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Everyday, Renown salutes its more than 150 active military and veterans on staff. Becca Gilbert, a Renown trauma nurse, is an example of the many outstanding service members at Renown who are serving both their country and their community. Becca Gilbert, BSN, RN, wears many uniforms. When she’s not wearing scrubs in her role as a trauma nurse in the intensive care unit of Renown Regional Medical Center, she’s wearing fatigues as a first lieutenant in the Nevada Air National Guard. “Service is huge,” says Becca Gilbert, RN, of her role in the Air Guard. “It’s something that is ingrained in me and a big part of who I am as a person. I find a lot of pride in being a part of something that is bigger than what is going on in my world.” Renown Health was named one of 15 recipients across the nation — and the only health system in the U.S. — for the Department of Defense’s highest employer award, the Secretary of Defense Employer Support Freedom Award, for exceptional support of its military employees. The Employer Support of the Guard and Reserves and Renown held a ceremony June 29 to recognize the award and to honor representatives of Renown who currently serve in the Guard and Reserves. With her Air Guard background, Gilbert is preassigned veteran patients at the Renown ICU. She says she’s able to relate to the veterans and their families and create a quick bond with them. “I’ve been assigned patients who are guard members with traumatic injuries — it’s good but hard,” Gilbert explains. “But I really love working with patients who are veterans.” Gilbert’s first career was as a veterinarian technician. Then enlisted in the Nevada Air National Guard in August 2008 — following in her father’s footsteps — and trained to serve as an EMT. While she was a medic, she went to nursing school for her second bachelor’s degree and was able to commission as an officer after graduation. Serving Our Community Gilbert says her work in the guard offers benefits that help with her job responsibilities at Renown, where she’s worked for four years. “At Renown, we are really a team and rely on each other to make sure there are good outcomes,” she says. “In the guard, officers are often put in charge, which teaches you a lot of things — organization, decision making and thinking of others. I think all of those things go hand-in-hand with my role as a nurse, especially in the ICU. People in the guard count on you as an officer and leader, and that is really important in the ICU when patients are counting on you for a positive outcome.” Gilbert’s responsibilities in the guard vary, including training for disaster relief missions and ensuring service members are fit and healthy enough to perform their jobs. “Training is a large part of the military — trauma training, physical fitness training and staying current on certifications,” she says. Locally she also leads the Self Aid Buddy Care program, a United States Air Force program that encompasses basic life support and limb-saving techniques to help wounded or injured personnel survive in medical emergencies until medical help is available. With the guard, Gilbert has also been involved in a bleeding-control program for volunteers in the community. She teaches community groups how to stop bleeding if they are a bystander to a car accident or other type of event, and is working with Renown trauma surgeon Marty Bain, M.D. to implement the program at Renown as well. Making a Difference Abroad In January, Gilbert was presented with an opportunity through the Nevada Guard State Partnership Program to travel outside the United States to the Kingdom of Tonga in the South Pacific and work at the Women and Children Crisis Centre, which assists families who are dealing with domestic violence. Gilbert praised the women who work at the center for their efforts towards change, as she says domestic violence is common in Tonga. “The women who work at the Women and Children Crisis Centre are pioneers,” she says. “They are trying to make changes by documenting what is going on and providing statistics to the lords and kings of Tonga. Some of it still isn’t accepted, but they continue to help the women and children of Tonga. They are helping so many people.” Renown Health salutes Gilbert for her tireless service to her country and her community here at home.

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Gone are the days of soggy PB&Js on white bread: Today’s school lunch is your chance to create a healthy, colorful midday meal! Here are a few simple tips, a week of lunch ideas and a shopping list to help you pack a lunch that won’t be offered up for trade during tomorrow’s lunch hour. While school lunches are getting healthier, packing and taking a lunch to school will ensure that your child is getting a healthy, well-balanced meal. Making lunches should be a team effort. Your kids can help pack their lunches by spreading on condiments or putting food in containers. To save time in the morning, pack lunches the night before. The following are a few suggested items you can use to ensure your child is eating a tasty but nutritious lunch: Main dishes Lunch meat and lowfat cheese roll ups English muffin pizzas Sandwich wraps – meat, cheese and veggies in a whole grain tortilla Pita pockets stuffed with grilled chicken and vegetables Soup Chef salad with spinach, veggies, cheese, lunch meat and dressing Tuna or chicken salad on a mini bagel Snacks and sides Fresh or dried fruit Natural apple sauce Baked tortilla chips and salsa Veggie sticks and hummus Cheese slices or string cheese with whole grain crackers Homemade trail mix with nuts, seeds and raisins Pudding Homemade fruit roll ups Popcorn (add different toppings such as salt, garlic, cinnamon, sugar or cayenne pepper) Drinks Water If you child doesn’t like plain water, try adding a few slices of fresh fruit (strawberries, lime, lemon) for more flavor. School Lunch Menu: Day-By-Day We’ve put together a week’s worth of colorful, fun and healthy school lunch ideas your kids will love. And we’ve also created a shopping list to help you easily locate all the ingredients on your weekend shopping trip. Monday: Turkey BLTA Roll-ups Roll-up Ingredients Turkey, cold cuts Bacon Avocado Tomatoes Side Dish Choices Blueberries Cucumbers Carrot sticks Tuesday: Bacon & Cucumber Sandwich Sandwich Ingredients Whole wheat English muffin Cucumber Bacon Side Dish Choices Apples slices Strawberries Vanilla yogurt mixed with sprinkled cinnamon Wednesday: DIY Lunchables Lunchables Ingredients Crackers Turkey, cold cuts Cheese Side Dish Choices Blueberries Carrots Cucumber Thursday: Veggie Grilled Cheese Veggie Grilled Cheese Ingredients English muffin Cheese Tomato Spinach leaves Avocado Side Dish Choices Apples slices Strawberries Vanilla yogurt mixed with sprinkled cinnamon Tomatoes Friday: DIY Pizzas DIY Pizza Ingredients 2 toasted English muffins Pizza sauce Cheese Turkey pepperoni Side Dish Choices Celery Black olives Shopping List (under 20 items) Cold section: Dairy 1 large container of vanilla yogurt 1 package of your favorite cheese  Cold section: Deli meats 1 package of turkey pepperoni 1 package bacon 1 package turkey cold cuts Inside aisles Whole wheat English muffins 1 can of whole black olives 1 jar of pizza sauce 1 box of whole wheat or multigrain crackers  Produce department 1 cucumber 1 stalk of celery 2 apples 1 container of strawberries 1 avocado 2 tomatoes 1 bunch of spinach leaves 1 container of blueberries 2 carrots  For more healthy school lunch box options, visit our Kids Health & Nutrition board on Pinterest.

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Sometimes, children’s asthma masks itself in symptoms that can be similar to other common respiratory problems. Dr. Shipra Singh of Renown Medical Group – Pediatrics discusses some diagnoses and treatments for asthma in children. Adults can easily recognize when we are out of breath or struggling to breathe, but what if you noticed this regularly happening to your infant or child during their daily play? Would you think they might have asthma? It may be difficult to tell if your small child has asthma because the symptoms can be similar to other common respiratory problems (bronchitis, croup, pneumonia) or even allergies. Read on to learn how to spot and manage asthma in your infant or child with advice from Shipra Singh, M.D., MPH, Pediatric Pulmonologist at Renown Medical Group – Pediatrics. According to the Centers for Disease Control, asthma in children is a leading chronic illness and cause of school absenteeism in the U.S. Asthma is a multi-factorial disease. Smoking during pregnancy or a family history of allergies or asthma has been linked to a greater chance of developing childhood asthma. Asthma is usually on a spectrum and not a single disease. It can range from mild to severe. Because an infant’s or toddler’s airway is smaller than in older children and adults, even a slight blockage caused by mucus or a restricted airway due to swelling can make breathing hard for them. In children five and younger, one of the most common causes of asthma symptoms is a respiratory virus, which narrows the airways in the lungs. These include a cold, the flu, bronchitis, pneumonia and other illnesses. How can I tell if my child has asthma? Unfortunately small children are unable to describe their symptoms, making asthma difficult to diagnose. Your child may even be active, playing and smiling, although they are experiencing chest tightness or labored breathing. Observe your child and let the child’s doctor know if: Your child’s breathing behavior has changed (coughing, wheezing, rapid breathing) Your child’s breathing pattern changes (day vs. night, with rest or activity, inside vs. outside) You have a family history of asthma or allergies Your child’s breathing is triggered by any foods or allergies With your help, your child’s doctor can make the best diagnosis to determine if your child has asthma. A pediatric pulmonologist (lung specialist) or pediatric allergist may also have to be consulted for special testing. Tests may include lung function testing, allergy tests, blood tests and X-rays for an accurate diagnosis. What is the treatment for infants and toddlers? Young children can use many of the same medications as older children and adults, although the way they take them and the dosage will differ. A nebulizer (or breathing machine) creating a medicated mist for your child to breathe through a mask may be used. An inhaler with a small spacer tube connected to a mask is also common to help your child breath medication into their lungs. Either of these options are effective. Asthma in children is treated with both fast-acting and long-term medicines to open up airways quickly for easy breathing and also to lessen asthma symptoms over time. Communicate with your child’s medical providers to create a personalized asthma management plan for them. How can I manage my child’s asthma? Recognize your child’s breathing habits and be aware of worsening symptoms. Consult with your child’s doctor on a daily asthma action plan to recognize worsening symptoms and track medications. (Here’s an example of an asthma action plan provided by the U.S. Department of Health and Human Services’ National Institutes of Health). Be consistent with the plan and talk to your doctor before changing it. Have an emergency plan in case of a serious asthma attack. Know where the closest ER is and know who can take care of your other children. Also know what the medical treatment coverage is under your insurance plan. We asked Dr. Singh about asthma in children: “Discussing asthma with your child may be a difficult subject. Some kids find the subject frightening or confusing. Others, especially the older kids, may be resentful of the treatment and may not be interested in doing the treatment. Talk to your doctor about advice to build an open and trusting relationship regarding your child’s asthma care.” What can I do to reduce my child’s asthma? Know your child’s asthma triggers (dust, pets, pollen, etc.) Follow your asthma action plan Keep your child away from smoke Can my child outgrow their asthma? Asthma symptoms change day to day and year to year. An older child can better recognize and manage their symptoms, so asthma episodes may lessen. However asthma is a life-long condition of the airways, so it is important to always have an asthma action plan, even with occasional asthma events. Renown Health Pediatric Care | Same-Day Appointments: 775-982-KIDS Our team of pediatricians, specialists and nurse practitioners have specialized training in children’s healthcare needs. We see children from birth to age 18 for the following pediatric needs: Wellness and preventive visits Sick visits Immunizations Behavioral health Allergy Asthma Common cold Diabetes  Asthma resources for parents: Asthma and Allergy Foundation of America Centers for Disease Control and Prevention

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Thanks in part to the care provided by Renown’s award-winning team of ICU nurses, Tony Mowatt is alive, thriving and engaged. Read his story — and learn about the exclusive Beacon Award of Excellence — below.  The open road. The growl of the engine. The feeling of freedom. That’s what Oakland resident Tony Mowatt was enjoying as he drove up Highway 88 toward Reno for the semi-annual Street Vibrations event. But he wasn’t expecting to hit the diesel truck — or to fly off of his bike over 100 yards, skidding onto the side of the road. He was severely injured and in the midst of rural Nevada. He had crashed just outside Centerville, Nev., and was miles away from any critical care hospital. Having the only trauma center equipped to treat his serious injuries, Tony was flown to Renown Regional Medical Center and admitted to the intensive care unit (ICU).   ICU Nurses Treat Patient, Support Family  Tony’s girlfriend, Tasha Klubock, was notified by his friend that he had been taken to the hospital. She immediately drove from Oakland to Reno to see Tony at Renown. Her first night there was overwhelming and scary — nobody knew if Tony was going to survive. But the nurses helped Tasha cope with the initial shock. Caring for the patient isn’t their only job — they also care for the family. “They [the nurses] just kept coming in and checking on me,” she said. “Angela was so amazing that first night. I really just bonded to her, and I remember when the shift switched, I panicked thinking about who was coming on and wanting to meet the next nurse … But they all came to talk to me — I had updates from everybody. It was just amazing.” ICU Nurses Became Family Tony spent 32 days in Renown’s Sierra ICU, surviving a serious head injury, all with Tasha by his side. He and Tasha still stay in touch with Renown nurses. “Even though this was literally one of the most hideous, craziest things to go through,” Tasha said. “There was so much hope and they became such a family to me and I still think of that time fondly because of the nurses.” “I’m alive because they wanted me to be,” Tony said. And Tony and Tasha are now happily engaged and planning their wedding. Exceptional Care: Renown ICU Nurses Win Awards Renown’s ICU nurses provide care like this every day to countless patients — it’s so second nature to them that they forget how exceptional it truly is. But it’s certainly care like Tony’s that has earned them national recognition. The American Association of Critical Care Nurses awarded the Beacon Award of Excellence to the Sierra, Cardiac and Roseview ICUs. These are the only ICUs in Nevada to obtain this honor. The Beacon Award recognizes critical care nursing teams who exemplify excellence in areas like leadership, process systems, quality care, knowledge, learning and development, excellence in patient care and superior patient health outcomes. “I couldn’t have been more proud of what we’ve done to accomplish this,” said Nick Dovedot, Cardiac ICU nurse. “It represents who we are. Just a great group of individuals who all work together as a team to make our patients get better.”

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Posture is important, but for those children diagnosed with scoliosis (spinal curvature) it can be a difficult issue. The Washoe County School District Student Health Services Department screens 7th grade students for scoliosis as growth spurts often reveal the condition and, if diagnosed early, scoliosis can stop progressing. We asked Michael Elliott, MD, head of the Department of Pediatric Orthopedics and Scoliosis to answer some frequently asked questions about scoliosis. What is scoliosis? There are many types of scoliosis: early onset (occurs before age 10), congenital scoliosis is when the bones of the spine do not form correctly, neuromuscular scoliosis which is due to children’s neurologic and muscle disease, and the most common is Adolescent Idiopathic Scoliosis. The term “idiopathic “ means the exact cause is unknown, although we do know it runs in families. This type of scoliosis occurs in 2-3 percent of adolescents and is mainly seen during their growth spurt. This is why middle school screenings are recommended. Both genders get scoliosis but girls are 8 times more likely to have their curves progress and become larger. What are the signs that my child may have scoliosis? A few signs for parents to watch for are: One shoulder might be higher than the other. One leg may seem longer. A hip may be higher or look more prominent. The waist may not look the same from side to side (asymmetry). The trunk or rib cage may be more prominent on one side or shifted. When they bend forward they may have a bump on their back. How is scoliosis diagnosed? It can be noticed by a pediatrician at a physical, school screening nurse, PE teacher or parents. Once the curve is suspected the child is usually referred to a pediatric orthopedic surgeon scoliosis expertise. At the initial visit the doctor will perform a thorough physical including a complete neurologic exam to assess the amount of curvature. Once the exam is completed the physician will determine if a spinal x-ray is needed. The curve on the x-ray is measured utilizing the cobb angle (a measurement in degrees) which helps guide the treatment. What are common treatments for scoliosis? The treatment depends on the size of the spinal curve and the amount of growth the child has remaining. An x-ray of the child’s hand is used to determine the amount of growth remaining. This allows the determination of the child’s bone age, and based on the hands growth plates it can determined if the child is in their rapid phase of growth. Treatments include: Observation - For curves less than 20-25 degrees. This entails visits every 6-9 months with a repeat scoliosis x-ray. Since scoliosis curves increase only 1-2 degrees per month, and variations in measurements can be 3-5 degrees, an x-ray is not recommended before 6 months. If the curve remains less than 25 degrees the child is followed until their growth is completed (usually age 16-18). Progressing Curve - If growth is finished and the curve is less than 40 degrees, the risk of more curvature into adulthood is small. If growth is completed and the curve is over 45 degrees, the child is followed for several years as these curves can progress into adulthood. If the patient is still growing and the curve has progressed greater than 25 degrees but still in the non-operative range (less than 45-50 degrees) bracing is used to stop the progression of the curve. Bracing - Indicated for curves over 25 degrees but less than 45 degrees. If a brace is required you will be referred to an orthotist (bracing specialist). The orthotist assesses your child, reviews the x-ray and then fits the brace. (Having a brace made usually takes 2-3 weeks.) Once the brace is fit, your child will visit the scoliosis specialist for an x-ray in the brace to ensure it fits correctly. The primary goal of bracing is to halt progression of the curve and prevent the need for surgery. The brace must be worn for about 16 hours per day to be effective. In a recent bracing study 72% of the patients who wore their braces as prescribed prevented the need for surgery compared to the group who did not wear their brace. Surgery: When a curve reaches 45-50 degrees, and a child is still growing, surgery is usually recommended because the curve is likely to continue progress. If a curve is over 50 degrees and the child is done growing surgery also may be recommended. This is because when curves are over 50 degrees they tend to increase 1-2 degrees per year for the rest of your life. As curves get larger the amount of lung function tends to decrease which could cause breathing problems later in life. The goals of surgery are to stop the progression of the curve and safely correct any misalignment. This is accomplished by attaching implants (rods, screws, hooks and bands) to the spine. Bone graft is then placed around the implants to encourage the spine to fuse (grow together). This then forms a solid column of bone with metal rods in place, preventing the curve from changing. Most patients are back to their regular sports and activities six months post surgery.

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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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Parents often struggle with installing and choosing car seats for their children. Picking out a car seat for your child is a never-ending battle. Safe Kids Washoe County has made it simple for you to understand the types of car seats that will work for your child. Types of Car Seats Rear-Facing Only Seat. Your baby's first car seat is often used from 5 to 40 pounds. People usually buy this type of seat because it is portable. Convertible Car Seat. This seat is larger and stays in the car; it may be rear-facing until your child is two years or more. After that, it can change to a forward-facing seat. Forward-facing-only car seat. This type of seat is used in one direction and has a 5-point harness and top tether.  Combination seat. This is a forward-facing seat with a 5-point harness and top tether and can change into a booster seat when you remove the harness.  3-in-1 car seat. This seat also stays in the car. You can use it rear-facing, forward-facing, and then later, as a booster seat. Booster seat.  It boosts the child for a safer and more comfortable fit of the adult seat belt. Make sure your child has outgrown the weight or height limits allowed in the forward-facing car seat. The seat belt must lie flat across your child's chest, on the bony part of the shoulder, and low on the hips or upper thighs. Most children will be between the ages of 8 to 12 years old before they are ready for the seat belt alone. Have a trained car seat technician check your installation Why: 3 out of 4 car seats are installed improperly, with some studies show that the misuse rate is 90%, with the average car seat having three mistakes. Solution: Ensuring that your child's car seat is installed correctly by a certified car seat technician will ensure your child's safety.

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Car seat technicians often find parents are moving their child to their next car seat stage too soon, as they get older. Here are a few reminders of when to transition your child from their booster seat to a seat belt. Moving to a booster seat too soon According to Safe Kids Worldwide, nearly 9 in 10 parents remove children from their booster before they’ve reached the recommended height, weight, or age of their car seat recommendations, which leaves the seat belt in a position on the child that could injure them. If the child is not the proper height, the seat belt can rise up on the belly, instead of the hips where it’s supposed to sit, which can lead to spinal cord damage or whiplash in the event of a car crash. Solution: You can switch from a car seat to a booster seat when your child has topped the weight allowed by the car seat manufacturer; typically 40 to 80 pounds (18 to 36 kilograms). Remember, however, that your child is safest remaining in a car seat with a harness for as long as possible. Booster seats must always be used with a lap and shoulder belt — never a lap-only belt.  Transitioning to a safety belt too soon Older children need booster seats to help ensure the seat belt stays properly positioned on their body. The lap belt should lie low across the child's hips and pelvis with the shoulder belt crosses the middle of the child's chest and shoulder, so that in the event of a crash, the forces are applied to the hip bones and not the abdomen. If the lap belt is not positioned properly then it could lead to injuries to the spinal cord and abdominal organs.  Solution: Most kids can safely use an adult seat belt sometime between ages 8 and 12. Always use a booster seat until the child passes the 6-step test Your child reaches a height of 4 feet, 9 inches (nearly 1.5 meters) Their back is flat against the seat back. Knees bend over the edge of the seat and feet are flat on the floor. The shoulder belt sits on their shoulder and chest (not face or neck.) The lap belt sits low on their hips and touches their upper thighs (not on their stomach.) Your child can sit comfortably this way for the entire trip.   The American Academy of Pediatrics reminds us that the back seat is the safest place for children younger than age 13.

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