Transition of Care Document

Patient Lindsey Anne Carver Preferred Language en
Date of birth March 26, 1989 Sex Female
Race White

Ethnicity Not Hispanic or Latino
Contact info Home:

2720 Tryon Pines Dr

Raleigh, NC 27603, US

Tel (Mobile): +1(757)-880-2206

Tel (Primary Home): +1(757)-880-2206

Mail: Lindsey.a.carver@gmail.com

Patient IDs 3089726 2.16.840.1.113883.3.3710.999.44.88800115636.7770000101

MM0000001162 2.16.840.1.113883.3.3710.3

MODMED 2.16.840.1.113883.3.3710.200.501

115636PAT000001172 2.16.840.1.113883.3.3710.200.500

Document Id test-id-108783325 2.16.840.1.113883.3.3710.0
Document Created: April 5, 2024, 22:44:35 +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 4398455 2.16.840.1.113883.3.3710.999.44.88800115636.7770000111
Encounter Date  From January 4, 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, 22:44:35 +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 Bisexual
Gender identity Unspecified

Problems

Problem Code Type Status Date of Diagnosis Date of Resolution
Mast cell disorder (disorder) 397007003(SNOMED) Diagnosis active 01/04/2024
Localized obesity (disorder) 270486005(SNOMED) Diagnosis active 11/10/2023
Lymphedema (disorder) 234097001(SNOMED) Diagnosis active 11/10/2023
Peripheral venous insufficiency (disorder) 20696009(SNOMED) Diagnosis active 11/10/2023
Localized obesity (disorder) 270486005(SNOMED) Diagnosis active 11/10/2023
Hypermobile Ehlers-Danlos syndrome (disorder) 30652003(SNOMED) Diagnosis active 11/10/2023
Lymphedema (disorder) 234097001(SNOMED) Diagnosis active 11/10/2023
Obesity (disorder) 414916001(SNOMED) Diagnosis active 11/10/2023
Autonomic neuropathy (disorder) 277879009(SNOMED) Diagnosis active 11/10/2023
Varicose veins of lower extremity (disorder) 72866009(SNOMED) Diagnosis active 11/10/2023
Peripheral venous insufficiency (disorder) 20696009(SNOMED) Diagnosis active 11/10/2023
Mast cell disorder (disorder) 397007003(SNOMED) Diagnosis active 11/10/2023
Autoimmune disease (disorder) 85828009(SNOMED) Problem active
Circulatory care for venous insufficiency (regime/therapy) 386238003(SNOMED) Problem active
Easy bruising (finding) 424131007(SNOMED) Problem active
Increased blood pressure (finding) 24184005(SNOMED) Problem active
Gastroesophageal reflux disease (disorder) 235595009(SNOMED) Problem active
History of obesity (situation) 161453001(SNOMED) Problem active
History of anemia (situation) 275538002(SNOMED) Problem active
History of fall (situation) 428942009(SNOMED) Problem active
Hypercholesterolemia (disorder) 13644009(SNOMED) Problem active
Hypothyroidism (disorder) 40930008(SNOMED) Problem active
Pain in female genitalia on intercourse (finding) 81712001(SNOMED) Problem active
Postural orthostatic tachycardia syndrome (disorder) 371073003(SNOMED) Problem active
History of clinical finding in subject (situation) 417662000(SNOMED) Problem active
Eczema (disorder) 43116000(SNOMED) Problem active
Anxiety (finding) 48694002(SNOMED) Problem active

Allergies

Substance RxNorm Reaction(s) Severity Status Start Date
Cefzil 224901 unspecified active
Neosporin Plus 466479 unspecified active

Medications

Medication Generic Name RxNorm Strength Strength Unit Route Dose Dose Form Frequency Date Started Date Ended Status Indication Sig
Acid Reducer (famotidine) famotidine 310273 20 mg Oral tablet twice daily 01/04/2024 active Take 1 tablet orally twice daily.
Claritin loratadine 206805 10 mg Oral 1 Tablet tablet Twice a day 01/04/2024 active Take 1 tablet orally twice a day.
liothyronine liothyronine 903456 10 mcg Oral tablet active
metformin metformin 861007 500 mg Oral tablet active
Quviviq daridorexant 2599098 50 mg Oral tablet active
Ajovy Syringe fremanezumab-vfrm 2056700 225 mg/1.5 mL Subcutaneous syringe active

Instructions

No Data

Results

No data

History of Procedures

Code Site Date Diagnosed Status
Documentation of past medical history (procedure) completed
Documentation of past medical history (procedure) completed
Documentation of past medical history (procedure) completed
Plastic surgery self-referral (procedure)
Documentation of past medical history (procedure)

Vital Signs

No data

Plan of Treatment

Future visit for 01/04/2025 - Follow up in 1 year

Code Detail Instructions
206805 Claritin 10 mg tablet Take 1 tablet orally twice a day.
310273 Acid Reducer (famotidine) 20 mg tablet Take 1 tablet orally twice daily.

History of Past Illness

Problem Code Type Status Date of Diagnosis Date of Resolution
Eczema (disorder) 43116000 FINDING
Hypercholesterolemia (disorder) 13644009 FINDING
History of obesity (situation) 161453001 FINDING
Gastroesophageal reflux disease (disorder) 235595009 FINDING
Increased blood pressure (finding) 24184005 FINDING
History of anemia (situation) 275538002 FINDING
Postural orthostatic tachycardia syndrome (disorder) 371073003 FINDING
Circulatory care for venous insufficiency (regime/therapy) 386238003 FINDING
Hypothyroidism (disorder) 40930008 FINDING
History of clinical finding in subject (situation) 417662000 FINDING
Easy bruising (finding) 424131007 FINDING
History of fall (situation) 428942009 FINDING
Anxiety (finding) 48694002 FINDING
Pain in female genitalia on intercourse (finding) 81712001 FINDING
Autoimmune disease (disorder) 85828009 FINDING

General Status

No data

Assessments

1.Mast cell activation, unspecified Prescription: Claritin 10 mg tablet PO Frequency: Twice a day; Acid Reducer (famotidine) 20 mg tablet PO Frequency: twice daily

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 15 minutes with >50% time spent counseling on mast cell activation syndrome.

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
Mast cell activation, unspecified (D89.40) Total Lipedema Care - Arizona 01/04/2024 18:30:00 UTC 99212

Review Of Systems

No Data

Goals

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Medical Equipment

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Health Concerns

No data

History of Present Illness

Additional HPI Comments: Good morning, I am sharing some mold test results and context that Dr. Herbst may find helpful for the overall MCAS picture--one from summer 2022 and a repeat from this month (my doctor's office changed testing companies in between tests). I have taken a detoxification supplement and charcoal for months and use Biocidin in my Xlear nose spray regularly, and these things are clearly not working. I also did one hyperbaric chamber session in January 2023 that I hoped would help with migraines and mold, but it made me feel worse rather than better and I did not continue. My functional doctor has recommended Bioflm CLR twice daily to begin breaking down biofilms + twice daily prescription Nystatin for 3 months (she originally recommended Itraconzazole 200 mg daily for 4 weeks, but it interacts with the CGRP inhibitors I take for migraines). She and I wanted to run this plan by Dr. Herbst to get her opinion on it in the overall MCAS picture at my appointment next week. Thanks! ------------------------------ Savannah Sandoval, Dr. Herbst [Jan 02 2024, 3:24 PM] Hi Lindsey, Dr. Herbst reviewed those results and this is her response: "The ochratoxin likely activates mast cells. Is it possible to avoid the foods you are ingesting the ochratoxin from?" ------------------------------ Lindsey Carver [Jan 02 2024, 3:32 PM] Possibly, but I was also exposed to mold in my childhood home and at my previous job where the building was known to have mold. It seems to be in my sinuses. She continues to test positive for different molds ________________________________________________ She had COVID recently and has fatigue Supplements D and K She has active Epstein Barr and is on ortho Immune and vitamins to support the immune system Thiamine Occasional Meyer's cocktails Compounded allergy drops Claritin - other antihistamines do not seem to help Probiotics A detox supplement did not help with the mold Apple cider vinegar Cod liver oil MVI DIM and CDG for PCOS Licorice blend for GI issues Magnesium threonate She has psychophysiological insomnia and takes medication for this that helps She eats a lot of Mediterranean food and will pick up food that is gluten and dairy free

Family History

Family history: Autoimmune disease (situation) - MOTHER
Family history of cancer (situation) - AUNT, GRANDMOTHER, FATHER
Family history: Anemia (situation) - GRANDFATHER, FATHER
Family history of headache disorder (situation) - GRANDFATHER, MOTHER
Family history of irritable colon (situation) - GRANDFATHER
Family history of seizure disorder (situation) - FATHER
Family history of dementia (situation) - GRANDMOTHER
Family history: Alzheimer's disease (situation) - GRANDFATHER
Family history of stroke (situation) - GRANDFATHER

Consultation Notes

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Laboratory Narrative

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Pathology Narrative

No data

Imaging Narrative

No data

Procedure Notes

No data

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