Family Medicine in Glenwood Springs

1
Family Medicine in Glenwood Springs

• Jonathan Burdick

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• Glenwood Springs
• Population 8564, but valley operates as a whole
  with over 25K total population
• Main piece of small talk around town this time
  of year is all about snow at
• the resorts

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But they kept me too busy to get out there!
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GMA

• Serves as the primary clinic for insured patients
  in Glenwood
• 6 Family Medicine physicians
• 3 Internal Medicine physicians
• 2 GI physicians
• Dr. Lorah HAPPY, Work comp
• Dr. Salmen YRC Tuesday mornings, clinic in
  afternoons
• Dr. Chansky at Silt satellite clinic 2 days per
  week, PHE, URI, Work comp
• Dr. Feinsinger semi-retired, HAPPY
• Common reasons for clinic visit
• URI
• Workmans Comp (DOT, Lowes, LaFarge)
• PHE
• HAPPY

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HAPPY program

• Heart Attack Prevention Program for You
• Every heart attack is preventable, based on
  Before the Heart Attacks, HR Superko.
• Patients identified from the practice with
  significant risk for ASCVD have follow-up
  q3months with
• Advanced lipid panels (VAP, Berkley, etc.)
  1-2x/yr
• Lifestyle factor modification (diet, exercise)
• Maximized medical intervention with statins,
  niacin, etc.
• Carotid IMT testing every 2-3 year

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Alice (a.k.a. Louise)

• 80 year old woman , lived in Glenwood for last 40
  years
• 4 Children, 2 live in Grand Junction, 1 in
  Carbondale, 1 lives in Denver
• Currently lives in Heritage Park Skilled Nursing
  Facility

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Louise

• Chronic Medical issues
• HAPPY Original LDL pattern B, direct LDL 200,
  multiple family members with premature ASCVD
• Hypertension Currently well controlled with
  HCTZ and Lisinopril
• Dyslipidemia Currently well controlled with
  diet and Simvastatin and niacin
• Shingles multiple times during adulthood
• Past surgical history
• Bilateral radical Mastectomy
• Appendectomy

8
Louise

• CC Chest pain since this morning
• more right sided
• not associated with anything (eating, breathing,
  stress, exertion, etc.)
• Full work-up revealed nothing. Sent home,
  working diagnosis of shingles, asked to come back
  if rash appears.

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Louises Course

• Re-evaluated next day in ER for continued CP
• Diagnosed with Acute Cholecystitis, Surgery took
  over
• Re-evaluated 5 days later for wound infection.
• Re-evaluated 1 week later for rash on abdomen,
  and itchy everywhere
• Acute allergic dermatitis, due to HCTZ(?). D/C
  HCTZ, burst of Prednisone, improved 1 week later