Salida

1
Salida

• Brian Christenson
• January 2007

2
Topics

• Salida info and overview
• Salida medical community
• Patient management
• Community medical resources

3
Salida Info

• The Salida, Colorado area is the crossroads for
  the three interstate highways U.S. 24, 50 and
  285.
• Driving distance from Denver 130 miles, 100
  miles from Colorado Springs
• The elevation just over 7,000 ft.
• Chaffee County has more mountain peaks of
  14,000-foot or more than any other county in
  Colorado

4
Salida statistics

• Working Class population
• Median household income 28,790
• Very Little Diversity
• 93 of the population is Caucasian
• The remaining population is mostly Hispanic

5
Salida History

• Settled by the Ute Indians, for whom many of the
  local mountain peaks are named.
• Chaffee County was established in 1879 and named
  for Jerome Chaffee, a United States Senator
• Early in its history the area experienced an
  influx of explorers, miners, railroad
  expansionists, farmers and ranchers.

6
Salida Climate

• Bordered on all sides by mountains
• Average snowfall in the valley is 50 inches,
  while in the surrounding mountains the local ski
  area (Monarch) boasts 400 inches or more.
• Temperatures are relatively mild. The average
  high temp for January is 49F. Night time temps
  average 19F
• July is the hottest month with daily average high
  temperatures of 77F

7
Salida Activities

• The most prominent business in Salida is tourism
• Winter Snowshoeing, cross country skiing,
  snowmobiling, skiing, and snowboarding

8
(No Transcript)
9
Salida Activities

• Salida located right on the Arkansas river
• Summer Hiking, camping, art festivals, music
  festivals, rafting/kayaking

10
(No Transcript)
11
Salida Health info

• Heart of the Rockies Regional Medical Center
  25-bed Critical Access hospital.
• Serves the 16,000 residents of the Upper Arkansas
  Valley including the communities of Buena Vista,
  Villa Grove, Saguache, Granite, Howard and
  surrounding communities.
• HRRMC was first established in 1885 as the
  Denver Rio Grande Railroad hospital for
  railroad employees

12
Salida Health info

• 31 full-time physicians
• Family care (obstetrics to geriatrics)
• Dermatology
• Gastroenterology
• General surgery
• Cataract Laser Surgery
• Orthopedic, Foot Ankle
• Gynecology
• Urology

13
Salida Health info

• Approximately 25 visiting or part-time
  specialists
• Allergists, Cardiologists, Neurologists,
  Oncologists/Hematologists, Otorhinolaryngologists
  (ENT), and Physiatrists (Physical Medicine
  Rehab)

14
Salida Health Info

• The hospital was threatening to shut down in the
  early 1960s
• Due to the railroad becoming obsolete
• The hospital was saved in large part by one mans
  efforts
• The Dr. we all aspire to be

15
(No Transcript)
16
The legend Dr. Leonardi

• The patriarch of the medical community in Salida
• Opened his practice in 1948
• Cared for more than three generations and
  delivered over 3,000 babies
• Would brag that he could see over 50 patients in
  a day
• Would still make house calls
• Kept the medical community alive in Salida by
  raising money to buy the local hospital and keep
  it running

17
(No Transcript)
18
1st St. Family Health
19
1st St. Family Health

• Largest family practice in town
• 4 physicians, 1 nurse practitioner
• Most physicians handle obstetrics
• Most common things seen
• Prenatal care
• Well child care
• HTN
• COPD
• Diabetes
• URI
• Sinusitis

20
1st St. Family Health

• Most unusual things seen
• Nocardiosis
• Myasthenia gravis
• Digeorge syndrome with tetralogy of fallot

21
Selected patient

• S.B.
• 82 yo white female
• Hx of COPD, HTN, CHF, Diabetes, PVD, Chronic
  tobacco use.
• Pt on multiple medications, including 4L of O2
• Pt. is retired and widowed
• Smokes ¾-1 pack/day and has a 62 pack year hx

22
Selected patient

• 1st seen in the hospital for shortness of breath
• Cause thought to be due to pneumonia given fever,
  elevated WBC, and evidence of infiltrate on X-ray
• CXR evidence of cardiomegaly. Questionable
  consolidated infiltrate in R. upper lobe
• Pt. started on abx for suspected
  community-acquired pneumonia
• Audience question What would be a good choice
  for an antibiotic?

23
Selected patient

• Pt. improved on azithromycin
• We decided to look at a repeat CXR
• New CXR Evidence of 6 cm mass in R. upper lobe.
  
• CXR from 6 months ago showed a 3 cm mass in the
  R. upper lobe

24
Selected Patient

• Of note, pt. has also had recent weight loss and
  fatigue
• The mass very likely represents a malignancy
• Pt. told about the finding on X-ray
• Audience question What would you tell her when
  she asks for your advice on what to do?

25
Selected Patient

• Pt. must travel to Denver or Colorado springs for
  bronchoscopy or percutaneous biopsy if desired
• In town oncology specialist to handle treatment
• In town chemotherapy
• Radiation treatments in Colorado Springs or
  Denver
• At a follow up meeting, pt. declined any therapy
• Audience question What community resources
  would you like to see utilized in this situation?

26
Community resources

• Hospice- Angel of Shavano Hospice. Services
  include palliative care, pain management,
  psychological and volunteer support, medical
  social work, and spiritual/pastoral counseling.
• Home care- Upper Arkansas Home Health. Services
  include help with dressing changes, IVs,
  injections, catheters, and medication.
• Meals on wheels- Meals prepared and brought to
  the home of the individual.

27
Community Resources

• Spoke with the family
• Gave them information about hospice
• My preceptor will continue to care for and
  counsel the pt.

28
Key concepts

• A family physician is a counselor
• A family physician is a problem solver
• A family physician coordinates different aspects
  of patient care.
• A family physician effectively utilizes resources

29
Thank you