Interstitial cystitis

Patient is healthy 70-year-old female who comes today to assess her autoimmune interstitial cystitis and possible allergies contributing to her symptoms and complaints associated with this. She states that she was diagnosed with this approximately three years ago. She feels that this complication has progressed throughout her life due to being exposed to multiple allergens and not drinking enough fluids throughout her life. She currently now for the last three years has been drinking lots of water to help with her symptoms although now it keeps her up at night going to the bathroom every half hour to one hour. She also complains of losing 20 pounds in the last three years and a cramping pain that feels like she just had a child in her pelvic region. She complains of brain fog due to lack of sleep. She feels that all of this may be associated with allergies, so she is here to address food allergies today. She did have an ImmunoCAP blood test done three years ago and showed multiple positives to various foods that she has been avoiding since. She has been reading books about interstitial cystitis and its prevalence and how it could be associated with allergies.

She denies any history of sinus problem or nasal congestion. Denies any sneezing, nose rubbing, clear nasal drainage, nasal stuffiness, mouth breathing, or snoring. She denies any history of significant sinus infection. She has had occasional ones here and there. She denies nasal polyps. She did have a nasal surgery from a broken nose at age 27 years old. She does have a history of frequent tonsillitis. She states that her eyes are worse than her nose. She gets itchy, red, tearing eyes as well as eyelid swelling and irritation. She uses eye drops and breathe right strips to help open her nose and for her eye complaints. She denies any frequent ear infection.

She denies any history of asthma or wheezing problems and never needed albuterol in the past. She denies frequent coughing spells or recurrent night cough. She denies any allergic skin problems. She did have a previous allergy evaluation 30 years ago with the ImmunoCAP blood testing.

ASSESSMENT:
1. Possible allergic rhinitis.
2. Possible allergic conjunctivitis.
3. Interstitial cystitis.
4. Raynaud’s syndrome.
5. Concern for food allergies.

PLAN:
1. At this time, we discussed that I do not believe that she should be concerned of food allergies causing her interstitial cystitis or worsening her symptoms associated with this. We did discuss the theories behind this but there is no documented proof that there is association other than there were rare instances of eosinophilic esophagitis and that skin testing may not prove to help with this condition. I encouraged her to follow up with her urologist to get the best care possible for her IC and possibly do a biopsy for eosinophilic to rule out the eosinophilic cystitis.
2. I encouraged her to try using Benadryl half tab to full 25 mg tab at night to help with sleeping and also any allergy symptoms she is having at that time. She can also use non-drowsy antihistamines during the day to help with any allergy symptoms she may be having. I would like to further test her for seasonal allergies if she would like in the future. Although, she denies it being a significant problem for her.
3. We will follow up as needed. I encouraged her to reduce the worry of food allergies playing a role and possibly with the reduced stress at night she does not have allergies she may be able to sleep better throughout the night. I also encouraged her good behavioral technique of reducing fluids early 7 p.m. at night to help her sleep through the night.

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