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“In sickness and in health” are words we often hear when celebrating the momentous occasion of marriage with our friends, families and loved ones. For James Breckenridge, these words were the foundation of the love and commitment he and his wife Carolyn showed to each other during their 30 years of marriage. In health, James and Carolyn shared a love of traveling. Hopping in their van, driving across the continental United States and enjoying the views along the way will be a memory James cherishes forever. Unfortunately, their excursions would be cut short when Carolyn fell ill, rerouting to their local hospital, Renown Health. Carolyn has spent more time at the hospital than the average person – including recovering from COVID-19 at Renown South Meadows Medical Center. However, hospital admittance for Carolyn meant the same for James, providing support to his wife during her stay. Following more than 40 years of exceptional experiences with Renown and their most recent discharge from the hospital, James wrote a letter recognizing the efforts of the team members and healthcare providers who not only cared for Carolyn but also James. To Whom It May Concern James began his letter by applauding two Renown Regional nurses they got to know well during their recent visit. Tiffany and Ashley went the extra mile to care for Carolyn attentively. From simple tasks like gathering requested supplies to answering James’ questions in detail, they helped provide a comfortable environment for the couple. To these nurses, these tasks may have felt like another day at work. Still, James’ letter commends them for their acts of service, reminding us that every interaction we have with a patient can be a memorable one. Tiffany and Ashley weren’t the only team members who received recognition in James’ testimonial. He also took a moment to recognize the various nurses, certified nursing assistants, therapists and doctors they encountered during their care journey. All provided the excellent and helpful experience we aim for at Renown. Healing Memories James first brought Carolyn to Renown Regional Medical Center, formerly known as Washoe Medical Center, in 1980, but it was 1996 when things changed for him. Carolyn was admitted to the hospital for a procedure they originally anticipated would come with a difficult prognosis. To their surprise, doctors found the opposite. It was in that joyous moment that James’ perspective of hospitals shifted, now viewing them for what they truly are – a place people go to get better. “Every time I walk around Renown Hospital, I remember all the times Carolyn was healed there,” James wrote in the latter half of his letter. Healing Isn't Just for the Patient James took advantage of the many support resources accessible to family members during their time at Renown. These donor-funded hospital initiatives are a valuable mental health resource in difficult circumstances. Whether it was an afternoon stroll with his wife through Fianna’s Healing Garden or quiet time alone in the Spiritual Center, James never hesitated to turn to these resources in his time of need. “Although I know the Tahoe Tower is the modern, state-of-the-art part of Renown, I prefer the Sierra Tower because that is where most of my memories are.” Even a simple daily walk to the on-campus Starbucks was a notable part of his day – grabbing a cup of coffee for himself and often a treat for Carolyn. An Inspiration in Healthcare When asked to describe Renown in one word, James chose “inspirational.” His collective experiences with Renown, James said, “helped him to be a better healthcare advocate” when his wife received care at other hospitals. As a healthcare leader, we challenge ourselves to go above and beyond for the health of our entire community. Collaborating with our patients and their families is at the center of everything we do at Renown. Positive reviews mean the absolute world to us, and something about this handwritten letter feels even more special. We could not be more appreciative to James for sharing how our vision to inspire better health in our community was reflected in his 40 years of experience with Renown. We were saddened to hear of Carolyn’s passing during a recent meeting to thank James for his letter. We take solace hearing James’ beautiful memories of his wife and knowing that Renown Health was there in times of sickness and health. We offer our sincere condolences to James, Carolyn’s children and their family members.

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Heart disease is the number one killer of women – claiming one life every minute – yet many women don’t know that the signs of heart attack may not be the same symptoms they’ve learned about all their lives. In women, nearly 71% experienced unusual exhaustion in the weeks before, 50% had trouble sleeping and 42% suffered shortness of breath. Most importantly, about 43% had no chest pain. Women and Heart Attacks: The Subtle Symptoms In both men and women, the most common symptom is pressure or pain in the mid chest, but there are also more subtle signs. “Women can experience a heart attack without chest pain,” explains Letitia Anderson, M.D., cardiologist with Renown Institute for Heart & Vascular Health. “It is not uncommon for women to experience extreme fatigue, shortness of breath, dizziness, lightheadedness, nausea, vomiting and pain in the abdomen or back as their primary symptom.” Other symptoms can include: Neck or jaw pain Fullness or pressure that goes away and comes back The feeling of a rope being tied around your body and squeezed Some doctors have reported seeing patients who just didn’t "feel right." One woman simply felt more tired than usual while cleaning, while another woman reported feeling winded carrying boxes to the basement. Admittedly these are symptoms many of us would shrug or sleep off versus going to the hospital for immediate care, which is why it’s important to pay close attention to the warning signs. “Women are good at being the caregiver for the rest of the family and writing off their own symptoms as something minor, like indigestion or a muscle pull,” says Dr. Anderson. “Remember that heart attacks have early warning signs, and if they are recognized and treated in time, a heart attack can be prevented and heart damage avoided.” When You Need to Call 911 Paying attention to your body is key. If you’ve experienced any unusual or flu-like symptoms, struggled to breathe or just don’t feel right – give yourself a gut check and ask if you’ve honestly felt this way before. If you’re worried at all, you need to seek emergency care. Do not wait – call 911 immediately Take an ambulance to the hospital if at all possible Try to stay calm and take deep, slow breaths until medical help arrives.

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If you ask most people who suffer from depression what it's like, it can be difficult to fathom. We spoke with the courageous and fearless Kathryn, who has endured major depressive disorder (MDD) most of her life. She recollects what it was like, and how grateful she is for a new rTMS therapy treatment she recently completed. Kathryn is a local resident who shares her story to provide hope and support to others surviving depression. From her accounts of the grueling years she faced this disorder to how hard she fought to find treatment, Kathryn is a true hero. According to the National Institute of Mental Health, major depression is one of the most common mental disorders in the U.S. The disease causes people to experience sadness and helplessness, and in some cases, may prevent people from carrying out their daily routines. No two people are affected the same way, meaning there's no "one-size-fits-all" for treatment. Finding help is typically a long and exhaustive journey for most surviving depression. The Long and Confusing Road to Finding Help Kathryn is no different from most major depressive disorder (MDD) survivors, fighting for a better future. Her mental health treatment journey started as early as 12 years old; however, she wasn't diagnosed with depression until much later in life. In her late 20s, a friend told Kathryn she was depressed, but like so many individuals battling the illness, Kathryn didn't know what depression was. The waiting lists to get into mental health treatment was devastating. She found mental health resources scarce, an issue far too familiar throughout the U.S. After being prescribed more than twenty different depression disorder medications, she wasn't sure who she was or if she'd survive. Determination to Fight Kathryn's darkest moments lead to experiences that are unspeakable to relive. But in her persistence to not give up, she began researching a more promising treatment. “I was looking for an evidence-based therapy,” says Kathryn. “In my research, I found Transcranial Magnetic Stimulation Therapy to be most promising.” After a yearlong waiting list for repetitive transcranial magnetic stimulation (rTMS) therapy in another state, Kathryn moved to Reno, Nevada, still searching for a location that offered this therapy. Thankfully, Kathryn's arduous journey led her to the Stacie Mathewson Behavioral Health & Addiction Institute at Renown. That is where she received news from her doctor, Gunjan Lehil, MD, that rTMS is offered for people looking for a new way to fight depression. How rTMS Therapy Works rTMS is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression – typically used when other depression treatments haven't been effective. This treatment involves delivering repetitive magnetic pulses, referred to as repetitive TMS or rTMS. During an rTMS session, an electromagnetic coil is placed against the person's scalp near their forehead.  The electromagnet painlessly delivers a magnetic pulse that stimulates nerve cells in the region of the person's brain involved in mood control and depression. It's thought to activate areas of the brain that have decreased activity in depression. Though the biology of why rTMS works isn't completely understood, the stimulation appears to impact how the brain works, which seems to ease depression symptoms and improve mood. On average, patients undergo rTMS treatments for four to six weeks, five days a week for about 40 minutes a day. A patient's doctor will determine a treatment plan that's best for the patient in all cases. Life After rTMS Therapy After completing six weeks of rTMS therapy, Kathryn feels as though she is coming back to life. She has noticed her posture is different, and she is more animated. She is also more interactive at work, and her coworkers are more perceptive and positive towards her. Life at home is also improving, as Kathryn's family is noticing a difference. She notes that while she still faces feeling depressed, it's so much different from it used to be. The difference is, she can better decipher a bad day and work through the challenging moments. She has hope - which she never felt before. rTMS Therapy has given Kathryn a chance at life, and she's excited to start living! The Future is Fearless Kathryn says the way to success is never to give up and to keep pushing herself forward every day. Currently a veterinarian technician in training, Kathryn is working on getting her license. She loves working with all animals, but her true passion is falconry and helping injured birds of prey. She loves falcons because they are utterly fearless, just like her. "It's time for me to be brave and show up. I couldn't do that before," says Kathryn. "I'm grateful to have rTMS treatment, and I share my story in hopes of helping others."

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According to a National Center for Health Statistics survey, about 8% of U.S. adults are not taking their medications because they can’t afford them. This means millions of adults aren’t taking their medication due to the high cost. Virtual Event with pharmacist, Adam Porath Thursday, July 23, 11 a.m. to Noon Attend Virtual Lecture 5 Ways to Cut Medication Costs Safely Cost might not be affecting your medication plan, but the following ways to save money on medication can help: 1. Questions to ask your prescribing provider Do I have to take this medication? This is particularly a good question when you’ve been taking a pill for some time and not sure if you should continue. Is there a way to combine my medications? A good example of this is for those who are taking blood pressure medications. Do I have to take this particular pill? Often there are generic choices in the same medication class. Can I get a larger supply? Basically, knowing the cost of a 30- vs 90-day supply is always a good idea. In other words, it could save you time and money. This generally works for medications you take long-term. Remember, asking questions can help you save money on medication, so communicate your concerns. 2. Research online Find the website for the medication and look to see if there are savings and support available through the drug company. 3. Consider a co-pay card Co–pay card programs offered by drug manufacturing companies are a direct way to lower out-of-pocket costs for prescription drugs for eligible patients. The cards can patients pay for the medications they, or their doctors, prefer. If you don’t qualify for a co-pay card, then you can look into patient assistance programs. 4. Consider patient assistance programs Drug companies sponsor these programs by income and they are often hard to find. The best way to find a patient assistance program is by asking your pharmacist. 5. If you’re on Medicare, consider updating your plan Medicare plans can change from year to year, which often times includes the medication they cover and the co-payments or deductible amounts. Annual Enrollment takes place October 15 – December 7, 2020. Most important, review the options and shop around for the best plan. Visit Senior Care Plus for information on Medicare Advantage Plans available to you. Want to ask a pharmacist more questions on how to save on medication? Join us for a Sterling Silver Club virtual event on Saving Money on Medication. To learn more about the Sterling Silver Club, visit our club website.

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Virtual visits are basically secure, video conferencing visits with your health provider. Of course if you are sick, you want to avoid going outside of your house. With Renown Health’s virtual visit program, you can now see a provider from the comfort of your own home. As we work to keep all of our patients home and healthy, we’re here for any ongoing healthcare needs you have. There are two easy ways to access a virtual visit with Renown Health. If you need an urgent care visit, you can get in line using your MyChart account You can make a virtual visit with some Renown Health providers you see currently Virtual Urgent Care from a Renown Provider By using MyChart, you can now login and request to “Talk to a Doctor.” After filling in some information and confirming your healthcare concern, you will be put into a virtual line. The healthcare team will notify you by text or email when a provider is ready to talk to you virtually. Virtual urgent care visits are available for all ages. Get To Know MyChart Virtual urgent care visits are available for all ages, and can address: Common cold and cough symptoms Muscular, tendon or joint pains not caused by injury Allergy or sinus symptoms Pink eye Urinary discomfort Diarrhea without vomiting Rashes or skin sores Backache Nail problems Screening examination for sexually transmitted illness (without symptoms) Medication refills (not controlled substances) Symptoms for In-Person Urgent Care Visits Shortness of breath Chest pain Abdominal pain Numbness or weakness of any location that is new Traumatic injuries (including eye injuries or something in the eye) Severe pain of any other body location Dizziness or confusion Bleeding from any location High fever (greater than 102 degrees for all ages) Persistent vomiting Loss of vision Ear pain Substance abuse or psychiatric problems Virtual visits are open 9 a.m. through 6 p.m. Monday-Friday and 10 a.m. to 4 p.m. Saturday and Sunday for Nevada residents. Renown Provider Virtual Visits Many primary and specialty care appointments for adults and children are now available virtually. If you have a provider with Renown Medical Group, call 775-982-5000 to see if you can have a virtual appointment from the comfort of your home. MyChart Assistance If you need assistance with your MyChart account, please call 775-982-6686. For all other questions about scheduling and appointments, please call 775-982-5000.

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If you’ve been putting off care for your child, know that Renown Health is prepared with updated processes and procedures to ensure safety for you and your little ones.   Doctor Max Coppes, MD, PhD, MBA, Physician-in-Chief of Renown Children’s Hospital, is concerned there could be an outbreak of serious illnesses if parents continue to delay getting their children immunized. Dr. Coppes and team understand your anxieties when it comes to visiting your pediatrician, and would like you to know; not only are well visits important to assess your child’s overall health, crucial vaccinations are administered to guard your little ones against disease. Immunizations Immunizations protect children from communicable diseases. Other benefits include: Children that are unable to have vaccines due to age or illness are protected through herd immunity Vaccinations are at given at specific intervals, and missing an appointment may put your child behind schedule Elderly populations are protected where immunity may be decreased Dr. Coppes states, “What we have noticed nationwide, and also in Washoe County, is that the number of kids immunized has gone down by about two-thirds. If that goes on, we’re just waiting for chickenpox, measles, any of those childhood diseases that were eradicated to come up again.” 4 Easy Ways to Schedule an Appointment: Call Us: 775-982-KIDS (5437) Request Appointment Online MyChart Virtual Visits In-Person Wellness Visits/Checkups Maintaining your child’s health is important! Contact your pediatrician to schedule an in-office visit. When you call to make an appointment, you’ll talk to a specialist at our Customer Care Center who will screen you to make sure you and your child have not been exposed to someone with COVID-19, and ensure symptoms of a respiratory illness are not present. Virtual Visits When appropriate, many pediatric appointments are available through virtual visits. Please call 775-982-KIDS (5437) to request a visit with your child’s established provider. All virtual visits require a MyChart account. Don’t have a MyChart account? You can easily sign up online. If you need assistance with your MyChart account, please call 775-982-6686. Virtual visits are able to connect to an ASL interpreter (sign language interpreter), and 37 languages including Spanish.

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Breast milk. It's often referred to as liquid gold. And fortunately, it can be safely refrigerated or frozen for later use, which can allow you to be a bit more flexible in your new routine with baby. Whether you're getting ready to return to work, planning for the chance date night out or just exclusively pumping, it's crucial to understand the guidelines for proper breast milk storage. Storing Breast Milk Use clean bottles with screw caps, hard plastic cups that have tight caps or nursing bags (pre-sterilized bags meant for breast milk). Be sure to label each container with the date the milk was pumped and your baby's name if the milk is going to childcare providers. You can add fresh, cooled milk to milk that is already frozen, but add no more than is already in the container. For example, if you have two ounces of frozen milk, then you can add up to two more ounces of cooled milk. For healthy full-term infants, milk can be stored as follows: Room temperature - six to eight hours (no warmer than 77°F, or 25°C). Refrigerator - up to five days at 32°-39°F (0°-3.9°C). Freezer– Varies depending on freezer type. Up to two weeks in a freezer compartment located within the refrigerator. Three to six months in a freezer that is self-contained (standard kitchen fridge/freezer combination) and kept at 0°F (-18°C). Breast milk should be stored in the back of the freezer and not in the door. Six to 12 months in a deep freezer that is kept at -4°F (-20°C). Be sure to leave about an inch of space at the top of the container or bottle to allow for expansion of the milk when it freezes. Thawing Breast Milk Place frozen breast milk in the refrigerator to thaw (about 24 hours) then warm by running warm water over the bag or bottle of milk and use it within the next 24 hours. If you need it immediately, remove it from the freezer and run warm water over it until it's at room temperature. Never microwave breast milk and do not refreeze it. Once your baby has started to drink from the bottle, you should use it within one hour. You may find that different resources provide different recommendations about the amount of time you can store breast milk at room temperature, in the refrigerator and in the freezer. Talk to your doctor or lactation consultant if you have any concerns or questions.

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Getting a shot can be scary for kids and anxiety-inducing for parents and caregivers. With flu shot season well underway and children's COVID-19 vaccine clinics in full swing, we wanted to share ways to reduce the stress for you and your child. Plan Ahead and Be Honest A few days before the scheduled appointment, casually mention to your child that you’re both going to the doctor’s office (or vaccine clinic, or pharmacy) soon for their vaccine. Explain to them that this will help protect them and will only take a second. Being honest is important, telling your child that it will hurt for a moment. If possible, try and schedule the vaccine at a kid-specific vaccine clinic, your pediatrician's office or a school-based site. Remember that words are powerful. Take notice if you are using a word that might make them more upset, such as prick, jab, needle or shot. You can interchange words such as vaccine, immunization or injection. Bring Toys Don’t be afraid to let your child bring one of their favorite toys or stuffed animals to the appointment. This can make them feel more comfortable and provide distraction. Ask for Pain Reliever/Numbing Agent If you know from past experience (or suspect) that your child has a needle phobia, talk to the vaccination location ahead of time and ask if they can use a pain reliever or numbing agent before administering the vaccine. Distract. Distract. Distract. Sing a song, tell them a joke, make a funny face. If you can pull your child’s attention away from the needle and make them laugh, they won’t focus all their energy on worrying about the shot. Lead By Example If you haven't gotten your flu shot, COVID shot or COVID-19 booster yet, ask the facility ahead of time if you can also get a shot before your child. Show them that the shot is no big deal and that they will have no problem getting it themselves. Celebrate Don’t be afraid to celebrate this victory with your child once it is over – bring them to the park, go out for an ice cream cone, let them pick what’s for dinner. This reward will show that you’re proud of them for being brave and may also make the next time your child is due for a shot easier.

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Participating in a clinical trial is voluntary and a personal choice. Clinical trials are research studies that involve people and are an important part of patient care. What is a clinical trial?  Clinical trials are research studies that involve people, and they are an important part of patient care. There are several different types of clinical trials; some are designed to understand trends in a disease or identify better ways to diagnose a condition, while others determine if a new treatment is safe and works when treating, improving or preventing a health condition. There are over 400,000 clinical trials currently being conducted in the United States, and even more across the world. This includes health conditions such as heart failure, cancer, Parkinson’s Disease, respiratory conditions like COPD, common infections, cystic fibrosis, and many more. Clinical trials lead the healthcare industry to new discoveries that contribute to reliable and exact care, improving healthcare quality and saving lives. Clinical trials are conducted by a team of researchers, including doctors, pharmacists and clinical research coordinators. These research teams are highly skilled in their specialty areas, often providing traditional patient care and seeing research patients in the same day. These teams are responsible for making sure the clinical trial is completed correctly, and their patients are their top priority. Why should I consider participating in a clinical trial? Participating in a clinical trial is voluntary and a personal choice. There are many reasons why patients decide to get involved in clinical research. While many clinical trials are designed for patients who have a certain health condition, many studies also ask healthy volunteers to contribute in order to compare health outcomes. Clinical trials are also for patients at all different stages of their diagnosis. Depending on the specific study, the patient may receive access to a new cutting-edge treatment before it is widely available. When patients join a clinical trial, the research team becomes a health partner dedicated to their health and well-being. When patients join a clinical trial, they make an informed decision in their healthcare by weighing all available options in addition to routine treatments. Research participants know that they are contributing meaningfully and helping other patients like them. Where can I find more information about clinical trials at Renown Health? Renown Health’s mission is to make a genuine difference in the health and well-being of the communities we serve. Renown’s clinical trial portfolio offers leading care options to patients in northern Nevada, close to home, in a variety of specialties. Contact the Renown Clinical Research Office for more information on clinical trials available to you!

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Most people know the symptoms of a heart attack, but what about heart valve disease? We asked Renown Structural Heart Program Director, Dr. Abhilash Akinapelli, to explain more about common heart valve issues and how to treat them. What is heart valve disease? Heart valve disease happens when one or more of the heart’s valves doesn’t open and close correctly, which affects the flow of blood through the body. If left unmanaged, heart valve disease can lead to other complications such as stroke, blood clots or heart failure. There are a few types of heart valve disease, including: Valvular stenosis, where the valve opening is narrowed by the valve flaps becoming thick or stiff. Valvular insufficiency or regurgitation, where the valve flaps don’t close correctly, which can cause blood to leak and go the wrong direction back into your heart.  What are some of the signs and symptoms that someone may have issues with their heart valves? Some people with heart valve disease might not feel any different or experience symptoms for quite some time, but if you notice any of the following symptoms, you should call your care provider: Fatigue  Shortness of breath, especially when you've been active or when you lie down Swelling of the ankles or feet  Dizziness Chest pain Irregular heartbeat If your care provider listens to your heart and notices an abnormal sound or heart murmur, he or she may recommend a visit to a cardiologist who can further test for heart valve disease.   Are heart valve issues preventable? There are several risk factors that can increase the chance of heart valve disease. Among them: high blood pressure, high cholesterol and diabetes. These can all be prevented by living a healthy lifestyle through a heart-healthy diet, getting regular physical activity and avoiding tobacco use. A history of certain infections or a history of certain forms of heart disease or heart attack are also considered risk factors, as well as things out of our control, such as age and heart conditions present at birth.   So if you or a loved one receives a diagnosis of heart valve problems, what treatment options are available? The Renown Institute for Heart and Vascular Health has many treatment options our heart care team can recommend. In some cases, your doctor may just want to closely watch the heart valve problem for a period. However, other options include medicine, or surgery to repair or replace the valve. Renown specializes in Transcatheter (minimally invasive) heart valve repair or replacement, including Transcatheter aortic valve replacement (TAVR) and Transcatheter mitral valve repair (TMVR).

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Knee pain and injury can restrict movement and make it difficult to be active, but studies show that the right type of exercise can help prevent these issues. It’s no wonder our knees are highly prone to injury. They house a complex network of muscles, ligaments and joints, and are crucial to our agility and daily movements. If you are experiencing knee pain, it’s important to not ignore this message from your body. While it’s fairly common to have occasional aches, if the pain limits your ability to perform normal daily activities like climbing stairs or walking with ease, have a medical professional check it out. “The take-home message here is to listen to your body,” says Amanda Henriques, PT, DPT at Renown Physical Therapy. “We are all built differently and respond to exercise in different and unique ways. Running may feel great for one person, but always lead to injury for another.” At any age, it's important to protect and strengthen your knees to help prevent pain and injury. Here are five tips from our experts: 1. Strengthen your muscles Choose exercises that focuses on the muscles around your kneecaps, hips and pelvis and places extra emphasis on your core. These muscles will absorb some of the stress places on your knees, helping them stay balanced and stable. 2. Maintain a healthy weight Each pound of body weight produces five pounds of force on the knee. If you need to shed weight, start with low-impact activities to avoid increased stress to your joints. 3. Pick the right exercise Opt for exercise that put less stress on your knees, such as cycling, walking or swimming. Choose flat surfaces when walking for exercise and avoid activities that put extra stress on your knees, such as deep knee bends or downhill running. 4. Warm up before working out Don’t overdo the workouts in length or intensity, and stretch after exercise to help prevent injury. 5. Avoid high heels Wear shoes with good arch support specific to your choice of exercise that provide a stable base for your feet and legs. Replace running shoes every 300 to 500 miles. Other athletic shoes should be replaced after 500 miles of wear. These tips can help keep your knees strong and prevent injury. But if you experience an accident or trauma, seek medical attention and follow up with any rehabilitation recommendations you receive. Depending on the injury, your doctor may recommend physical therapy, where you will be guided through individualized exercises to strengthen and heal. “If you listen to your body and take the appropriate preventative measures, you can find the right type of exercise to keep you happy, healthy and fit for life,”

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