Pleurisy

Patient comes in for a recheck. She was last seen by Dr. last November and was told to stop Pulmicort at that time. She does feel that she has been doing very well without the Pulmicort. She has not need to use her albuterol since last time we saw her. She does occasionally get pleurisy in the right lower lung. Her doctor has prescribed her meloxicam to use for this as needed and it does really help. We did discuss difference between this causing more restrictive lung condition rather than obstructive and this would be a great treatment plan for her if her pleurisy flares up. We have also been treating her for idiopathic hives. The last time she had hives was about two and a half months ago. She did have to go to the ER and get steroid shots because it was so bad even on the Zyrtec twice daily. Otherwise, she has not had any other troubles with the hives and has been consistently using her Zyrtec. She states that when she does get the hives they seem to be at night around 8 p.m. to 9 p.m. It does not seem to be associated with food or other allergy triggers. I did discuss with her that if she continues to have this problem we may need to pursue more blood work to rule out any other internal etiology of these hives. She has not had any troubles with allergy symptoms lately not controlled with the Zyrtec.

ASSESSMENT:
1. Chronic idiopathic urticaria.
2. Pleurisy.
3. Allergic rhinitis.
4. Allergic conjunctivitis.
5. Mild intermittent asthma possible.

PLAN:
1. At this time, I discussed with that I think that she should continue with the Zyrtec twice daily. If she does have an outbreak of hives. I want her to increase her dose of Zyrtec to two tablets twice daily to see if we can get her hives under control without needing prednisone. If she continues to have outbreaks, we may want to pursue blood work to rule out any hereditary angioedema as well as any other factors that could be involved triggering her hives and she will contact us and let us know if she has another outbreak.
2. She will continue to be off Pulmicort and will have albuterol as needed. If she has any troubles breathing, she will contact us and let us know. I do think the meloxicam is probably the best treatment for her for pleurisy if she is having any trouble with that.
3. We will follow up in six months time and see how patient is doing or sooner if she has trouble controlling her hives.

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