REASON FOR VISIT:
1. Lip swelling, upper lip.
2. Discuss ADD.
SUBJECTIVE: The patient presents to the office concerned about upper lip swelling. She states last night she was watching TV and she started noticing some tingling and leaking sensation on the lip. She noticed that the whole lip was swollen. She felt her throat was scratchy. She denies any tongue swelling. She denies any other rash on her body or any itchy eyes or swollen, puffy eyelids.
She states that yesterday she did have a regular meal, and she did eat some strawberries that she has been eating for the last few days without any problem. She did eat a dinner, a regular meal. She also had some mashed potatoes, which was given to her by her neighbor. She did not have any symptoms two hours after dinner. She denies any shortness of breath or wheezing.
She also states that approximately a few months back she had similar kind of symptoms. She was unable to relate any exposure during that time. She states it was almost a similar symptom of her upper lip swelling but she did not call the office. She took over-the-counter Alavert and the symptoms subsided. She has taken Alavert yesterday and the symptoms did improve mildly minimally.
The patient has a history of ADD, for which she has seen Dr. (XX) in the past. She was on Adderall 5-10 mg once daily as needed. She states that she has not seen Dr. (XX) for almost 2-3 years, and she has been off the ADD medications. Recently, she has been stressed out with the job and she is also planning to move to (XX) and had been running to do the packaging and move. She wonders if she will get a prescription for ADD until she finds a new psychiatrist or pharmacotherapist at (XX). She states that she is unable to focus or organize before her travel. She does not want to follow up with Dr. (XX) now since she is busy trying to organize her travel. In terms of allergies, sulfa causes hives.
Her past medical history is significant for obesity, hypertension, asthma, depression, status post gastric bypass, ADD, and iron deficiency anemia.
She is on Dyazide 37.5/25 mg 1 tablet daily, lisinopril 20 mg daily, Zoloft 150 mg daily, Wellbutrin 150 mg b.i.d., Adderall 5 mg 1-2 tablets as needed, Flonase, Alavert, and aspirin.
OBJECTIVE: On examination, blood pressure 144/92. No pallor. No icterus. Ears: Tympanic membranes are clear. Nasal cavity: Clear. Oral cavity: No tongue swelling. Status post uvulectomy. Right upper lip swollen with no signs of any lesions or insect bite marks noted. Neck: Supple. No lymphadenopathy. Lungs: Clear to auscultation. Cardiac: Normal. Extremities: No edema. Skin: No rash or hives noted.
ASSESSMENT AND PLAN:
1. Upper lip swelling: Given the history and medication and due to recurrence of similar symptoms, we wonder if it is possible angioedema secondary to lisinopril versus food re-exposure. This is the second episode. We will stop the lisinopril. She was given prednisone 20 mg 1 tablet daily for 3 days and then 10 mg for 2 days, then stop. If she develops any worsening symptoms, she will call.
2. Hypertension: Since we are stopping the lisinopril, she will continue with the Dyazide 37.5/25 mg 1 capsule daily and start her on amlodipine 5 mg daily. She will return to the office in a week to recheck her blood pressure.
3. History of ADD: Given a prescription for Adderall 5 mg 1-2 tablets as needed, #60, without any refills. After her travel, she will try to find a pharmacotherapist or a psychiatrist in (XX) to go for her ongoing ADD and further refill of medication.
