DURANGO

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DURANGO
Beau Carubia
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WILL COVER

• Small town mountain community
• Little history, demographics, things to do
• Major health issue facing community
• Durango Family Medicine
• Interesting case Mrs. B

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THE COMMUNITY

• Durango comes from the Basque word Urango meaning
  water town
• Founded in 1880 by Denver and Rio Grande Railroad
• Elevation of 6512 feet
• Located in LaPlata County (population 50,000)
• Near Mesa Verde National Park

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DEMOGRAPHICS
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DEMOGRAPHICS

• RACE
• Caucasian 86.8
• Hispanic/Latino 10.3
• American Indian/Alaska Native 5.5
• Asian 0.7
• Black/African American 0.5
• Native Hawaiian/Pacific Islander 0.1
• Other 4.1

• GENDER
• Male 51
• Female 49
• AGE
• 15 or younger 13
• 16-24 29.7
• 25-44 27.2
• 45-64 19.4
• 65 10.7
• INCOME
• Median Household 34,892

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THINGS TO DO
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THINGS TO DO

• DO YOU LIKE THE OUTDOORS??
• Skiing, camping, biking, fishing, hiking,
  hunting, rock climbing, rafting, kayaking, hot
  springs, and cliff dwellings, miles of nature
  paths, snowdown
• NOT SOO MUCH THE OUTDOOR TYPE??
• Downtown area, shops, art galleries and walks,
  museums, numerous restaurants, year round
  concerts and entertainment

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HEALTH ISSUE IN COMMUNITY

• Closure of Valley-Wide Health systems in Durango
  (MARCH 31)
• Family medicine and pediatric clinics
• Total patient population 12,000
• 31 are gt 65 yrs old
• Medicare patients in biggest trouble
• Most other practices and Mercy Regional Medical
  Center are maxed out

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THE PRACTICE
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DURANGO FAMILY MEDICINE

• Family Practice Clinic that began in January 2003
• Located in Mercy Regional Medical Center
• DFM has approximately 12,000 patients
• 7 providers (6 MDs and 1 FNP)
• Joseph M Murphy, MD
• Martin P Pirnat, MD
• J Steven Lavengood, MD
• Patrick J Kearney, MD
• Alison W Jackson, MD
• Kristen L Searfus, MD
• Barbara Rakita, FNP

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DURANGO FAMILY MEDICINE

• Several do OB/GYN
• One does C-sections
• Dr. Pirnat
• Two do vasectomies
• Electronic medical record system
• Most important teaching principle Continuity
• Most common health issues seen
• 1) Pregnancy/Prenatal care
• 2) DM Type II
• 3) WCC

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Mrs. B

• CC Abdominal Pain
• HPI 86 yo female presenting with new onset abd
  pain for 1 week. Pain located in epigastric area
  and worse at night. Occasional palpitations and
  feels hot from time-to-time. Denies fevers, night
  sweats, and chills. Denies N/V but has increased
  gas and belching. Good appetite, no headaches
  and no problems/pain with urination. Denies
  blood in stool or urine. Denies melena. Has
  taken Maalox with some sx relief but has noticed
  looser stools. States her chronic neuropathy
  in feet seems worse lately, particularly when abd
  pain flares. Denies weakness or lightheadedness.
  Pt had an IV treatment with Boniva 10 days ago.
  H/o PUD on baby ASA last yr, states this pain
  feels different. On Protonix daily for PUD.

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Mrs. B

• PMH/SH Significant for Osteoporosis with
  degenerative disease of cervical spine, herniated
  intervertebral disk (L4-L5), HTN, peripheral
  neuropathy, mild sigmoid diverticulosis,
  osteoarthritis, PSVT, and upper GI bleed last
  Aug. Non-smoker
• MEDS Protonix, Vit B12, Ca, MTV, Glucosamine,
  Micardis, Donnatal, Amiodarone HCL, Zetia,
  Lidoderm
• PE GEN well-appearing, well-nourished vigorous
  elderly woman in no acute distress, normal mood
  and affect
• SKIN good turgor, no rash or prominent lesions,
  good color
• EYES/MOUTH conjunctiva clear, sclera
  non-icteric, mucus membranes moist, no lesions
• CV RRR, no murmur, thrills, or gallop
• LUNG CTAB
• ABD soft, BS, no tenderness, no organomegaly,
  no masses

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Mrs. B

• A/P 86 yo female presenting with acute onset
  abdominal pain of unknown etiology Possible
  causes include recurrent PUD, medication-induced,
  infectious causes
• Continue Maalox PRN, try TUMS because Maalox may
  be contributing to diarrhea
• Additional samples Protonix 40 mg given
• Follow-up appt in few days to reevaluate
• Possible need for imaging (UGI endoscopy) if sx
  worsen or do not improve due to hx of PUD
• Possible Labs SED rate, CMP, Fecal Occult Blood,
  Hgb, Hct, Lipase

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Boniva (Ibandronate)

• Bisphosphonate Derivative reduces bone
  destruction in postmenopausal osteoporosis.
  Available in PO and IV.
• SE (oral or IV)
• Abdominal Pain
• Reflux
• Nausea or vomiting
• Diarrhea
• Rare jaw bone damage

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Medicine in Durango

• Lab draw station in office
• Imaging suite down the hall
• All clinics attached to hospital
• Mercy Regional Medical Center is an 82-bed,
  full-service, acute care hospital.
• 40 specialties offered
• Level III trauma center
• Family Birth Center

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The End

• Small town mountain community
• Major health issue facing community
• Durango Family Medicine
• Interesting case Mrs. B
• Questions?