Frisco Medical Center

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Frisco Medical Center

• David Hakkarinen MS III

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Intoduction

• Overview of Summit County
• Overview of Frisco Medical Center Family Practice
• Discussion of a patient with HTN treated at
  Frisco Medical Center
• Conclusions

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Summit County Colorado

• Located approximately 80 miles west of Denver
• Land Mass of 619 square miles
• Average elevation of 9000 ft above sea level
• Elevation Ranges from 8000-14,000 feet
• Population of 24,000

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Summit County Colorado

• 4 major Population Centers (Breckenridge, Frisco,
  Dillon, and Silverthorne)
• 4 ski resorts (Copper Mountain, Breckenridge,
  Keystone, Arapahoe Basin)
• County Seat in Dillon
• Largest Town Silverthorne

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Summit County Colorado
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Summit County Colorado

• 1 Hospital
• St. Anthony Summit Medical Center
• Level 3 Trauma Center
• 24 hour ED, Surgery, Orthopedic, OB/Gyn, and
  Hospitalist coverage
• Affiliated with St. Anthony Central and North
  Hospitals
• Flight for Life Helicopter Base

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Summit Medical Center
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Frisco Medical Center

• Family Medicine and Occupational Medicine
  Practice
• Located next to the hospital in Frisco
• 2 Physician Practice (Dr. James Bachman and Dr.
  Stephen Gray)
• Smaller of 2 Family Medicine Practices in Summit
  County

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Frisco Medical Center

• 3 major types of patients seen
• Family Medicine Patients
• Visitors to Summit County
• Occupational Medicine Patients

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Frisco Medical Center

• Common Problems Include
• Orthopedic Injuries
• Hyperlipidemia
• HTN including bi-landers
• Depression
• Asthma

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M. J.

• 55 year old retired female
• Lives in Florida in Summer and Summit County in
  winter (bi-lander)
• Previously healthy with no chronic health
  conditions
• Upon arrival to Summit County had a BP of 146/92
  (previous BP of 120/70)

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M.J.

• Family history significant for
• a father with high blood pressure and
  hyperlipidemia
• a mother with colon cancer
• Paternal grandfather with CAD
• Maternal grandfather with lung cancer

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M.J.

• Social history
• non-smoker (never smoked)
• EtOH use of 2 glasses of wine a day
• Retired, lives with retired husband of 25 years
• Lives in Summit County for 6 months a year (Miami
  Florida for other 6 months)
• Skier (55 days last year)

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M.J.

• Review of Systems
• negative for systemic complaints, HEENT,
  Cardiovascular, Pulmonary, GI, GU,
  Dermatological, Endocrine, Hematological,
  Musculoskeletal, neuro, or psych problems
• In particular pt has no Hx of headache,
  dizziness, syncope, heart disease, chest pain,
  palpitations, murmurs, rapid heart rate, or
  previous HTN.

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M.J.

• Physical Exam
• General NAD, pleasant, well developed
• CV RRR no murmurs, rubs, or gallops
• Lungs CTA bilaterally
• Abdomen Soft nontender B/S
• Extremities No edema noted DTRs 2
• Skin Pink, Warm, Dry
• Neuro AAO x 3, no e/o deficits

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M.J.

• Assessment
• 55 year old female with possible new onset HTN
  possibly due to bi-lander phenomenon

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M.J.

• Plan
• Pt was given a home self monitor to monitor her
  blood pressure
• Pt was asked to keep a blood pressure diary and
  check blood pressures several times throughout
  the day
• Pt was instructed to follow up in 2 weeks

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M.J.

• Follow Up
• M.J. returned 2 weeks later
• M.J.s diary demonstrated elevated BPs between
  135-155/85-95
• At Follow Up appointment M.J.s BP was 142/94

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M.J.

• Follow Up Plan
• Pt started on Hydrochlorothiazide 12.5 mg PO
  every day
• Pt asked to continue with BP monitoring and diary
  and to follow up in 4-6 weeks
• Pt counseled on decreasing sodium intake,
  increasing fiber intake, and decreasing fat
  intake
• Pt counseled on bi-lander phenomenon

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M.J.

• Discussion
• Bi-lander phenomenon is the term Dr. Bachman has
  termed for HTN induced in people who live part of
  the year in low elevation and the other part in
  high elevation
• Unknown etiology
• per Dr. Bachman people with bi-lander phenomenon
  were destined for HTN and it just appears
  suddenly and earlier due to high elevation

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M.J.

• Discussion
• Bi-lander Phenomenon Treatment
• Same as HTN recognized elsewhere
• Advise pt that they were destined for HTN and
  altitude just precipitated it
• Advise pt that they need to continue HTN
  treatment at low altitude

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Conclusions

• Summit County is a unique location in Colorado
  due to Socioeconomics, Elevation, and population
• Frisco Medical Center is an important medical
  institution in Summit County
• One of the major problems seen in Summit County
  is HTN often in bi-landers leading to the
  bi-lander phenomenon

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Questions?
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Acknowledgements

• Dr. James Bachman MD
• Dr. Stephen Gray MD
• The Staff of Frisco Medical Center
• Rich and Kathy Hakkarinen