Transition of Care Document

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

Table of Contents


Social History

Code Activity Start Date End Date
266919005 (SNOMED) Never smoker
Birth Sex female
Sexual orientation Straight (Heterosexual)
Gender identity Unspecified

Problems

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

Allergies

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

Medications

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

Instructions

No Data

Results

No data

History of Procedures

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 Signs

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

Plan of Treatment

Future visit for 02/15/2025 - Follow up in 1 year

History of Past Illness

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

General Status

No data

Assessments

1.Lipedema 2.Hypermobile Ehlers-Danlos Syndrome 3.Lymphedema 4.Mast cell activation, unspecified 5.Disorder of the autonomic nervous system, unspecified 6.Varicose Vein of Lower Extremity with Edema, Pain, and/or Swelling 7.Chronic Peripheral Venous Insufficiency 8.Other specified abnormal findings of blood chemistry 9.Methylenetetrahydrofolate reductase deficiency 10.Psoriasis

Immunizations

No data

Functional Status

No data

Mental Status

No data

Reason for Referral

No data

Encounters

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

Review Of Systems

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.

Goals

No data

Medical Equipment

No data

Health Concerns

No data

History of Present Illness

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

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

Consultation Notes

No data

Laboratory Narrative

No data

Pathology Narrative

No data

Imaging Narrative

No data

Procedure Notes

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Progress Notes

No data

Care Team

Care Team Member Name Role Identifier location Telecom
Karen Herbst Doctor 1114977840 6365 E Tanque Verde Road, Suite 200 Tucson, AZ 857153830, US 3108825454

History And Physical Notes

No data