Lyme syndrome, including post-Lyme encephalopathy, is a possible explanation for Ms. Williams’ multiple neurocognitive deficits. A SPECT scan of her brain, done at Columbia Presbyterian Medical Center in September 2005, revealed a moderate to severe decrease in cerebral cortical perfusion, findings consistent with Lyme encephalopathy. Please find a copy of the report attached.

Despite treatment with a variety of oral and intravenous antibiotics, Ms. Williams continued to experience worsening symptoms. Her sleep was severely disturbed, resulting in vastly reduced ability to perform tasks. A sleep study done on June 11, 2007, at Cornell University/New York Presbyterian Hospital shows significant abnormalities, including severe sleep onset difficulties, severely reduced sleep time, and non-restorative sleep. Please find a copy of this study enclosed.

Sleep medications prescribed for Ms. Williams include Ambien, Klonopin, Xanax, Trazodone, Remeron, and Xyrem. Unfortunately, these medications have provided scant relief of her insomnia, while leaving her groggy and unable to concentrate and function when she is awake. She also suffers from daytime sleepiness.

Closely linked to her chronic persistent insomnia is Ms. Williams’ extreme fatigue. She has been diagnosed with chronic fatigue syndrome. Again, an inability to perform tasks is a consequence of this condition.

A neuropsychological evaluation performed at Columbia University Medical Center on July 7, 2007, found Ms. Williams to be a woman of superior intelligence with impairments in processing speed, attention and memory. In addition to significant decline in memory and concentration, the evaluation noted prominent depression and mood problems. A copy of the report is enclosed.

Ms. Williams scored in the severe range on both the Beck Depression and Zung Anxiety Scales. This represents a departure from her cheerful and industrious approach to life before her illness. Ms. Williams’ illness appears to have induced a treatment-resistant major depressive disorder. She has tried several antidepressants, and currently takes Amitriptyline (Elavil) and mirtazapine (Remeron) without significant relief of symptoms.

She also suffers from severe and poorly controlled pain, particularly left-sided abdominal pain and pain in her left leg. She has been prescribed Oxycodone and Tramadol for this pain, medications which result in further impairment of ability to perform tasks.

Treatment with intravenous Doxycycline 100 mg bid was initiated on August 30, 2007. During the fall Ms. Williams demonstrated significant improvement, with lessening of abdominal pain, moderately improved sleep, and improved ability to concentrate, and decrease anxiety. Unfortunately, as is often the case with persistent Lyme infection, her illness continues to follow a relapsing and remitting course. In the past several weeks she experienced an increase in symptoms including sleep disturbances, gastrointestinal problems, sinusitis, fatigue and loss of energy.

Despite her dedicated search for effective treatment, Ms. Williams has been unable to recover her health and stamina to the point where she could meet the demand of any job.

Due to the severity, persistence and chronic nature of her symptoms, her prognosis is guarded. It remains uncertain that Ms Williams will ever regain her ability to sustain employment.

Upon review of Ms Williams’ history it is apparent that a patient with such obvious and well-documented impairments has long been eligible for disability. Indeed, the question here should not be whether Ms. Williams’ qualifies for disability benefits, but why she has not received such benefits already.

Please contact our office if we may be of further assistance regarding Ms. Williams.



Bernard D. Raxlen, MD                    Carolyn B. Welcome, PA-C