at subcutaneous adipose tissue (SAT) Disorder Specialist University of ARIZONA, TUCSON
Canadian patients: The Canadian Health Care Insurer (Pacific Blue Cross) has agreed to cover 100% of the cost of manual lymph drainage treatments, garments and sequential pneumatic lymph pump after a patient of mine with stage 3 lipedema wrote to the review committee (they were paying 50% previous). British Columbian provincial government may pay for her liposuction. For LIDOCAINE infusions for chronic pain: The University of Arizona Anesthesiology department performs lidocaine infusions IV for appropriate candidates. ____________________________________________________________ UNIVERSITY OF ARIZONA CLINICS WHAT I PROVIDE: 1. HOPE - based on my years of experience with ATDs, I have a lot of ideas for you to try that people with ATDs before you have tried and found out to work for them in many instances. With medical science roaring ahead, there are always new things to try. 2. EXPERIENCED FINGERS - Doctors and nurses, PAs and other healthcare providers were never taught how to examine fat. I know how and learn more as time goes on. 3. A PLAN - you will leave my clinic visit with ideas on how to continue to improve your life. 4. A PARTNERSHIP - I learn from you as well so feel free to share your ideas with me on what works for you and what does not work; I will listen. ********************************************************************************************** IF YOU ARE FLYING IN TO TUCSON FROM OUT OF THE STATE OR OUT OF THE COUNTRY: PLEASE BE SURE TO GET FLIGHT INSURANCE OR AN OPEN END TICKET IN CASE I AM CALLED OUT OF TOWN OR BECOME ILL. I AM HAPPY TO WRITE A LETTER FOR YOU TO GET YOUR TICKET CHANGED BUT USUALLY THIS ONLY WORKS IF YOU HAVE INSURANCE OR AN OPEN END TICKET. ********************************************************************************************** FAXES For notes, labs and other clinical information: 520-874-7042 SCHEDULING AND APPOINTMENT LINE You will need a medical record number prior to getting an appointment which you can get by calling (520) 694-8888. This same number can be used to schedule an appointment with me at either the Main or South campus. Appointments are: Mondays at BUMC NORTH 6OPC: 1501 N. Campbell Ave. Tucson, AZ 85724 Parking: Visitor's lot. You can validate your ticket for free parking or use valet parking at no cost at the front circular drive. Enter the main hospital and go straight to the bank of elevators. Take the elevators to the 6th floor. The 6th floor outpatient clinic (6OPC) is right off the elevators. BILLING Many insurance programs including Medicare are accepted by the University of Arizona. See if your insurance is accepted here: http://www.uahealth.com/patients-visitors/billing-insurance/accepted-insurance Be aware that office visit charges include a physician fee and a facility fee. The physician fee is a University of Arizona fee. I am on salary so do not get this fee or any fees directly. Be sure your insurance coverage includes coverage not only for the UA physician fee, but also, the facility fee. Call your insurance provider to see if they cover BOTH charges. Ask them if you will have any charges in general or as part of your deductible. APPROXIMATE COSTS: Complex Visit CPT 99205 $651.00 For ICD-10 codes: Dercums E88.2 Lymphedema (lipedema) I89.0 MRI CPT 74182 ABDOMEN W/CONTRAST CPT 72196 PELVIS W/CONTRAST PHYSICIANS REPORT/INTERPRETATION (billed at a later date) NUCLEAR MEDICINE: LYMPHOSCINTIGRAPHY CPT 78195 INJECTION CPT 38792 PHYSICIANS REPORT/INTERPRETATION (billed at a later date) To speak to people in billing at the University of Arizona, please call: 520-694-2748. For those paying cash, there is an uninsured discount that you should receive on your bill. Please call the billing department to discuss and ask about this at your appointment. I am not able to keep up with phone calls and emails at this time. All phone calls for clinical care need to go through 520-694-8888. Better yet, sign up for MyChart and leave a message. WHAT TO BRING TO AN APPOINTMENT 1. ALL Labs in ATDs tend to be normal. Bring any abnormal labs, a lipid profile, an ESR, CRP, CH50. 2. Any imaging that provides information on your ATD. 3. A copy of the Overview form filled out. Click on the underlined words to download pdf, fill out and bring with you to the appointment. 4. The fax number of any physician or healthcare provider you want your note sent to. 5. Wear clothes you can easily take on and put on. Do not wear your compression if you are expecting an exam - you can put on after the exam. 6. LABS Here are some labs you can consider getting with your provider's help prior You can get a copy of a printable lab information sheet here. a. Lipid panel; if on lipid lowering medications, also get homocysteine and Lp(a) levels b. Marker of inflammatory mediators in the blood causing blood cells to precipitate quicker: Erythrocyte sedimentation rate (ESR) c. Stable marker of inflammatory repair: C-reactive protein (CRP) d. CH50 - checks if your complement (clotting system) is normal or elevated. The complement system is part of the inflammatory cascade and when other markers of inflammation/repair tend to be negative, this one can turn out to be positive and guide us in your treatment. e. Angiotensin converting enzyme (ACE) level - this is a non-specific marker of inflammation and can turn out to be positive when other markers are negative. If it is positive, it does not mean you have sarcoid, a condition in which ACE levels are high - it just means you have inflammation. Your healthcare provider may want a chest X-ray to evaluate for sarcoid if this lab comes back positive. f. IgE, IgA, IgG levels - many people with fat disorders have low IgG levels. IF this lab comes back low, check a IgG subclass panel to find which IgG is low. You may want to see an Immunologist/Allergist if you have low IgG levels. g. Vitamin D level - vitamin D helps fight off infections, improves bone mineral density and tends to be low in people who have excess fat. h. If you have a lot of chemical sensitivities, allergies, itching, flushing, edema, or think you might have a mast cell activation disorder, please check: -Serum tryptase (Quest Diagnostics; 34484); CPT code 83520 -Plasma histamine (Quest Diagnostics; 6586X); CPT code 83088 -Prostaglandin D2 (FPGD2 90154); Mayo clinic; CPT code 84150 - http://www.mayomedicallaboratories.com/test-catalog/print/90154) -Factor VIII activity (Quest Diagnostics; 8353); CPT code 85240 -24 hour urine for the histamine metabolite N-methylhistamine (Quest Diagnostics; 83011); CPT Codes 82570, 83789; Includes creatinine) Must be off all H2 antagonist/blockers (ranitidine, cimetidine, famotidine), all antihistamines (benadryl, zyrtec, allegra, claritin, quercetin and others) and off all NSAIDs (ibuprofen, naproxen, ketoprofen and others), and off aspirin (ASA) for 7 days to get the tests in "h". i.Women: please get a fractionated estrogen panel (estradiol, estriol, estrone) plus an Estronex urine test (first morning void) from ARUP labs (mnemonic is ESTRONEX). Test includes: 2-Hydroxyestrone (2-OHE1), 2-Hydroxyestradiol (2-OHE2), 2-OHE1 + 2-OHE2, 4-Hydroxyestrone (4-OHE1), 16a-Hydroxyestrone (16a-OHE1), 2-Methoxyestrone (2-OMeE1), 4-Methoxyestrone (4-OMeE1), Creatinine, 2/16 Hydroxyestrogen Ratio, 4-Hydroxyestrone and Methylation Ratio. j. Consider a heavy metal screen k. If you have fatigue ***Please get a TSH to check the thyroid ***Check the hypothalamic pituitary adrenal axis circadian rhythm and function with four salivary cortisol levels: 8AM, noon, 4PM and before bed through Labcorp test number 502124 (four serial samples); CPT code 82533 IMAGING If you have significant edema (lymphedema) and have never had a lymphoscintigraphy scan but want one to better understand your lymphatic anatomy and physiology, your primary care physician can order one for you either locally or at the University of Arizona. Please call well ahead of time as they book 1-2 months out. Lymphoscintigraphy can be used to detect blockages in the lymph vessels or the absence of lymph vessel. This test requires a small amount of radioactive material to be injected through a small needle into the hand or foot. Except for minor discomfort (some people with chronic pain experience more pain) and skin injection, this test is not otherwise dangerous or painful. More here: http://www.uahealth.com/library/sections/article/lymphoscintigraphy PULMONARY If shortness of breath is a main component of your ATD and you will be seeing me, please ask your healthcare provider to order pulmonary function testing (PFTs). If you have had a CT or MRI of your lungs, please bring the actual scan and report with you. I am working with the Cardiothoracic Imaging Chief and she and her colleagues have taken an interest in ATDs. ______________________________________________________________ PLACES TO STAY Please rely on your own decision for a hotel to meet your personal needs. Near the Main campus University of Arizona Here is a list of hotels near the main campus: http://wc.arizona.edu/LodgingNearUA/ This hotel received a rave review from one patient: Tucson Hospitality Inn. Be sure that this Inn meets your standards as well. The Arizona Inn is literally across the street from the main campus hospital on Campbell Street Here is another near the main campus hospital: http://www.starwoodhotels.com/alofthotels/property/overview/index.html?propertyID=3801 Sincerely, Karen L. Herbst, PhD, MD The CVAC Process has been shown to reduce pain and fluid in people with Dercum's disease (http://www.ncbi.nlm.nih.gov/pubmed/21197318). It has also been described as the best "touchless" manual lymph drainage by women with lipedema. You can experience the CVAC Process Here: Tucson Arizona: 630 South Craycroft Road, Tucson, Arizona 85711 520-332-2333 California Ascent CVAC 3300 Irvine Ave #200 Newport Beach, CA 92660 www.Ascent-OC.com Email: info@ascent-oc.com Phone: 949-474-4404 Beverly Hills Rejuvenation Center 1860 S. Sepulveda Blvd Los Angeles, CA 90025 www.bhrcenter.com Phone: 310-473-5800 CVAC Systems, Inc. 43397 Business Park Dr. Ste D2 Temecula, CA 92590-3686 www.GoCVAC.com Phone: 951-699-2086 Earthbar Brentwood 11640 San Vicente Blvd Los Angeles, CA 90049 www.earthbar.com Phone: 310-826-3549 Eterno Group Know Your Options Wellness Center 3151 Airway Avenue, Suite M-3 Costa Mesa, CA 92626 www.EternoGroup.com Email: info@eternogroup.com Phone: 714-708-3600 Mahaan Rehab Services 825 Webster Street, Suite C Fairfield, CA 94533 Email: haanpt@sbcglobal.net Phone: (707) 718-0151 The Sporting Club 8950 University Center Lane San Diego, CA 92122 www.thesportingclub.com Contact: Ian Robb Irobb@gocvac.com(P) 858-922-0860 Florida bFitnWell 1110 133rd Ct. NE Bradenton, FL 34212 (P) 941-932-1744 Synergistiq Integrative Health 3165 N. McMullen Booth Rd Ste D2 Clearwater, FL 33761 www.synergistiqhealth.com Phone: 727-754-2936 New Jersey Body Works Tanning Salon 30 Passaic St. Garfield, NJ 07023 www.bodyworkstanning.com Phone: 973-249-1100 New Mexico MERIDIAN 805 Early St. Ste C106 Santa Fe, NM 87505 Phone: 505-982-0679 Tennessee New Hope Wellness 6824 Tice Lane Knoxville, TN 37918 Email: ncywyrick@gmail.com Phone: 865-922-1266, or Phone: 865-621-0411 Virginia Mid-Atlantic CVAC 4807 A Shore Drive Virginia Beach, VA 23455 www.morganwellnesscenter.com Email: mid.atlantic.cvac@gmail.com Phone: 757-498-8455 Non-U.S. Turks & Caicos Islands CVAC Centre The Shops at Ports of Call, Unit 111 Grace Bay, Providenciales, TCI Email: tcicvac@gmail.com Phone: 649-941-3172 - See more at: http://www.cvacsystems.com/index.php/locations/#sthash.IdSWKnpe.dpuf ______________________________________________________________ Below you see macrophages (roundish dark dots which are the nuclei of the macrophages) or collagen (that thick pinkish colored area in the picture to the right) surrounding blood vessels from people with Dercum's disease.
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Please support me on iGive: http://www.iGive.com/DercDz
 Dr. Karen L. Herbst
Dr. Herbst was voted as one of San Diego’s top doctors in San Diego Magazine 2009 and in the "Guide to Americs's Top Physicians" in 2013 - see: consumersresearchcncl.org/ She was a guest on the Doctor's Show where she discussed the Cyclic Variations in Adaptive Conditioning (CVAC) Process as a unique form of exercise eventually publishing on the ability of the CVAC Process to reduce pain in a pilot study of Dercum's disease. Dr. Herbst was the research Physician on Mystery Diagnosis in June 2010 highlighting a young man with Dercum's Disease (The Man with 1000 Lumps). 
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