I spoke to the nurse and finally understand what I am to do.

This is my current regimen, before seeing the MC doctor:

H1
Xyzal 1/2 of a 5 mg tablet in the AM
Hydroxyzine HCL 2 25 mg tablets before bed

H2
Tagamet OTC 200 mg before bed

Leukotriene inhibiter
Singulair 10 mg in the AM

I will experiment as follows:
I will only change one thing at a time.  This is my preference.

I will be increasing Tagamet 200 mg to twice/day first.  I will wait 4 -5 days before doing anything else.  If I am worse, I will go back to my baseline dose of once/day.

Whether I go back to baseline or whether I remain on the twice/day Tagamet, in either case, my next experiment will be to take the Xyzal 1/2 tablet twice/day.

Again, if I do worse, I will discontinue it.

So, ideally if all goes well, I would be on the H1 and the H2 twice/day instead of once/day.  And that is a big if.

Once the above experiment is resolved with increased doses, I can go ahead after 2 weeks, and double the amount of Hydroxyzine HCL to two 50 mg doses/day instead of one.  I already told the nurse this was not going to happen since the extreme sleepiness and fatigue I would experience would not be worth it.  But, it was mentioned to me as an option anyway.  I doubt this will materialize.

Once I am on the H1 and H2 twice/day, the next experiment would be to increase the Singulair to 2X/day.

So, by my next visit in September, I should have tried using an H1 and an H2 and Singulair, all three twice/day.  We'll see.

For all who have followed my saga up until now, this does NOT mean that other things will not be added.  I can only change one thing at a time and the doctor prefers the cheapest route first.  Since, these are the medicines I have been on, he's starting with them.

All for now.