Sample Physician's Letter for College Student with CFS and NMH

Date

Office for Students with Disabilities
________ University
Street
City, State Zip

Re: Patient's Name (DOB: __/__/__)

To Whom It May Concern:

__________ is a patient in my clinic at the ________ Hospital. She has a complicated series of medical problems, but, largely due to her discipline and determination, she has made enormous progress in the past two years. I understand she will be attending _______ University in the Fall of ____, and I wanted to write with some background on her medical conditions and on the accommodations she will need while at school.

____________ has the following medical disorders:

1. Chronic fatigue syndrome (CFS)
   
2. Sleep disorder
   
3. Asthma
   
4. Allergies to milk and soy protein
   
5. Gluten intolerance
   
6. Neurally mediated hypotension (NMH)
   

Her CFS began insidiously in early adolescence, but the symptoms of this disorder were present more regularly by 1991. At the peak of her symptoms, she was unable to tolerate much activity outside the house, and by January 1993 required home tutoring. She thus was unable to work or to save for college expenses. Her CFS was associated with a profound disruption in her sleep pattern, which improved using a light therapy supervised by a sleep specialist at ______ University, and by using a dusk-to-dawn light simulator above the bed. The neurally mediated hypotension was diagnosed in 1995, and treatment of this disorder has been associated with improvement in her main symptoms. The NMH is characterized by improper regulation of blood pressure when individuals are upright for prolonged periods of time. Among the recently recognized symptoms caused by the NMH are chronic fatigue, which is made worse by modest physical exertion, and cognitive disturbance, as evidenced by difficulty concentrating, remembering, and paying attention. On tilt table testing, blood pressure can fall to the 40-60 mm Hg range, which would not be compatible with remaining upright.

__________ also has hypersensitivity to milk and soy proteins, and is intolerant of gluten. Exposure to even tiny amounts of these proteins causes a worsening of fatigue, as well as upper gastrointestinal symptoms of pain, reflux, and reduced appetite. By staying away from these foods, in conjunction with treatment of her other problems, she has been able to return to academic work in the past year, and has developed enough endurance to tolerate the rigors of college classes. Although her symptoms are likely to wax and wane somewhat, I think she has a strong likelihood of succeeding at ______ University, provided the following accommodations are in place to help reduce the impact of her problems:

1. She will need to adhere strictly to the milk, soy, and gluten-free diet. Many of our other CFS patients with food allergies need to have access to a kitchen facility to prepare their own food, but depending on the flexibility of the food service arrangements at ______, she may not require this. Most of our patients with food allergies also need to eat frequent, small meals, so she will need permission to take food back to her dormitory room.
   
   
2. Her sleep disorder and CFS mean that she will need more rest than other college students, and to ensure this she will need a single room.
   
   
3. Excessive physical exertion can activate symptoms. Ideally, she should be in a dorm that is as close as possible to her classes. Employment probably represents an excessive increase in her activity level at present, and I do not think she has the stamina yet to tolerate any work beyond the effort required for academics. This may change over time. She also may need some extra flexibility with scheduling her classes and academic workload.
   
   
4. Any events that cause excessive stress have the potential to worsen NMH symptoms by leading to higher adrenaline levels. As a consequence, individuals with this disorder often benefit from more time for assignments and flexibility with regard to test taking. Whether ________ will need this remains to be seen.
   
   
5. Hot environments, prolonged standing, and prolonged sitting can lead to substantial
   increases in NMH symptoms. I would request that measures be taken to ensure that the temperature in her dormitory is well regulated, preferably with air conditioning in the hot weather, and well controlled heat in the winter (to prevent excessively warm room temperatures). For her classes, as long as she has permission to get up and move around to improve circulation, she should do well.
   
   

Having mentioned these accommodations, I do not think ________ is likely to experience any major health events at university, and my hope is that the treatment program we have initiated will lead to fewer symptoms over time. Any flexibility you can bring to her health problems will go a long way. I remain very impressed with this woman's achievements given the number of obstacles she has had to overcome. I think she will bring a great deal to ________ University, and that you will be proud of her accomplishments. Thank you in advance for your help with her university needs. I can be reached at __________ if there are any questions.

Sincerely,
Physician's Name
Professor of Pediatrics
__________ University

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