Family Medicine 7000

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Family Medicine 7000

• Dr. Grady Snyder, MD
• Colorado City, CO
• Ryan Nowak, MSIII

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Presentation Outline

• I. Practicing medicine in Colorado City, CO
• a. Where is it, what is it like, and who lives
  there?
• b. Family medicine with Dr. Snyder
• c. Common (and not so common) health issues
• II. The case of A.C.
• a. HPI and medical history
• b. Physical exam findings diagnostic studies
• c. Diagnosis
• d. Community resources

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• I-25 S to CO-165 W
• 140 miles south of Denver, 25 miles south of
  Pueblo

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Colorado City Demographics

• Population (year 2000) 2,018Males 1,005
  (49.8), Females 1,013 (50.2)
• Median resident age 37.1 years Median household
  income 37,331 (year 2000)
• Races in Colorado City
• White Non-Hispanic (87.2)
• Hispanic (9.2)
• American Indian (2.6)
• Other race (2.4)
• Two or more races (1.9)
• Black (1.0)

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Welcome to Rural Colorado
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Greenhorn Mountain

• Elevation 12,347 feet

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Lake Beckwith
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Common Sights in Colorado City
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Only the bare essentials

• Hollydot Golf Course

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Scenic Views
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Medicine in the Greenhorn Valley
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Friendly Faces
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Dr. Grady Snyder, M.D.

• Graduated from U. North Carolina Medical School,
  1985.
• Clinical Assistant Professor, New Mexico Medical
  School, 90-91
• Southern Colorado Residency Clinical Director,
  91-92
• Southern Colorado Associate Residency Director,
  92-95
• Private practice, 95-06
• 8th Grade basketball coach
• Favorite Band Barenaked Ladies
• Enjoys hiking, biking, guitar, spending time with
  his children

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Health Care Problems in Colorado City

• Common
• Diabetes Mellitus, Type II (33)
• Hypertension (21)
• Hyperlipidemia (20)
• Viral URI, GABHS Pharyngitis (18)
• Low Back Pain (11)

• Rare
• Q Fever
• Polymyositis
• Multiple Myeloma

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The Case of A.C.

• HPI
• 84 y.o. woman, presenting for F/U from a recent
  ER visit
• Watched daughter in a MVA, with resultant
  pressure in her chest
• No diaphoresis, nausea, pallor, or radiation of
  chest discomfort
• EKG in ER showed an arrhythmia
• Discharged from ER with prescription of Vicoden
• Chest discomfort slowly improving
• Now, pain is described as stabbing, exacerbated
  by deep inspiration, relieved by Alleve 2 tabs PO
  bid
• Pt. localizes the pain to the right parasternal
  region.

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The Case of A.C.

• PMH COPD, DM Type II
• Meds Lasix 40mg qd, Spironolactone 50mg qd,
  Avapro 150mg qd.
• Allergies Zestril, Levaquin
• SHx No tobacco, EtOH, or illicit drug use.
• Sig. exposure to 2nd hand smoke
• FHx Mother asthma, CAD
• Father CHF, DM Type II

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The Case of A.C.

• Physical Exam
• Respiratory Diminished breath sounds, wheezing,
  and prolonged expiratory phase. Hyper-resonance
  to percussion in all lung fields.
• Cardiac Regularly irregular rhythm, without
  rubs, murmurs, or gallops.
• Musculoskeletal Reproducible tenderness to
  palpation at the R 4th costosternal junction.
• Extremities Mild clubbing of the fingernails,
  with slight acrocyanosis.

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The Case of A.C.

• Chest Pain Differential Diagnosis?
• Cardiac Ischemia
• Musculoskeletal Pain
• Pulmonary Pain (e.g. pnemothorax, pulmonary
  embolism, etc)
• Panic Attack

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The Case of A.C.

• Labs/Studies
• Serial Troponin-I levels lt0.03 ng/mL

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The Case of A.C.

• Diagnosis?
• Costocondritis of R 4th costosternal junction
• Atrial bigeminy 2/2 chronic hypoxia/COPD

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The Case of A.C.

• Community-Based COPD Resources
• www.lungcolorado.org
• Pueblo Pulmonary Association
• Pueblo Better Breathers Club
• American Lung Association Hotline,
  1-800-LUNG USA.
• www.lungusa.org

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Main Points

• Family Medicine in Colorado City
• A relatively isolated farming and ranching
  community.
• Typical patients are Caucasian, aged 40s 60s,
  with no gender difference
• Pt.s most common problems include HTN, DM II,
  Hyperlipidemia, and Low back pain.

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Main Points, Cont.

• Chronic Disease Management
• A.C. is a 84 y.o. woman with COPD caused by
  secondhand smoke
• Her chronic lung disease lead to hypoxia,
  creating an irritable focus in the atria,
  resulting in atrial bigeminy
• Chronic disease can present in a number of
  different ways!
• There are numerous support groups available for
  patients with COPD.

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The End