Colorado City, Colorado

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Colorado City, Colorado
View of the Greenhorn Mountains from Hollydot
Golf Course
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Colorado City, Colorado
Winter view of the Greenhorn Mountains not bad
if you like snow
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Not to be confused with Colorado City, AZ the
polygamy capital of the world
Polygamist patriarch Joseph Smith Jessop with his
youngest daughter shortly before his death in
September 1953.
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You can imagine my horror
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Colorado City, CO Population 2,018 Average
Income 60,000 Many families and
retirees Demographics 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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And just in case you did not figure it
out Colorado City is not really a city
The Hardware Store
One of the two restaurants
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And for those of you who do not know me (and
what a city girl I am)
!!!
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Welcome to Colorado City a great place to
raise a family (one of the clinic
nurses), suicide if you are single (anonymous
source), and a town with only ONE doctor.
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Dr. Grady King Snyder Total Life Care
The only doctor not only in Colorado City, but in
the entire Greenhorn Valley (about 8,000
residents).
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Total Life Care. Taking care of the entire
patient, and not just his or her somatic
complaints. For Dr. Snyder serving as the only
doctor in the community, this involves talking
about depression or anxiety, or helping a patient
discover why they are feeling so fatigued, when
her TSH is normal. Often times this means talking
about life issues, such as bad marriages, sick
family members, or stressful jobs. One
important lesson I learned from Dr. Snyder is
that sometimes people are scheduled for a vague
somatic complaint, but when you start talking
about how things are at home or what is really
bothering them, it becomes clearer what is
contributing to his or her chief complaint.
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Purpose Emphasize that Family Practitioners
handle the majority peoples health issues,
even with limited resources close at
hand, and sometimes help the patient uncover
other things that impact his or her
health. 1) The types issues the patients
had 2) An interesting patient as an example of
Dr. Snyders approach to patients and
chronic disease management 3) Summarize how
chronic care model is integrated into Dr.
Snyders practice
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Community Health Resources
San Isabel National Forest
Recreation Center
Sledding Hill _at_ Lake Isabel
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Community Health Resources
30 minute drive from Colorado City
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• Dr. Snyders Practice
• Hypertension, Hyperlipidemia, and other chronic
  illnesses,
• Skin lesions
• Acute illnesses and injuries
• 50 psych issue/life issue
• Of these, he counsels about 40 himself, and
  refers the rest to Pueblo or the one part-time
  therapist in CO City
• If he refers to a psychologist, he works closely
  with that person to manage the patients
  medications and progress
• If he starts a patient on a new medication he
  will follow-up with him in 2-4 weeks
• He typically only refers to a psychiatrist if the
  patients medication regimen is complicated, or
  if the patient is not making progress

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Visit 1 The Patient Mr. H. Age 42 years old CC
Anti-depressant is not working HPI Struggled
for years with depression mood is irritable,
difficulty concentrating, anhedonia, poor
appetite for the past few months tired all the
time, snoring with episodes of waking up
gasping for air no problem falling asleep, just
staying asleep patient also wants help to quit
smoking PMH Htn, snoring SH Married with three
children, works 2 week shifts on the gas fields
near Grand Junction Smokes 1 ppd x 20 years PE
General the patient was pleasant and seemed to
be in a good mood, slightly anxious, but
maintained good eye contact throughout the
interview PE was unremarkable
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Assessment 1) Depression, 2) snoring with
episodes of apnea 3) nicotine dependence Plan
1) Wellbutrin 150 mg BID 2) Overnight
pulse-oximeter for possible sleep apnea 3)
Education and resources to quit smoking 4) F/U
in 2 weeks
In the mean time I met the rest of his family
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18 year-old daughter just learns she is pregnant.
Turns out she and her boyfriend are ecstatic.
Mom knows and is accepting. Dad has been out of
town on a job, and according to daughter,
probably suspects, but does not formally know.
Two sons, ages 7 and 11 both have ADHD that has
not been well-controlled with the meds they were
taking.
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Visit 2 with Mr. H The patient is feeling much
better with the Wellbutrin, and has no craving to
smoke. He feels his mood is improved, and he has
more of an appetite. He still feels fatigued, but
is less bothered by it. When asked about things
with his daughter, he said, it is not what I
would have chosen for her, but it is not my
decision. He also said that things at home are
also going better now that his sons have adjusted
their doses of Strattera. Talked at length about
how the things at home and his stressful job may
be contributing to his sense of wellbeing.
Plan Continue Wellbutrin, F/U pulse ox and
possible sleep study, And choose a date to quit
smoking.
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In the end 1) Give patients tools and education
to help themselves 2) Follow-up care to
reassess 3) As a primary care provider one often
ends up providing care for more than just
physical complaints
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I enjoyed working with Dr. Snyder, and
appreciated his approach to patients, which
recognizes that mental and social well-being also
play in important role in an individuals health.