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Dr. Carilyn Hoffman with Renown's Women's Health explains the symptoms, causes and treatments of Polycystic Ovary Syndrome (PCOS) (also referred to as Polycystic Ovarian Disease (PCOD)), a prevalent condition among women of reproductive age that influences hormonal balance, metabolism and fertility. Make an appointment with Renown Women's Health Click here to schedule Call to schedule: 775-982-5000 PCOS Defined PCOS is a constellation of symptoms characterized by two of the three criteria: multiple small cysts on the ovaries visible via ultrasound, irregular periods and signs of hyperandrogenism. Other symptoms include infertility, insulin resistance, and increased risk of cardiovascular disease. Symptoms of PCOS The symptoms of PCOS can vary from woman to woman, but some of the most common include: Irregular menstrual cycles: This is often one of the first signs of PCOS. Women may experience fewer than nine periods a year, more than 35 days between periods, frequent spotting, and/or abnormally heavy periods. Excess androgen levels: High levels of male hormones may result in physical signs such as excess facial and body hair (hirsutism), severe acne and male-pattern baldness. Polycystic ovaries: Enlarged ovaries containing numerous small cysts can be detected via ultrasound.     Causes and Risk Factors The exact cause of PCOS is unknown, but several factors may play a role: Genetic predisposition: A family history of PCOS increases the risk. Insulin resistance: High insulin levels might increase androgen production, causing difficulty with ovulation. Obesity: Women with elevated BMI’s are more likely to have PCOS, although 20% of women with PCOS are not obese. Diagnosis and Treatment Dr. Hoffman outlines that diagnosing PCOS requires a medical history review, a physical exam, blood work and an ultrasound to evaluate the ovaries. Treatment options can range from lifestyle modifications, like diet and exercise and weight loss, to medications for menstrual regulation, fertility assistance, and rarely surgery. Lifestyle Changes A healthy lifestyle is a cornerstone of managing PCOS. Regular exercise, a nutritious diet, and weight management can help reduce symptoms and the risk of long-term health issues. In overweight patients, weight loss as little as 5% has been shown to improve symptoms of PCOS. Medication Medications may include hormonal contraceptives to regulate menstrual cycles, anti-androgens to reduce hair growth and acne, and Metformin to address insulin resistance. Fertility Treatment For women with PCOS who are trying to conceive, ovulation induction with clomiphene or letrozole is sometimes necessary. Sometimes a referral to a reproductive endocrinologist and infertility specialist is needed for more advanced technologies like IVF. Health Implications PCOS is not just about cystic ovaries or irregular periods; it can have profound implications on a woman's overall health. Women with PCOS are at an increased risk for several conditions, including type 2 diabetes, high blood pressure, heart disease, and endometrial cancer.

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Having a primary care provider is important and some health insurance plans even require you to select one. But does that provider need to be a doctor (MD)? The good news is your primary care provider doesn’t need to be an MD. They can be an advanced nurse practitioner (APRN) or physician assistant (PA). We’re here to explain the differences between MDs, APRNs and PAs. Have you ever called Renown Health to schedule an appointment with your doctor and the Contact Center offered you an earlier appointment with an APRN or PA? Did you wonder why? Perhaps you even declined because you were concerned about the continuity of your care, or wondered about the qualifications of the other practitioners who aren’t doctors. We’re here to answer your important questions about primary care providers and the different types. Why would I want to see anyone other than a doctor? In order to keep up with demand for primary care services and provide the highest quality care possible, Renown created care teams. This means our doctors, APRNs and PAs all work hand-in-hand to manage your health with the benefit of their combined expertise. This team approach provides you with more flexible scheduling options to see anyone on the care team, all with the same continuity of care. How qualified are APRNs and PAs to treat patients? APRNs and PAs are highly educated in medicine with a minimum of a Master of Science degree and at least six years post-high school education. Some APRNs even have doctorate degrees. Similar to doctors, both positions have a minimum number of required clinic hours and participate in continued education. Both APRNs and Pas are just as qualified as doctors (MDs and DOs) to conduct physical exams, diagnose and treat illnesses, order and interpret tests, write prescriptions and even deliver babies. There are some instances where you need a doctor, including specialized treatment of complicated or high risk conditions or surgery. Your APRN or PA will refer you to a doctor in those instances. You don’t need to worry about whom to see when – your care team will guide you based on your medical needs. If I see an APRN or PA, will my doctor know about my visit? Absolutely. The care team system ensures that everyone on your care team is aware of the details of your visit, regardless of who you’re seeing. Everything is clearly documented in your medical record so there are no gaps in care between visits. Can an APRN or PA be my primary care provider? Definitely. APRNs and PAs make excellent primary care providers and can be established with your insurance company. Learn more about the differences between doctors, APRNs, PAs and more with this handy infographic. Schedule A Doctor Visit | 775-982-5000 Renown Medical Group primary care providers provide annual exams by appointment. Our providers coordinate each patient’s medical care including checkups, immunizations, referrals to specialists, lab work, X-ray & imaging and hospital admissions. Request an Appointment

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To be on the move is a scary concept when you’re recovering from surgery. But did you know getting up and at ’em could be the key to a quicker recovery, post-surgery? Here’s some expert insight from Renown Surgical Services. The team at  has some news for you: Rest and movement are important to prevent serious complications. Here are some tips about how to get mobile after your procedure — and why it’s fundamentally important. Tip 1: Start Simple While you’re in bed, move your legs and feet up and down. Be sure to ask the nurses to help you get out of bed and into the chair for all your meals, or walk to the bathroom when needed. If you feel up to it, take a walk in the hallways with the nursing staff. Tip 2: The Sooner, the Better This may be surprising, but too much rest is not necessarily a good thing. The old saying “You use it, or you lose it” rings very true to maintaining the strength needed to get yourself out of bed. Beginning the mobility process early in your hospital stay will not only help you maintain strength and function, it may also help you get home sooner. Though it may seem counter intuitive, lying in bed all day can delay your healing time and cause serious complications to arise, including pneumonia, deep vein thrombosis or blood clots, pressure ulcers and sometimes constipation. Tip 3: Mobilize Your Support System Getting out of bed, sitting in a chair for meals and walking around your room or hospital unit can help reduce your risk of complications. The nursing staff will help you out of bed the same day of your surgery if it’s cleared by your doctor. Tip 4: Safety First The nursing staff is here to keep you safe, so make sure you call them for assistance getting out of bed. Even if you think you can do it yourself, use your call light to notify the nursing staff you are ready to get up and move. In addition, new medications can sometimes impair our judgment, balance and safety, so it’s always better to have help even though you may not need it. This is also why you may have a “bed alarm” on, to remind you to call for help and keep you safe while you are recovering. Tip 5: Move, But Manage Your Pain Many people find that getting up and moving actually helps their pain, rather than making it much worse. Taking the right amount of medication at the right times will minimize your pain and help you to get moving. Your care team will work with you on how much pain medication is right to manage any postoperative pain, with the goal for you to be comfortable enough to be able to move and gradually increase your activity each day. Tip 6: Maintain that Momentum at Home Mobility doesn’t end once you’re discharged from the hospital. It’s key to keep moving to maintain health and function. When you first arrive home, it’s crucial to take frequent movement breaks throughout the day. Increase activity as it becomes more comfortable, and be sure to ease back into an active daily routine. If you have concerns about your mobility once home, be sure to discuss this with your doctor at your follow-up appointment. Renown Surgical Services | 775-982-3993 Ask your doctor if you have any questions about your medical condition or the specific surgical procedure planned, or contact the team at Renown Surgical Services. Learn More

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Becoming a caregiver or playing a more active role in another’s healthcare is a big responsibility. At some point, almost all adults will support an aging parent or a loved one in need. Keeping track of their needs and wellbeing, while also prioritizing your own can become overwhelming. It’s important to know: you are not alone, and help is available. Read on for 11 tips to help you manage your time, your own wellbeing and your loved one’s care. Self-care comes first. When your main priority is the person in your life who needs care, it’s easy for your own needs to take the backseat. Give yourself time each day to focus on your personal wellbeing. It’s hard to give a loved one the care they need if your own needs are not met. Prioritize the Activities of Daily Living (ADL). Make a note of what ADLs your loved one can do alone, what they need help with and what activities require the most help. This will help you work through the day with them, as well as plan out how the day’s activities will go. Do a home safety audit. Do showers, bathtubs and steps have safety grab bars? Look around the house for additional tripping hazards, like rugs or electrical cords. If your loved one struggles with day-to-day navigation of the home, consider scheduling an occupational therapy appointment. This type of therapy helps a person develop or maintain the motions required to accomplish daily tasks. You might also qualify for a referral to in-home healthcare, such as Home Care. Have the hard conversation. The best time to discuss views about end of life care and to learn what choices are available is before a life-limiting illness or crisis occurs. With advance care planning, you can help reduce the doubt and anxiety related to decision making at the end of life. Completing an Advance Directive is a great tool to sort out all these decisions before they’re needed. Attend a free workshop to learn more and complete this important document. Identify when you need respite. Respite care involves receiving a short-term break from caregiving. Organizing in-home care for your loved one will allow you to step away and tend to your needs. By identifying what kind of respite care you are seeking, you can find the right person to provide you with that much-needed break. Don’t wait until you feel overwhelmed, plan ahead. Write down insurance contact information. Have a direct connection to the right insurance professional for support and advice. If your loved one is eligible Medicare, this is a good opportunity to review their current selections and if they would benefit from a Medicare Advantage Plan or Medicare Supplement Insurance. Seeking out expert advice or information on Medicare options is a great way to navigate this. Consider calling a broker, or attend a free educational seminar with Senior Care Plus. Gather legal and financial information. Make a list of all existing legal documents and financial accounts that your loved one has. These might include a will, advance directive, power of attorney, bank accounts or investment accounts. If you have questions about how to manage them, or need assistance in setting up additional framework, reach out to a lawyer, legal service, financial adviser or bank representative. Create an inventory of medical information. Identify where all of your loved one’s medical records are, as well as a list of providers or healthcare practices where they have received care. Consider if you should have your loved one give you Proxy Access in MyChart, which allows you to access all the features in MyChart on their behalf, including viewing upcoming appointments, viewing test results and emailing a doctor on their behalf. Make a list of what others can do. Think about all the little (and big) things that need to happen, and write down tasks that others could take care of you. When someone says “let me know what I can do” you’ll be ready with a pre-written list of items they may be able to assist with. Tasks could include tackling around-the-house repairs, scheduling lawn work, helping to walk the dog, taking a car for an oil change and cleaning. Find programs and events for social enjoyment. If and when possible, seek an activity outside of the home. Look for community centers that have programs for seniors, recreational activities or meals that you can patriciate in together. If leaving the home is not an option, arrange for visits or in-home activities, such as movie nights, card games or time to visit with family. Research long-term options. If you will be considering a nursing home or assisted living, make a list of amenities that you and the person you are caring for would like. Take this list with you when visiting potential locations to make sure you don’t forget to ask about each item.

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When you have an ill child in the hospital, it is a stressful event. And Panda Express is helping local families support children who need special care. Their generous donation provides much-needed equipment, programs, and resources via the new Panda Cares Center of Hope, Renown Children’s Specialty Center. Their partnership directly benefits patients and their families! The ‘Panda Cares Center of Hope, Renown’s Children’s Specialty Center’ In fact, this new center provides care to not only children, but also comprehensive support to the entire family. Similarly, it creates an environment that reduces stress, promotes healing, and provides a superior patient and family experience. This facility upholds Panda Express’ mission, vision, and values and its four pillars: to directly help fund the emotional, mental, physical, and spiritual needs of children. This center, the first-ever in northern Nevada, will provide care for children who have chronic conditions. In particular, it offers ongoing treatment, health management, and specialty medical services, including: Nephrology Endocrinology Neurology Pulmonary Infectious Diseases Medical Genetics Adolescent Medicine How You Can Help! When you order from Panda Express, you can opt to round up your change, which will help support programs and services, such as the Center of Hope for Renown Children’s Hospital. Order Online A Partnership for Health & Education of Underserved Youth This partnership allows Renown Children’s Hospital to continue to strengthen regional services and increase Panda’s visibility within our growing community. Last year, 21,930 sick children received care from Renown Children’s Hospital. To date, Panda Express has raised $449,200 in financial support to assist us in providing health and education to every child, regardless of illness, injury, insurance, or ability to pay. Panda Express funds have already supported: Giraffe omni beds for the NICU Ultrasound machine for the Children’s ER Panda warmers and a hand held Accuvein machine Child Life Program to support sick patients and families Meeting room in the Children’s Specialty Center In kind donations, volunteer time and support of local events such as the University of Nevada Reno, Wolf Pack Dance Marathon

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One of the most pressing issues in modern medicine is the need to improve rural healthcare. This challenge hits particularly close to home, as Renown Health is the only provider covering 100,000 square miles in northern Nevada, an area that’s mostly rural. People in rural areas suffer from chronic diseases such as heart disease, cancer and respiratory disease, at higher rates than the general population. One of the largest contributors to these health disparities is a lack of access to health services. Many rural communities have fewer providers and care facilities. This forces residents to travel farther to receive preventive care and medical treatment. We must identify ways to better support the health needs of the millions of Americans who live in rural communities. Ideas for improving rural healthcare Health systems must identify innovative ways to leverage existing resources and new technologies to care for patients in these communities. For example, telehealth can help diminish a person’s need to travel long distances to receive specialty care. Similarly, online classes can help educate patients about preventive behaviors. Remote monitoring technology also allows patients to track their health conditions from home. Additionally, we can address physician shortages by empowering health professionals such as nurse practitioners, physician assistants and technologists to care for patients. These providers receive excellent training and have demonstrated success in improving health outcomes. Renown Health cares for people from diverse backgrounds and we are dedicated to caring for patients in every community we serve. Renown Telehealth We’re leading the region in using video conferencing technology to provide the best care possible – no matter where you are. Renown Telehealth is telemedicine that gives you access to top-level care and better outcomes with less stress and fewer travel costs. Learn More

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Order in the (healthcare) court! Being a transparent and accountable healthcare organization is in our roots and is a commitment we at Renown Health take seriously. In order to uphold that promise, a lot of legal work must be done behind-the-scenes. Contracts, subpoenas, trials, depositions, arbitrations and mediations, service and provider agreements, immigration processes, powers of attorney – the list goes on.  So, who brings that order to Renown? Answer: Renown’s Legal department. With a small-but-mighty team of attorneys, contract administrators, immigration specialists, paralegals and assistants, these professionals tackle the intricate balance between the law and the care our teams provide every day. Their dedicated work allows our health system to focus on what matters most – bringing healing to our community. Protecting the Protectors The Legal department at Renown serves as the backbone of our health system, ensuring that both patients and employees are protected within the complex web of regulations, standards and more. This team is immensely talented in guarding the integrity of the community-minded care we provide.  No matter what problem comes across their desk, the Legal team will step in to find a solution. In fact, problem-solving is a fundamental part of their everyday work.  “We are a support department; we support the people who do the important hands-on work with our patients,” said Paul Harris, Chief Legal Officer. “Most on the legal team are skilled problem solvers, so we often get questions that are not quintessentially legal but require us to help someone solve the puzzle. It is very gratifying work when we help the greater Renown team address complicated situations.”  Resolution is at the foundation of their role within our health system, so you, as the reader, can probably imagine how busy their day-to-day lives at work get. But never fear – this team thrives on overseeing many different aspects of the law when it comes to the patients and employees at Renown.  “What I love about my job is that every single day I feel like I solve a problem or help a patient, health plan member or internal ‘client’ at the organization,” said Jamie Winter, Deputy Chief Legal Officer. “I also love that every day is different.  On any given day I can be attending a committee meeting either as a member or as the legal advisor, attending an administrative law hearings,  appearing at a mediation or arbitration,  reviewing and negotiating contracts, overseeing litigation in coordination with outside counsel,  assisting with Hometown Health member appeals, assisting the Medical Staff Services team and medical staff leadership and committee chairs, reviewing  powers of attorney, guardianship orders and records requests . No two days are the same, which keeps my work interesting, fun, and exciting!”  “A day in the life of the Legal department is always different,” added Mary Ann Ellis, Associate General Counsel. “We handle many different areas of law, including issues from across all the departments as they arise. I work on drafting, revising, reviewing, negotiating or analyzing contracts, including non-disclosure agreements; business associate agreements; supply chain agreements, and physician or other professional service agreements. I also advise on employment matters and assist in responding to subpoenas or other government requests. I help draft or review different policies across the organization.”  Before Renown brings on any new physician or vendor, there is one key part of the process they all must take part in: contracts. Contract structure, negotiations and signings are all part of the onboarding process. And the Legal team has contracting down to a science.  “I work primarily on independent (physician) contracts; these contracts include call coverage, professional services agreements, medical director agreements and medical staff officer agreements,” added Adam Harris, Staff Attorney. “It is important to have these agreements in place so that our community physicians can legally and compliantly provide patient care."  “I maintain relationships with our community partners around their service contracts which allow them to treat patients at Renown,” added Jackie Johnston, Contract Administrator. “I also oversee our contract management software, working with multiple departments in maintaining a compliant contract structure for all contracts within Renown. I am proud of how we established a new policy around contract management and are assisting departments with onboarding the new system.”  In alignment with our commitment to employing a diverse workforce, Renown excitedly welcomes providers from across the world. This past year, our Human Resources and Legal teams saw a crucial need for a role that focuses exclusively on facilitating the processes for international hires: the Immigration Specialist.  “The Immigration Specialist position at Renown, which is a new role in the organization, is an excellent fit for my professional background and experience,” said Derrick Lacey, Immigration Specialist. “A day in the life involves interfacing with the Renown Medical Group's Provider Recruitment team, HR Operations and other departments which partner on behalf of physicians and nurses who require immigration sponsorship and support. Since joining Renown, I have been able to contribute the necessary technical skills and knowledge required for the role, while taking on the unique challenges and responsibilities associated with expanding Renown's existing footprint in the realm of employment-based immigration sponsorship.”  No matter the need, the Legal team is proud to support our many departments and has an open-door policy for any employee to come to them with any concern. “I am proud that people feel empowered to come to the Legal department and trust we will partner with them to find solutions to any problems,” said Mary Ann Ellis. “We work closely with various leaders on a regular basis to check in and make sure we meet their needs and keep everyone on track on meeting various contracting deadlines or other needs.”  Even if you don’t physically see the Legal team every day, the work they do is incredibly important to keep our health system running. After all, there is no order without law.  “The work we do in the Legal department may not always be front and center, but it’s critical to ensuring that patient care is provided safely, ethically and efficiently,” said Michelle Gibbons, Paralegal. “By ensuring compliance with laws, protecting patient privacy, mitigating risks and facilitating access to care, we create a legal framework that allows clinical teams to focus on what they do best: providing outstanding patient care.”  The Journey to Healthcare Law  Employment law, civil rights law, family law, criminal law, real estate law, corporate law...there are many fields of law an aspiring legal professional can delve into. So, what inspired our Legal department employees to enter into healthcare law?  Let’s hear from a few of these team members on how and why they ended up in this intense-yet-rewarding career field:  “I was a political science major as an undergraduate student in Washington, DC, and, during that time, I worked on Capitol Hill for a Nevada Senator and Nevada Governor. The natural progression for many political science students is to go to law school and I did just that. After law school, I worked as a litigator for 11 years and then came to Renown. Although I joined Renown after becoming an attorney, I started with Renown as the Hometown Health Compliance Officer to not only learn compliance, a fast-growing area at the time, but to also “get my foot in the door” in hopes of ultimately becoming an in-house attorney for Renown. Years later, I took a position as in-house counsel for the health plan and later moved to the larger Renown Health Legal Department to broaden my healthcare law practice.” - Jamie Winter “My life has always revolved around the legal field. My father was a District Judge in Douglas County for 25 years. He is currently serving as the Chief Justice of the Appellate Court of Nevada. My childhood involved campaigning and spending many hours at the Courthouse with my dad. It was a natural progression for me into the field of law after graduating college.” - Michelle Gibbons “My career background is in the area of global mobility, which involves the management of international employee populations and their movements, including immigration, relocation logistics, and international tax requirements, processes and compliance matters." - Derrick Lacey “I went to school for Retail Merchandising to further my career with a major retailer in Minnesota. After transferring to Reno and working in retail for many years, I wanted to explore new and rewarding challenges. I found the opportunity in the Renown Legal Department where I am now assisting in managing contracts and communicating with multiple providers to assist them with compliance metrics and payments.” - Jackie Johnston “Before attending law school, I worked in healthcare. It was a natural transition for me to apply my education in an industry with which I was already familiar, and Renown was an easy choice as the top hospital in the area.” - Adam Harris Our Legal team enjoys a reputation of being powerful yet personable in the office, the hospital and the courtroom. Many departments across our health system know they can rely on this team to provide the best possible solutions for them.  “I am most proud of growing my team to better assist the organization in multiple areas such as immigration, litigation and contract negotiation management,” said Bekah Riley, Manager of Legal Department & Board Liaison. “We have established a department recognized for its accessibility to other leaders and its role as problem solvers.”  “Our team's biggest accomplishments are generally associated with successful outcomes in litigation, or long-running projects that have, after much effort, been completed,” added Adam Harris.  As the old saying states, “the proof is in the pudding.” Our Legal team members are excited to share a few notable success stories of which they played a large role in.  "One success story that comes to mind is when the lab was being overwhelmed by law enforcement demands for legal blood draws and the resulting subpoenas,” said Mary Ann Ellis. “We worked with the district attorney, law enforcement and city leadership to develop some action plans for reducing that burden. Eventually, many of the law enforcement agencies reached a solution to get legal blood draws done by an outside organization, helping to reduce the burden on our teams. The district attorneys also agreed to various methods to try to make physical appearances in court less onerous.”  “As the newest member of the Legal team, I recently learned that an immigration sponsorship project I was asked to lead on my third day at Renown, which involved consulting on case strategy, as well as authorship of enhanced immigration support letter documentation, had been a resounding success,” added Derrick Lacey.  “We were able to make a big push on managing the many contracts entered into by the organization and help to maintain access and accountability,” added Paul Harris.  All in all, our Legal team’s commitment to legal excellence – from the start of their careers to today – not only safeguards the interests of our health system but also fosters an environment where quality of care can thrive.  “We are a dedicated team working behind the scenes to enhance the organization's overall productivity and support its strategic vision for the future,” said Bekah Riley. It’s All About the People At Renown, all our teams are committed to leaving a positive impact on our patients, fellow team members and community. The Legal department is no different. In a world where the intensities of both the healthcare space and legal space collide, they find support and solidarity in each other.  “I wanted to work somewhere that I felt I could make a difference in the community,” said Mary Ann Ellis. “Instead of working in a field that can traditionally be very adversarial, at Renown, I can use my skills in collaborative and positive ways to help the organization and the people in it. What keeps me here are the amazing people I get to work with every day. We have a small team that genuinely enjoys working together and have become friends over the years.”  Their commitment to giving back to their community aligned with Renown’s same commitment and was a defining reason for why they joined Team Renown. When values align, everything else can fall into the right place.  “I chose to work for Renown because of its reputation in the community and my desire to work as in-house counsel at a respected, local organization,” said Jamie Winter. “My mom worked as a nurse at Renown for many years and it is wonderful to now be working for the same organization where my mom provided patient care. What keeps me here is my amazing team and the people I work with throughout the organization. The individuals on my small legal team are very collaborative and supportive of one another. We work closely with the Risk, Compliance, and Payer Contracting teams, and we all work really well together.”  “I was drawn to Renown Health because of its strong commitment to providing high-quality, compassionate care to the community,” added Michelle Gibbons. “I really resonate with the organization's mission to improve the health and well-being of northern Nevada and beyond. Renown provides a collaborative and supportive work environment where I feel encouraged to grow and continue learning. The leadership and my colleagues are invested in my development, and there's a culture of teamwork that makes coming to work each day a positive experience.”  There is never a dull moment in healthcare – there is always something new to explore and discover. Our Legal team not only finds their work rewarding, but they also find it incredibly exciting.  “I had an opportunity early in my career to work with healthcare clients and professionals, and in my experience, there is not a more exciting job than sorting through the complexities of healthcare and hospital legal work,” said Paul Harris. “It's challenging every day, but I've been able to work with smart, innovative and motivated people. Renown has a great culture and working with dedicated people keeps me excited about my work here and Renown's future.”  Behind-the-scenes and above-the-standard, our Legal department consistently blows expectations out of the water. Anyone who walks through Renown’s doors can rest assured they are in the best of hands with this best-in-class team.  “We are a dedicated team working behind the scenes to enhance the organization's overall productivity and support its strategic vision for the future,” closes Bekah Riley.

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