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October is Domestic Violence Awareness Month in the United States. We spoke with Renown Health experts and local domestic violence prevention organizations who gave us a deeper look into understanding the warning signs of abuse and the many proactive and reactive resources in our community that you can reach out to today.  Domestic violence, also referred to as domestic abuse, is an everyone issue. Whether you identify as male or female, an adult or a child, single or partnered – domestic violence can affect anyone. In fact, it may be closer to home than you might think.   According to the Nevada Quality Parenting Initiative, in Nevada, 43.8% of women and 32.8% of men experience domestic violence in their lifetime, and the risk of that figure rising is imminent. This year alone, the Domestic Violence Resource Center (DVRC) in Reno experienced a 55% increase in overnight emergency stays, according to the Reno Gazette-Journal.   This problem also, unfortunately, extends to children. More than 5,000 children in Nevada were reportedly primary or secondary victims of domestic abuse in 2021, as stated by the Nevada Coalition to End Domestic and Sexual Violence.  “Domestic violence can manifest in many different ways,” said Kami Price, Supervisor of Social Services for Renown Health. “Abuse isn’t always strictly physical. It can also be emotional, verbal, sexual and even digital. Understanding those differences can help you prepare accordingly and respond safely if you or a loved one are experiencing domestic violence.”   Knowing what to look out for is crucial in protecting yourself and others against the effects of domestic abuse and taking action when warning signs appear. The National Domestic Violence Hotline shares the common signs of an abusive partner, no matter how old they are or what gender they identify as:  Telling you that you never do anything right.  Showing extreme jealousy of your friends or time spent away from them.  Preventing or discouraging you from spending time with friends, family members or peers.  Insulting, demeaning or shaming you, especially in front of other people.  Preventing you from making your own decisions, including about working or attending school.  Controlling finances, including taking your money or withholding money for needed expenses.  Pressuring you to perform sexual acts you’re not comfortable with.  Pressuring you to use drugs or alcohol.  Intimidating you through threatening looks or actions.  Threatening to harm or take away your children or pets.  Intimidating you with weapons.  Destroying your belongings or your home.  "People experiencing domestic violence may feel as though they are trapped,” said Kami Price. “The reality is – this often couldn’t be further from the truth, especially with the resources we have at our disposal in northern Nevada.”  Respected Resources Ending the Silence on Domestic Violence  While these facts and figures might be staggering, those experiencing domestic violence at any age are not alone. There is hope at the end of the tunnel, especially here locally.  Devoted to meeting the growing needs of the communities we serve, Renown Health proudly supports and sponsors several organizations in our community that are committed to educating children and adults on the signs and symptoms of domestic violence, along with what each child and family member can do today to prevent abuse in the household. These essential organizations are on the frontlines of shifting attitudes from “I don’t want to get involved” to “How can I help?”  Serving children across northern Nevada, the Child Assault Prevention (CAP) Project offers “education and prevention programs designed to increase children’s safety from bullying, abuse and assault” and break the cycle of domestic abuse. During 2021 and the first half of 2022, CAP led about 500 different workshops, teaching 10,000 second-grade and fourth-grade children in Washoe, Storey, Lyon and Churchill Counties how to keep themselves safe from domestic violence.   “As domestic violence is on the rise, open communication, early intervention and education are key to protecting children from the effects of domestic violence," said Rebecca LeBeau, Executive Director of the CAP Project. “That’s why I begin speaking about child assault prevention and stranger danger to kids as young as six years old. It's important to explain the true reality of domestic violence to both children and adults, tailoring language specifically to whatever age they are, and allowing them to process it. Kids of all ages will learn how to deal with extremely dangerous situations this way.”  According to Rebecca, common symptoms of abuse to be on the lookout for at school include grades dropping, a lack of focus and feelings of not wanting to return home after the school day ends. If someone in a child’s home is being hurt or abused, children are always encouraged to speak with a trusted adult or school counselor. From there, organizations like the CAP Project develop a safety plan moving forward.  Adults and family units aren’t alone either. The DVRC provides a wide variety of services to Washoe County residents experiencing domestic abuse. To date, the DVRC has helped more than 100,000 victims of domestic violence, and with the recent launch of their crisis text line, they are poised to serve many more. Like the CAP Project, the DVRC also believes that education is one of the first lines of defense against domestic violence.  “Education on what domestic violence looks like is so much more than talking about physical violence,” said Aria Overli, Volunteer Coordinator at the DVRC. “Educating the community, and particularly youth, about what healthy relationships look like is a major factor in preventing abuse. Understanding the intersection of how other issues – such as race, mental illness and immigration status – affect domestic violence risk factors is key to addressing those issues.”   The list doesn’t stop there. Renown Health Foundation has provided financial support for many more organizations that are dedicated to ending the silence on domestic violence, sexual violence and family abuse, including:  The Children’s Cabinet – A child-focused organization offering many support services for youths and families, including Safe Place, a program that partners with local businesses to offer safe locations for children to seek help if they feel threatened at school or at home. The organization also provides free family counseling, providing a pathway to better communication for families experiencing a myriad of issues ranging from domestic violence to substance abuse.  Awaken – A nonprofit committed to increasing awareness and education regarding sex trafficking and providing housing and healing to all survivors.  Safe Embrace – The largest and most inclusive safe house in Reno-Sparks for survivors of domestic and sexual violence, offering a wide range of resources including counseling, emergency transportation, court support and more.  Eddy House – A safe space for at-risk individuals aged 18-24 recovering from the effects of domestic abuse, unsafe housing conditions, homelessness and more.  Being an advocate starts with us – if you see something, say something. Keeping a transparent line of communication is key to preventing, noticing and combating domestic violence.   “The more you reach out and talk about the issues, the better,” closed Kami Price. “No one has to go through their struggles alone.”

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Navigating care through the hospital system can be a daunting task for any patient. When faced with a difficult diagnosis or a complex healthcare journey, patients hope for, and deserve, the gold standard of support in helping them get connected with the resources, counseling, follow-up care and action plan to Fight the Good Fight.  That hope quickly turns into reality and relief when the case managers and social workers at Renown Health step in to help.  Renown’s Hospital Care Management department consists of caring, compassionate case managers and social workers who are the ultimate welfare protectors. By tapping into the needs of every patient and bridging any needs gaps with the resources they need, these team members move mountains to ensure every case results in the best possible outcomes.  Your In-House Patient & Family Liaisons  Whether they are providing therapeutic services to patients experiencing behavioral health issues, referring patients in addiction recovery to resources to aid in their recovery process or guiding a patient with cancer through the complicated care process, our case managers and social workers ensure patients and family members stay on course throughout their healthcare journey from beginning to end.  “Our department has teams that cover all areas of the hospital, including the emergency department,” said Mary Matteoni, LSW, Director of Hospital Care Management at Renown Health. “We see all-aged patients, ranging from NICU babies and families to those experiencing the last moments of their life (and everyone in between).”  “All of our cases start in the prevention, or pre-acute, phase and continue through the healthcare continuum,” added Alma Yanez, DNP, Manager of Hospital Care Management at Renown Health. “We are here to partner with patients and families, helping them assess, plan, implement and evaluate options of care and services to meet everyone’s needs.”  These team members are your go-to counselors, crisis interventionists, community resource referrers, and most of all, patient advocates. When patients need a leader to follow if confronted with an intimidating hospital stay or life-altering diagnosis, our experienced Hospital Care Management department gladly steps in to be that support system, easing fears and anxieties along the way. Providing optimal care and guidance is par for the course for this team.  "We help patients understand confusing diagnoses, arrange rehab and other post-hospital supports, help families understand how they can best support a loved one facing a ‘new normal’, navigate end-of-life decisions and so much more,” said Abbie Smith, LSW, MSW, Social Work Care Coordinator at Renown Health.     This department also serves as Renown’s discharge experts. Our case managers and social workers facilitate appropriate length-of-stay and work around the clock to arrange services for patients as they acclimate back home.  “Reviewing each patient’s medical records to ensure every resource and section of care is delivered at the right time is crucial,” said Alma Yanez. “Patients depend on us to use the best judgment when it comes to cost-effective outcomes and the planning and execution of their care after they leave our hospital.”  Expert care coordination, health resource referrals, therapeutic services, workshop facilitation, healthcare financial liaising, crisis support, staff training...a better question for this department might be, “what don’t they do?” These team members are proud “do-it-all-ers.”  “Our team is proudest of being a support to our patients and their families, as well as the positive impact our work has during traumatic and difficult times in people’s lives,” said Abbie Smith.  “Everything is ‘Figure Out-able'”  Those are the wise words said by Abbie Smith, LSW, MSW and emphasized by her entire team. No case is too complex for our Hospital Care Management department, yet every case poses great rewards for both the providers and the patients.  “I love being a social worker for Renown, as every day is filled with new and diverse situations,” said Abbie Smith. “As the social worker assigned to the trauma intensive care unit, my experiences at Renown are challenging but very rewarding. I have the privilege of helping victims of traumatic situations get the social, emotional, psychological and medical assistance they need to help recover from their experience.”   Every team member in the Hospital Care Management department leads with the utmost care and concern for every single patient and their families, leveraging compassionate communication techniques every step of the way.  “For so many patients, they are admitted to the hospital and receive life-changing news,” said Mary Matteoni, LSW. “Our department is the one to answer questions like ‘what do I do now?’ or ‘how am I going to get through this?’ Our team members are experts in their field, and they have a unique holistic lens into the patient’s situation. They spend time learning about the patient’s experiences and circumstances before they were admitted and navigate the next steps of what their new reality means. We spend countless hours ensuring each patient has the resources needed to be successful upon discharge.”  “I always ask open-ended questions to help reduce my patients’ fears, such as, ‘How are you feeling?’ or ‘What can I do?’” added Abbie Smith. “We listen to learn more about the individual’s unique circumstances so we can offer appropriate support and guidance.”  Compassionate communication is especially important when our case managers and social workers approach terminal illness, palliative care options and end-of-life conversations with patients and families. While never easy, these team members always lead with empathy.  “End-of-life conversations, which I help facilitate, frequently occur in the ICU,” said Abbie Smith. “When needed, I help families work through painful, initial moments of grief after losing a loved one.”   Each social worker and case manager takes any opportunity to lessen patient stress, which can make all the difference in the end.  “Patients and families look to us for comfort and support, and we are proud to be a source of solace for them,” said Kami Price, LSW, Supervisor of Social Services at Renown Health. “No matter how complicated the case is, we are always there to guide them through what may otherwise be a daunting journey.”  Now Hiring: Holiday Heroes Needed  This dynamic department is expanding! This team is seeking case managers and social workers in a wide variety of disciplines, including behavioral health, oncology and chronic care management. From social work bachelor’s and master’s students looking for an enriching entry-level opportunity to highly experienced case managers seeking to make a genuine difference, the Hospital Care Management department is the team for you.  “Our team consists of some of those kindhearted and thoughtful individuals I’ve ever worked with,” said Alma Yanez, DNP. “Those attributes are vital to ensuring a positive patient experience, especially as we help them navigate a complicated and intimidating healthcare journey.”  “Respect and compassion are also required characteristics to work in social services,” added Abbie Smith, LSW, MSW. “Having respect for our patients, their personal information and challenges is essential. Social workers interact with highly diverse populations, and it is imperative to keep an open mind and seek understanding of patients’ unique situations.”  The holiday season can be especially difficult for many patients and families dealing with a difficult diagnosis or facing a long hospital stay. That’s why we need social work and case management heroes more than ever this time of year. Giving a patient and family the gift of support can be one of the greatest gifts of all.  “I strongly believe that Case Management/Social Services often gets to be the light in many dark moments,” said Mary Matteoni, LSW. “I have a great passion for the work that is done in Hospital Care Management and am so proud of the team we have built and the work they do daily. We are a team of laughter, enjoyment and solid expertise in our work.”  It’s time to ask yourself: are you ready to change the lives of patients and families?

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The title of “largest nursing specialty in the country” belongs to medical-surgical nursing (commonly known as “med-surg”). Devoted to providing care for patients with a variety of health conditions and who are preparing for or recovering from surgery, this ever-popular nursing niche attracts impassioned, talented individuals who make a genuine difference in the health and well-being of every patient.  Med-surg nurses at Renown Health emulate this dedication and more. From general surgery to oncology and orthopedics, the med-surg team at Renown Regional Medical Center and Renown South Meadows Medical Center play a critical role in our care delivery for patients facing challenging diagnoses or procedures. Their ability to seamlessly juggle multiple tasks while providing the highest quality of care makes them excellent patient advocates, guiding them through the path to healing.  High-Paced with High Results Our med-surg team has the ability and willingness to provide high-caliber nursing for patients with virtually any medical condition – orthopedic injury, trauma surgery, infections, sepsis, pulmonary disease, you name it. No matter the diagnosis or procedure, med-surg has the experience and enthusiasm to handle the fast nature of the job well. Med-surg nurses are always on the go, handling a growing list of conditions together as a team. They work side by side to assess each patient’s condition and assist with both education and discharge planning for patients and families. “Med-surg is a high-paced and unpredictable environment with the largest variety of diagnoses and patient populations,” said Danyel Gish, Manager of Nursing at Renown Regional. “Every patient is everyone’s patient in med-surg. We help each other by answering each other’s call lights, communicate clear expectations and build strong trusting relationships with one another.”  “You never know what kind of disease or conditions your patient may present with,” added Brittani Manatt, Registered Nurse in the Cancer Nursing Unit at Renown Regional. “We care for patients with almost any medical diagnosis.”  Being admitted to the hospital, regardless of the reason, can be a scary and vulnerable time for anyone. However, patients can breathe a sigh of relief knowing that their competent and confident med-surg nurses are here by their side before and after they experience surgery or treatment.  “We communicate with our patients at every step of their care journey to ensure they understand what is going on and help alleviate any fears or concerns,” said Jenni Gilligan, Associate Nurse Manager at Renown South Meadows. “Some of my tips include asking the patient how they are feeling and validating those feelings; getting them and their families and friends involved in the process; and ensuring them that we are here for them and will take the best possible care of them."  “What we do as a team to reduce patients’ fears revolves around clear communication and support, whether it’s grabbing them a Starbucks drink, taking them outside for a walk or simply just listening to their concerns,” added Rose Simonian, Supervisor of Clinical Nursing at Renown Regional. “Connecting with our patients through kindness and laughter helps alleviate some of the anxiety that comes with being in the hospital.”  Jenni and Rose are exactly right – that clear communication is the “secret sauce” to success within the med-surg team. Their patients are the direct beneficiaries of this crucial skill.  “Everything we do throughout our shift focuses on teamwork and communication, making sure every piece of our plan comes together for optimal patient care,” said Cristina Vazquez, Registered Nurse at Renown Regional.  “We collaborate a lot within each healthcare team,” added Reena Clark, Registered Nurse at Renown South Meadows. “We also make sure the patients participate and are involved in their plan of care. This is important to set a common goal and help each other achieve that goal for the patient. The nurses on the floor are the eyes, ears and hands of inpatient care."  When faced with a daunting diagnosis or procedure, it’s important to have a strong support system within your personal care team, cheering you on every step of the way. Our med-surg team members are masters at this, finding new ways to connect with patients and help them feel empowered to Fight the Good Fight.  “We always try to find something that the patient loves or is passionate about that helps shift their mindset,” said Paola Espinoza-Patino, Associate Nurse Manager in the Cancer Nursing Unit at Renown Regional. “It will help them focus their attention on something that brings them joy, even if it’s for a short period of time. This helps them let their guard down and trust the team. We are here to take the best care of them as possible.”  "Med-surg provides a safe place to openly discuss any fears or anxieties a patient may be experiencing,” added Danyel Gish. “Our nurses are kind, compassionate and highly-trained professionals that work hand-in-hand with our patients to maintain their safety and wellness. We understand that being in the hospital can be a difficult experience, but we work hard to provide a calming presence and reassurance. We identify different ways to connect with our patients by holding their hands, listening, educating and providing individualized care and interventions.”  Much like many other departments across Renown, for med-surg, their patients’ accomplishments are their accomplishments. Witnessing one of their patients reach a significant milestone in their healthcare journey inspires them to continue doing what they do best: provide care driven by equal parts determination and hope.  “The biggest accomplishment for me is seeing a patient complete their last round of chemotherapy with us and getting to ring our ‘Chemo Bell,’” added Trevor Owens, Unit Clerk at the William N. Pennington Cancer Institute. “There is no greater joy than witnessing the happiness and relief of a patient completing a step in their healthcare journey."  Working tirelessly to provide exceptional care to every patient – and celebrating all their wins along the way – alongside their dedication to Renown’s cultural commitments of Caring and Collaboration are what make our med-surg nurses prosper day-in, day-out.

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Celebrate Leap Day by leaping into the world of Pathology at Renown Health! Think of discovering a diagnosis like solving a mystery: the condition is the suspect, the nurses are the frontline police force and the doctors are the lieutenants or captains finalizing the results of the case. You may notice that one crucial role is missing on this list – the detectives. In the diverse network of healthcare, the detectives are a significant part of each patient’s mystery-solving care team and represent many roles across our health system. When it comes to figuring out the elaborate details of a growth, disease, organ abnormality or cause of death, one team of detectives, quite literally, goes as deep as possible. Those detectives are the team members within Renown Pathology. For each specialized field within medicine or surgery, the Pathology department is here to play a crucial role in accurate diagnoses. With each slide examined and each test meticulously conducted in their bright laboratories, these dedicated professionals shape a path towards wellness and recovery.  Meet Your Anatomy Experts  Whether you have a chronic disease that needs consistent testing, a high-risk birth that requires placenta testing, a suspected cancerous tumor that needs a biopsy or a gall stone that must be removed (or anything in between), Renown’s Pathology team steps in to provide biological answers to your body’s questions. This department offers the most comprehensive in-house diagnostic testing in the region, from routine histology to full pathology.  As the busiest pathology department in northern Nevada, this team boasts the fastest turnaround times from respected experts, including:  Pathologists Pathology Assistants Histotechnicians Histotechnologists Clinical Lab Assistants Let’s break down the complex nature of these team members' jobs by walking through their everyday responsibilities at work!  Pathologists  Pathologists are medical doctors who specialize in the study and diagnosis of disease. With every slide they scrutinize and every sample they analyze, pathologists unravel the mysteries of disease with precision and compassion. Their responsibilities include interpreting laboratory tests, analyzing tissue and fluid samples (obtained from a variety of different sources, including biopsies and surgeries), staging cancer diagnoses and providing diagnostic insights that guide treatment decisions.  “Our job is to help the patients and their doctors figure out what’s wrong,” said Dr. Christie Elliott, Pathologist and Medical Director of the Clinical Laboratory at Renown Regional Medical Center. “As the bulk of our cases deal with cancer, almost every day we start with a tumor board alongside fellow surgeons, oncologists, radiologists and geneticists. From there, we order extra studies, run through our cases to make diagnoses, review slides and ensure all information goes into the charts, which is especially important as 70% of data in medical charts is from the lab. A patient’s history is everything.”  Pathology Assistants With the steadiest of hands, pathology assistants, also known as PAs (not to be confused with physician assistants), guide the diagnostic journey from patient specimen to diagnosis. They can typically be found processing surgical and biopsy specimens (includes accessioning, gross examination, description, and sampling for microscopic analysis), preparing tissue samples for microscopic evaluation, helping the pathologist determine a cause of death for autopsies by conducting organ dissections and maintaining detailed records of all diagnostic findings.  “As a PA, I still impact patient care without being directly patient-facing,” said Andrew Whitner, Pathology Assistant. “I handle 300-350 small tissue blocks a day. During dissections, I identify landmarks, document what I see and turn those landmarks into slides, looking for things that don’t look normal.”  “Our job is 90% all about gross specimens, and we also do eviscerations for autopsies,” added Leslieann Haffner, Pathology Assistant. “We are trained on what normal looks like; our goal is to find the abnormal.”  Histotechnicians Histotechnicians work behind the scenes to help transform ordinary tissue into extraordinary windows of insight, revealing the inner workings of the human body. As vital members of the Pathology team, histotechnicians embed tissue specimens in paraffin wax blocks (a process that preserves the tissue's structure for examination), cut thin sections of tissue from the paraffin blocks using a microtome, mount tissue onto glass slides and stain the tissue slides using histological stains to highlight structures or cells.  “With all the patient specimens we work with, we get to see a lot of organs and learn what is causing the abnormalities,” said Reiny Hitchcock, Histotechnician. “I enjoy the opportunities to expand my knowledge, especially while working alongside the doctors.”  “Our job can change by the week,” added Jessica Fahrion, Histotechnician. “One week I’ll be in the grossing room, and the next week I might be training in cytology." Histotechnologists In a world where every slide holds the key to a patient's future, histotechnologists are the champions of progress. One career ladder step above histotechnicians, these team members often have a broader scope of responsibilities, including more complex laboratory procedures, developing and validating new techniques, managing laboratory operations, interpreting results and troubleshooting technical issues. You can count on histotechnologists for validating antibodies and handling orders from pathologists, oncologists, emergency physicians and more.  “My day always involves looking into cases, reading reports, getting orders together and working with pathologists to help them with their diagnoses; I also work a lot with immunohistochemistry, helping out with routine slides,” said Charles Koeritz, Histotechnologist. “I especially enjoy doing validations, which help maintain the integrity of lab testing and our diagnostic processes.” Clinical Lab Assistants Our pathology clinical lab assistants are the masters at “filling in the blanks,” assisting in whatever area needs it most, especially in cytology and the grossing room. They are essential aspects of the Pathology team, collecting and storing specimens for further testing, assisting in managing test results, gathering data, managing supply inventory and more.  “As a Clinical Lab Assistant, I can be scheduled anywhere, from tissue cassetting to grossing,” said Ellie Somers, Clinical Lab Assistant. “Working in cytology is one of my favorite parts of my job. It’s very rewarding to work with the doctors to uncover what treatments will help each patient. We do cytology very well here.” The Bottom Line Even though the Pathology department doesn’t always experience a lot of patient face-to-face time, they interact with patients in a different way – by uncovering the story that is the inner workings of the human body, one slide and one sample at a time.  “It’s important to remember that the slide IS a patient,” said Dr. Elliott. “We are constantly learning from every case so we can continue to provide the best patient care possible.”  Take a Photo Tour of the Pathology Lab!

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Want to know more about osteoporosis and osteopenia? We'll dive into these conditions and give you some handy tips on preventing future problems and taking care of your bones. What is Osteopenia? Osteopenia (low bone density) is the initial stage of bone mineral density loss, which can eventually progress to osteoporosis if steps are not taken to prevent it. What is Osteoporosis? Osteoporosis is a condition that weakens our bones. While it literally means “porous bone," it doesn’t mean that our bones are doomed to succumb to the changes that can happen to us silently over time. Our bones are living tissues that are constantly breaking down and remodeling themselves.  Osteoporosis and osteopenia are typically diagnosed by testing bone mineral density using scans that your primary care provider can easily order. This is important testing because it dictates your risk of breaking a bone in common areas like your hip, wrist or spine. It also helps set the stage for talking with your healthcare team to develop a treatment plan. Most people will reach their peak bone mass in their mid to late twenties. There are several factors that increase our risk of osteoporosis or osteopenia as we age, such as menopause, genetics and other lifestyle factors. However, there are several things you can do to mitigate this breakdown and assist your body in the constant remodeling it does to our bones. 3 Controllable Factors to Build Strong Bones 1. Talk to your primary care provider They can go over a plan and prescribe things such as vitamin D, calcium and medications that can help if you are at risk or have osteoporosis or osteopenia. 2. Maintain a healthy diet Talk to a dietician if you need further help as they can be an invaluable resource to develop a plan.  Eat foods rich in calcium, vitamin D and vitamin C. These assist with the rebuilding of bone. Examples include but aren’t limited to leafy greens, legumes, salmon and healthy dairy products.  Don’t smoke — it directly correlates with a decrease in bone mass. Smokers also take longer to heal from a fracture.  Limit alcohol to two to three beverages per week. Alcohol interferes with the production of vitamins needed to absorb calcium and the hormones that help protect bones. 3. Exercise Talk to your primary care provider to get a referral to physical therapy if you need help with exercise.  Our bones adapt to the stresses we put them through. Therefore, exercise should be tailored to putting the right stress on our bones. There is good quality research that most exercise is safe when dealing with less bone mineral density.  The exercises should be progressively challenging and increase the load for resistance and weight training at least two to three days a week. Examples include squats, step-ups, chest presses and rows.  Exercises higher in velocity will lead to more power and bone adaptation. Examples include quicker push-ups, marching and quicker walks.  Exercises that are weight-bearing will lead bones to adapt to the stress placed on them. Movements such as mini stomps, step-ups, jumping, jogging and so forth may be used depending on how your body tolerates these things to really stimulate bone adaptation. There are aspects of aging and bone health we can’t control, but we can take steps to minimize the chances of bone loss and osteoporosis. Talk to your healthcare team to determine your risk and don’t forget to show your bones a little TLC – you’re going to need them.

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Entering the emergency room (ER) is intimidating for any person, let alone when you’re unsure what condition or illness you might have. Many may also spend their time in the ER wondering if they will need to be admitted to the hospital.  Now, let’s say you don’t need to be admitted. That’s great news! But in order to figure out what’s going on in your body, you may need to stay a little longer – say, under 24 hours – for observation, tests or further treatment. This work is done swiftly by a specific team at the hospital to get you home sooner.  That team at Renown Health is the Clinical Decision Unit (CDU). These nursing and acute care professionals seamlessly fill in the gaps between inpatient and outpatient care, helping patients return home sooner through rapid tests and treatment.  Quick Interventions for Efficient Care The key goal at the forefront of the CDU’s patient care philosophy lies in their name: decisions. The team makes quick decisions in order to deliver timely, accurate assessments so they can treat patients efficiently and get them home. Not only do these efforts help reduce the amount of time patients have to stay in the hospital, but they also achieve cost savings for both the patient and our health system. And in cases where patients do end up needing to be admitted, the CDU walks them through everything they can expect during their stay.  The main duties of our CDU team include:  Observation and monitoring, where patients with conditions that are not immediately life-threatening but need closer monitoring Diagnostic testing, including blood work and imaging, to help providers gather critical information quickly Treatment and stabilization to receive treatments like IV fluids, medications or other therapies to prevent the need for inpatient admission Decision-making to determine whether the patient should be admitted for further care or discharged with follow-up plans  Think of the CDU as the ER and inpatient admission go-between. By diverting patients who don’t necessarily need emergency intervention away from the ER, the CDU helps relieve high patient volumes and reduce wait times.  “The CDU offloads patients from the emergency room who require slightly longer observation status to complete more complex testing or exams,” said Kristine Barnes, RN. “You could consider us a ‘limbo’ unit between the ER and admission to the hospital, if required.”  As with many other teams at Renown, every day is different for this team. They enjoy the variety of cases they see and solving the puzzles that present with patient care.  "The CDU is always fast moving, with discharges and admissions all day,” said Tyler Cathcart, Acute Care Technician-Advanced. “As an observation unit, we function as both an extension of the ED and PACU, with Medical, Telemetry and post-op patients. We have a wide range of patients and responsibilities to keep the unit moving quickly.”  “We see a variety of patients and enjoy the variety each day brings,” added Angie Marrale, Acute Care Technician-Basic. “A day in the life as a tech on CDU is full of surprises because we have such a wide variety of patients. It requires all team members to be attentive, hardworking and communicative in order to provide our patients with the care they need.”  If you’re ever looking for an example of a team that moves and acts quickly, the CDU is a shining example of that. Due to their hyper-focused attention, patients are able to embrace better outcomes and higher satisfaction.  “We move quickly to get today's group of patients comfortable, complete the tests ordered, make the appropriate interventions and get them discharged back home or transferred in less than 24 hours; then, we refill the unit, and each patient receives excellent, expedited care,” said Tyler Cathcart. “Efficient patient care within 24 hours is our goal, and we strive to meet that goal daily.”  A place to get extra care and attention without needing to stay for a long time while also having a team of professionals solely dedicated to figuring out what is going on in your body? Sign us up!

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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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August is National Make-a-Will month. We talked to Renown Health Foundation Planned Giving Officer, Abbey Stephenson, to learn more about wills, trusts, and estate plans and why you should feel motivated this month to get started. Did you know that 2/3 of Americans don't have a will or trust? If this is you, don’t worry, you’re not alone. Although there are laws in place to determine who inherits your assets if you die without a will or trust, having a will or trust ensures your assets go where you want them to go after you are gone. They can also help minimize disputes between family members and heirs about who gets what. In Nevada, the laws that govern who gets what if you die without a will or trust can be found in Chapter 134 of the Nevada Revised Statutes. There are other documents that people often prepare at the same time as their will or trust – like an advance health care directive and durable power of attorney for assets. These documents all together are called an estate plan. Although they have other purposes too (like nominating a guardian for a child, planning for disability or avoiding probate, which is a court process), wills and trusts are documents that say who will receive your assets after you are gone. The most common type of trust is often called a revocable living trust or a family trust. People who have a trust usually still have a will, although it is a shorter form of will called a pour-over will. It’s a good idea to talk to an estate planning attorney about whether or not a trust makes sense for your family or circumstances.  Now that you’re ready to get started, here are some mistakes to avoid: 1. Failing to plan Not setting aside the time to plan may be the biggest mistake. Failing to prioritize preparing or updating your estate plan means your last wishes and desires may not be fulfilled. The right documents memorialize what you would like to happen upon your disability and death so that other people can know and follow your wishes with respect to your care and your assets.  2. Failing to coordinate beneficiary designations Certain types of assets like life insurance and retirement accounts are not covered by your will or trust and need to be addressed separately. These types of assets are referred to as non-probate assets because they transfer under contract principles and don’t require court supervision or probate to be distributed to the named beneficiaries. By completing beneficiary designation forms provided by the retirement account custodian, insurance company or financial institution, you can direct your assets to one or more beneficiaries. 3. Failing to title your assets properly Asset titling refers to how you own your asset – such as in your individual name, jointly with someone else, or in a trust or entity. For example, assets titled for two people with a “right of survivorship” will automatically go to the surviving owner. Review your asset titling and make changes, if needed, to ensure your property and assets are passed down the way you intend. 4. Failing to include charities meaningful to you In addition to providing for family members and other important people in your life, you many also choose to give to charities meaningful to you in your estate plan. When you include a charity in your estate plan, that gift is called a planned gift and many charitable organizations, including Renown, recognize such donations through their legacy giving societies. As you prepare to make your own will or a more comprehensive estate plan, we recommend you consult with a lawyer. Here are some free resources that may be helpful too:  Renown Health Foundation is proud to sponsor the Family Estate Planning Series put on by PBS Reno and the Community Foundation of Northern Nevada. The free, 8-week course of 90-minute, in-depth workshops is a great place to learn much more and to help you get started in the planning process. The next course begins on September 7, 2022. More information can be found here. Renown Health offers periodic advance health care directive workshops where attendees can learn about, complete, and sign their directive. The next workshop is scheduled for September 14th. More information can be found here. The American College of Trust and Estate Counsel provides information on a number of commonly asked estate planning questions here. If you are interested in including a charitable gift to Renown in your estate plan, we would be happy to talk to you about how your gift will make a difference for our mission. Please contact Abbey Stephenson at abbey.stephenson@renown.org or visit renown.org/LegacyGiving to learn about Renown Health Foundation’s Legacy Giving Society and ways to give.

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March is Colorectal Cancer Awareness Month, and we want you to receive the best preventative care possible. Early detection can help prevent serious illness, yet many people still choose to skip their annual exams and routine screenings. Bonnie Ferrara, MD, MPH, Section Chief for Primary Care at Renown Medical Group, further explains the importance of this simple, easy way to stay healthy. Why are annual exams so important? The benefits of early detection and prevention to save lives and reduce the impacts of disease have been proven. These exams are the perfect opportunity to get your health questions answered. “This is your chance to sit down with your provider and talk about your overall health and your family’s health history as well as your concerns for the future,” says Bonnie Ferrara, M.D., family medicine. “It’s the opportunity for your provider to talk with you about your lifestyle, tobacco use, exercise and alcohol use, all of which make a difference in your future longevity.” The annual wellness exam is also an ideal time for most adult patients to discuss health screenings. In addition, these visits are the perfect time to address issues that may not directly relate to a particular medical problem or immediate illness. A good rule of thumb is to schedule these appointments around your birthday each year to make sure you and your provider are both updated on your care. Why would you need an annual exam if you aren’t feeling sick? According to Dr. Ferrara, seeing your care provider when you aren’t sick is one of the best times. “It is better if you try to arrange this visit when you are not feeling ill,” she says. “It is an opportunity to talk about wellness. Not only how to contribute to your wellness but also the changes that you can make that will make huge dividends in the future for your wellness. In addition, it allows us to do some education about what to expect in the coming years as far as your health and lifestyle changes.” What can you expect at an annual exam? Annual exams usually check your: History – lifestyle behaviors, health concerns, vaccination status, family medical history Vitals – blood pressure, heart rate, respiration rate and temperature General appearance – your care provider can find out a lot about you just by watching and talking to you Dr. Ferrara adds, “If this is a Medicare annual wellness exam, it is an opportunity to talk to your provider about depression and dementia as well as be tested for those.” You can also leverage your annual exam to speak to your provider about managing your chronic health problems. "As a provider, these visits give us the opportunity to hear how the medications and lifestyle changes we have recommended are working and if you are having problems with these, we have the opportunity to make suggestions of how to do things better for the future," Dr. Ferrara.

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