La Junta Spanish for the Junta

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La JuntaSpanish for the Junta

• Matt Rustici

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Overview

• Some fun things to do in LJ and some great things
  about Valley Wide Health Systems
• The story of A.A.
• Resources available for A.A. in La Junta

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La Junta in a nutshell

• Preceded by Bents Fort in 1840s
• Railroad hub, founded as a city in 1881
• Current population about 7500
• Average income 29,000
• Average cost of house/condo 79,000

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Valley Wide Health Systems

• 17 clinics across southern Colorado
• La Junta clinic connected to the Arkansas Valley
  Medical Center
• Satellite clinics in Rocky Ford (1 MD and 1 NP)
  and Las Animas (1 DO)
• In LJ, there are 3 MDs
• All physicians take in house call at the hospital
  

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Dr. Perry and his posse
Dr. Perry
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Didnt I get hit by the tornado?

• No

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So you are stuck in south-east CO for a few
days, now what do you do?
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Bents Old Fort

• Bents Old? Fort
• Trading post built by the Bent bros in the 1840s
• Fun for the whole family

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Santa Fe Trail

• Traversed by countless pioneers
• Attractions for the whole family

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Santa Fe Trail
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Picketwire and Vogel Canyons

• Comanche National Grasslands (ie the middle of
  no-where)
• Real dinosaurs
• Native American art
• Native Coloradoan graffiti
• Stop Pinon Canyon Expansion signs

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Koshare Indian Museum

• Started by boy scouts
• Koshare dancers still performing
• Collected relics from around the country

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Gormet Healthy Cuisine

• McDonalds
• KFC
• Sonic!
• Pizza Hut
• Little Caesar's
• Wendys and
• COUNTRY HOME BUFFET!!!

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The Story of A.A.

• A.A. is a 80 yo hispanic man with a remote
  history of prostate cancer 10 years s/p RT, Type
  2 diabetes, hypertension, COPD, and bilateral
  cataracts that have lead to blindness.

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The Story of A.A.

• 12/00 Seen at VW for first time. DM identified,
  nutrition consulted. BG 312
• 1/01 DM meds started
• 2/01 Skips F/U 2/2 cost, never gets A1C
• 9/02 ER visit for fall, not taking DM meds, h/o
  prostate CA noted, PSA 75
• 10/02 F/U from ER, DM meds restarted, no A1C

Representative picture of patient if he was an
African-American female
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The Story of A.A.
Orchitis

• 11/02 Seen in hosp for urinary incontinence, dx
  with L orchitis, started on insulin for DM
• 12/02 L orchiectomy and TURP -gt recurrence of
  prostate CA, refusing insulin 2/2 cost and of
  meds, BG 399, if it is my time to go, then OK
• 1/03 ER for UTI, on FU agreed to insulin, BG 170,
  PSA 53
• 2/03 ER for urin. ret., gets R orchiectomy for CA
  risk, DM well controlled

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The Story of A.A.

• 12/03 ER urin. ret. No F/U
• 2/05 Seen in hosp for peri-anal abscess, CT notes
  adrenal mass, on F/U not taking DM meds so
  restarted and referred to endocrine, F/U
  scheduled in 2 wk
• 6/05 Seen in clinic for
• epistaxis, denies h/o DM

Mass
Adrenal Gland
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The Story of A.A.

• 4/06 Seen in clinic for urin. ret., referred to
  surg for adrenal bx, Casodex started for prostate
  CA, bone scan considered for mets, on F/U refuses
  DM meds, PSA 335
• 5/06 Skips appt. with urology for CA F/U 2/2
  money
• 11/06 ER chest pain, on F/U DM meds restarted

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The Story of A.A.

• 1/07 Seen in hosp for weakness/fall and urin.
  ret., bone scan and CT show stable adrenal tumor
  and mets to bone, flutamide started
• 2/07 F/U with urology taking flutamide, PSA
  3964, F/U with us A1C 11.3, restarted on DM meds
  and insulin, F/U in 3 mo
• 4/07 (my visit) A1C 5.6!!!!, PSA 4308 (down from
  6000s) taking meds with
• help of granddaughter, invested in treatment,
  optimistic about CA

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Healthcare resources available in La Junta

• Services
• Case Manager (or SW in hosp) and social services
• Medication outlet pharmacy and discount programs
  (Casonex vs. flutamide)
• Providers
• Onc comes out 1-4 times/mo
• Local nurses can give chemo
• Clinic is cheap

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Healthcare resources available in La Junta

• Cancer
• Cancer support group once a month
• Hospice
• Home health
• Home bound care services (cook and clean)

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Highlights of LJ

• Fantastic physicians
• Friendly staff
• Interesting patient base
• No pharm reps
• Lots of OB
• Small town feel
• No tornados

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So, thats La Junta

• Any questions?