I have a 52-year-old female whose appearance is consistent with her stated age.
She is currently taking:
- 25 mg Atarax® p.m. for control of chronic hives
- 300-600 mg ranitidine a.m./p.m. for control of chronic hives
- 75 mg Armour® Thyroid a.m. for control of hypothyroidism
- 10 mg Zyrtec® a.m. also for control of chronic hives
All vitals WNL.
There is nothing pressing in terms of her dental needs currently. She is seeing a local allergist and local endocrinologist (last seen eight months ago). She reports that when she gets hives they involve her entire body and can be quite severe. I am not convinced that her thyroid is supplemented (or monitored) adequately.
She reported an onset of hives shortly after a stressful time in her life six years ago (death of her father). The patient is willing to travel to Boston for additional workups. I am considering referring her to Massachusetts General Hospital (Dr. Michael Terry Wilson) before considering moderate sedation with hydroxyzine (which she is already taking) and triazolam.
Any suggestions? Thanks in advance.
Dr. Anthony Feck, DOCS Education faculty, provides his advice:
Sedation with triazolam and additional hydroxyzine appears to be the safest, most prudent method of proceeding in this case, given the patient's condition is predicated on stressful situations. Still, there is nothing wrong with obtaining additional medical information before proceeding.
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