I am writing to request an evaluation and palliative care for Ms.

Bayliss who has been diagnosed

with a metastatic tumor in the lumbar spine.

In the context of her medical history, she was diagnosed with right-sided breast cancer in April last
year which was removed with excision and axillary clearance; subsequently, she was given
radiotherapy to the residual right breast. No evidence of metastases was detected during her follow-
up visit on 05/04/2009, and she was advised to continue chemotherapy.

Today, she presented with complaints of severe low back pain that began four weeks ago and has
worsened since then; she also reported that the pain is constant and gets exacerbated with
movement. Moreover, she has lost 4kg of weight and appetite. An examination confirmed pain in
the front and inner aspect of the thigh and knee and leg. Sensory loss in the anterior aspect of the
thigh and absence of knee jerk was also observed. Consequently, she has been advised to undergo a
bone scan, a CT scan of the chest and abdomen, and radiotherapy for pain-relief.

Given the above, it would be greatly appreciated if you could take over the management of this
patient from this point on.

Please contact with any questions.