Patient | Azra Altindere | Preferred Language | bs |
Date of birth | November 15, 1984 | Sex | Female |
Race | White
|
Ethnicity | Not Hispanic or Latino |
Contact info | Previous Primary Home:
439 W Grant Pl, Unit D Chicago, IL 60614, US Tel (Mobile): +1(773)-627-7550 Mail: Aaltindere@gmail.com |
Patient IDs | 533956 2.16.840.1.113883.3.3710.999.44.88800115636.7770000101
12633 2.16.840.1.113883.3.3710.3 Ellkay 2.16.840.1.113883.3.3710.200.501 12633 2.16.840.1.113883.3.3710.200.500 |
Document Id | test-id-861977867 2.16.840.1.113883.3.3710.0 |
Document Created: | April 5, 2024, 07:50:14 +0000 |
Performer | Karen Herbst |
Author | Diana Tagaban, Total Lipedema Care - Arizona |
Contact info | Work Place:
240 S La Cienega Blvd Ste 200 Beverly Hills, CA 902113324, US Tel (Work Place): 3108825454 |
Encounter Id | 4747887 2.16.840.1.113883.3.3710.999.44.88800115636.7770000111 | ||
Encounter Date | From February 15, 2024 | ||
Encounter Participant | Karen Herbst | ||
Contact info | Work Place:
6365 E Tanque Verde Road, Suite 200 Tucson, AZ 857153830, US Tel (Work Place): 3108825454 |
Legal authenticator | Diana Tagaban signed at April 5, 2024, 07:50:14 +0000 |
Contact info | Work Place:
240 S La Cienega Blvd Ste 200 Beverly Hills, CA 902113324, US Tel (Work Place): 3108825454 |
Document maintained by | Total Lipedema Care - Arizona |
Contact info | Work Place:
6365 E Tanque Verde Road, Suite 200 Tucson, AZ 857153830, US Tel (Work Place): 3108825454 |
Code | Activity | Start Date | End Date |
---|---|---|---|
266919005 (SNOMED) | Never smoker | ||
Birth Sex | female | ||
Sexual orientation | Straight (Heterosexual) | ||
Gender identity | Unspecified |
Problem | Code | Type | Status | Date of Diagnosis | Date of Resolution |
---|---|---|---|---|---|
Localized obesity (disorder) | 270486005(SNOMED) | Diagnosis | active | 02/15/2024 | |
Hypermobile Ehlers-Danlos syndrome (disorder) | 30652003(SNOMED) | Diagnosis | active | 02/15/2024 | |
Lymphedema (disorder) | 234097001(SNOMED) | Diagnosis | active | 02/15/2024 | |
Mast cell disorder (disorder) | 397007003(SNOMED) | Diagnosis | active | 02/15/2024 | |
Disorder of autonomic nervous system (disorder) | 15241006(SNOMED) | Diagnosis | active | 02/15/2024 | |
Varicose veins of lower extremity (disorder) | 72866009(SNOMED) | Diagnosis | active | 02/15/2024 | |
Peripheral venous insufficiency (disorder) | 20696009(SNOMED) | Diagnosis | active | 02/15/2024 | |
Blood chemistry outside reference range (finding) | 166318006(SNOMED) | Diagnosis | active | 02/15/2024 | |
5,10-Methylenetetrahydrofolate reductase deficiency (disorder) | 41797007(SNOMED) | Diagnosis | active | 02/15/2024 | |
Psoriasis vulgaris (disorder) | 200975007(SNOMED) | Diagnosis | active | 02/15/2024 | |
Anxiety (finding) | 48694002(SNOMED) | Problem | active | ||
Arthritis (disorder) | 3723001(SNOMED) | Problem | active | ||
At high risk for malignant neoplasm of breast (finding) | 448731000124102(SNOMED) | Problem | active | ||
Attention deficit hyperactivity disorder (disorder) | 406506008(SNOMED) | Problem | active | ||
Autoimmune disease (disorder) | 85828009(SNOMED) | Problem | active | ||
Bipolar disorder (disorder) | 13746004(SNOMED) | Problem | active | ||
Depressive disorder (disorder) | 35489007(SNOMED) | Problem | active | ||
Easy bruising (finding) | 424131007(SNOMED) | Problem | active | ||
Ehlers-Danlos syndrome (disorder) | 398114001(SNOMED) | Problem | active | ||
Familial multiple lipomatosis (disorder) | 766888002(SNOMED) | Problem | active | ||
Family history of breast cancer 2 gene mutation (situation) | 431331006(SNOMED) | Problem | active | ||
History of appendicitis (situation) | 161532008(SNOMED) | Problem | active | ||
History of appendectomy (situation) | 428251008(SNOMED) | Problem | active | ||
History of gastritis (situation) | 691501000119103(SNOMED) | Problem | active | ||
History of syncope (situation) | 674191000119109(SNOMED) | Problem | active | ||
Hypothyroidism (disorder) | 40930008(SNOMED) | Problem | active | ||
Lipedema (disorder) | 234102003(SNOMED) | Problem | active | ||
Mast cell disorder (disorder) | 397007003(SNOMED) | Problem | active | ||
Pain in female genitalia on intercourse (finding) | 81712001(SNOMED) | Problem | active | ||
Sexual abuse (event) | 213017001(SNOMED) | Problem | active | ||
Sleep apnea (disorder) | 73430006(SNOMED) | Problem | active | ||
History of clinical finding in subject (situation) | 417662000(SNOMED) | Problem | active | ||
Abdominoplasty and liposuction (procedure) | 177252003(SNOMED) | Problem | active | ||
Circumferential lipectomy (procedure) | 442732003(SNOMED) | Problem | active | ||
History of reduction of breast (situation) | 428667005(SNOMED) | Problem | active | ||
Nasal septoplasty (procedure) | 13529000(SNOMED) | Problem | active | ||
Reduction of batwing arms (procedure) | 24298005(SNOMED) | Problem | active | ||
Thigh reduction (procedure) | 177256000(SNOMED) | Problem | active | ||
Weight reduction regimen (regime/therapy) | 388976009(SNOMED) | Problem | active | ||
Wrist repair (procedure) | 119656001(SNOMED) | Problem | active | ||
Psoriasis (disorder) | 9014002(SNOMED) | Problem | active |
Substance | RxNorm | Reaction(s) | Severity | Status | Start Date |
---|---|---|---|---|---|
peach | Anaphylaxis | moderate to severe | active | 07/14/2018 | |
gluten | 1370781 | Rash, GI upset, Swelling, Headache | moderate | active | 02/14/1990 |
lactose | 6211 | GI upset, Swelling | moderate to severe | active | 02/14/1990 |
corn | GI upset | mild to moderate | active | 02/14/2015 | |
levonorgestrel | 6373 | Shortness of Breath, Rash | moderate to severe | active | 02/14/2005 |
Flexeril | 224954 | Fatigue, Shortness of Breath, Dizziness | moderate to severe | active | 06/14/2016 |
Medication | Generic Name | RxNorm | Strength | Strength Unit | Route | Dose | Dose Form | Frequency | Date Started | Date Ended | Status | Indication | Sig |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Botox | onabotulinumtoxinA | 203279 | injection | 01/01/2022 | active | ||||||||
Adderall | dextroamphetamine-amphetamine | 577962 | 20 | mg | Oral | tablet | 01/01/2023 | active | |||||
estrogens-methyltestosterone | estrogens-methyltestosterone | 197670 | 1.25-2.5 | mg | Oral | tablet | 01/01/2021 | 10/20/2024 | suspended | ||||
midodrine | midodrine | 993462 | 10 | mg | Oral | tablet | 01/01/2017 | active | |||||
nabumetone | nabumetone | 311893 | 750 | mg | Oral | tablet | 01/01/2022 | active | |||||
naltrexone | naltrexone | 4.5 | mg | Oral | capsule | 01/15/2021 | 10/22/2023 | suspended | |||||
Prometrium | progesterone micronized | 261319 | 200 | mg | Oral | capsule | 01/01/2021 | active | |||||
rizatriptan | rizatriptan | 314209 | 10 | mg | Oral | tablet | 01/01/2022 | active | |||||
trazodone | trazodone | 856377 | 50 | mg | Oral | tablet | 01/01/2023 | active | |||||
vilazodone | vilazodone | 1086778 | 20 | mg | Oral | tablet | 01/01/2022 | active | |||||
Stelara | ustekinumab | 853354 | 45 | mg/0.5 mL | Subcutaneous | syringe | 01/01/2020 | active | |||||
CombiPatch | estradiol-norethindrone acet | 1251501 | 0.05-0.25 | mg/24 hr | Transdermal | patch, transdermal semiweekly | 01/01/2021 | 01/01/2022 | suspended |
Code | Site | Date Diagnosed | Status |
---|---|---|---|
History of appendectomy (situation) | completed | ||
History of liver excision (situation) | completed | ||
Hysterectomy (procedure) | completed | ||
Documentation of past medical history (procedure) | completed | ||
Wrist repair (procedure) | |||
Nasal septoplasty (procedure) | |||
Abdominoplasty and liposuction (procedure) | |||
Thigh reduction (procedure) | |||
Reduction of batwing arms (procedure) | |||
Weight reduction regimen (regime/therapy) | |||
History of reduction of breast (situation) | |||
Circumferential lipectomy (procedure) | |||
Hysterectomy (procedure) | |||
History of appendectomy (situation) | |||
History of liver excision (situation) | |||
Documentation of past medical history (procedure) |
Vital Sign | Measurement | Date Recorded |
---|---|---|
Heart Rate | 96 /min | Thu Feb 15 15:58:40 UTC 2024 |
Systolic Blood Pressure | 158 mm[Hg] | Thu Feb 15 15:58:40 UTC 2024 |
Diastolic Blood Pressure | 90 mm[Hg] | Thu Feb 15 15:58:40 UTC 2024 |
Body Temperature | 98.4 [degF] | Thu Feb 15 15:58:40 UTC 2024 |
Body Height | 74.0 in | Thu Feb 15 15:58:40 UTC 2024 |
Body Weight | 192.0 lbs | Thu Feb 15 15:58:40 UTC 2024 |
Body Mass Index | 24.6 kg/m2 | Thu Feb 15 15:58:40 UTC 2024 |
SaO2 % BldA PulseOx | 70.0 % | Thu Feb 15 15:58:40 UTC 2024 |
Future visit for 02/15/2025 - Follow up in 1 year
Problem | Code | Type | Status | Date of Diagnosis | Date of Resolution |
---|---|---|---|---|---|
Psoriasis (disorder) | 9014002 | FINDING | |||
Bipolar disorder (disorder) | 13746004 | FINDING | |||
History of appendicitis (situation) | 161532008 | FINDING | |||
Sexual abuse (event) | 213017001 | FINDING | |||
Lipedema (disorder) | 234102003 | FINDING | |||
Depressive disorder (disorder) | 35489007 | FINDING | |||
Arthritis (disorder) | 3723001 | FINDING | |||
Mast cell disorder (disorder) | 397007003 | FINDING | |||
Ehlers-Danlos syndrome (disorder) | 398114001 | FINDING | |||
Attention deficit hyperactivity disorder (disorder) | 406506008 | FINDING | |||
Hypothyroidism (disorder) | 40930008 | FINDING | |||
History of clinical finding in subject (situation) | 417662000 | FINDING | |||
Easy bruising (finding) | 424131007 | FINDING | |||
History of appendectomy (situation) | 428251008 | FINDING | |||
Family history of breast cancer 2 gene mutation (situation) | 431331006 | FINDING | |||
At high risk for malignant neoplasm of breast (finding) | 448731000124102 | FINDING | |||
Anxiety (finding) | 48694002 | FINDING | |||
History of syncope (situation) | 674191000119109 | FINDING | |||
History of gastritis (situation) | 691501000119103 | FINDING | |||
Sleep apnea (disorder) | 73430006 | FINDING | |||
Familial multiple lipomatosis (disorder) | 766888002 | FINDING | |||
Pain in female genitalia on intercourse (finding) | 81712001 | FINDING | |||
Autoimmune disease (disorder) | 85828009 | FINDING |
All recommendations in this note should be evaluated by you and your primary healthcare providers to determine if they are appropriate for you. All supplements can have side effects similar to medications and all ingredients on the supplement package should be assessed by you before taking. This visit was 60 minutes with additional time spent in chart review of our clinical questionnaire and data input into our EMR by the patient, and ordering tests or procedures after the face-to-face portion of the visit, with >50% face-to face time spent counseling on lipedema and other causes of fat tissue growth and possible treatments that may help.
Service provided at Total Lipedema Care - Arizona, 6365 E Tanque Verde Road, Suite 200, Tucson, AZ 857153830. Office phone number is 3108825454. Office fax number is 3107475908.
Encounter Diagnosis | Location | Date / Time | Type |
---|---|---|---|
Lipedema (E65) Hypermobile Ehlers-Danlos Syndrome (Q79.62) Lymphedema (I89.0) Mast cell activation, unspecified (D89.40) Disorder of the autonomic nervous system, unspecified (G90.9) Varicose Vein of Lower Extremity with Edema, Pain, and/or Swelling (I83.899) Chronic Peripheral Venous Insufficiency (I87.2) Other specified abnormal findings of blood chemistry (R79.89) Methylenetetrahydrofolate reductase deficiency (E72.12) Psoriasis (L40.0) | Total Lipedema Care - Arizona | 02/15/2024 16:00:00 UTC |
Provider reviewed on Feb 15, 2024. A complete review of systems was performed. No Problems With Bleeding, No Problems With Healing, No Problems With Scarring (hypertrophic Or Keloid), No Rash, No Immunosuppression, No Hay Fever, No Chest Pain, No Leg Pain With Walking, No Fever Or Chills, No Night Sweats, No Unintentional Weight Loss, No Thyroid Problems, No Sore Throat, No Malocclusion, No Nasal Obstruction, No Blurry Vision, No Abdominal Pain, No Bloody Stool, No Constipation, No Diarrhea, No Difficulty Swallowing, No Bloody Urine, No Genital Discharge, No Joint Aches, No Muscle Weakness, No Neck Stiffness, No Headaches, No Seizures, No Facial Weakness, No Facial Numbness, No Shortness Of Breath, No Wheezing, No Bloody Sputum, No Problems With Snoring, No Anxiety, No Depression, No History Of Abuse, No Suicidality, No Difficulty With Body Image, No Anorexia, And No Bulimia.
This is a 39 year old female who is being seen for a chief complaint of Lipedema. Patient is seeking a plan of care. Patient reports being diagnosed by Dr. Joseph Larry Feldman.
Additional HPI Comments: Please choose any of the following connective tissue conditions or associated conditions that you are seeking care for: Lipedema What is the name of the physician who diagnosed you? Dr. Joseph Larry Feldman What is the name of your primary care physician? Dr. Ernesto Villegas What is your PCP's phone number? (312) 549-4400 What is your PCP's fax number? (312) 549-4401 When did your condition start or when do you think it started? a. Puberty Have you ever noticed your legs were larger than the rest of your body or larger than people of your same age? At what age? 10 Is your tissue painful? Yes If yes, at what age and/or after what event did the pain start? Advancement into stage 2 more fat tissue pain (previously other symptoms, restless legs, occasional nerve pain, blood pooling, etc) Which areas of the body are you experiencing pain? c. Breasts d. Abdomen f. Lower back g. Front of thighs h. Back of thighs m. Ankles Are there areas of your body that are tender to the touch? If yes, where? a. Upper arms c. Breasts g. Front of thighs h. Back of thighs i. Inner thighs m. Ankles On a comparative pain scale of 1-10 (10 being the most painful), what pain level are you experiencing on a daily basis? 4 / 10 What pain level do you experience on a bad day? 6 / 10 What pain level do you experience on a good day? 3 / 10 Do you experience swelling? Yes If yes, where on the body do you experience swelling? a. Upper arms b. Lower arms c. Breasts d. Abdomen e. Upper back f. Lower back g. Front of thighs h. Back of thighs i. Inner thighs j. Front of calves k. Back of calves l. Inner calves m. Ankles Do you swell more standing for long periods of time? Yes How long (minutes) can you stand without swelling, pain or other issues? e. 21-40 minutes Do you swell sitting for long periods of time? Yes How long can you sit without swelling, pain or other issues? e. 21-40 minutes Do you swell or does your swelling worsen in the heat? Yes Do you elevate your legs to make them feel better? Yes Does any swelling you have resolve with elevation or sleeping overnight? Yes Are there any areas of your body that you don’t lose fat tissue from by diet or exercise? (choose all that apply) a. Upper arms b. Lower arms c. Breasts d. Abdomen h. Abdomen i. Front of thighs j. Back of thighs k. Inner thighs Have you been able to lose weight on an eating plan? Yes Have any of the following medications or supplements been helpful for your signs and symptoms? (Choose any that apply) Adderall/Dextroamphetamine What eating plans have you tried that improved your symptoms, including swelling and pain? Ketogenic Mediterranean Anti-inflammatory Intermittent fasting Low carbohydrate Other What exercise do you do? Walking elliptical, new rebounding/trampoline Do you experience extreme fatigue defined as a lingering tiredness that is constant and limiting; in other words, unexplained, persistent, and relapsing exhaustion. Yes Do you have brain fog? Yes Choose all parts of your body where you have heavy tissue: Upper arms Lower arms Abdomen Upper back Lower back Front of thighs Back of thighs Inner thighs Front of calves Back of calves Inner calves Ankles Do you wear compression garments? Yes How long have you worn compression? > one year What are the benefits of wearing your compression garments? Reduction in swelling Have you tried the following manual therapy: manual lymphatic drainage (MLD) therapy as part of complete decongestive therapy? Yes If you tried MLD, did it improve your symptoms? Yes Have you tried the following manual therapy: Deep tissue therapy such as myofascial release, Rolling, Swedish massage, Thai massage, etc. Yes If you tried deep tissue therapy, did it improve your symptoms? No Do you have an intermittent pneumatic compression (IPC) pump? Yes If you have an IPC pump how often do you use it? A few times a week Which of the following therapies have you tried and received benefit for your symptoms (Choose all that apply): Cavitation therapy Acupuncture Does your physical health interfere with your social activities? Yes What do you do for work? Trying to get disability. Quit years ago due to health (diagnosed EDS heds) Does your physical health interfere with your work? Yes Do you bruise easily? Yes How often do you find bruises on your body? Daily Do you have spider veins? Yes Do you have varicose veins? No Do you have venous insufficiency? No Have you ever had a vein procedure such as injection of detergent or radio frequency ablation or stripping to close one of your veins? No If your veins were ever treated, did your symptoms improve? No Have you ever experienced a blood clot or have been diagnosed with deep vein thrombosis DVT)/pulmonary embolus? No Do you feel hard nodules, lumps, or "grains" under the skin in areas with affected tissue? Yes What areas of your body have nodules, lumps or grains? Upper arms Breasts Abdomen Upper back Lower back Front of thighs Back of thighs Inner thighs Front of calves Back of calves lnner calves Ankles Rate your overall health? Poor What was your highest weight in pounds? 245 post pregnancy What was your lowest weight in pounds? 141 (3 years after pregnancy with lots of work) Have you participated in a supervised weight loss program such as a bariatric surgery program, a weight loss clinic, a supervised dietary program, a nutritionist supervised program, a personal trainer or other? Yes If you participated in a supervised weight loss program, did your affected tissue reduce or did your symptoms improve? No If you have previously had any surgical procedures for your condition, did your symptoms improve after the surgery? Yes Is there any additional information you would like for us to know so we can better care for you? Had 1 Lipo, reduced symptoms but did not eliminate, have EDS, my mom recently diagnosed with breast cancer. She has EDS, PCOS, severe endometriosis, psoriatic arthritis. Recently her mother was diagnosed with breast cancer. Here mother and sister have PALB2. Her own gene panels suggest that she is at risk for cancer. She has the MTHFR mutation. She has C6772 which increases the risk of breast cancer. She had her whole genome completed. She has a mutation in CYP19A1. She has found a correlation of her genes with lipedema and PCOS. She also has adenomyosis. Her cancer screening did not find anything. She was on HRT. She found an article from Al-Ghadban showing that estrogen upregulates an enzyme important in breast cancer. After her lipedema surgery she stopped any estrogen. She was on methyltestosterone, a testosterone cream, multiple estrogens and prometrium progesterone. She is having hot flashes, zero libido for over a year. She is having pain with intercourse even with lubricant. She got a full hysterectomy age 36. She used to be hypothyroid bu she exercised and changed her diet, avoided teflon and now her TSH and free T4 are normal. Free T3 was not tested (ok to get tested for free T3). On August 2020 she had a liver lesion 2.9 x 2.6 cm. On a subsequent check 12/16/2021 they found a focal nodular hyperplasia 3.4 x 2.8 cm. It was a CT abdomen and pelvis. Prior to recent liposuction her liver enzymes were normal. Her liver enzymes have been elevated for years and after the liposuction the enzymes reduced. Her A1C started to increase after the liposuction. Her mother and sister have lipomas on the head and now they have them elsewhere. [Familial multiple lipomatosis is associated with PALB2 mutations] Reducing inflammation is important if you are developing lipomas with PALB2. Watch the lipid panel. Avoid high fat not fat in general - eat good fat.
Family history of diabetes mellitus type 1 (situation) - GRANDFATHER, FATHER |
Family history of osteoporosis (situation) - MOTHER |
Family history of breast cancer gene mutation in first degree relative (situation) - MOTHER |
Family history of endometriosis in first degree relative (situation) - SISTER |
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Care Team Member Name | Role | Identifier | location | Telecom |
---|---|---|---|---|
Karen Herbst | Doctor | 1114977840 | 6365 E Tanque Verde Road, Suite 200 Tucson, AZ 857153830, US | 3108825454 |
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