Bipolar

Patient is 56-year-old man who is here due to recent onset of runny nose that started in approximately July of this year. He states that he has increase in allergy symptoms and a history of allergy symptoms including sneezing, clear nasal discharge, postnasal drip, frequent nose swelling and nasal stuffiness, mouth breathing, frequent throat clearing, sore throat and snoring. When he was a young boy he also had a problem when was playing with a cat and then rubbed his eyes and his eyes swelled shut. Ever since then he has been fearful of an allergy to cats, although now he is considering having a cat in his home for companionship. He states his symptoms seemed to be worse through spring, summer and fall. He denies any sinus infection problems, nasal polyps, aspirin-induced nasal symptoms, nasal surgery, frequent bad cold or frequent tonsillitis. He has used over-the-counter antihistamines in the past but they did not much help. He has never used a nasal spray.

He does admit having eye itching, redness, tearing, dryness, burning, and eyelid irritation some of the time.

He denies any history of asthma or wheezing.

He does have eczema problems on his hands that seems to flare-up sometimes and he uses topical steroid creams when it gets bad and resolves nicely. He has never been evaluated for allergies in the past.

ASSESSMENT:
1. Allergic rhinitis.
2. Allergic conjunctivitis.
3. Obstructive sleep apnea.
4. History of GERD.
5. Status post hiatal hernia surgery.
6. Bipolar.

PLAN:
1. At this time, I started Flonase two sprays each nostril twice daily to help with his nasal rhinorrhea and hopefully reduce his rhinorrhea.
2. I do feel like he would be a great candidate for allergy immunotherapy because he is very interested in having a cat in the future or other pets for companionship and this seems to be an important thing for this man. I think also the social atmosphere of coming for injections weekly and having the continuity of care would be benefit for this patient as well. We will begin immunotherapy for long-term management and reduction of medications need as well as enhancement of quality of life.
3. We will follow up with him in two weeks’ time to see how Flonase is working. If he is not having much relief with Flonase, we may try another nasal spray.

Advertisements

Leave a Reply