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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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You can still have a healthy pregnancy and baby if your pregnancy is high-risk. Learn what steps you can take to give your baby the best start possible. A “high-risk” pregnancy is one that threatens the health or life of the mother or her fetus. Women with high-risk pregnancies should receive care health care specialists to ensure the best possible outcomes. Some examples of a high-risk pregnancy include: Maternal age, women 35 and higher or 17 and younger Lifestyle choices, including smoking, drinking alcohol and illegal controlled substances Existing medical history, chronic hypertension, diabetes and breathing issues Multiple gestation, pregnancy with twins or triplets Overweight and underweight  Remember: You can still have a healthy pregnancy and baby if your pregnancy is high-risk. Some ways to promote a healthy pregnancy: Schedule an appointment with your OBGYN Eat a balanced diet Avoid substances Prenatal care Healthy weight gain Reduce stress Exercise  Pregnancy & Childbirth at Renown | 775-982-KIDS (5437) When you are expecting a new baby, you can depend on Renown Children’s Hospital for all your mom and baby healthcare needs. We can help you find the right doctor and tell you what to expect during your stay. We offer childbirth education classes and tours to help you prepare. Be sure to check out our virtual tours of our Labor Assessment Area.

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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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Deciding you’re ready to start a family is a big decision for any couple. So once you’ve decided – what are the next steps for both moms and dads-to-be? And what should you know if you’re struggling to conceive? Dr. Myron Bethel, OB/GYN with Renown Women’s Health, offers key insights about fertility. What’s the first thing couples should do when they decide to start a family? For the mom-to-be, it’s important to meet with your obstetrician before you get pregnant. This appointment gives you an opportunity to discuss your family medical history, any past or current health problems, immunization history, medications you’re taking and any issues with previous pregnancies. Your doctor can also provide helpful tips to ensure your body is ready for a healthy pregnancy and help guide you on how to monitor your period, basal resting body temperature and other important factors to help you get pregnant more quickly. How can couples who are trying to get pregnant make sure they’re healthy to conceive? Of course it’s important to maintain a healthy lifestyle all the time, but it’s especially important if you’re trying to get pregnant. There’s no magic pill or single food, but women should start focusing on nutrients they’ll need during pregnancy. Before trying to conceive, start taking folate and folic acid to help prevent birth defects. You can get good sources of these nutrients from cereal, spinach, beans, asparagus, oranges and peanuts. Lifestyle changes can also help improve fertility. For both men and women, extra weight can reduce fertility. Both sexes can increase their chances of conception by not smoking, not drinking alcohol and exercising regularly. And for men specifically, take a daily vitamin containing zinc and selenium to support healthy sperm. What is the average timeline for conception, and what do you suggest for couples who may be struggling to conceive and start a family? First, remember getting pregnant can take longer than you expect. Do not to get stressed out about it or place blame. Seventy percent of couples conceive within six months and 85 percent within one year of trying to get pregnant. To help improve your chances of pregnancy, monitor your ovulation closely. You can do this by tracking your period, watching your body closely and logging symptoms, logging your basal body temperature or using ovulation kits. If you still aren’t sure when you’re ovulating, try to have sex every other day to improve your chances of conception. If you’ve been trying for nine months to a year, you can talk to your OB about options and discuss meeting with a fertility specialist.

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Watch as two dads look back on their newborn adoption process. They reminisce about discovering their newborn was on his way — and how Renown Health subsequently helped them navigate the process.  During Memorial Day weekend, Chris Mulhern and his husband, Jeffrey Bodimer, learned a set of birth parents chose them to parent their unborn baby boy. After writing a letter to the birth parents, they were chosen over other applicants in a private adoption. The adoption agency took care of many details, like connecting Mulhern and Bodimer to the birth mother and dad. In fact, they could participate in nearly all the phases of the pregnancy. The mother's prenatal care and delivery took place at Renown Health, where Mulhern and Bodimer attended her appointments and took childbirth classes. "Our experience was wonderful at Renown," says Mulhern. "We thought it was absolutely incredible how nice and accepting everyone was." The Nuances of Newborn Adoption Their son, Bradley, was born via cesarean section. And the adoptive parents got to see him an hour after he came into the world. The labor and delivery nurses even helped coordinate everything between them and the birth mom. Mulhern and Bodimer stayed in a room at The Inn at Renown. The closeness of the facility on the Renown campus made it possible to feed Bradley every two hours. Incredible Nurses "They were great, the nursing staff. If we weren't sure about doing something right, about burping him right they would say 'It's okay. He's not going to blow up. He will eventually do it'," says Mulhern. The nurses also made arrangements for the two dads to participate in skin-to-skin contact with their newborn baby. Experts agree parents and babies should be in direct contact for at least the first 1–2 hours after the birth. Taking Baby Home Chris and Jeffery took Bradley home after three days at Renown. “It was the most joyful thing to be chosen as his parents, even before we met him,” says Chris.

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

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We asked, you answered: Moms and dads who have been there, done that offer up 10 pregnancy surprises. These are the things they wish they knew before, during and after their pregnancy. Check out these real examples of insights that would have proved helpful and enlightening to these parents and parents-to-be. When you’re pregnant or considering becoming pregnant, it seems the unsolicited advice runs rampant. You’ll hear people tell you what kind of Boppy Pillow to buy. You’ll have people tell you that you should “definitely” have a natural birth or a pool birth or a doula or a therapy dog present. And you’ll definitely hear about what kinds of foods to induce labor, what kind of tea to drink to reduce nausea during your pregnancy and what kind of underwear for less “chafing.” But something you might not hear as often: Some of the symptoms and side effects, both before and after giving birth, that were totally unexpected. These are the ultimate pregnancy surprises. So we asked the question of moms and dads who have been there, done that: What do you wish you had known would happen during your pregnancy — you know, during the time you were supposed to be all sweet and beautiful and glowing? Here is Part 1, featuring 10 real-life, crowdsourced pregnancy surprises from parents. And yes, there are multiple parts to this post, because people are passionate about sharing their wisdom! We’ll publish the second part later this month. Pregnancy surprises: What do you wish you had known about pregnancy? “The only symptom I never heard anyone talk about is extra blood flow making me feel all sorts of weird feelings in my head. I feel like I’m in a dream half the time. I looked it up online when it started happening, and tons of women have the same symptom.” — Anna K. “For me it was an after-birth surprise. I had no clue your tummy doesn’t just spring back to where it was pre-pregnancy. It was a rude awakening in the hospital when I had to have my husband go home and get a pair of maternity sweatpants to get dressed to go home in. I’d hoped to dress in my old cute jeans…. nope!” — Suzanne M. “I didn’t know that while you’re pregnant, friends and strangers would tell you their nightmare delivery stories. Oh — and that complete strangers will, uninvited, touch your baby bump. I didn’t know that you’re in the safety zone while pregnant and that men and women openly adore you. I didn’t know that besides the mother, the nurses do most of the work. I didn’t know that even though they’ve obviously seen hundreds of deliveries, nurses and doctors cry too once your baby is out. I didn’t know even though I thought they must be crazy to send a tiny human home with me, that you instinctively know how to parent. I didn’t know what it meant to love something more than myself and how that changes everything.” — Cathy B. “I had no idea the weird things that it does to hair. My bangs stuck straight out for months, and I just had to go with it. There wasn’t enough product that would make them lie down.” — Heidi P. “That you may not go home with your child if there are any complications. That was a sad day. But 22 years later, we are blessed, because everything turned out fine.” — Kristine F. “I didn’t know people would opine out loud to you, that you must not have purposely gotten pregnant with Baby #2 or 3, etc., implying you failed basic high school biology and that you should have known better than to have more than one kid.” — Jessica L. “I didn’t know that near the pregnancy’s end, as the hips widen, that those bones could begin to separate. I was sore and achy. And I wish I’d slowed down and rested more in the last few weeks.” — April C. “I had heard about food cravings, but no one told me food aversions were also a thing. I bought a whole load of groceries for the week, and by the time I got home, I suddenly couldn’t even look at the ground turkey (that’s not an exaggeration), let alone cook it and eat it. I didn’t throw up necessarily, but my body told me to avoid most meats and vegetables. I pretty much lived on plain bagels and cereal for half my pregnancy.” — Danielle S. “Morning sickness is SO not just in the morning! All-the-time sickness is what I experienced. And why didn’t anyone warn me about butthole pain during and after birth?” — Stephanie C. “The juiciness. Every possible secretion was in hyper drive.” — Jane F. Giving Birth at Renown At Renown Regional Medical Center we have the skill, expertise and technology — along with a friendly environment — to make your experience a memorable one. Pre-register for childbirth, take virtual tours of our rooms and facilities, and learn more about our labor and delivery offerings at the link below. Explore Our Services

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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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You’ve likely heard about bariatric surgery — and perhaps even have friends who’ve done it. But is it a potential solution for you? Here, Dawn Remme, RN, Metabolic Bariatric Surgery Program Manager, provides insight. You may have been struggling with excess weight for years. You’ve tried high-protein diets, low-carb diets and more. Most patients considering weight loss surgery have tried numerous dieting methods. The truth is, some patients who suffer with obesity are successful dieters. Unfortunately though, excess weigh often returns. This impacts their health and the quality of their life. It can be a disheartening battle. Weight loss surgery is a big decision. In making this decision, keep in mind that surgery is only one step toward your goal of achieving better health. It is neither magic, nor is it the “easy way out.” Weight loss surgery can offer you a TOOL to help you become more successful in controlling the disease of morbid obesity. By combining this tool with a lifelong commitment to important lifestyle changes, medical follow-up and nutritional modifications, you have the potential to become a healthier you. Bariatric Surgery By the Numbers Exploring the facts about obesity, how it impacts your health, and how surgery can resolve or significantly improve your chronic medical conditions is the first step to making a decision. Obesity is medically defined as “excess body fat” and is measured by a mathematical ratio known as the Body Mass Index (BMI). To calculate your BMI, we consider your height, weight, age, gender and body build. Here are the standards: “Normal” BMI: less than 25 Overweight: 25 – 29.9 Obese: BMI of 30 – 39.9 Morbid obesity: BMI of 40 or more Morbid obesity (BMI over 40) is a lifelong, progressive disease, and the prevalence of morbidly obese Americans (100 or more pounds over a healthy weight) is increasing rapidly. According to the CDC, the disease of obesity affects 78 million Americans. Further estimates indicate about 24 million have morbid obesity. Serious medical problems known as co-morbidities often occur when someone is morbidly obese. Studies tell us conditions such as type 2 diabetes, high cholesterol, sleep apnea, high blood pressure and degenerative arthritis increase in severity as the BMI is increasing in patients. When may weight loss surgery be an option? When someone has a BMI greater then 40. If a person’s BMI is 35 – 39.9 and they have significant health problems such as type 2 diabetes, high blood pressure, high cholesterol, sleep apnea, or other diagnosed health conditions related to obesity. Gastric Sleeve, Gastric Bypass Explained To resolve or significantly reduce these health conditions, bariatric surgery can be done when diet and exercise haven’t worked. Weight loss surgery makes changes to your digestive system to help you lose weight. The gastric sleeve limits how much you can eat, whereas gastric bypass limits how much you can eat and reduces the absorption of certain nutrients. Other Benefits of Surgery You can greatly increase life expectancy by resolving or significantly improving conditions like diabetes, high cholesterol, high blood pressure, sleep apnea, and obesity itself. Infertility can also be positively affected. A significant weight loss and relief from serious health conditions and diseases will greatly improve your quality of life. Studies tell us that type 2 diabetes is resolved or significantly improved in 84 percent of patients following bariatric surgery. Cholesterol levels dropped in 95 percent of patients. And hypertension and sleep apnea showed improvement in 68 and 80 percent of patients, respectively, following bariatric surgery. Bariatric Surgery at Renown In making the decision to move forward to better health, it is important to remember: Obesity is a disease, and the desire to have a healthier, longer, more fulfilling life is possible. If you are interested in learning more, please visit the Bariatric Surgery Program page to view more information about Renown Regional Medical Center’s MBSAQIP accredited bariatric program, as well as information about upcoming educational seminars. Or call 775-982-RSVP (7787) to reserve your seat. Learn More

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Watch what happens when a family’s matriarch finds out she has to have heart valve replacement surgery. Thanks to supportive cardiac care, she is now back to health and enjoying her extended family with a healthy heart.  Marilyn O’Gorman has a full heart full of love: Just ask her six children, 15 grandchildren and six great grandchildren. However, in 2009, tests showed that same heart had medical issues. So her close family was by her side when she underwent heart valve replacement surgery. O’Gorman says her heart doctor, Athan Roumanas, MD, FACS, put her at ease about the surgery. “You’re very nervous — you’re scared,” says O’Gorman. “You don’t know: Are you going to come out of it? Is it going to work?”  Heart Valve Replacement Surgery Comes with an Unexpected Question O’Gorman was asked to choose whether she’d prefer a pig or a cow valve — ultimately inquiring of Dr. Roumanas which one he’d choose for his own mother.  “And he said, ‘Well, probably pig,'” she recalls. “And I said, ‘OK, I’ll oink for you.’ And that’s how I got that, and he did a wonderful job.”  O’Gorman continues her care at the Renown Institute for Heart and Vascular Health, so she can stay heart healthy and spend her free time with the many generations of family in her life.

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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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