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Do you find yourself struggling to stay awake during the day or having no energy? You’re not alone. Whether you’re a full-time employee, a student or retiree, that “I’m tired” feeling comes in all shapes and sizes. What’s even more frustrating is not knowing the source of your exhaustion.  Dr. Brandon Flores, a sleep medicine physician with Renown Medical Group, breaks down nine key reasons why you may be feeling so fatigued.  You did not get enough sleep, or your quality of sleep is poor. This may seem obvious, but in today’s “rise and grind” culture, sleep can be considered a luxury rather than what it really is: a necessity. Ensuring you get adequate hours of sleep between 6-9 hours and quality sleep is essential. You may not be breathing well during sleep. Interruptions to your breathing, such as snoring, can decrease airflow at night causing your sleep to be less restorative. This is often due to Obstructive Sleep Apnea (OSA). OSA can lead to daytime fatigue and sleepiness and can also impact other chronic health conditions, such as hypertension, diabetes, acid reflux, migraines and heart rhythm. You are not getting enough regular exercise, or you are exercising too much. Incorporating at least 30 minutes a day of physical activity can help keep you energized throughout the day. It has also been shown to increase deep slow wave sleep, which is often associated with feeling rested. On the other hand, getting too much exercise can tire you out more easily and heighten stress levels. You drink too much caffeine. This one may seem counterintuitive – caffeine is supposed to keep you awake, right? Well, overdoing it with your favorite coffee or soda could affect your sleep quality. Pay attention to your caffeine limits and have a cut-off time, as most caffeine should not be consumed past noon. You have a food allergy or intolerance. If you find yourself feeling especially tired after eating a lot of a certain food, you could have an allergy or intolerance to it – and vice versa. Consider speaking with your primary care provider (PCP) about a food allergy test or being referred to an allergist. You’re drinking too many alcoholic beverages. Alcohol is a depressant, which as the word implies, can make you feel especially tired during the day. It can also affect your breathing at night and disrupt your sleep cycle. Cutting back on alcoholic drinks may be beneficial to your overall health. You are anemic. This is the leading cause of fatigue in women but can affect people of all genders. It can be associated with low iron. Eating foods high in iron, including leafy greens and many different meats, can help your iron levels. A blood test ordered by your PCP can help you understand if you are iron deficient. You are experiencing depression or anxiety. Emotional exhaustion can be just as taxing as physical exhaustion. Prolonged feelings of sadness, hopelessness, nervousness or panic can be signs and symptoms of depression or anxiety. Speak with your provider about the many resources available to help you. You have an underactive thyroid. Feeling fatigued can also be a symptom of hypothyroidism, which affects your metabolism and energy levels. Medication can help get your thyroid back to normal. Your PCP can order a blood test to determine your thyroid levels.  If you experience severe exhaustion that lasts six months or longer, worsens after physical or mental exertion and does not get better after resting, it could be a sign of myalgic encephalomyelitis, otherwise known as chronic fatigue syndrome (CFS). This is a diagnosis of exclusion, and other causes must be ruled out. While there are no tests that detect CFS, your provider can order blood and urine tests to rule out other causes of your fatigue and help develop a care plan.

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Abdominal pain is one of the most common complaints that brings individuals to the emergency room. We spoke with emergency physician Bret Frey, MD, to ask about when and where to seek care for abdominal pain.   Dr. Frey advises that any time you feel something is developing inside your body that is substantially different from what is normal for you, understand that something is wrong. He further explains that warning signs of an acute medical situation include fever, vomiting or a rapid change in function and ability to move due to pain. These symptoms indicate that one needs to be evaluated by a medical professional.   This evaluation will include the care team conducting an examination and asking a series of questions to determine if additional diagnostics, such as lab work or imaging, are needed. Be prepared to discuss where the pain is and what it feels like, in addition to how long it’s been bothering you and if it’s constant or intermittent.  While appendicitis often comes to mind when thinking about abdominal pain, Dr. Frey says that this is not the bulk of cases that the Emergency Department sees. In fact, often the pain does not have a specific diagnosis, but our team of board-certified emergency physicians are experienced in assessing and caring for those experiencing the acute symptoms he described.   “We often don’t come away with an answer about exactly what it is, but we substantially rule out life threats in a very methodical and systematic way,” said Frey.  The abdomen includes many organs, including the stomach, liver, small and large intestines, gallbladder and pancreas. In addition, pain stemming from your chest, pelvis or back may be felt in the abdominal area.  If you are experiencing abdominal issues that are persistent but not an emergency, talk to your primary care doctor about what you are experiencing, and be prepared to review the history of this pain, medications, allergies and diet. He or she will be a good partner to review conditions such as gas, heartburn, constipation, diarrhea, inflammation or menstrual and ovulation pain. Drinking plenty of water is always an important part of supporting your health.

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Dry weather – as northern Nevadans we know it well. Of course this doesn’t mean we’re not affected by its health impact whether you’re new to the area or are a native. Stephanie Stutz, DO, a Renown Medical Group doctor specializing in family medicine, explains how to live comfortably in the high desert. Have you noticed dry skin, itchy eyes or more bloody noses? If you call northern Nevada home, you’re probably no stranger to these problems. “We get a lot of questions from people wanting to know, ‘what can I do to prevent things from happening from the dry weather?’” says Dr. Stutz. “We do have a dry climate, and obviously in the summertime you notice it more than in the winter, so we look at things like dry skin, dry eyes and dry nose.” It generally takes about two weeks to become used to the change in climate. Dry Weather Health Tips Fortunately, there are some easy things you can do to reduce your discomfort in dry weather. Dry skin. “If you have dry skin, use a lotion without perfumes so it won’t increase the potential for drying your skin out,” recommends Dr. Stutz. For example, one home remedy for extremely dry skin (or for those with thinner skin) is cocoa butter. “It’s thicker so it goes under the skin and takes more time to absorb. As a result, you get a much more long-lasting effect.” Dr. Stutz adds. “You can also add lavender essential oil to your cocoa butter to help you sleep at night.” Dry and itchy eyes. “Use eye drops on a regular basis and keep them with you. I recommend people have a couple of bottles – one at home and one in their bag,” Dr. Stutz suggests. Dry nose. “Overall one of the best things to use is a simple nasal wash,” she says. “You can get it over the counter; it’s a saline nasal wash. Use it a couple of times each day and it can be extremely helpful. In particular, gets up into the sinuses and clears them of any pollen or residue in there.” Dry Weather Nosebleed Advice In our dry climate, you may also notice more allergies and nosebleeds. Dr. Stutz cautions, “Surely the dry air can make your allergies much worse. It can create much more irritation, pain and pressure, particularly in the nose and sinuses.” Again, Dr. Stutz recommends using a nasal wash to remove discomfort. Using a nasal wash two to three times a day can also help prevent nosebleeds. “And if you’re someone who has severe or chronic nosebleeds, you can put a little bit of Vaseline along the inside of your nose to create a moisture barrier”. Dry Weather Medication Advice In addition to allergy and nosebleed sufferers, people on certain medications may be at greater risk for symptoms in our dry climate. “The medications you are on can make you much more susceptible to drying out and becoming slightly dehydrated,” Dr. Stutz warns. For this reason discuss all of your medications with your doctor. Specifically, see if you can time them throughout the day or look at changing the dosage. Should I Get a Humidifier? Given our year-round dry weather, you may want to purchase a humidifier to help ease your symptoms. But there are some things you should know first. “You have to be careful with humidifiers as there are pros and cons,” states Dr. Stutz. “The small tabletop humidifiers are not beneficial. You need to get one covering a huge amount of square footage and holding approximately 10 to 30 gallons of water to help your home. On the negative side, if you’re not maintaining it on a regular basis, it will hold on to mold and other allergens. So the next time you turn it on, you’re actually putting that back into the air.” Do I Need to Go to the Doctor? To be sure, it’s important to know yourself and your family. If this is something you experience each year, you can try over-the-counter medications. “But remember, there’s always the caution if you’re on prescription medications,” Dr. Stutz explains. “If you are on chronic prescriptions, come in to get evaluated just to make sure you’re not using anything which interferes with your medications.” Not Just a Summer Problem As the temperatures drop, remember this isn’t just a seasonal issue here in the Reno-Tahoe area. During the winter months, our dry climate combined with cold temperatures and heaters can still cause dry skin, aggravated sinuses and even itchy eyes. So use these helpful dry weather tips all year. Comprehensive Primary Care Renown Medical Group primary care physicians provide comprehensive primary care by appointment. Doctors coordinate each patient’s medical care including checkups, immunizations, referrals to specialists, lab work, X-ray & imaging and hospital admissions. Find a Doctor

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Every patient, regardless of how they may identify, greatly benefits from preventive healthcare and early detection. Members of the LGBTQIA+ community face unique considerations when it comes to their health, and a proactive approach to preventive screenings and vaccines is important in order to address their individual health needs.  Dr. Karen Thiele, Family Medicine Physician with University Health and Assistant Professor of Family and Community Medicine at the University of Nevada, Reno School of Medicine, breaks down key steps that LGBTQIA+ patients should take to safeguard their health.  PrEP and PEP  Pre-exposure prophylaxis (PrEP) is a strategy to prevent human immunodeficiency virus (HIV) infection. It is an important measure for those who are HIV-negative but may be at risk of contracting it. The highest risk sexual practice is receptive anal intercourse, due to the relative fragility of rectal tissue. This medication can stop HIV from spreading in the body and help patients maintain their HIV-negative status. PrEP is available in both pill form, which is taken every day, and injection form, of which the first two injections are initiated one month after another while all other injections are initiated every two months.  Post-exposure prophylaxis (PEP) is an antiretroviral drug regimen taken after potential HIV exposure to prevent an HIV-negative individual from converting to HIV-positive status. PEP is only for emergency situations and must be started within 72 hours of exposure – sooner is always better than later – and must be taken for 28 days.  PrEP and PEP are available in many ways, including visiting your primary care provider (PCP) or an urgent care location.   HPV Immunization  All genders and identities can protect themselves against human papillomavirus (HPV), a sexually transmitted infection (STI) that can lead to the risk of cervical, mouth, head, neck, throat, anal, vaginal, penile and vulvar cancers. HPV is so common that nearly all sexually active people, regardless of sexual orientation and practices, will be exposed at some point in their lifetime.  The HPV vaccine (common brands include Gardasil and Cervarix) is a safe and effective method to prevent HPV, according to the Centers for Disease Control and Prevention (CDC). This vaccine protects against infections that can lead to HPV-related cancers and precancers, as well as genital warts. While patients should start receiving the vaccine at 9 years old years old, unvaccinated adults up to the age of 45 can also receive the vaccine through their PCP – better late than never!  STI Testing  Sexually-transmitted infections form from bacteria, viruses or parasites that can be transmitted by person-to-person sexual contact through semen, vaginal, blood and other bodily fluids. According to the U.S. Department of Health and Human Services, there are more than 20 million estimated new STI cases across the nation each year.   Luckily, most STIs are preventable. Annual STI testing for HIV, gonorrhea, chlamydia and syphilis is important to stay on top of your sexual health. Because these STIs may sometimes have no symptoms, screening is recommended regularly and with any change in sexual partners. Depending on the specific condition, tests for these infections include urine, swab and blood tests. Speak with your primary care provider on a screening schedule that works best for you.  Prostate Exams  Prostate exams look for early signs of prostate cancer in patients who still have a prostate. The CDC recommends those who are at least 55 years old get regular prostate screenings; however, for patients with a family history of prostate cancer, screenings may be recommended as early as 45 years old.  These exams are done via two common methods – a prostate specific antigen (PSA) blood test and a digital rectal examination (DRE). Your provider can help you determine your risk and when you should start getting screened.  Pap Tests and Pelvic Exams  Patients of all genders who have a cervix, uterus, vagina and/or ovaries will benefit from regular pelvic exams and Pap screenings. A pelvic exam consists of a provider looking inside the vagina and at the cervix for anything unusual. A Pap test, also known as a Pap smear, involves your provider using a small, soft swab to collect cervical cells to check for early signs of cancer.  Generally speaking, people with these organs should have a Pap test every three years starting at age 21 through the age of 30. After age 30, patients should receive a Pap test with HPV co-testing every five years until age 65. These recommendations are changing based on new research, so it is important to have a conversation with your PCP about the current guidelines so you can make an informed choice about what schedule you should follow. A gynecologist or your primary care provider can counsel you and perform these screenings.  Mammograms and Breast Exams  People with breast tissue, especially dense breast tissue, are at risk for breast cancer, and regular breast screenings are your best line of defense. At-home breast self-exams are the first step – you will want to check your breasts for any lumps, changes, fluid leaks, irregular tissue thickening or anything else that feels unusual.  The Breast Cancer Risk Assessment tool, provided by the National Cancer Institute, is a good place to start to identify your risk. Talk with your primary care provider about the risks and benefits of starting screening at age 40 so you can make an informed decision about when to start. If you have any family history of breast or ovarian cancer, your PCP will offer you genetic testing for BRCA 1 and 2 mutations. Nevadans over the age of 18 can also get BRCA genetic test for free by enrolling in the Healthy Nevada Project.  Mammograms are important screening tools, but for a significant portion of people with breast tissue, density of the breast tissue may make mammograms less helpful in detecting cancer. Your primary care provider can help you decide what additional imaging (such as breast ultrasound) might be best for you.

Read More About 6 Healthcare Action Items for the LGBTQIA+ Community