Dear Maryann:

Thank you for our conversation today regarding my Physican to Physican review and Level Two Appeals. I understand that you will contact Dr. Sichelman and let their office know what time to phone in for the meeting. I won't be calling in as I believe the final information I would send would be these photos. I'll add captions to each one so that your team can understand what the photo is of.

First, I was not able to capture my entire body by myself because it is too large. I used the bathroom mirror so I apologize for the lack of clarity. Please let me know if you wish to have clearer photos and full body. My husband will be home later and can take them for me.

Photo 019: On the bed taken from below my stomach looking up towards my face. This is how I must sleep because my stomach is large and gives me back pain if I lay on my back.

The fat folds present on my body create havens for infections in the form of yeast infection and trapped moisture from perspiration or the shower. Eventually I will produce a small red blister (022 photo) that if not controlled can spread into a very painful rash. I use hydrocortizone solution on my skin on a regular basis. You can see the scaring that has already taken place under my breasts. This is also true under my stomach. These pictures illustrate the depth of the fat folds which are up to 12 inches in depth. I am attempting to hold up my stomach when I sit but can only lift the front portion. 002 , 003 and 006 and 009 for a fuller body view of how low my stomach drops.

The stomach falls between my legs and when I urinate on the toilet part of my stomach drops into the bowl if I am not careful. I've never "hit water" but the bacteria contact is what I feel is responsible for these random blisters and odd "pimple" like discs that appear on my skin in that region. They can sometimes leave a scar.(003) There is one healing on the underside of my stomach in this photo. I have also lost much sensation in my genital area and as a result do not experience sexual pleasure. This is the part I referred to impacting my husband and our spousal relationship. Photo: 002. 005 and 006, 009.

This is a lower viewpoint of my front stomach. The navel is about six inches or more below the center of my stomach. There is a tiny tear in my skin below the navel.005

I have a serious balance problem as after walking for a few minutes my body pulls forward and down. My back becomes sore/painful and weak. My legs also tire and my feet begin to ache. The position I am standing in against the bathroom wall is what I typically do if I am in a store and there is no cart to support my weight. 009. I lean against a wall or rack.

Most of the time I simply don't go out. Walking is becoming too painful.

Again, if there is anything else I can send visually to put a name with a face and body, please let me know.

I would appreciate confirmation the photos came through clear for you.

Thank you.

Patty Reeves