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Due to her schedule, Dr. Karen cannot guarantee responses to every question, but we'll do our best to publish them when possible. Email Dr. Karen at: buster@cybrzn.comDr. Karen

The following information from Dr. Karen is to help your understanding of PAN, offer you some possible options, and help you make intelligent decisons on your medical care.

Please consult your physician before making any changes to your current treatment

Background on Dr. Karen Himmel

Tell us a little bit about yourself and your background, Dr. Karen.

Dr. Karen:

I am an Internist working in NE Wisconsin. I had been dx with PAN a few years ago, later was undiagnosed. That is how I got involved in the PAN-network.

I decided to became a physician at the age of 4, after having eye surgery as an infant. I went to Wayne State School of Medicine in Detroit Michigan. I graduated in 1988 with a Medical Doctorate degree. I did a residency in Internal Medicine in the Primary care tract which concentrated on care of patients in the outpatient setting as well as physician/patient communication. I finished my residency in 1991 and joined a practice in the Upper Peninsula of Michigan for one year. I then went back to Detroit for one year for a preceptorship in office Gynecology as I had female patients needing Gynecology services and no Gynecology in the area where I had practiced. I then moved to Northeast Wisconsin and started a solo practice where I am currently. I do Internal Medicine and office Gyn.

Tell us about your symptoms and your diagnosis.

Dr. Karen:

For about a year and a half prior to being diagnosed I had symptoms of fatigue, and aching all over mostly. My SED rate was elevated. I was evaluated and found to have a sinus infection in the ethmoid sinuses which in deeper than the maxillary sinuses and behind the nose.

I was treated with Prednisone and antibiotics and eventually surgery. After surgery was when most of my symptoms started.First after going off the Prednisone I had severe abdominal pain, headache and worsening fatigue. My blood pressure became labile and I had hyponatremia(low sodium in the blood). I had never had problems with my blood pressure prior. Each time I was put on Prednisone I would develop abdominal pain after stopping.

I had consistent headaches for months requiring hydrocodone then Oxycodone for pain relief.I went to Mayo Clinic as my Internist wanted another opinion which was a bad experience. Since I was a female with a hx of fibromyalgia the Internist I saw "blew me off". He did not look at my chart enough to realize that I was a doctor. I had blood in my urine, headaches, and continued to have labile hypertension. I was not given a diagnosis. My SED rate remained elevated. I was slowly improving. I had a complete work up for the elevated SED rate and nothing was found. That was in October 2002.

In January 2003 I tried to do call again and all my symptoms returned but worse. I had a skin lesion which I had bx which show inflammatory cells around the blood vessel. I was referred to a rheumatologist and was dx with PAN. I had a suspicion that I had a vasculitis, although I thought it was hypersensitivity vasculitis. I was put on Prednisone and had a arteriogram of the abdominal arteries which was normal.


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