Page of Jackie Cuin From: "Carrie 'l"hornburgh" To: Sent: Friday, September 19, 2008 227 PM Subject: FW: Alyssa O'She|l (SMA4 Baby) Carrie - Thornburgh Sawaya, Rose Kaplan, 7600 Ogden Street Denver, Colorado 80278 (303) 839-7650 From: Gary Chan Sent: Friday, September 19, 2008 2:20 PM To: Carrie Thornburgh Subject: Re: Alyssa O'ShelI (SMA-I Baby) Carrie, have spent 3 hours reviewing the xrays and the reports. The fractures are consistent with subjects with SMA. The bone problems are rachetic in orgin from calcium deficiency and lack of movement or activity. The age of these multiple fractures is difficult to deterrnine since it depends on the location and the size of bone. Also the nutritional state of Alyssa would greatly affect the healing ofthe bones. I would guess some of these fractures may occur at time of delivery, but most occurred after birth from normal handling. It does not surprise me that Alyssa had fractures noted at 3 months of age. Gary Chan so 1 12003