May 1, 2017

Ian R. Wing, MD
2261 Arizona Avenue
Suite B
Madison, WI 53207

Dear Dr. Wing:

I saw your patient, Mrs. Elvira Martinson, in consultation in my office

today. She brought the x-rays from your office with her. She was afebrile
today, but on questioning admitted a low-grade fever over the past few days.

I removed the fluid, as seen on your film on April 30, from the right
lower lung field and she felt considerably more comfortable. On
thoracentesis, there was 50 mL of straw-colored fluid. Her history is well
known to you, so I will not repeat it.

On physical examination I found a well-developed, well-nourished

white female with minimal dyspnea. There was no lymphadenopathy, breath
sounds were diminished somewhat on the right; there was dullness at the
right base, and the left lung was clear to percussion and auscultation. The
remainder of the examination was negative.

Because of her history of chronic asthma, I suggested she might

consider bronchoscopy if this fluid accumulates. Because she is a heavy
smoker, I insisted she stop smoking completely. If she does not, she will not
enjoy continuing good health; though I have no idea of the actual prognosis.

1
 Your patient has been returned to you for her continuing care. I will be
glad to see her again at any time you think it necessary. Thank you for letting
me see this pleasant Lady.

Sincerely yours,

Jon I. Mikosan, MD

P.S. I am enclosing a copy of the pathology report on the fluid. As you can
see, it is negative.

rk
enclosure