Results were discussed with the patient and her mother.  I am concerned about progressive symptoms.  Although she only has subtle symptoms now, we made her aware that with progression of this process, she may have paralysis.  If she is involved in any type of trauma to the neck such as motor vehicle accident, she could have an acute paralysis.  I strongly recommended to her and her mother that she followup with you as soon as possible for surgical evaluation.  I agree with the previous physicians who have told her not to exercise as I am sure that her vigorous workouts and weight training since November 2005 have contributed to this problem.  I have recommended that she wear a hard collar while driving.  The results of my consultation were discussed with you telephonically.