Family Medicine Rotation: Family Care Medical Center

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Family Medicine RotationFamily Care Medical
Center

• Denver, CO
• August 2006
• Eric Salinger

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Family Medicine and Chronic Care in Denver

• Family Care Medical Center
• Location
• Demographics
• Available Services
• Common Problems
• Chronic Care An Interesting Patient
• Community Resources Diabetes

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Family Care Medical Center1340 Leyden Street
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Dr. Aris Sophocles MD, JD
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Client Demographics

• 60-65 White
• 12-15 African-American
• 12-15 Latino
• 10 Other (Ethiopian, Asian)
• 75-85 Insured Patients

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Services Provided

• First Trimester Abortions (6-10 weeks) 40 of
  total practice
• Basic Lab Testing UA, KOH, Wet Prep, Blood Draws
• Simple Procedures Stitches, Mole Removal
• Imaging X-ray, Ultrasound

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Common Problems

• Unwanted Pregnancy
• Type II Diabetes
• Hyperlipidemia
• Hypertension
• Headache
• Upper Respiratory Infection
• Depression/Anxiety

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More Pictures
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More Pictures
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Chronic Care An Interesting Patient

• H.G., 58 year-old male
• Latino
• 5 feet 7 inches, 206 pounds
• PMHx Cholesterol sludge in gall bladder
  (ultrasound), beginning of divertuli in colon
  (colonoscopy)
• SHx No tobacco, occasional alcohol, no drugs,
  homosexual (celibate for 21 years)
• FHx Diverticulosis (mother and sister),
  Degenerative Disc Disease (father), Stroke
  (mother, 47)

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Initial Presentation June 14, 2006

• New patient with complaints of
• Foreskin irritation
• Nocturia, urine flow problems
• Foot pain
• Non-specific GI complaints bloating, discomfort
• Rectal bleeding
• Armpit irritation

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Physical Exam (6/14/06)

• BP 140/100
• BMI 32.2
• Abdomen firm, obese, BS
• GU foreskin irritated, flaky
• Random Finger Stick Glucose 348

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Evaluate 6/15/06

• Fasting Labs
• Finger Stick Glucose 188
• HgBA1C 8.9
• Total Cholesterol 226
• LDL 108
• HDL 39
• Triglycerides 396
• BUN/Creatinine 12/0.8
• PSA 5.9
• BP 135/100

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Treat 6/15/06

• Glipizide 5 mg Q day
• Dyazide 1 tab Q day
• Follow up in 1 month after returning from NM

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He went to NM for 2 months,but only took his
medicine for 1 month
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Follow-up 8/7/06

• New FHx Prostate Cancer (father)
• Complaints
• Foot pain was better when he took his medicine,
  but it is bad again.
• PEx
• BP 170/115
• Feet no sores, pinprick sensation intact
• Microalbumin 13.0

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Restart Treatment (8/7/06)

• Glipizide 5 mg Q day
• Dyazide 1 tab Q day
• Attend Rose Medical Center Diabetes Education
  Classes
• Follow up in 2 weeks

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8/21/06

• Started Diabetes Education Classes
• Seeing gastroenterologist for continuing GI
  symptoms
• Seeing urologist for urination problems and
  elevated PSA
• Foot pain improved in last 2 weeks

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8/21/06 Physical Exam

• BP 150/110
• Feet no sores, pinprick sensation intact
• Finger-stick glucose (fasting) 184

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Re-evaluate (8/21/06)

• Increase Glipizide to 10 mg Q day
• Add Lisinopril 20 mg Q day
• Add Flomax 0.4 mg Q day
• Add Lovastatin 20 mg Q day
• Continue Dyazide 1 tab Q day
• Follow up 1 week

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8/28/06

• Feet almost completely better
• Amitryptiline added by GI for IBS
• Had prostate biopsy at urologist
• Completed Diabetes Education

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8/28/06 Physical Exam

• BP 110/84
• Glucose (fasting) 136
• Feet no sores, pinprick sensation intact
• Weight 201 pounds (BMI 31.5)

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Re-evaluate (again)

• Add Metformin 500 mg Q day
• Continue all other drugs
• Follow up in 3 weeks for fasting lipid panel

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Community Resources for Chronic Disease Type 2
Diabetes

• Rose Medical Center Diabetes Education
• Free classes
• Support Groups
• Online information
• American Diabetes Association
• Denver Branch
• www.diabetes.org
• Denver Diabetes Expo

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Family Medicine and Chronic Care in Denver

• Family Care Medical Center
• Location
• Demographics
• Available Services
• Common Problems
• Chronic Care An Interesting Patient
• Community Resources Diabetes

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Questions