Sjogren’s syndrome

Patient comes in for recheck today. I last saw her on March 4, 2016 as a new patient to address her nasal symptoms. She has been using Dymista nasal spray twice daily and she feels that this helps much more than Flonase alone. She also has been using Alertec and that has also been helping. We did begin allergy immunotherapy today. This is her first her first shot appointment and we wanted to just reevaluate to make sure that Dymista was a good treatment for her. We did discuss that this is an extensive medication that is not usually covered through insurance, so that we can continue using this nasal spray by using the active ingredients fluticasone and azelastine in combination to continue maintaining her allergy symptoms. She has no other concerns or changes in her medical care today.

ASSESSMENT:
1. Allergic rhinitis.
2. Allergic conjunctivitis.
3. Upper airway cough syndrome.
4. Heartburn controlled.
5. Moderate persistent asthma.
6. Lupus.
7. Sjogren’s syndrome.
8. Hypertension,
9. Sleep apnea.

PLAN:
1. At this time we will begin the allergy immunotherapy and start desensitizing her immune system to her allergies. This in the long run will help reduce her medication needs as well as prevent triggers of her asthma. She does see Idaho Pulmonary for her asthma and uses Advair currently and feels that her breathing is well controlled.
2. We also will prescribe her fluticasone nasal spray on spray each nostril twice daily and azelastine nasal spray one spray each nostril twice daily to use in combination to mimic the Dymista that seems to work very effectively for her. We will follow up every six months for refills of her immunotherapy and then we will take to next.

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