Dear Mr Gabarra,

    Thank you for your letter.

    Unless it has recently been changed, Dr. Pizzo's
e-mail address is "pizzo@netcom.com" If you write to him
you might consider sending me a copy of the letter. In
the event then that your message is not delivered, I
could post it from my address, from which I have at
various times been able to reach him.

    My customary procedure in providing information for
patients is: first to review all relevant clinical data.
In your case that would involve trying to reconstruct
the history of your obesity, the actual body weight,
the diets prescribed and followed, the medications taken,
and all other relevant clinical information.

    Such data could be obtained from your medical records,
from your personal records, or if nothing else, from what
you remember. If necessary, I review the relevant medical
records myself, but I consider it far preferable, to
provide a patient, like yourself, with a template outline,
a questinnaire, which the patient then completes and sends
to me by e-mail. Usually there are several exchanges of
such a document, as important details are explored.

    Once the medical record has been compiled in this way,
    I review the medical literature to determine what if anything
more should be done to confirm the diagnosis; I also review
the literature with respect to drug therapy, diet, medication,
and or environmental changes that might be helpful. Then
if it seems desirable, I present the memorandum that I have
compiled to one or more physicians in the special fields
of medicine implicated in the problem for their comments
or suggestions. I confer with the patient's physicians by
telephone as appropriate.

    I then prepare a memorandum for the patient's physicians
suggesting available diagnostic and therapeutic possibilities.
I would expect that in consequence of this work, a different
and perhaps better treatment schedule might be instituted,
or, if there were no better treatment than that presently 
employed, I would like to think that both the patient and
his physician(s) might be better able to accept the limitations
which the disease inflicts upon us all.

    Obviously such an effort might involve me in a great deal
of work; which, as I have explained to you, I would be willing
to undertake for whatever sums you could comfortably pay me
under the schedule which I outlined in my recent letter.

                                     Sincerely yours,

				     Ernst J. Meyer, M.D.