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University of Nevada, Reno student Khoa Le was paralyzed in 2010 after a longboarding accident. Through physical therapy, a positive attitude and sheer will, Le is walking again. This weekend, Le will walk across the commencement stage to accept his college diploma. “Walking around on my own power is just the greatest feeling,” says Khoa Le, a senior at the University of Nevada, Reno. Just after finishing summer school at the university in July 2010, his whole life changed within seconds after stepping on a longboard skateboard for the first time. He lost control of the board and hit the curb, causing paralysis on the left side of his body. His journey to recovery began at Renown Health Physical Therapy & Rehab. His physical therapist, Dina Barry, says he never complained once in four years. “I started seeing Khoa in April 2011, and we worked for four years together,” says Barry, a lead physical therapist at Renown. “Everything I’ve ever asked him to do, he does. Le is a hard worker, is continuously optimistic and smiling, and I think that is why he’s accomplished what he has.” Le plans to pursue a career as an information systems manager.

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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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Low back pain is not only a problem most people have at some point in life, but also the leading cause of disability in the U.S. Whether it is a sharp spasm from lifting something heavy or a daily constant ache, there are various treatments available to relieve your pain. Jessica Ryder PT, DPT, cert VRS, with Renown Health Outpatient Therapy, explains some common causes of this pain, how to treat it and ways to prevent pain flare-ups. It’s important to realize most cases of low back pain are short term. Frequently lasting only a few days or weeks. In general these cases leave no long-term damage to the spine, muscles, discs or nerves. “However, it can become episodic or chronic (lasting longer than 12 weeks) if it is not properly understood or managed by the individual, ” cautions Ryder. Causes of Pain Specifically back discomfort can be related to: Wear and tear on the spine due to age or poor movement patterns Injury to spinal discs Sprains (overstretching or tearing of ligaments) and strains (tears in tendons or muscles) Trauma Irregularities of the spine present at birth (example: scoliosis)Notably the above issues may result in a “pinched nerve” or sciatica, causing pain to extend down the leg. Risk Factors for Pain In particular, your chance of developing low back pain increases with the risk factors below: Age Being overweight Low fitness level or occasional physical activity (“weekend warrior”) Family history Pregnancy Poor posture Jobs requiring heavy physical work (landscaping, plumbers, construction, etc.)

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As an avid soccer player, Sarah saw her fair share of doctors growing up. However, it wasn’t until she was diagnosed with celiac disease, an autoimmune disease affecting how the body ingests gluten, that she became passionate about healthcare. “I couldn’t figure out what was going on,” Sarah said. “I was getting sick, and my symptoms were getting worse.” Thankfully, after seeing a handful of doctors, she was on the path to recovery.  “I remember being so relieved, and still am! Now I can focus on getting better,” said Sarah. The most important change people make after being diagnosed with celiac disease is the shift to a gluten-free diet. For many, Sarah included, living gluten-free is a lifestyle change. Thankfully, Sarah sees significant improvements in her health after adjusting her diet. “No one should just accept their symptoms as part of life,” said Sarah. Her increased awareness of health and nutrition motivated Sarah to study biology at the University of Nevada, Reno (UNR). “I want to be a pediatrician so I can help patients, especially kids, figure out treatment plans.” said Sarah who credits her experience living with celiac disease as her inspiration. Dancing for Kids’ Health Currently a senior at UNR, Sarah is a member of Phi Delta Epsilon, a co-ed international medical fraternity. Together with her classmates, she is bringing new energy and ideas to philanthropy. Sarah and the members of Phi Delta Epsilon are doing things differently and in many ways redefining what it means to give. This year, they are on a mission to raise funds for kids’ health at Renown Children’s Hospital. And they are doing this by dancing. The UNR Dance Marathon is part of the Miracle Network Dance Marathon, a student-led, year-round philanthropic movement that unites students across the United States and Canada. Collectively, they raise critical funds for Children's Miracle Network Hospitals. And Renown Children’s Hospital is our northern Nevada CMN partner hospital. Since 1991, over 400 college campuses and thousands of students have raised $300 million for kids. Sarah is the executive director of UNR’s chapter. “So far this year we’ve already raised $10,000 for Renown," said Sarah. Most of the fundraising happens on the day of the dance marathon. But throughout the school year, students hold mini fundraisers on campus and in the community. One hundred percent of the funds raised stay local, impacting Renown’s youngest patients. For every dollar donated, 18% helps provide charitable care, 15% goes to life-saving equipment, 12% supports medical research and 55% provides education, patient services and advancement services. “It's inspiring that we banded together to help kids in our community,” said Sarah. Last year they raised over $18,000. They are hoping to exceed that number at this year’s dance marathon in April.

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Katherine Bunker, Physical Therapist and Certified Lymphedema Therapist (PT, DPT, CLT) at Renown, discusses how patients can manage lymphedema with changes to daily routines along with diet and exercise. Lymphedema is a condition that affects millions of people around the world. It is a chronic and progressive disorder that results in swelling of the arms, legs, or other parts of the body due to an accumulation of lymph fluid. Lymphedema can occur because of cancer treatments, surgery, or other medical conditions.   Managing Lymphedema Treatments to help reduce symptoms such as pain, swelling and discomfort associated with lymphedema can include compression garments, exercise, skin care, manual lymphatic drainage and pneumatic compression.  The goal is to avoid triggering the onset of lymphedema. Lymphedema can present itself immediately after surgery or radiation. It can appear months later or even years later. There are many factors that influence the development of lymphedema which is why prevention is so important. If you have had injury or disruption to your lymphatic system, then:  Avoid injuries to the skin near the affected area. For example: wearing gloves during gardening, using bug spray to ward off mosquitos, covering your limbs while playing with pets, keeping nails clean and avoiding cutting too close to cuticle, utilizing electric razors at the armpit (instead of a traditional razor).,   Avoid blood pressure readings to the affected limb or request blood pressure to be taken manually, not by a machine.   Avoid heat like saunas, hot tubs, sunburns, hot packs, and even massages.    Avoid tight jewelry like rings or bracelets, which can be too tight.

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In August 2016, six-year-old Jakob was admitted to Renown Children's Hospital with what seemed like a common ear infection. Jakob's condition quickly progressed, and he started experiencing neurological symptoms such as difficulty speaking and a full-body shutdown. Doctors, neurologists and specialists from Renown worked with doctors from Stanford, where he was ultimately diagnosed with Bickerstaff brainstem encephalitis (BBE). BBE is a rare, autoimmune response that attacks the nerves in the body due to an acute illness such as a cold, flu or, in Jakob's case, an ear infection. Jakob could not breathe or eat and experienced paralysis on the side of his face, throat, stomach, bowels, lungs and legs. In addition, he started to rapidly lose weight as well as body function. Jakob lost half his body weight which resulted in the need for a Gastrostomy tube. This device is placed surgically and gives direct access to the stomach to give the child the nutrition needed. He also needed occupational therapy, and after three and a half months of ICU respiratory therapy, surgeries and treatments, he was released home to regain his strength. Forever Grateful Anica, Jakob's mom, said, "If it were not for the quick response and unconditional support and compassion from the team at Renown, Jakob would not be here today." Jakob's family is forever grateful to the staff, community and expertise at Renown for their unwavering commitment to their son and family during their most trying time in life. "When I met Jakob on the first day of his illness, so much was unknown. My team and I were worried, as his symptoms were very unusual. His rapid deterioration, after being a perfectly healthy child, was clearly terrifying for his parents. Handing over a child's care to a team of strangers is one of the scariest things that can happen to parents,” said Dr. Kris Deeter, Physician in Chief at Renown Children’s Hospital. “However, Anica and Jeremiah were also very clear that they did not want Jakob transferred somewhere else. So, we used all our resources to care for him, arrive at a diagnosis, and start aggressive therapies. They listened to every word we said, educated themselves, and became partners in Jakob's care. We all became part of Team Jakob, and soon, he proved to us just how strong he was." Today, Jakob is 13 years old and thriving in every aspect of his life. He is currently on the honor roll in school and finds joy in his newfound passion for the violin. He loves spending his free time learning about mixing music, making new friends and traveling to different parts of the country. This summer, he will travel to Europe to explore his passion for culture. The family says, "We owe it all to the family and staff at Renown."

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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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There are a lot of impressive titles you can use to describe Stephanie Kruse: entrepreneur, marketer, philanthropist, leader, adventurer, nurse. And now with her planned gift to the Renown Health Nursing Excellence Endowment, she can add one more to the list: a member of the Renown Legacy Society – a group of visionary supporters who have chosen to make a lasting commitment to the future health and wellbeing of northern Nevadans. This generous planned gift comes on the heels of a significant cash gift made to the Nursing Education Fund last summer. Stephanie is an inspiring example of someone who has dedicated her life to helping others. The daughter of a nurse and a retired nurse herself, Stephanie knows the hard work, selflessness and dedication it takes to create a successful business and community. As Chair of the Renown Health Foundation Board of Directors, she also understands the importance of attracting and retaining nurses within a healthcare system. As a way to contribute to a cause near and dear to her heart, she decided to include the Renown Nursing Excellence Endowment as a beneficiary of her retirement plans. “I wanted to honor the memory of my mother, who was a registered nurse in a small-town hospital in Iowa.,” said Stephanie. “I was always very conscious of her passion for providing great care to her patients, and I wanted to provide funding for others interested in nursing.” Across the nation, health systems are facing a shortage of nurses and nursing-related professionals. Renown is proactively implementing programs to build our pipeline of potential future nurses and keep those already in the field. Stephanie’s generous gift will help the endowment provide programs such as training, scholarships, loan repayment and professional development to increase retention and recruitment of prospective nurses. “As nurses, we are entrusted with our patients’ lives,” said Melodie Osborn, Chief Nurse Executive at Renown Health. “We have the privilege of caring for people in their most vulnerable time and helping those who cannot help themselves. Stephanie’s generous gift to the Nursing Excellence Endowment Fund will help us develop new nurses for the future so we can continue to provide care to those in need for generations to come.” No Stranger to Healthcare Long before she found herself leading the Renown Health Foundation Board, Stephanie learned the ins and outs of healthcare. She graduated from nursing school and became a part-time nurse in a Sioux Falls, South Dakota nursing home while attending Augustana College to obtain a degree in journalism and a minor in theater. As part of her journalism program, Stephanie completed an internship in the public relations department of a Sioux Falls hospital, and that led to her accepting a position as director of public relations at a sister hospital. She later was recruited by Saint Mary's Hospital and moved to Reno to be the director of marketing in 1981. She stayed at Saint Mary's for almost 10 years before starting her own company in pursuit of her passion for marketing strategy. Since launching her brand, Stephanie has grown KPS3 to a multi-million-dollar firm with more than 60 staff members. Somehow, she is still able to find time to serve on six (!) volunteer boards, most of which are dedicated to improving access to better health and human services. “I have a soft spot in my heart for organizations who strive against all odds to help those with the greatest needs,” said Stephanie.

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