Ms.

Joyce Mathew
Oncologist, St. Thomas Hospital
West Minister Bridge Rd, Lambeth London, U.K.

5 April 2019

Dear Ms. Mathew

Re: Katty Nuhara, 45 years old

I am writing to refer Ms. Nuhara who presented herself last 1 January 2019 due to a severe vaginal
bleeding whom requires further evaluation and management.

Ms. Nuhara is a known smoker who consumes 9 to 12 cigarettes a day and a heavy drinker. Medical
history revealed that she had a PCOS, endometrial hyperplasia, excessive hair growth and irregular
menstruation since January 2019. Moreover, she was also on thyroxine 0.5mg because of
hyperthyroidism. On the other hand, her mother died because of uterine cancer.

Upon assessment, Ms. Nuhara presented herself with pain in legs, back and in the pelvic area, dysuria,
and pain during intercourse that may cause her severe vaginal bleeding. She underwent initial treatment
and diagnostic procedures that includes; TFT, TVS to reveal presence of polyps, complete blood test and
hysteroscopy. Panadol for pain was also given twice a day. Last 2 March 2019, unusual vaginal discharge
with foul smelling, pus like or blood tinged has been observed. Moreover, she experienced ascites,
lymph edema, pelvic pressure, constipation, pain during defecation and bleeding was noted from
bladder and rectum. Furthermore, she fainted at her home last 5 April 2019 as she had a profound
vaginal bleeding, difficulty of breathing and verbalized a pain scale of 9 over 10. Pap test also revealed
abnormal growth of cells.

It would be appreciated if you review and follow up her biopsy, MRI and x-ray pending reports for
further assessment and treatment. Please note that she is allergic to penicillins.

If you require more information, don’t hesitate to contact me.

Yours sincerely,

Freyna Weizher
Nursing sister
Ramsay Health Clinic