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Renown’s team of nurses and respiratory therapists discuss what you need to know before undergoing surgery, including fasting guidelines and how to improve recovery. There are several things to know before you undergo surgery, including steps to prepare at home in advance of your procedure.   Fasting Guidelines: No solid foods eight hours prior to surgery You may have clear liquids three hours before your surgery. Clear liquids include water, apple juice and lemon or lime-flavored soda water (not cola). In addition, do not chew or smoke tobacco (regular or e-cigarettes) after midnight the night before your surgery, unless instructed by your doctor or anesthesiologist.

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At 85, James Domingos is still enjoying life as a cowboy, thanks to a transcatheter aortic valve replacement. Always rolling with the punches when it comes to life, 85-year-old James Domingos faced his health issues with the same grit. For many years, he roped cattle for friends and rounded up horses for the Bureau of Land Management. In recent years, a pacemaker controlled the rhythm of his heart, but didn’t slow him down. “We used to be able to take walks for 15 minutes in one direction and take the dog,” says Domingos’ wife, Joy. “Then it got to be less and less.” Tests at Renown Health revealed a heart valve was nearly closed. His heart doctor, Jake Ichino, MD, FACC, FSCAI, suggested a transcatheter aortic valve replacement, known as TAVR, which repairs a heart valve without removing the damaged valve. The procedure is recommended for patients who are at high risk for open heart surgery.

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If you’re having surgery on your shoulder, why does it matter what’s in your stomach? We asked Dr. Matthew Hoberg to explain more about pre-surgery directives, including fasting. If you have an upcoming surgery, your care team likely gave you instructions to fast before your procedure. But why? We asked Matthew Hoberg, M.D., medical director of Renown Surgical Services, to explain why it’s important to forgo food and drinks before surgery. Why are patients instructed to fast before surgery? Regardless of surgery type or site, we want the stomach to be empty before having anesthesia, because anesthesia can reduce your body’s ability to protect and prevent food or acids from the stomach from entering the lungs. Normally, your body is able to prevent this, but anesthesia medicines make it harder for your body to do so. When food or liquids from the stomach get into the lungs, doctors call it “aspiration.” This is rare, but can be dangerous if it does happen. Solid foods and liquids leave the stomach at different rates too. Solid food takes longer to empty from the stomach than liquids, so the time to stop eating solids (eight hours) is longer than that for clear liquids (two hours). The body has energy reserves to produce needed nutrients and fuel during fasting. Recently, studies have shown it is important to stay hydrated and have some carbohydrates in clear liquids up to two hours before surgery, so clear liquids are allowed until two hours before surgery. There are also special rules for babies and young children who need surgery. For example, you may give breast milk up to four hours before surgery. If your baby drinks formula, you should stop six hours before surgery, and all solid foods you should stop eight hours before. Your child’s doctor or nurse will give you exact instructions. What if you show up for surgery and have broken the no-eating rule? Will surgery be re-scheduled? If patients have not followed the fasting guidelines, surgery will be postponed or rescheduled due to the possible increased risk associated with not having an empty stomach. The exception would be emergency surgery that cannot be delayed in which case special precautions are taken to help prevent anything from getting into the lungs. What other pre-operative rules should be followed to the letter? All instructions given to patients before their surgery or procedure should be followed. There are specific medical reasons behind all the instructions and they are designed for safety — to minimize risks, lower complications like infections and enhance the recovery process to help patients get back to normal as quickly as possible. Also, many patients ask if they should continue taking medications before surgery. The answer is: It depends. Your doctor or nurse will tell you which medicines you should take and when. Some medicines need to be stopped before surgery. But for others, it’s important you keep taking them as usual. You may also get new medicines to take before surgery. You may be asked to take some medications before surgery as part of advanced pain management protocols. If you need to take medicine right before your surgery, you can take it with a sip of water.

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Many factors are contributing to the rise of early onset puberty in girls. Learn what they are below and how you can support your daughter. The number of girls experiencing early puberty has increased dramatically over the last few years and continues to grow. More and more girls in the U.S. are starting to show signs of development before the age of 8. Recent studies show that up to 10 percent of Caucasian girls and 23 percent of African American girls are showing signs of puberty by age 7. What’s Contributing to Early Puberty in Girls? Determining the exact cause is difficult. But experts agree that several factors may be contributing to these growing numbers. Increasing rates of childhood overweight and obesity. Excess body fat alters the levels of hormones responsible for the acceleration of pubertal timing. Physical inactivity may decrease melatonin levels, which can also trigger pubertal development. Increased animal protein intake. Higher total protein, animal protein and meat intake in children ages 3 to 7 have been associated with earlier onset of menstruation. High protein intake elevates IGF-1 levels and promotes growth, which could accelerate the onset of puberty. Poor diet. Children with lower-nutrient diets tend to enter puberty earlier. A diet rich in processed foods and meats, dairy, and fast food is disruptive to normal physical development. Exposure to EDCs (endocrine-disrupting chemicals). EDCs are synthetic chemicals found in plastics, pesticides, fuels and other industrial chemicals that inhibit or alter the action of natural hormones. Because EDCs accumulate in the fatty tissues of animals, animal foods contain higher levels of these chemicals than plant foods. Exposure to BPA (bisphenol A). BPA is an industrial petrochemical found in a variety of products including plastics, tin-can linings and even cash register receipts. Because it acts as a synthetic estrogen it may speed up pubertal development. Soy products. Soy contain isoflavones which are converted to phytoestregens in the body, and are similar to the hormone estrogen, Dr. Chelsea Wicks says. “Soy consumed from natural food sources is likely safe and will not cause abnormal hormones levels. However, when consumed in large amounts, such as with soy supplements or in more processed foods, there have been links to chronic medical problems due to elevated estrogen levels. I feel a good answer to this is to continue working on eating fresh foods and trying to avoid the processed, packaged foods as this will be best for overall general nutrition as well,” she adds. What You Can Do While some genetic factors play a role in the early onset of puberty, parents can help lessen environmental causes of the condition. Encourage and help your child to maintain a healthy weight with proper nutrition and exercise. Avoid exposure to hormones such as estrogen and testosterone that may be found in hair products, medications and nutritional supplements. Avoid exposure to EDCs and BPA. Offer your child a diet centered around whole plant foods rather than animal foods, which will help keep protein intake within a safe range and reduce consumption of EDCs. Create a supportive environment for your daughter. Avoid commenting on her appearance and instead focus on her achievements, academic successes or artistic talents. Speak to her openly and honestly about the physical changes she’s experiencing — that although these changes are normal, she’s simply developing early — and that ultimately her peers will undergo the same changes. Encourage your daughter to continue participating in social activities and pursuing her interests, and reassure her you are always open to discuss any questions or worries. If you are concerned that your child may be going through these changes before expected, speak with your pediatrician. Sources: Early Puberty: Causes and Consequences When Is Puberty Too Early? Precocious Puberty (Early Puberty) Precocious Puberty

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