Brian | Syne we pen lore & leading Fediadic GI pe cial A dick ees at Fimeny Cnildrene eer “and delermened Sepbatg has: ‘Celiaes Oisease! 4 frund Sime swe m jem her | Heat 4 gilictun is cre eas et in. dt s - avoid aaniptirng made From Clowe Le tan vave. allenative Anus like rie flour Theres ja lot of Auden Fret foods araund. Fin meeting uhh alana ar Chilkreds Wubiternliet and Tu gue You the. Me wo. thay qne me, ve s4 discomfort | Fler 7 i eh] ce t have it, savor glictenn Could wets pate: | 3/jofoe | | | You have the girls on Marek 24 The qivls wanted to attend a Fireside that Din sige’, for, ln ei dlontt [bnew iPad also, Bx ee ede bike om the ae and D heer cvratzrocl acting Wodl ‘be alle to trade “the re ean? TU fase [mone ag Man. erTHes « shane ) DuidhteJanet K. Harnsberger, M.D. Louis L. Mizell, M.D, ediatric Gastroenterology and Nutt Cottonwood Medical Towers 5770 South 250 East, Suite 330 Murray, Usah 84107 May 4, 2006 John R. Wynn, MD. Utah Valley Pediatrics 171 North 400 West, Suite C12 Orem, UT 84057 Fax: 801-224-1057 RE; Sidney Wolferts Date of Service: 5/3/06 ‘Dear Dr. Wynn: Sidney came in follow-up of her recent diagnosis with celiac disease. She has now been on a gluten-free diet for 7 weeks. She has gained a full 4 Ibs. and grown 14". Her abdominal pains are easing. Her energy is much improved. However, Sidney is still moody and complaining of neck pain, limb pain and having a hard time breathing, There has not been nausea or vomiting. Stools are passed 2 or 3 times a day and are still loose. Sidney is “always hungry”. She and her mom are having a pretty easy time of adhering to a gluten-free diet, ‘The interim medical history is important for brain and spine scans being “okay”. A number of blood tests being done by the neurologists at Primary Children’s Medical Center have led toa diagnosis of Hashimoto's thyroiditis. Sidney will be seeing you for treatment of the Hashimoto's, Hopefully, this will help her moodiness and some of her pains. Sidney had a recent negative strep test for swollen glands. She is often well enough to go to school. Her only current medications are vitamins and fluoride. Sidney is sleeping fairly well. ROS is negative for all other systems today. The family history is unchanged from my previous notes with the exception of the fact that Sidney father thinks he maybe cannot handle wheat. There is a strong family history of diabetes with Sidney's maternal grandmother dying at 30 years of age from complications of diabetes, The social history shows Sidney to be quite bright in school. She will go on a field trip tomorrow toa reptile exhibit.RE: Sidney Wolferts May 4, 2006 Page Two On physical exam, Sidney is the picture of health at 46 Ibs. and 44”. Her skin is warm and rosy. She sparkles and flirts. Skin, hair, nails and membranes show no evidence of nutritional deficiency. ENT are not inflamed. There is no thrush. The thyroid is not enlarged. Lymphadenopathy is not present. Eyes are clear. Lungs are clear. There is no overt evidence of arthritis. There is no heart murmur. The abdomen is soft, flat and quiet. Liver and spleen are normal size. There is no intra-abdominal mass. A hernia is not present. Bowel sounds are normal. The spine is straight. Cranial nerves are intact. Face and palate motion are ‘symmetrical and strong. Lower extremity tone and reflexes are normal, | reviewed Sidney's current status in detail with her and her mom. We went over the biopsy results, which, as you know, show intense inflammation associated with the celiac disease. We talked about the good things in terms of Sidney’s weight gain and improvement of energy. We also reviewed the clustering of Hashimoto's thyroiditis with celiac patients. We talked about numerous strategies that might improve Sidney's general sense of well being, abdominal pains and loose stools. Our discussion included possible trials of Prednisone, digestive enzymes and an antispasmodic, With all of this said, Sidney is now starting on Levsin at a dose of 9 tablet three mes a day. If she is not improving, her mother knows to be in contact with me so that Wwe can consider other aids to helping the intestine heal. The Wolferts will be in touch with you about the thyroid. A follow-up visit has been scheduled here in August. Sincerely, Syphon Janet K, Harnsberger, MD. JKHanf Ref: office notes 2/15/06 - 5/4/06May 5, 200k "exes, i ira Bey | Waar ae Brian- ynedieal infirmecion : ' Syd ney andl Deni are losth a Zit rom aye tne insimetions re m the be ~ please follow Ouse belly and rehom oftes Theyve Already hee their dose for today Deni had 202 F car inbetimns Suydle tA te get Strep. from Br lhe ended ig team ta wel ig sim (please dont allow than ty Linke or eatober ach Mar | OF dco else paplee ‘Cliae Baase! — te 1s cnsidenef actoinmunse the qecialit is also lookting unto ‘Hashinotes thyroidifis'— another audtoi disorder Which oflerr comes tn cludders- uf tee dutounnune problems, No trodtnent for that j ae looking Mty What may mel ty be nay geo be the Cause fof the ott foun Aydnesss a itheDate: May 10, 2006 gy From: Michelle Wolferts ojos Subject: Response to 5-7-06 memo Doctor's have run maay tests on Sydney from the time she was very young. Over the years, you have not asked about ‘pany of therm, I have takes her tote De. for at ofthese appointments and you have never indicated that you wanted to po. Syaey vas notin the hospital for a major procedare; she went tothe hospital for more tess again. Everything came out normal except like I mentioned in my memo, the blood test, which indicates a possibilty of something ealled Hashimoto's ihe pickup time to 6:30 pm, and whea you recently asked to change it again I said this would be fine, but because of the ‘You frequently imply in your memo's thet things aro said or done differently than they are and have been, it’s not hard to se Garough statements made sich as “Please make cersin you do not keep them home the day you're going to pick them up) and dot check them out early” when you're well aware tht no such thing has ever happened during an exchange time, ou continue to state that you have not been given the children’s schoo! contact information. You have been given this Information repeatedly. From the beginning of the year you have known the gil’s schools and teachers, The school sleo notified you at the beginning ofthe year that you are welcome to call and ask about any school event cr tlk to the ieachors atmny te, Sjdmys Pedictyic qastroeealepst said thet it Cadd he Sony Scot, | coe es tor fos stermcle to heal — bust cas a i [ fe alpen nee Ba te He Nhs in 2 mcs. nal j mans thet iy my Juder | : Wide We ee i een i Feo “Ale & fredpean, hae 4p alesoroe Michelle Br. chert re dashansot es and mallee WERE pmee Coen dng’ RECEIVED May 15, 2006 : m4 F calene ome sis7 Brion, gor your inewrante ros PCalesig ans jsiae wanted to nfe sure that you received the addtional information about Sydney's medication ete, Please check to see if under the autoimmune deficiency section the possibility of ‘Hashimoto's Thyroiditis’ was written down. 'll wait to hear back from you about the possibility of giving me more than a couple of hours to review the insurance papers before signing, The form said either a parent or guardian could sign. Was all of the health information sufficient? My family continues to have a large family reunion every other year (on the odd numbered years) during the week of July 24" We have family coming from California, Arizona, Ohio, Canada, Washington and maybe a few other places. ‘The girls missed the last one and everyone would like to see them at the Reunion from now on. Would you trade my upcoming 24" Holiday with the girls this year for next year, and begin taking the Holiday on the even numbered years instead? The girls are supposed to have a field day at Lindon Elementary on Fri, May 26". They have the event during school hours!tiid I’m waiting for more information on exact times. Would you like to spend the field day with them? If so, we can let ACAFS know the times you’ll be there, and I could have a 3 party bring Dani to meet you there too. MichelleDate: May 16, 2006 ‘To; ‘Brian Wolferts From: Michelle Wolfert Subject: Insurance, Brit's birthday, tax return, Friday pickup time, kid’s phone calls, kid's have been sick Insurance Please let me know if there’s anything else I can do to help speed up your insurance application. Please give me the phone number of the insurance broker so I can ask them about what else they may be looking for. Brittany’s Birthday [noticed that you'd recently put Thurs. the 25 on the ACAFS calendar down as the time you'd like to spend for Brittany’s birthday. Brittany was originally going to be playing atthe Parson's on that day. but as long ae you can pick her up at 4:00 from their house, it works great for her to spend that time with you. Sydney and Dani ould also be fee if you'd like to take them with you, They've had ‘fiend time’ once a week on Thursdays for the past few weeks, and will be playing atthe Parson's until 6:30pm on May 25" unless you want to toketeoge with you. Tax Return Please work with me on figuring out a way to have our tax return divided in order to be able to star the custody evaluation Friday Pickup Time School’s out after June 2“. You recently requested changing back to an earlier Friday pickup time, Would you {ke to start the earlier time on or after the 2° I was wondering if during the summer you would be intereatec an Something like minimizing the cost of ACAFS and maximizing your time withthe kids by umaybe combining some of the mid-week visits into an all day Saturday, or another day you may have off work Kids Phone calls Thave been asking the kid’s if they would like to call you on my phone lately only because they left their phone out of town. We will be getting their phone back soon and will continue to Keep all communication with them on their phone. have been sick Pat has been hanging on to a cough and some congestion, but her fever's gone, Brittany came down with a Sever and bad virus on Wed. Her fever is gone but she is till feeling sick. Sydney's had a really good week. Dr, ‘Wynn said that although her antithyroid levels have been rising and 20% of peaple with Cellac’s Disease alco develop Hashimoto's Thyroiditis, Sydney still has a good chance not to develop fll Down thyroid diseses Ls Boing to do another blood tes, and have her see a pediatric endocrinologist from Primary Childsen'c just to be as careful about what is going on as possible. Have a great weekend, oa Choon, Geavre. ores Abord Forwch eta Are er te cde erties coker PUREE serrd dre lrte eel. She had ow a, Michelle f os oe Picdulea, — cand Oivies 5: s H EN en tac EE 44a aw Noe hee eg \ (bead ae ene iDate: 6-16-06 To: Brian a From: Michelle av Subject: Summer Info: ‘wfslee SWIMMING CONCERNS: Dani: She can’t swim at all yet, so [ keep her yellow swim ring on her at all times. Is teaching her to develop some swimming muscles but she still needs to be watched very carefilly, as she can go under easily even with it on Sydney: Please be extremely careful with her around water, She has started to become an ‘apprentice swimmer, and has become unusually brave. She'll try and swim into the deep water and does not yet have the muscle development to keep swimming for long enough to keep her afloat, I stay with her every second. Brittany: She's doing pretty well on her own. After not having lessons for a couple of years she had forgotten most of what she learned, but we have brought some of that back over the last couple of weeks. I till feel she needs to be watched very carefully, because when she panics she seems to freeze up. - put 45 sunblock on Brittany twice, but her shoulders still burned. 1 put the same amount of sunblock on all 3 Birls and Sydney and Dani did not bum like she did, Brittany will prob. need to wear a tshirt to better protect her shoulders HEALTH. Dani: She's very healthy right now. Sydney: Her stomach is healing up pretty well. The specialist had said that with as sick as she had been that it should take about 6 months of no ghuten for her stomach to start feeling better, and the swelling and sores have Sradually been healing, In case she complains of stomach pein, I'll send you her medicine. She does not need it unless she starts complaining, which she rarely does these days. You can keep the bottle with the remaining medicine over there. I'll get the refill for her to have over here. Brittany: T talked withthe Dr. a couple of weeks ago about her sinuses. She seems to have some allergies/sinus raed ion that has lingered and may be gradually turning ito a secondary sinus infection. If she develops any Kind of temperature please take her to the Dr. right away. The Doctor said at that point she will need to be treved with antibioties “Remember to be sure and notify ACAFS for me to pick them up during i days you'are not on vacation with them and working, or the kids are not visiting relatives from out of sta kids will be playing @ lot this Summer and having vacations with both you and I with lots of fun things planned, but there is also a schoolwork schedule for all of them to maintain that is very important for next year’s academic achievement The following are the things that I'm sending with the girls Father's Day Cards and gifts for Aubriana, Nathan, Trevin and Sarah from the girl, toys you sent them with that they can keep over there. Here’s some items to please send back with them: Science papers, Sydney's school shoes for next year—they may be better for running (it would be nice if you ould only use them for her race and use the older pur for the rest of the time), Dani’s yellow swim ring and a few other swim items, Sydney and Brittany's tennis shoes. The girls said you have a pair of running shoes for Dani over there—she's growing out of her old ones over here. Thanks, MichelleEY ES RAR FIM ait ooeeaees en = sont foAtS wid Mode) pe £1406 Brian, Schedules Tealled ACAFS today to let them know how a couple of plans have changed and the kids are now going to be around on Aug. 18" and 19". We came back a little early and we would be able to rearrange some things if you'd like to see the kids more before the summer vacation is over. You mentioned you'll be out of town on the 18" aad 19". If your plans happen to change and you would like to sce the kids it wouldn’t hurt to call ACAES to check and see if we're here. My ‘uncle's flying into Ogden for a small family get together but we might possibly decide to save the gas $ and stay around home to work on the girls school and music. T've decided to cancel our out of town plans this week so the kids can be more ready for school, ete. We'll stay around ‘here and also do some swimming and attending a play and music performance. You and I had traded mid-week visite and I don’t think ACAFS still has the 16° visit on their schedule, but since we'll be here now would you like to see them from 5 to 9 (or whenever ACAPS closes) on Aug 16°? If you want they could be free to stay the night with you at your parents and come back the next morning, but Sydney needs to be somewhere at 9am and J don’t know how early ACAFS opens in the morning. ‘You'd asked if I could watch the girls for you when you go out of town on the Weekend of the 25" —and I'd also asked for that to be my 2 summer week vacation. You mentioned in your last note that your plans have been cancelled and that now you will be around. Would you like to have the kids on Fri the 25" through Sat, the 267 We have plans on ‘Sunday the 27". Do you still want them to come over for your birthday on the 24"? Have you thought of a time? Girls Joint Family Reunion and Travel Journal Pm putting together both a family reunion and travel journal forthe girls. It will be an ongoing thing and will take time, ‘but I was wondering if you would like to write down the dates and places of family events, camping trips or vacations you and your family have been taking with them. It would be nice if you had some pictures to contribute, so a joint book could be put together which would include their memories with family and cousins on both sides, Everyone's Cooperation on this might be one more little thing to help the girls feel more together. Sydney's Gluten Intolerance Sydney's not supposed to have the amount of gluten in a piece of sacrament bread, so I've asked my Bishop how he thinks we should bless her own sacrament bread. He suagested bringing the bread with us and holding it on our lap while they bless the sacrament. don’t know how your Bishop would like to do things, but wanted you to know how a fourth teaspoon of flour is supposed to be like poison to Sydney. It’s been wonderful how you have been careful with her gluten intake and please thank your mom for making such efforts to make gluten free recipes for Sydney. Scriptures It would be nice if we could have the girls on the same scripture reading schedule. Would you like to try and do this? If ‘you're interested, the girls have been engaging really well in a question activity where they eam a bead for every question they answer correctly. When they fill their jars with the beads they get to make a “Choose the Right” necklace Out of the beads, adding in some CTR Rings from different countries. If you'd like to participate, you could send the girls with the number of correct answers they gave, and we'll add beads for your questions when they get back. Brittany’s Math Brittany said she has forgotten some of the math from the past. T've been reviewing a lot with her, could you help her some with this too? T bought her a Review Workbook that she may bring with her sometimes, She could use reviewing the basics from past grades to gain more confidence in this area for 6° grade, She mentioned needing more help with long division, Divorce Hf you've decided to write lists ofthe property each of us have, etc, please email the lists or suggestions about what you Want to do of anything about the divoree to my olsansmichelicvahoo com email account. T imagine these things could be very simple to resolve? Did you mention something about changing your AT&T email address? Hope you're having a good summer, Wu hebfauet K. Harnsberger, M0, Laie 1 Mz, M0. Costin Medieal ewer 250 as 5770 Soa ad AT Novernber 13, 2006 RE: Sidney Wolferts Date of Birth: 5/24/99 ‘To Whom It May Concern: ‘This letter is to confirm that Sidney Wolferts has been diagnosed with celiac disease. She had a small bowel biopsy at Primary Children’s Medical Center on February 28, 2006 that confirms this diagnosis. Celiac disease is a condition of digestive surface erosion caused by gluten-containing foods. ‘The disease is cured with a gluten-free diet. Sidney needs to be maintained on a diet absolutely free of wheat, rye, and barley. If she is not maintained on a gluten-free diet, she may suffer multiple complications of the disease including bone fractures, anemia, lymphoma, and recurrent infections. A pamphlet from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition is enclosed with this letter that outlines the basics of a gluten-free diet. Sincerely, ns Se x~™ = eich oS JKH:lbm321-07 7 Ww Ae aplnssp baw aw Brain Suan “ek gx endoscopy — ok Senne Red Hhugneenger said a ee atl Gfore fant Blood leats ae not sure wort na ehadka One tn wi! ; et a lite wredeiole bod, Coe Whee do we fo rot? -t : papel, Wetets Poe hte. °F Sregpant Semple