adipose tissue Disorder (atd) Specialist University of ARIZONA, TUCSON
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 While much research remains unpublished, I want to share my understanding of these disorders and provide suggestions for treatment so that you and your healthcare provider can help you live a better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.
At the University of Arizona, I see patients with ATDs in two locations, the Main campus and the South campus. I will likely see patients with ATDs on the main campus (University Medical Center) on Monday mornings. I will see patients with endocrine issues Tuesday through Friday at the South campus but can see people with ATDs on Wednesdays and Thursdays.
UNIVERSITY OF ARIZONA CLINICS
For notes, labs and other clinical information: 520-874-2251
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:
Monday morning on 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 6 outpatient clinic (6OPC) is right off the elevators.
Tuesday-Friday mornings on the South campus (Thursday is the best day for people with Adipose Tissue Disorders):
3950 South Country Club Road, Tucson, AZ, 85714
University Medical Imaging
Make An Appointment
SCHEDULES ARE NOW AVAILABLE FOR MY CLINICS.
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 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 $165.3 For ICD-9 codes:
Lymphedema (lipedema) 457.1
CPT 74182 ABDOMEN W/CONTRAST $428.00
CPT 72196 PELVIS W/CONTRAST $428.00
PHYSICIANS REPORT/INTERPATATION (billed at a later date)
LYMPHOSCINTIGRAPHY CPT 78195 $252.00
INJECTION CPT 38792 $175.00 ea (4 TOTAL)
PHYSICIANS REPORT/INTERPATATION (billed at a later date)
Here are some labs costs
1. Serum tryptase CPT Code 83520 / $18.22
2. Plasma histamine CPT Code 83088 / $27.20
3. 24 hour urine for the histamine metabolite N-methylhistamine CPT Codes 82570 / $7.28; 83789 / $15.00; Includes Creatinine).
4. Blood levels of IgM / $7.50 IgG / $7.50 and IgE / $24.00
5. Chromogranin A level (ARUP 0080469) unless on a proton pump inhibitor which can raise chromogranin A levels. / $40.00
6. Angiotensin converting enzyme / $21.00
7. C-reactive protein / $7.50
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
Any imaging that provides information on your ATD
ALL Labs in ATDs tend to be normal. Bring any abnormal labs, a lipid profile, an ESR and CRP.
There are additional some labs you can consider getting with your provider's help prior to the visit. These are not required.
You do not need additional labs before the visit. The labs below may be of interest.
2. Lab list of particular interest (THESE ARE NOT REQUIRED LABS):
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
e. Cromogranin A (ARUP 0080469); do not get this lab if you are on a
proton pump inhibitor (omeprazole, Nexium, etc.) which can raise
chromogranin A levels (a marker of neuroendocrine tumors)
f. Angiotensin converting enzyme (ACE) level
g. IgE, IgA, IgG levels
h. Vitamin D level
i. If you think you have a lot of inflammation that is hidden (not found on usual labs) please get a Nagalase level (please see here: http://www.hdri-usa.com/tests/nagalase/)
j. If you have a lot of chemical sensitivities, allergies, 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 Ccdes 82570, 83789; Includes creatinine)
Must be off all H2 antagonist (ranitidine, cimetidine), all antihistamines (benadryl, zyrtec, allegra, claritin, quercetin and others) for 7 days to get the tests in "j".
k. If menopausal not on hormone replacement therapy, please get an estrogen panel measured
l. Consider a heavy metal screen
m. If you have fatigue, please get a TSH to check the thyroid, and 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
n. Hyaluronic acid from Quest diagnostics; CPT code 83520; a good test to run if you think you have jelly-like fat (geloid fat) as in lipedema, diffuse Dercum's disease and widespread Madelung's disease.
3. Overview form filled out. Click to download pdf, fill out and bring with you to the appointment. Please e-mail or fax prior to the appointment so we can guarantee to have it at the time I see you.
4. E-mail synopsis = a paragraph or at most a page about you and what you have going on with your ATD. If I get this by email, I can modify this as part of your visit and spend more time talking with you rather than gathering information.
If you have significant edema (lymphedema) and have never had a lymphoscintigraphy scan but want one to better understand your lymphatic anatomy and physiology, please contact me and I can schedule one for you prior to your appointment time. 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 as I too am new to the Tucson area
Near the Main campus University of Arizona
Here is a list of hotels near the main campus: http://wc.arizona.edu/LodgingNearUA/
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
Near the South Campus University of Arizona
If you will be coming to the University of Arizona South campus address, here is a list of nearby hotels:
Any hotel near the airport would be a good choice for this clinic location.
I wish you health and pain-free days.
Karen L. Herbst, PhD, MD
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).