I am a board certified Endocrinologist by training and have always been interested in fat - why do daughters have fat just where their mothers do, and why do men develop large abdomens and skinny arms and legs as they age. While training at the University of Washington in Seattle, Washington, USA, I was introduced to patients with familial partial lipodystrophy and Madelung's disease (multiple symmetric lipomatosis; MSL). I was fortunate to work with one patient with MSL in Los Angeles and have come to know more as I continued working in San Diego. While conversing with the owner of the "About Madelung's Disease" website, she told me to look into Dercum's Disease. Finding out about lipedema was next. Since that time, I have seen many people with adipose tissue disorders (ATDs) such as Dercum's disease, familial multiple lipomatosis (FML), Madelung's disease and lipedema (lipoedema and lipolymphedema) from all over the world. While much research remains unpublished, I want to share my understanding of these disorders and provide suggestions for treatment so that you and your healthcare provider can help you live a better life.
Concerning the lymphatic system, I will be working with Dr. Marlys Witte:
We meet and discuss lymphoscintigraphy exams and various patient issues.
I no longer see sny patients on the South campus of the University of Arizona. I see patients with ATDs only on the main campus (University Medical Center - North Campus) on Mondays.
Canadian patients: The Canadian Health Care Insurer (Pacific Blue Cross) has agreed to cover 100 per cent 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 barely 50 per cent previously). My clinic report convinced them. It looks like the British Columbian provincial government will pay for her liposuction as well.
For LIDOCAINE infusions IV for pain, contact Anesthesiology at the University of Arizona.
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.
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 the main university campus:
1501 N. Campbell Ave. Tucson, AZ 85724
Parking: Visitor's lot. You can validate your ticket for free parking
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.
Many insurance programs including Medicare are accepted by the University of Arizona. See if your insurance is accepted here:
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.
Complex Visit CPT 99205 $541.00
For ICD-10 codes:
Lymphedema (lipedema) I89.0
CPT 74182 ABDOMEN W/CONTRAST $2915.00
CPT 72196 PELVIS W/CONTRAST $3583.00
PHYSICIANS REPORT/INTERPRETATION (billed at a later date)
LYMPHOSCINTIGRAPHY CPT 78195 $1971.00
INJECTION CPT 38792 $1500.00 ea (4 TOTAL)
PHYSICIANS REPORT/INTERPRETATION (billed at a later date)
To speak to people in billing at the University of Arizona, please call:
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 and CRP.
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 the compression on after the exam.
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
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
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
Ascent CVAC 3300 Irvine Ave #200 Newport Beach, CA 92660 www.Ascent-OC.com Email: email@example.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: firstname.lastname@example.org Phone: 714-708-3600
Mahaan Rehab Services 825 Webster Street, Suite C Fairfield, CA 94533 Email: email@example.com 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
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
Body Works Tanning Salon 30 Passaic St. Garfield, NJ 07023 www.bodyworkstanning.com Phone: 973-249-1100
MERIDIAN 805 Early St. Ste C106 Santa Fe, NM 87505 Phone: 505-982-0679
New Hope Wellness 6824 Tice Lane Knoxville, TN 37918 Email: firstname.lastname@example.org Phone: 865-922-1266, or Phone: 865-621-0411
Mid-Atlantic CVAC 4807 A Shore Drive Virginia Beach, VA 23455 www.morganwellnesscenter.com Email: email@example.com Phone: 757-498-8455
Turks & Caicos Islands CVAC Centre The Shops at Ports of Call, Unit 111 Grace Bay, Providenciales, TCI Email: firstname.lastname@example.org 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.
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).