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With allergy season’s extended stay and cold and flu season having just begun, you may soon find yourself seeking relief through several different kinds of over-the-counter medications. Know what precautions you need to take when fighting multiple symptoms with multiple medications. When you’re too sick to go to work but not sick enough for a doctor’s visit, over-the-counter medicines are a welcome relief to help alleviate that fever, runny nose or allergies. But because those medicines aren’t signed off on or managed by your doctor and pharmacist, it’s crucial that you’re especially mindful of what you put into your body. Whenever you pop a pill, you want to make sure you’re taking the right dosage, waiting the right amount of time before taking another dose and not mixing certain medicines together. Recent stories like this one detail dangerous over-the-counter medicine combinations, and we’re following suit: Here is a quick go-to guide about potentially harmful over-the-counter combinations. Too Much Tylenol/Acetaminophen Tylenol — or acetaminophen — is a popular pain reliever for many, but too much can be bad for your liver. “Our bodies have a finite ability to metabolize Tylenol,” says Andy Wright, clinical pharmacist at Renown Rehabilitation Hospital. “When too much builds up in the liver, it becomes toxic. In patients with medical conditions like cirrhosis of the liver or hepatitis, this could be disastrous.” Remember, acetaminophen is in more than just Tylenol and generic pain relievers. You may also see acetaminophen in flu, cold and cough medicines, like Nyquil, and some prescription medications including Norco and Percocet. Keep a list of the medications you take, and limit daily acetaminophen use to 3,000 mg per day. When you’re scanning medicine bottle contents, remember acetaminophen is also referred to as APAP, AC, acetam or paracetamol. Mixing Painkillers When you’re dealing with pain and not getting any relief, taking a different medication may seem like the easy solution. Maybe you take some Aleve — a form of naproxen — for a headache, but it isn’t working, so you switch to Motrin, an over-the-counter form of ibuprofen. Not a smart idea. Ibuprofen and naproxen along with aspirin are known as nonsteroidal anti-inflammatory drugs (NSAIDS). Because these medicines work in similar ways, they should never be combined or used in larger doses or more frequently than directed. Otherwise your risk of side effects can increase, which range from mild nausea to severe gastrointestinal bleeding. It’s also important to consider your family history when taking NSAIDs because, “recent studies have shown NSAIDs may have greater cardiovascular risks for people taking blood thinners or those with hypertension,” explains Andy. “A good example is ibuprofen: It has a relatively low gastrointestinal bleed risk while it has a moderate to high cardiovascular risk. The opposite is true for naproxen.” Rather than experimenting with multiple medicines, figure out which drug works best for you. You may find muscle soreness improves with aspirin, whereas when a headache hits, naproxen is best. Keep in mind that these medications aren’t always best for everyone in the family. “Aspirin in children and teens is not recommended unless under the supervision of a doctor,” Andy says. And pregnant and lactating women should generally avoid NSAIDS due to risk of birth defects and bleeding. “In both of these cases, acetaminophen or Tylenol are preferred but only if approved by an OB/GYN.” Fighting Allergies Over-the-counter antihistamines like Claritin, Zyrtec and Allegra have made fighting itchy eyes and runny noses a little easier. But these daily medicines — when taken inappropriately or in the wrong combinations — can also have an adverse effect. Similar to acetaminophen, you need to watch for antihistamines in other products. Sleep aids — like Tylenol PM and Unisom — commonly use an antihistamine known as diphenhydramine, which may increase your risk of overdose. “Combining antihistamines, or overdosing, can cause many adverse effects including dry mouth, blurred vision — even arrhythmias,” Andy says. “Only take these medications on their own.” If you’re still struggling with symptoms, you can talk to your doctor about adding an over-the-counter nasal steroid. Andy confirms the importance of closely following the directions listed on antihistamine (and all medicine) bottles. He has seen extended release nasal decongestants cause significant arrhythmias requiring medical care after a patient took the medicine with warm fluids. “The decongestant in question is designed to slowly release, but it can dissolve suddenly in the presence of warm liquids like coffee,” Andy explains. “This can cause the pill to deliver 12 to 24 hours of medication all at once.” Taking an Antidiarrheal with Calcium Calcium supplements and antidiarrheal medicines are another harmful combination. Calcium firms up your stool, but if taken with an antidiarrheal, can cause severe constipation. If you need to take an antidiarrheal, take a break from your calcium for a few days until you’re back to normal. Another consideration when taking calcium supplements or calcium-based antacids is gas. “I’ve had several patients report cases of excessive gas using Tums or calcium carbonate-based supplements.” Andy suggests instead “trying Maalox or Mylanta for indigestion and Citracal as a supplement.” Talk with Your Doctor or Pharmacist About Your Medications If over-the-counter drugs aren’t providing the relief you need, it’s time to see your doctor. And remember, for your safety it is important to keep your doctor and pharmacist up-to-date with any medications — prescribed or over-the-counter — that you are taking.

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One of the best things about living in the Reno area is the beautiful mountain range that surrounds our city. Many families take advantage of the activities the mountains have to offer or travel over them to visit friends and family in neighboring areas. However, for parents of infants there is often angst over your baby’s ears and altitude changes and the associated potential for ear pain and/or “popping.” Fortunately, there are things you can do to protect your infant’s ears the next time you drive over the mountain or hop on a plane with your little one. Baby’s Ears and Altitude Changes: What Causes Them to “Pop” The simple answer is pressure. The problem originates in the middle ear where there is an air pocket that is vulnerable to changes in pressure. The Eustachian tube, which runs behind the nose to the middle ear, is constantly absorbing and resupplying air to this pocket to keep it balanced. When the pressure is not balanced, your ears feel “clogged” or like they need to “pop.” In some cases this sensation can cause significant ear pain and even temporary hearing loss. Rapid changes in elevation or altitude, like driving over a mountain, or ascending or descending on an airplane, can cause rapid changes in pressure. In order to avoid problems, the Eustachian tube needs to open widely and frequently to equalize those pressure changes. The problem often intensifies during descents as you go from an area of lower atmospheric pressure to an area of higher atmospheric pressure. This is why you hear babies screaming on planes during descent or why your infant is wailing in the car seat as you head down the mountain. What can you do to make it a more comfortable trip for your child? First, be prepared. Babies cannot intentionally “pop” their ears like adults can, but we can help them by encouraging them to swallow. Offer your baby a pacifier or bottle while making ascents and descents. If possible, it may be helpful to have an adult ride in the back seat with baby if you’re in the car to ensure this can happen. Don’t let your baby sleep during descent on a plane. Help your little traveler out by offering him or her a pacifier during this process, as descent is the most likely time for pain associated with altitude changes. If your baby is congested prior to travel involving altitude changes, seek the advice of your pediatrician since they may have other solutions, including medications such as decongestants. If you return from a trip and notice your infant is still fussy and uncomfortable, contact your child’s doctor for a thorough ear evaluation. Safe travels!

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Most prescriptions meds are available in generic form. Find out the similarities and differences between the two and how to determine whether a generic is right for you. Approximately 80 percent of prescriptions sold today are generics. If you’re taking a prescription medication, chances are it’s a generic form of the brand-name drug. But are you getting the same quality in a generic medication? Do generics measure up? The answer in most cases is yes — generics, just like branded products, are regulated by the Food and Drug Administration. “To have a generic product approved by the FDA, the generic manufacturer must prove that its product is bioequivalent to the branded product,” explains Adam Porath, PharmD, BCPS AQ-Cardiology, BCACP and Vice President of Pharmacy Services. Basically, it has to function the same. “Generic products are extremely well tolerated and will provide the same results as using a branded product,” Porath says. Here’s how generics are the same as name-brand prescriptions: Generic products contain the same active ingredients. They produce the same desired clinical effect and accompanying side effects. Generics come in the same form as their branded counterparts: pill, liquid or inhaler, for example. Release into the bloodstream matches the name brand in timing and strength. Here’s how they differ: Generics generally cost less. Federal law requires generics have different names and look different: shape, size, markings and color. Generics contain different inactive ingredients, like binders, fillers and artificial colors. Different side effects with generics can usually be attributed to these additions. Why do generics cost less? When pharmaceutical companies develop a new drug, they are paying for research, development, clinical studies, marketing — in some cases it can cost more than $800 million and take 10 to 15 years to develop a new drug. “The manufacturers of branded medication products have to recoup their research and development costs,” Porath says. So companies are granted a limited patent to sell their drug without the competition of generic counterparts. “When patent exclusivity ends, the market is open for any generic manufacturer to make a competing product with FDA approval.” Without the same startup costs, companies can sell generics at 80 to 85 percent less. And because more than one company can produce the same generics, competition drives prices even lower.

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National Healthcare Decision Day is forthcoming. Here’s an easy and free way to commemorate the occasion: openly discussing how we want to be cared for at the end of our lives. Join Renown Health’s experts at a workshop about making decisions about an advance directive. Among the random national holidays, this one has significance: April 16 is National Healthcare Decision Day. And experts agree that the best time to discuss your views about end-of-life care and to learn what choices are available is before a life-limiting illness or crisis occurs. By preparing in advance, you can help reduce the doubt and anxiety related to decision making for your family if you cannot speak for yourself. “Completing your advance directive is a gift you give your family,” says Mary-Ann Brown, RN, MSN, director of Palliative Care. “The stress associated with these difficult decisions is decreased if everyone knows what is important to you and what you want the end of life.” What Are Advance Directives? An advance directive is a document that states your choices about medical treatment and names another person to make medical decisions on your behalf if you are unable to. This document allows you to make legally valid decisions about future medical care. Find more information about advance directives and the form online. The Conversation The first step in completing an Advance Directive is to think about what’s important to you and talk to your loved ones. The Conversation Project provides helpful tools to guide you and your family through this challenging topic. Getting this information together will help you fill out and complete your advance directives. Some things to consider and discuss with your family include: When you think about the last phase of your life, what’s most important to you? Who do you want involved in your care? Who should make decisions on your behalf if you’re not able to? Where do you want or not want to receive care? Are there specific treatments you would or would not want? Complete Your Advance Directive Planning In order to complete an advance directive, you will need either two witnesses or a notary to sign the form. Be sure to note restrictions on the witness process. When an advance directive is complete, you should keep the original. Copies should be given to your agent named in the form, your family, your doctor(s) and the location that you receive care. Renown Health offers four advance directive workshops every month to cover the details of filling out this document. A healthcare team is available to answer questions and work through the process with you. A notary is also present to finalize the process, which means you can complete your advanced directives during this workshop. Find the workshop by calling 775-982-RSVP for more information. Advance Care Planning Workshop April 17, 1-2:30 p.m. | Free Join Renown Health’s experts for a workshop about making decisions regarding end-of-life care. You will learn how to fill out an advance directive, receive one-on-one assistance and have your documents signed by a notary. Workshops are typically held several times each month. To RSVP, call 775-982-7787

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

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By taking our pregnancy and birth class, you will gain the tools necessary to have a safe and empowering birth experience for both you and your baby. Chris Marlo, Childbirth Educator at Renown Health explains why birth classes are important. For questions regarding classes or tours, contact Chris Marlo: chris.marlo@renown.org 775-982-4352 What is a Certified Childbirth Educator/Doula? If you are expecting a baby, Renown has a wide variety of classes to help prepare you for birth. Classes are taught by certified childbirth educators and doulas. A certified childbirth educator is a trusted resource who has a passion for educating expecting parents about childbirth, and will provide you with non-biased, evidence-based information. A doula is a professional labor assistant who provides physical and emotional support during pregnancy, childbirth and postpartum. As you prepare for birth, our certified educators will guide you each step of the way and ensure you receive the quality care you deserve. Why Should I Take Pregnancy and Birth Classes? For expecting parents, taking a childbirth education course is an important step in preparing for their new arrival. We cover topics such as labor and delivery, postpartum care, breastfeeding, nutrition, pain management techniques, and more. Our experienced instructors will provide you with the information you need to make informed decisions during your pregnancy and childbirth. With our classes, you can be sure that you have all the knowledge necessary to have a positive experience before, during, and after your baby’s arrival. Our classes will help ease your fears as we practice breathing, relaxation and the many tools you can utilize for birth. At Renown we understand that there is no right way to give birth, and our educators will offer a supportive environment where questions are encouraged, and everyone is respected. Childbirth Class Options: Baby and Family Suites Tour & Virtual Tour Breastfeeding Basics and Beyond Class Breathing & Relaxation Techniques for Birth Pregnancy and Birth – 5 & 7 Week Series Pregnancy and Birth Class Additional Resources: Baby Safe Class Babysitter Class Grandparents Virtual Class Infant CPR & Choking Class Newborn Care Nurturing Your Newborn Preparing for Postpartum Virtual Class

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Giving birth expends as much energy as running a marathon. And just like you would only run a marathon with training beforehand, there are exercises you can do to prepare for birth. But instead of a coach, you'll have your birth team. Your birth team exists to help you navigate pregnancy and labor and support your choices. Let's say you've never put together a birth team before and are wondering where to start. Today we'll go over the three main positions to fill for your birth team's starting lineup. Birthing Person The birthing person is the leader of the team. After all, you can't have a birth team without someone giving birth. This person could be the baby's mother, gestational surrogate, birth parent before adoption, a transgender father or a non-binary parent. If you are not the birthing person, don't presume to know what the ideal labor and birth circumstances should be. And if you are the birthing person, don't allow anyone else to tell you what you want. This is your body and your birth; you are the boss in the birth room. Doula No birth team is complete without a doula, and although doulas have increased in popularity lately, many people still don't know what a doula is. Simply put, a doula is a birth professional – not a medical provider – who offers emotional, physical and informational support during pregnancy, labor and beyond. Most doulas' services include at least one prenatal visit and one postpartum visit, as well as continuous care throughout active labor. Some doulas provide more than one prenatal/postpartum visit, so be sure to ask what is included in their fee. Even if you have a partner who will support you during labor, studies have shown that a doula can significantly increase your likelihood of a positive birth outcome. Even the most supportive partner needs to rest, and a doula can ensure that you still get the care you need while your partner gets a break. Midwife or Obstetrician Finally, you'll want to choose the medical professional who will attend your birth. Many folks choose to give birth with the OB/GYN who does their annual check-ups, but there are many reasons someone might choose a different provider for their birth. The first step to finding the best attending provider for your birth is to decide which model of care aligns closest to your values and goals: the Midwifery Model of Care or the Medical Model of Care. .tg {border-collapse:collapse;border-spacing:0;} .tg td{border-color:black;border-style:solid;border-width:1px;font-family:Arial, sans-serif;font-size:14px; overflow:hidden;padding:10px 5px;word-break:normal;} .tg th{border-color:black;border-style:solid;border-width:1px;font-family:Arial, sans-serif;font-size:14px; font-weight:normal;overflow:hidden;padding:10px 5px;word-break:normal;} .tg .tg-gqvw{background-color:#ffffff;color:#56266d;font-family:Arial, Helvetica, sans-serif !important;font-weight:bold; text-align:left;vertical-align:top} .tg .tg-8vim{background-color:#ffffff;color:#56266d;font-family:Arial, Helvetica, sans-serif !important;font-size:18px; font-weight:bold;text-align:left;vertical-align:top} .tg .tg-qm8j{background-color:#ffffff;color:#56266d;font-family:Arial, Helvetica, sans-serif !important;text-align:left; vertical-align:top} .tg {border-collapse:collapse;border-spacing:0;} .tg td{border-color:black;border-style:solid;border-width:1px;font-family:Arial, sans-serif;font-size:14px; overflow:hidden;padding:10px 5px;word-break:normal;} .tg th{border-color:black;border-style:solid;border-width:1px;font-family:Arial, sans-serif;font-size:14px; font-weight:normal;overflow:hidden;padding:10px 5px;word-break:normal;} .tg .tg-gqvw{background-color:#ffffff;color:#56266d;font-family:Arial, Helvetica, sans-serif !important;font-weight:bold; text-align:left;vertical-align:top} .tg .tg-8vim{background-color:#ffffff;color:#56266d;font-family:Arial, Helvetica, sans-serif !important;font-size:18px; font-weight:bold;text-align:left;vertical-align:top} .tg .tg-2rvk{background-color:#ffffff;color:#000000;font-family:Arial, Helvetica, sans-serif !important;text-align:left; vertical-align:top} Midwifery Model of Care Medical Model of Care Philosophy Birth is physiological. Birth is potentially pathological. Interventions Medical interventions can cause more complications, and therefore are only used as needed. Medical interventions should be used, even in non-emergency situations and sometimes as preventative measures. Decisions Birthing person is the key decision maker. Medical professional is the key decision maker. Provider’s Role Providers monitor labor and will intervene or transfer to hospital if needed. Providers assess and control the birthing process.

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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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Bringing in new life is an exciting and beautiful occasion. The possibilities for the newest members of our world are endless – what will the child grow up to become? What will they achieve in their lifetime? Anyone will agree that a new life is precious and protecting that life by any means possible is a necessity.  Sometimes, however, a baby’s journey into our world brings along obstacles. Prematurity, congenital defects and other complications can accompany a birth and the baby’s first few moments of life. But what happens when these complications happen outside of a fully-functioning Labor & Delivery unit, or if the complications need a special level of intervention with a health system capable of caring for their unique needs?  Enter the NICU Transport team at Renown Health. As the only Neonatal Intensive Care Unit (NICU) Transport team in northern Nevada, these dedicated nurses, respiratory therapists and neonatal nurse practitioners – who have normal unit duties of their own at Renown Regional Medical Center – step up to the plate to take on this extra duty to support members of their community facing some of the scariest moments of their lives. To them, transporting babies in critical condition and giving them the best chance of life isn’t just a responsibility; it’s a calling.  The NICU on Wheels  When the Saint Mary’s maternity unit, which was Renown’s partner in NICU transport duties, made the decision to close, our dedicated NICU nurses and respiratory therapists diligently rose to the occasion to fill the demand. Dubbed the “NICU on Wheels,” Renown’s team went from taking on transport duties every other day to 365 days a year – and they are always ready to go at a moment’s notice, whether it’s by ambulance or by fixed-wing aircraft.  “When we learned about the closure we knew it was our calling and knew we had to step up,” said Rachel D., Neonatal Transport RN at Renown. “We still have regular days on the floor, and we each switch off being on-call for transport. Once we get a distress call, we have 30 minutes to get to the hospital, grab our gear and go. We have to essentially put a whole room’s worth of portable equipment in one bag.”  “I really enjoy being a part of the transport team and making a difference from northern Nevada to northern California,” added Sam V., Supervisor of Respiratory Care at Renown. “We are able to practice at the top of our skill level and use autonomy that not every practitioner gets to use.”  Each NICU Transport unit works in teams of three when heading out into the field: one nurse (our bedside experts), one nurse practitioner (our education experts) and one respiratory therapist (our lung and breathing experts). With several years – and in many cases, decades – of experience in NICU nursing, NICU transport duties and respiratory therapy, this team is poised to provide state-of-the-art lifesaving care en route to the hospital. This diverse array of experiences among the team especially comes in handy as they continue to face the increased transport workload.  “We are so thankful to have Saint Mary’s employees come over and work on our team after their maternity ward closed,” said Melyssa H., RN, NICU Transport Coordinator at Renown. “Helping the babies, as well as helping the scared families, will always be our top priority.”  “I love the complexity that babies provide in the NICU,” added Jennifer J., Neonatal Transport RN at Renown. “Providing hands-on care right at the bedside along other members of the team is such a rewarding experience.”  Education is also a crucial tool in NICU care, especially in the field. The nurse practitioners on this team make it their mission to outreach to the community, including our rural health partners, and help them build the tools and skills they need to care for our smallest and most critical patients.  “I have been on a few transports where we went out and did not have to bring the baby over to the hospital, and we were able to provide lots of education instead,” said Shiela A., Respiratory Specialist at Renown. “For instance, I was called out to Fallon for a baby that was in respiratory distress. When we arrived, we saw the baby was awake and active although intubated. The tube came out, and we retaped it. While we stayed to observe the baby to make sure everything was okay, the nurse practitioner on the team provided educational tools to the family on what they can improve on regarding their baby’s tubing. Our nurses do such a great job with these teachings.”  “When I started, I quickly noticed that more education was needed in the field,” added Jennifer J., RN. “Now I see the momentum we’ve had in these communities really take full force. Because of this education, and the confidence we instill in our patients’ families, each baby’s transition to our team has become so much easier. It has been awesome to watch this progress over the years.”  With immense experience, education and a strong commitment to their community under their wing, the NICU on Wheels is only just getting started.  Teamwork Makes the Dream Work  Running a successful NICU Transport operation, especially as the sole health system participating, takes a village. With only three professionals out in the field, the team leans on their fellow nurses, physicians, surgeons and specialists to make the operation run as smoothly as possible.  From REMSA and Care Flight helping load patients in and get them to the hospital safely, to Renown’s Clinical Engineering team who are first on the scene when machines need repairs and troubleshooting, everyone rises to the occasion to achieve the best-possible outcome for our youngest patients at some of the most challenging moments of the beginning of their lives – and they are fully trusted to move those mountains.  “Being a part of the NICU Transport team has given us the opportunity to facilitate a deeper, meaningful relationship with providers and a patient’s entire care team,” said Rachel D., RN. “They entrust us with our assessment skills, opinions and skill levels. There is an equal layer of trust between us and them.”  Despite the pressure they feel every day, the NICU Transport team never let it overtake them and instead let it empower them.  “We are under a lot of pressure and stress regardless of the case, and yet, we all work so well together; the teamwork really is incredible,” said Lisa A., Respiratory Specialist at Renown. “I am very proud of how our team steps up and is very intricate, even down to organization. For example, team members like Shiela arrange all the respiratory bags and make sure they are laid out in a way that makes the procedure as simple as possible to ensure there are no complications.”  The nurses and respiratory therapists also partner together on the NICU floor and are always ready to provide coverage when their transport colleagues get a call. Committed to collaboration and ready to jump into action, the NICU Transport team works together to elevate each other and the bottom line for each patient.  “This is a full-time gig, and the group works together to make sure everyone is covered; we are all very collaborative,” said Sarah K., Respiratory Specialist at Renown. “We all think of our patients as extra special, and it’s nice to know that you can make a difference in the baby’s life and the lives of the family. We all have a sense of purpose in giving back to the community.”  “I am just so thankful to be a part of this team,” added Marcia A., Neonatal Transport RN at Renown. “We really have developed a strong bond.”  A Track Record of Success  The life-saving measures that each member of the NICU Transport team take surpass hospital walls. The impact they have on each baby are remembered and celebrated for years, and they often develop lifelong relationships with patients and their families after their stay in the NICU.  One prime example of this can be found in an impassioned letter from Tess, the mother of a young boy who was in the midst of respiratory distress and needed immediate intervention. Because of the valiant efforts of Renown’s NICU Transport team, her child, Warren, is a healthy and happy baby to this day. She recalls the experience: Warren had stopped breathing while getting routine blood work. He was resuscitated twice while at an area hospital. We made the decision to transfer him to Renown for him to be admitted into the NICU. Within an hour and a half of this decision, Renown had sent a team consisting of a respiratory therapist, nurse and nurse practitioner to come and get him. As soon as the team entered the room, we immediately felt safe and comforted. The team made sure we knew exactly what was going on and what was going to happen in the following hours, and they let us know they would do everything for Warren. He was resuscitated two more times by the respiratory therapist while getting ready for transport. At that time, the decision was made to intubate for a smoother ride to Renown. We knew you all had his best interest in mind, and of course, we trusted you with everything. The intubation went well, and he was packed up and ready to drive. Today, Warren is hitting all of his developmental milestones and is a normal, happy baby in everyone’s eyes. We can’t thank the NICU Transport team enough for taking such good care of Warren and helping him Fight the Good Fight.  “This success wasn’t just due to our three-person unit – our manager, Jason, also jumped in and drove all the way to Carson City to stabilize the child,” said Shiela A. “This just goes to show that no matter our title, we are always here to help and make a huge difference in the lives of our patients.”  Success stories of children like Warren describe the common mission of the NICU Transport team in detail, and while there are more of these stories to come, the team is always ready to make the necessary sacrifices for the greater good of their patients.  “Sarah K. is like Warren’s guardian angel,” said Tess. “We call her ‘Auntie Sarah’ now. He wouldn’t be here if it weren’t for her and the entire NICU Transport team. It takes a special kind of person to work in the NICU. I can never repay this team for what they’ve done for Warren and our family.”  “I am proud of this team, their flexibility and the sacrifices they have made to do transport 365 days a year,” added Melyssa H., RN.”  The remarkable success of the NICU Transport team serves as proof of the unwavering and tireless commitment of each and every team member, bringing hope to families during their most difficult moments.  “NICU Transport forces you to be confident in yourself and your abilities and to push yourself a step further,” said Rachel D., RN. “I am a better nurse because I joined the transport team.”

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

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Whether watching a 4th of July celebration from her father’s boat on the Saint Johns River or sneaking a peek at a post-game display over Gator Bowl Stadium from her parents’ bedroom window, the fondest childhood memories of Sterling Silver Club featured member are of fireworks. “I love watching fireworks,” says Rhogenia. “And I get just as excited by them now as I did then.” Well, fireworks are certainly a fitting introduction to this Sterling Silver Club member who shines with a spectacular collection of accomplishments, adventures and interests. A Passion for Teaching Rhogenia remembers herself as a happy, carefree child “who read all the time” while growing up in Jacksonville, Florida with her younger sister, Rosemary, and her father and mother, who was a public school teacher. It’s easy to see how this natural enthusiasm for reading (and learning), along with her mother’s influence, would spark Rhogenia’s calling – and passion – for teaching. After earning her bachelor’s degree in education, Rhogenia spent the first 2 years of her career as a kindergarten teacher in a “one traffic light” town in her home state. She then moved to Oakland, California where she taught kindergarten and first grade classes at various schools for 4 years. The Biggest Little City in the World came next, and her stay there would last much longer. In Reno, Rhogenia added a master’s degree to her credits and found a home for her teaching career at Grace Warner Elementary School – where she taught first and second grade for 20 years! During that time, she also took on the additional role of adjunct professor, teaching graduate students for the University of Phoenix, College of Education.   “A great teacher never stops learning,” explains Rhogenia. “I believe the art of teaching is the act of facilitating discovery, for students and also for myself.” In recognition of her efforts, Rhogenia received the Reno Gazette Journal’s Best of Education Award, the Washoe County Teachers Association Distinguished Performance Award, and was also awarded a grant from Learn and Serve America to help her support student programs that gave back to the community. Rhogenia’s favorite quote: “One hundred years from now it will not matter what my bank account was, the sort of house I lived in, or the kind of car I drove. But the world may be a little better, because I was important in the life of a child.” – Adapted from an essay by Forest Witcraft Commissions, Councils & Space Camp Life outside the classroom also kept Rhogenia busy – and inspired – throughout her career. In 1998, she was selected to participate in an educator externship, and in 1999, was chosen to be a teacher consultant to the Alliance Summer Geography Institute. These opportunities allowed Rhogenia to return to her students with exciting lessons to share about different types of industries and the importance of geography, respectively. In 2002, the governor appointed her commissioner for the state of Nevada’s Commission on Professional Standards in Education. And Rhogenia followed that up with an appointment to the National Council for Accreditation of Teacher Education in 2004. She also got to travel. Rhogenia was one of two teachers from Nevada chosen to participate in the Japan Fulbright Memorial Fund Teacher program on its 50th anniversary. Originally established in 1946 to foster mutual understanding between the U.S. and Japan, the trip allowed Rhogenia to represent her state, her country and her race to Japanese dignitaries, business people and students alike. For over three weeks, she toured schools, universities, factories, temples, art galleries and museums, and stayed in the home of a Japanese family for a few days – which she calls the highlight of her trip.  Oh, and then there was the time she went to space camp! The Nevada Teacher in Space Program sent Rhogenia to join teachers from across the county at the out-of-this-world camp in Huntsville, Alabama. On “Team Endeavor,” she learned what it would be like to deliver payloads and perform experiments at the International Space Station, and took a seat in flight simulators and an antigravity chair. The goal of the program was to inspire teachers to help their students learn about the infinite possibilities of math and science. Time for What Matters These days, Rhogenia enjoys spending time on the things that matter most to her. Personally, that means diving into hobbies like genealogy, music, reading, writing, cooking and the occasional card or board game. She also continues to learn and broaden herself through Osher Life Long Institute (OLLI) classes and Retired Living Truth Series seminars. But her greatest joy comes from spending time with family – four generations of her own family, her church family, retired teachers from Warner Elementary and the many acquaintances and friends she’s come to know over the years. Other things worthy of Rhogenia’s time: Giving back to the community, rainbows, sunsets and sometimes, just watching the clouds roll by. Membership & Senior-ship What does Rhogenia think about being a Sterling Silver Club member and a senior? She told us. “Before COVID, it was the face-to-face club events that I liked most,” recalls Rhogenia. “At the Silver Stars Gala, I had such a wonderful time chatting with old and new friends… the fashions, decorations and the food were delightful.” Over the past year, she also found things to love about the club’s virtual events and regularly attends lectures, cooking and yoga classes and weekly meditation sessions – from her home! It Starts with Hello offers some of her favorite club events. “It reminds me of the television show, Cheers, where everybody knows your name!” she grins. “We meet at noon on Tuesdays and Thursdays. There are a variety of topics and guest speakers, and with the virtual events, I feel like the presenters are talking directly to me… I have the best seat in the house.” As far as being a senior goes, Rhogenia is living her best life and has some advice to help others do the same. “As a senior, I have the time to explore and take advantage of the many opportunities available out there,” she says. “I live life in the present and to the fullest. I make the most of each day because tomorrow, it will be the past.” Rhogenia feels that the biggest challenges for seniors today are health and isolation, and wants people to know there’s help if they need it. “Sometimes we need a little help to make everyday activities a little easier, or just need a person to talk with,” she explains. “My advice is never be too proud to ask for help with anything! Most people are glad to help or guide you to someone who will.” “Lastly, to seniors, I would like to say this: Love yourself and make peace with who you are and where you are at this moment in time,” Rhogenia continues. “And give yourself a big hug!” The Sterling Silver Club thanks Rhogenia for dazzling us with her story, her friendship and her collaboration – and we send her and all of our members a “BIG hug.”

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While breastfeeding is natural, it's not always easy. We asked Certified Lactation Counselor Sarah Mitchell for some tips to help make the process easier for mom and baby. From increased infant immunity to improved maternal health and well-being, the benefits of breastfeeding are many. Still, only 60 percent of U.S. moms in the United States continue to breastfeed past their baby's first six months. There are for many reasons for why moms stop, including the mother's their need to return to work. We reached out spoke to Sarah Mitchell, a certified lactation counselor at The Lactation Connection at Renown, for some expert advice. Tip 1 At first, it's normal to expect obstacles. Even in cultures where close to 100 percent of moms breastfeed, they can experience issues, including getting the baby to "latch on," sore nipples, and milk production. In addition, it sometimes can take several weeks for mom and baby to get comfortable. Tip 2 Line up a coach, even before the baby is born. This can be a professional lactation coach, family member, or friend who is experienced and encouraging. While online videos can be helpful, most new moms need the one-on-one guidance that a coach can provide. Renown offers outstanding resources in its Lactation Connection center, including expert consultants, products, and support. Tip 3 Well ahead of the due date, set up a support network of friends, family members, or community groups such as La Leche League. Women historically have relied on extended support systems to help them with raising children, and breastfeeding is one of those areas that, while natural, still needs encouragement from the women who’ve been there. Tip 4 Don’t get discouraged if you need to supplement at times with formula. This, too, as it turns out, is not uncommon in other cultures. In other parts of the world, babies are given beverages and foods such as tea, broth, soup, juice, mashed bananas, and papaya. The American Academy of Pediatrics recommends supplementation only with approved formula -- but the point is, it’s ok to supplement if you need to. Finally, don’t forget the importance of breastfeeding for connecting with your baby. It’s essential to maintain breastfeeding over the weekends, preferably “on-demand,.” and will keep that special bond strong after you have returned to your job.

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