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Breast cancer is the leading cause of cancer deaths in women in the U.S. That’s why early detection is so important. Dr. George Krakora, a radiologist with Renown Institute for Cancer, explains what to watch for and how new technology can lead to early detection. Most women know the importance of breast health and staying current with annual breast exams, but may not know that both screening guidelines and technology is evolving. So we asked George Krakora, MD, a radiologist for the Renown Institute for Cancer, what every woman should know about breast cancer detection and which screening method is right for them. First off, when should women start getting breast exams? Generally, women should start getting breast exams using mammography or ultrasound after they turn 40 years old. But we also want women ages 18 to 39 to talk to their primary care provider and ask for what’s called a formal risk assessment to see if screening is needed sooner. And you want to make sure your care provider is giving you a breast exam starting at age 25. It’s also a good idea to be familiar with how your breasts look and feel so you can report any changes to your care provider. What are the risk factors for breast cancer? Are there any preventive steps women can take? There a few risk factors you can’t control, like your age, family history of breast or other cancers, and if you have dense breast tissue. Your risk for breast cancer increases as you get older, and most breast cancers are diagnosed after age 50. Knowing your family history is important because a history of cancer and shared lifestyle can raise your risk. Your breast density can also increase your risk: Women with high breast density are four-to-five times more likely to get breast cancer than women with low breast density. But the good news is there are quite a few things you can do to prevent breast cancer, like not smoking, watching your alcohol intake, and maintaining a healthy weight with good diet and exercise. There are a lot of newer screenings out today. What is the difference between 2-D and 3-D mammography? In a 2-D mammogram, the tech takes X-rays of the breast. These pictures can show the radiologist if there are any lumps or tumors you might not be able to feel. In 3-D mammography, the process is largely the same but more X-rays are taken and it takes a few seconds longer for each image. This kind of exam detects 41 percent more cancers and reduces the number of false-positive results given to patients. This improvement in technology is great for both patients and their care providers. 3-D mammography provides better images of the breast, which allow doctors to more clearly diagnose and avoid false positives, especially in women with dense breast tissue. And what about a whole breast ultrasound. What is that? A whole breast ultrasound uses sound waves to detect cancerous tumors in the breast without using any radiation — it’s an ultrasound just like pregnant women get to check up on their baby. And the exam only takes about 20 minutes. We recommend these exams for patients whose mammograms have shown that they have dense breast tissue. Dense breast tissue can make it harder for doctors to see any abnormalities, lumps or tumors in a mammogram, so this technology ensures better early detection.

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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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According to the American Cancer Society, approximately 14,100 new cases of invasive cervical cancer will be diagnosed, and 4,280 women will die from cervical cancer. However, cervical cancer is preventable with regular screening tests and the HPV vaccine. It’s important to note that medical advances have allowed progress in diagnosing and treating cervical cancer. While it used to be one of the most common causes of cancer death for American women, the incidence of death has significantly declined. What to Know About the HPV Vaccine HPV vaccination is the best way to prevent cervical cancer and is recommended for all youth starting as early as age 9, or for teens and adults up to age 45 who didn’t start or finish the series. In Nevada, only 50.1% of teens ages 13-17 have been vaccinated for HPV.  There are 13 types of HPV, and the vaccine Gardasil 9 protects against 9 of those HPV strains, greatly reducing the incidence of cervical cancer among vaccinated individuals. What to Know About Cervical Cancer Screenings The CDC says the most important thing you can do to help prevent cervical cancer is to have regular screening tests starting at age 21. And there are two common tests that can detect early stages of cervical cancer (or precancer) and improve health outcomes. The pap test (or pap smear). This screening looks for precancers. Women should begin getting pap smears when they’re 21. The human papillomavirus (HPV) test looks for the virus that can cause these cell changes. Cervical Cancer Screening Schedule The American Cancer Society offers the following guidelines for screenings: All women should begin cervical cancer screening at 21. Women between 21 and 29 should have a pap test every three years. Beginning at 30, the preferred way to screen is with a pap test combined with an HPV test every five years. This is called co-testing and should continue until age 65. A pap test (or pap smear) is performed during a regular screening appointment to look for precancers, cell changes on the cervix that might become cervical cancer if they are not evaluated or appropriately treated. Typically outpatient procedures can reduce the risk of long-term health impacts that prevent pre-cancerous cells from becoming cancer cells. Women over 65 who have had regular screenings in the previous ten years should stop cervical cancer screening as long as they haven’t had any severe precancers found in the last 20 years. How to Get Screened Request an appointment with your primary care physician or OBGYN to schedule a screening.

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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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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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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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Parkinson’s disease – you may have heard of it because Neil Diamond and Ozzy Osbourne were recently diagnosed with it. Or perhaps you know Michael J. Fox is a strong advocate and funds research through his foundation. Neurologist Jonathan Spivack, MD, discusses this disease, while physiatrist Stephanie Jones, DO, explains how physical therapy can help as a supplemental treatment. According to the Parkinson’s Foundation about ten million people worldwide currently have this disease. What is Parkinson’s Disease? “Parkinson’s disease is a neurodegenerative disease that progresses slowly and definitely, though at variable rates,” explains Dr. Spivack. “Symptoms go beyond the classic motor changes. It results from a loss of specific dopamine-producing brain cells. Specifically, this loss is likely due to a mix of genetic and environmental factors,” he adds. Dopamine allows communication between particular nerve cells responsible for movement. If you have Parkinson’s dopamine levels gradually drop, causing a loss of motor skills. Generally, most patients with the disease are over age 65. Early Signs and Symptoms Diagnosing Parkinson’s can be difficult as some of the symptoms happen during the natural aging process. The Parkinson’s Foundation identifies the following 10 early signs of PD: Tremors or shaking of your hand, fingers or chin Small handwriting Loss of smell Sudden movements during sleep Stiffness when walking or moving Constipation Softer or lower voice volume Mad facial expression Feeling dizzy or faint Hunching or stooping posture A single sign may not point to the disease, but if you (or a loved one) has multiple signs, talk to your healthcare provider.

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Dr. Derek Beenfeldt first joined the Renown family in 2014 as a family medicine physician after graduating from University of Nevada, Reno, School of Medicine (UNR Med) in 2011. His son Davis was only 10 years old when Dr. Beenfeldt decided to change careers and attend medical school. Ten years later, Davis is following in his dad’s footsteps as a third year student at UNR Med. “I am proud of Davis for taking on the challenges and the commitment that I know goes along with attending medical school,” Dr. Beenfeldt said. “I also feel lucky that we have a medical school with such a great reputation and resources close to home.” The affiliation is a great source of pride for Dr. Beenfeldt. Not just because two important organizations in his life are joining forces, but he also sees it as both entities taking on an immense responsibility – the challenge to be better for incoming students, and subsequently to improve healthcare in Nevada. Davis is currently going through his rotations and spending countless hours a week at Renown Regional. His dad is right there by his side supporting him along the way. “It has been really interesting to have discussions about the UNR medical school with Davis, I recognize the names of many of the professors and courses from when I was a student,” Dr. Beenfeldt said. “I tried to be empathetic, as I can relate to how difficult and stressful this time is for him. Dr. Beenfeldt currently works as chief medical officer for Renown’s insurance arm Hometown Health, and Davis is still browsing specialties. “I don’t know what kind of medicine I want to focus on yet, but I feel lucky that I can attend medical school so close to home and have the option to continue helping my fellow Nevadans after I graduate.” UNR Med at a Glance UNR’s Medical School was established in 1969 Over the last 50 years, UNR Med has educated 3,900+ physicians More than 30% of UNR Med physician graduates continue to practice in Nevada UNR Med is the state’s oldest medical school

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