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petermaguire-2649-78985- 289709-9377 <BODY> Re-eval AR IT. He is only on vial 2, but he feels that this has helped. We talked about getting H1N1. For him, influenza vaccine, and Pneumovax I think it would be reasonable, but maybe a little bit young, but can discuss with PCP, certainly would be okay to do. He has not had early pneumonia since beginning immunotherapy. Respiratory tract infection now of about 2-week duration, however, today it is actually getting better. Was wheezing and some SOB last week, now minimal SOB to none. PND, cough, breathing better today. He was on Advair 45, increased this from 1 p. daily to 1 p. b.i.d. In the past, I have had him on a higher dose of Advair when needed. Sick colleague at work. ROS: 14-point stable. Other vitals normal. See nursing. Normal SAO2. SKIN: Nonfocal. HEENT: NC, AT. PERRLA. EOMI. TMs clear. NP 1 bilat. OP: WNL. LUNGS: There is a slightly prolonged expiratory phase mid-upper field, very slight. Otherwise, good lung capacity. No focal rhonchi, rare coarse breath sounds, no rales. EXT, NEURO: Stable. Successful resolution of respiratory tract infection, probably virally induced. We will hold off on ABX, if worsens clinically Z-Pak, but will not use, although I gave printed prescription for future. Contact office as needed. Advair sample 115 one p. b.i.d. and then when normal return to Advair 45 one p. daily. If we are able to give H1N1 influenza vaccine he will be sent to our allergy department versus flu shot clinic if unable to do there. I recommend he increase his IT dosing if possible. 15 minute plus AR, counseling greater than 50 percent. </BODY>
