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Some risk factors associated with osteoporosis are out of your control. But you’re in luck, because some can be lessened by following simple tips. Below, Orthopedic Nursing Manager Katie McCarthy discusses the signs, symptoms and preventive measures. By Katie McCarthy, BSN, RN, ONC, Orthopedic Nursing Manager, Renown Health Osteoporosis is often called the silent disease, because it develops gradually for years with no clear signs or symptoms. And while some bone loss is expected as we age, osteoporosis is not a normal part of aging. So it’s important to start thinking about your bone health early.  Bone is not just a lifeless scaffold for the body. It is living tissue that regenerates continually. Once we reach peak bone mass around age 25, we begin losing more bone than we produce, increasing the risk of developing osteoporosis — which literally means porous bone and points to a loss in bone density. In severe cases, normal everyday activities or movements, like hugging, can cause a fracture. After the first fracture you’re at higher risk for more, which can lead to a life of chronic pain and immobility. Bone fractures in the spine or hip are the most serious. Hip fractures can result in disability and even death — especially in older adults. Spinal fractures can even occur without falling. The vertebrae weaken to the point that they simply crumple, which can result in back pain, lost height and a hunched-forward posture.   Osteoporosis: Uncontrollable Risk Factors Women are at greater risk of developing osteoporosis than men, and white and Asian women are at higher risk than black and Hispanic women. Other uncontrollable risk factors include: age; a family history of osteoporosis; certain genetic conditions; medications and medical treatments; eating disorders; a low body weight and small, thin frame; ethnicity; menopause: In fact, the lack of estrogen produced during menopause is largely responsible for a woman’s increased risk. Poor diet, tobacco use, excessive alcohol consumption, lack of exercise and an unhealthy weight also contribute to bone loss. Fortunately, those risk factors are in your control. Without symptoms, you can’t know if you’ve developed osteoporosis unless you get a bone density test or suffer a fracture. If you fall into a high-risk group, are over age 50 or have any concerns about your bone health, consult your doctor and find out if you need to be evaluated. Additionally, if either of your parents sustained hip fractures, you experienced early menopause or took corticosteroids for several months — a steroid often prescribed to relieve inflammation and arthritis — you’ll want to talk to your doctor about your bone health. If you test positive, your doctor will devise a treatment plan to match your needs, which will include lifestyle changes surrounding diet and exercise to build and strengthen weak bones. Medication to slow bone breakdown and build new bone may be prescribed, depending on the severity of your bone loss. If you’ve sustained a spinal fracture that is causing severe pain, deformity or is not responding to non-surgical treatment, your doctor may recommend surgery. Reduce Your Risk of Osteoporosis You can strengthen your bones now to prevent osteoporosis from starting. Here are some tips: Eat a diet rich in fruits and vegetables and low in caffeine, sodium and protein. Avoid soda, and talk to your doctor to make sure you’re getting enough calcium and vitamin D. Don’t smoke — it directly correlates with a decrease in bone mass. Smokers also take longer to heal from a fracture. Limit alcohol to two to three beverages per day. It interferes with the production of vitamins needed to absorb calcium and the hormones that help protect bones. Exercise three to four times each week — it’s key to healthy bones. Weight-bearing exercises like jogging, hiking and especially weight lifting build bone mass and density. There are aspects of the aging process we can’t control, but we can do something about bone loss and osteoporosis. Find out your risk, and show your bones a little TLC — you’re going to need them. This story was also published in the Reno Gazette-Journal’s Health Source on April 24, 2016.

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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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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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We get it – the entire world has been overwhelmed with COVID-19 vaccine information, questions and celebrations around vaccines developed to combat COVID-19 induring the past several months. It’s hard to know where to start in digesting all this news and information. But one thing is clear: healthcare experts agree that the authorized COVID-19 vaccines are safe, effective and recommended to help end this pandemic. If you are passionate about stepping up in your community to encourage the vaccination efforts, we’re offering a few ideas on how you can be an ambassador. Find the Facts Content on the vaccine is abundant, but and there’s a few resources that we can all rely on to help digest the information: The Centers for Disease Control (CDC) updates its website content around the vaccine regularly, and also offerings information in Spanish. Health departments across the U.S. are leading the way in distribution logistics planning, and partnering with other providers, like such as hospitals and pharmacies, to distribute give people doses. Their websites are great resources to understand options where you live. Locally, check out washoecounty.gov/health/programs-and-services/environmental-health/covid-19-guidance for vaccine updates in Washoe County. Many providers like Renown Health and other providers are sharing content around their recommendations for the vaccine. Get answers about the vaccine types from one of our pharmacists, read common concerns addressed by experts and view videos from many doctors and other specialists on our YouTube Channel.

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Renown Health patient, Alden Nash, hiking Death Valley National Park just three months after a Transcatheter Aortic Valve Replacement. Alden Nash isn’t your average 80-year-old. For much of his life, he could be found outdoors enjoying nature and hiking some of the west coast’s highest elevations. A husband and father of two, Alden turned his passion into a career as a Yellowstone park ranger in 1965. Alden believes his passion for the outdoors is responsible for his many years of health – until the unavoidable happened. The Hardest Climb The number one doctor recommendation for a healthy heart – lead a healthy, active lifestyle. Any cardiologist would be thrilled to have Alden as a patient due to his robust physical activity regimen. “Don’t have a TV set or a lounge chair in your house and you’re all set,” said Alden when asked how he has remained so fit throughout his senior years. Unfortunately, many other factors come into play when it comes to heart health, one of which is the reason we are telling Alden’s story today. Familial history - it’s a hot topic in the world of medicine. Understanding your genetic risk factors can help care providers develop updated care plans based on your results. Alden’s family has a long history of high cholesterol, which he avoided for much of his life by staying active. This combined with his age resulted in his first heart attack in December 2021. Doctors later determined that Alden was suffering from a type of heart valve disease known as aortic valve stenosis. Aortic stenosis is the narrowing of your aortic valve opening that impedes normal blood flow. Over time, the leaflets of your aortic valve become stiff, reducing their ability to fully open and close. When the leaflets don’t fully open, your heart must work harder to push blood through the aortic valve of your body. Eventually, your heart gets weaker, increasing the risk of heart failure. People who are most at risk for aortic stenosis include those who have had certain heart conditions present at birth, have chronic kidney disease or have heart disease risk factors such as high cholesterol and high blood pressure. However, generally, aortic stenosis is a degenerative process of aging with no modifiable risk factors. The incidence of aortic stenosis increases rapidly with age and is very common above the age of 80 – with 1/10 having the condition and 1/50 with a problem severe enough to warrant surgery. When symptoms are present, the disease can be rapidly disabling or even deadly, often progressing over several months unless treated.

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Although coined the most wonderful time of the year, the holiday season can unfortunately bring with it injuries and illness. Woke up on Christmas morning with the gift of a sore throat and fever? Sliced your finger carving the delicious turkey you spent all day preparing? While no one ever wants to cut their festivities short, the reality is we should all be prepared with how and where we will receive care should we need it. Are Renown Urgent Care Facilities Open During the Holidays? Renown Urgent Care sees patients 365 days a year, with limited hours on holidays, for medical concerns that are urgent but not life-threatening. Urgent care providers can treat everything from cuts and burns to fevers and allergic reactions and appointments can be booked ahead of time online. If no appointments are available, you may also walk into any of our various urgent care facilities. Conditions and injuries treated at urgent care include: Cuts Fractures Burns Sprains Fevers Allergic reactions Animal bites Rashes Sore throats Does Renown Offer In-Home Care Options on Holidays? If you’d like to see a healthcare provider without leaving the house and exposing others to illness, consider a Virtual Urgent Care Visit. This convenient video conference service allows you to see an urgent care provider from the comfort of your home using a cellphone, computer or tablet with video capabilities. Providers are available for video chat from 9 a.m. to 6 p.m. Monday through Friday, and 10 a.m. to 4 p.m. Saturday and Sunday. Scheduling a Virtual Visit is easy directly through MyChart. Login to MyChart and click on the "Talk to a doctor" video icon within the portal to get started. Before scheduling, be sure your illness or injury is included on the following list to ensure a healthcare provider can assist you virtually: Common cold and cough symptoms Muscular, tendon or joint pains not caused by injury Allergy or sinus symptoms Pink eye (no trauma or something in the eye) Urinary discomfort Diarrhea without vomiting Rashes or skin sores Backache Nail problems Screening examination for sexually transmitted illness (without symptoms) Medication refills (not controlled substances) When Should I Go to the Emergency Room? Urgent care and Virtual Visits are great options when experiencing minor illness or injury and it’s too urgent to see your primary care provider. Renown Emergency Rooms are designed to treat patients who need immediate attention for emergencies, such as: Burns Allergic reactions Broken bones Stitches Skin infections Heart attack Stroke Rashes Venomous stings and bites Asthma attacks Choking or poisoning Fainting, dizziness or confusion Head injuries Seizures Severe bleeding Difficulty breathing Severe headache Eye injuries Severe pain Renown Emergency Rooms are open 24 hours a day, 7 days a week, 365 days a year. For life-threatening emergencies, always call 9-1-1 immediately. We know there is nothing jolly about getting sick or injured during the holidays, but we hope you can find some comfort knowing that Renown Health is here with the care you need, when you need it most.

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In sailing, when you encounter rough seas, you can’t change the wind pattern, but you can adjust your sails. The same rings true for life. We confront unpredictable circumstances daily, but how we react to them can make all the difference. For Renown patient and avid sailor Robert (Dan) Seifers, recent events make this mantra reign true. A Concerning Alert Monday, Aug. 22, started out just like any other day for Dan. He was on a walk with his dog, enjoying the sunshine, when suddenly he felt a wave of dizziness and a buzz on his wrist. His Apple Watch alerted him that his heart rate had dropped to dangerous levels. Returning home immediately, he notified his wife, Carol. Doing their best not to panic, the couple confirmed the reading with their at-home blood pressure machine. The watch was right – Dan’s heart rate was in the low 30s. After taking some time to see if Dan’s heart rate would return to normal, the couple decided it was time he sought medical help. Conveniently, Carol had a lab appointment scheduled next door to Dan’s primary care physician, Dr. Bonnie Ferrara. The couple headed out the door, not realizing what the rest of the day would bring. The Next 48 Hours Upon arrival at the office, Dan calmly approached the front desk to explain his situation. With no delay, staff members sprang into action, quickly showing Dan to a patient room and notifying Dr. Ferrara. Before he knew it, Dan was receiving an electrocardiogram (EKG). Following a review of the results, Dr. Ferrara returned to let Dan know he needed to get to the hospital immediately. The rest of the afternoon moved quickly for the couple. Dr. Ferrara had already notified the Renown Regional Medical Center Emergency Room staff, who were on standby for the couple’s arrival. “Gee, this must be serious,” thought Dan, who at the time was experiencing no other alarming symptoms other than the low heart rate indicated on his watch. Several doctors and nurses began their analysis, including a chest x-ray, blood test and additional EKG. Confirming Dr. Ferrara’s results, a Renown cardiologists, Dr. Christopher Rowan and Dr. Shining Sun, joined Dan’s care team. Within two hours of checking into the hospital, Dan was admitted, monitored overnight and prepped for surgery to receive a pacemaker the next day. Tracking Your Heart Health Following the purchase of their Apple Watch devices, Dan and Carol were unaware of these heart health features. Like many others, they were looking forward to the next best tech gadget that would help them stay connected with their friends and family. Now, the couple says they will use their experience to spread the word about the importance of ensuring these settings are enabled. According to Apple, you can turn on these notifications from the Heart Rate app on your Apple Watch (Series 1 or later) to alert you to high or low heart rates and irregular heart rhythms. If you receive a notification, an irregular rhythm suggestive of atrial fibrillation (A-Fib) or a low or high heart rate has been identified and confirmed with multiple readings. In Dan’s case, the signal from his watch was the result of a heart block, a condition where the electrical signal that controls your heartbeat is partially or completely blocked. Dizziness and low heart rate are common symptoms of a heart block. But this was not the first time the couple had experienced this type of alert from their watch. More than a year and half ago, Carol’s watch notified her of an irregular heart rhythm that was suggestive of A-Fib. She immediately made an appointment with Dr. Danish Atwal, the lead cardiologist at Renown’s Helaine Greenberg Women's Heart Center. Thanks to medication prescribed by Dr. Atwal, Carol now lives a healthy, active life while managing her A-Fib, continuing to wear her Apple Watch, which can also help track her A-Fib History. “I’ll share our story with anyone who will listen and encourage them to get a smart watch. I consider myself an unofficial spokesperson,” said Carol with a chuckle. A Thankful Heart The Senior Care Plus members could not be more amazed at the way Dan was treated by the staff at Renown. “I wish I could personally thank them all. I will highly recommend Renown to all I come in contact with,” said Dan with his Apple Watch still proudly strapped to his wrist. “I was closely monitored and treated like royalty.” Quick action to medical emergencies like Dan’s is just one of the many reasons why collaboration is part of our four key values at Renown. The open line of communication between our primary care facilities and hospitals helped Dan get the prompt care he needed, right when he needed it. A month post-op, Dan is doing well and back to enjoying the things he loves during his retirement, including playing the harmonica in the Grumpy Old Man Band, exploring the northern Nevada backroads in his jeep and working on his swing at the golf course. Dan can rest assured that while enjoying the winds of life, if his heart begins to beat too slowly again, the pacemaker will send a signal to correct the beat. “The prompt attention to my heart block undoubtedly saved my life,” said Dan in what he calls his 6-star review of Renown Health. “Thank you from the bottom of my heart, which is happily beating at 60 beats per minute.” This article is not sponsored by or affiliated with Apple, Inc. For more information on the Apple Watch and it's features, visit apple.com.

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“In sickness and in health” are words we often hear when celebrating the momentous occasion of marriage with our friends, families and loved ones. For James Breckenridge, these words were the foundation of the love and commitment he and his wife Carolyn showed to each other during their 30 years of marriage. In health, James and Carolyn shared a love of traveling. Hopping in their van, driving across the continental United States and enjoying the views along the way will be a memory James cherishes forever. Unfortunately, their excursions would be cut short when Carolyn fell ill, rerouting to their local hospital, Renown Health. Carolyn has spent more time at the hospital than the average person – including recovering from COVID-19 at Renown South Meadows Medical Center. However, hospital admittance for Carolyn meant the same for James, providing support to his wife during her stay. Following more than 40 years of exceptional experiences with Renown and their most recent discharge from the hospital, James wrote a letter recognizing the efforts of the team members and healthcare providers who not only cared for Carolyn but also James. To Whom It May Concern James began his letter by applauding two Renown Regional nurses they got to know well during their recent visit. Tiffany and Ashley went the extra mile to care for Carolyn attentively. From simple tasks like gathering requested supplies to answering James’ questions in detail, they helped provide a comfortable environment for the couple. To these nurses, these tasks may have felt like another day at work. Still, James’ letter commends them for their acts of service, reminding us that every interaction we have with a patient can be a memorable one. Tiffany and Ashley weren’t the only team members who received recognition in James’ testimonial. He also took a moment to recognize the various nurses, certified nursing assistants, therapists and doctors they encountered during their care journey. All provided the excellent and helpful experience we aim for at Renown. Healing Memories James first brought Carolyn to Renown Regional Medical Center, formerly known as Washoe Medical Center, in 1980, but it was 1996 when things changed for him. Carolyn was admitted to the hospital for a procedure they originally anticipated would come with a difficult prognosis. To their surprise, doctors found the opposite. It was in that joyous moment that James’ perspective of hospitals shifted, now viewing them for what they truly are – a place people go to get better. “Every time I walk around Renown Hospital, I remember all the times Carolyn was healed there,” James wrote in the latter half of his letter. Healing Isn't Just for the Patient James took advantage of the many support resources accessible to family members during their time at Renown. These donor-funded hospital initiatives are a valuable mental health resource in difficult circumstances. Whether it was an afternoon stroll with his wife through Fianna’s Healing Garden or quiet time alone in the Spiritual Center, James never hesitated to turn to these resources in his time of need. “Although I know the Tahoe Tower is the modern, state-of-the-art part of Renown, I prefer the Sierra Tower because that is where most of my memories are.” Even a simple daily walk to the on-campus Starbucks was a notable part of his day – grabbing a cup of coffee for himself and often a treat for Carolyn. An Inspiration in Healthcare When asked to describe Renown in one word, James chose “inspirational.” His collective experiences with Renown, James said, “helped him to be a better healthcare advocate” when his wife received care at other hospitals. As a healthcare leader, we challenge ourselves to go above and beyond for the health of our entire community. Collaborating with our patients and their families is at the center of everything we do at Renown. Positive reviews mean the absolute world to us, and something about this handwritten letter feels even more special. We could not be more appreciative to James for sharing how our vision to inspire better health in our community was reflected in his 40 years of experience with Renown. We were saddened to hear of Carolyn’s passing during a recent meeting to thank James for his letter. We take solace hearing James’ beautiful memories of his wife and knowing that Renown Health was there in times of sickness and health. We offer our sincere condolences to James, Carolyn’s children and their family members.

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