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With allergy season’s extended stay and cold and flu season having just begun, you may soon find yourself seeking relief through several different kinds of over-the-counter medications. Know what precautions you need to take when fighting multiple symptoms with multiple medications. When you’re too sick to go to work but not sick enough for a doctor’s visit, over-the-counter medicines are a welcome relief to help alleviate that fever, runny nose or allergies. But because those medicines aren’t signed off on or managed by your doctor and pharmacist, it’s crucial that you’re especially mindful of what you put into your body. Whenever you pop a pill, you want to make sure you’re taking the right dosage, waiting the right amount of time before taking another dose and not mixing certain medicines together. Recent stories like this one detail dangerous over-the-counter medicine combinations, and we’re following suit: Here is a quick go-to guide about potentially harmful over-the-counter combinations. Too Much Tylenol/Acetaminophen Tylenol — or acetaminophen — is a popular pain reliever for many, but too much can be bad for your liver. “Our bodies have a finite ability to metabolize Tylenol,” says Andy Wright, clinical pharmacist at Renown Rehabilitation Hospital. “When too much builds up in the liver, it becomes toxic. In patients with medical conditions like cirrhosis of the liver or hepatitis, this could be disastrous.” Remember, acetaminophen is in more than just Tylenol and generic pain relievers. You may also see acetaminophen in flu, cold and cough medicines, like Nyquil, and some prescription medications including Norco and Percocet. Keep a list of the medications you take, and limit daily acetaminophen use to 3,000 mg per day. When you’re scanning medicine bottle contents, remember acetaminophen is also referred to as APAP, AC, acetam or paracetamol. Mixing Painkillers When you’re dealing with pain and not getting any relief, taking a different medication may seem like the easy solution. Maybe you take some Aleve — a form of naproxen — for a headache, but it isn’t working, so you switch to Motrin, an over-the-counter form of ibuprofen. Not a smart idea. Ibuprofen and naproxen along with aspirin are known as nonsteroidal anti-inflammatory drugs (NSAIDS). Because these medicines work in similar ways, they should never be combined or used in larger doses or more frequently than directed. Otherwise your risk of side effects can increase, which range from mild nausea to severe gastrointestinal bleeding. It’s also important to consider your family history when taking NSAIDs because, “recent studies have shown NSAIDs may have greater cardiovascular risks for people taking blood thinners or those with hypertension,” explains Andy. “A good example is ibuprofen: It has a relatively low gastrointestinal bleed risk while it has a moderate to high cardiovascular risk. The opposite is true for naproxen.” Rather than experimenting with multiple medicines, figure out which drug works best for you. You may find muscle soreness improves with aspirin, whereas when a headache hits, naproxen is best. Keep in mind that these medications aren’t always best for everyone in the family. “Aspirin in children and teens is not recommended unless under the supervision of a doctor,” Andy says. And pregnant and lactating women should generally avoid NSAIDS due to risk of birth defects and bleeding. “In both of these cases, acetaminophen or Tylenol are preferred but only if approved by an OB/GYN.” Fighting Allergies Over-the-counter antihistamines like Claritin, Zyrtec and Allegra have made fighting itchy eyes and runny noses a little easier. But these daily medicines — when taken inappropriately or in the wrong combinations — can also have an adverse effect. Similar to acetaminophen, you need to watch for antihistamines in other products. Sleep aids — like Tylenol PM and Unisom — commonly use an antihistamine known as diphenhydramine, which may increase your risk of overdose. “Combining antihistamines, or overdosing, can cause many adverse effects including dry mouth, blurred vision — even arrhythmias,” Andy says. “Only take these medications on their own.” If you’re still struggling with symptoms, you can talk to your doctor about adding an over-the-counter nasal steroid. Andy confirms the importance of closely following the directions listed on antihistamine (and all medicine) bottles. He has seen extended release nasal decongestants cause significant arrhythmias requiring medical care after a patient took the medicine with warm fluids. “The decongestant in question is designed to slowly release, but it can dissolve suddenly in the presence of warm liquids like coffee,” Andy explains. “This can cause the pill to deliver 12 to 24 hours of medication all at once.” Taking an Antidiarrheal with Calcium Calcium supplements and antidiarrheal medicines are another harmful combination. Calcium firms up your stool, but if taken with an antidiarrheal, can cause severe constipation. If you need to take an antidiarrheal, take a break from your calcium for a few days until you’re back to normal. Another consideration when taking calcium supplements or calcium-based antacids is gas. “I’ve had several patients report cases of excessive gas using Tums or calcium carbonate-based supplements.” Andy suggests instead “trying Maalox or Mylanta for indigestion and Citracal as a supplement.” Talk with Your Doctor or Pharmacist About Your Medications If over-the-counter drugs aren’t providing the relief you need, it’s time to see your doctor. And remember, for your safety it is important to keep your doctor and pharmacist up-to-date with any medications — prescribed or over-the-counter — that you are taking.

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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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Award given to Truckee Meadows Health Communities, Renown Health & Washoe County Health District. Truckee Meadows Healthy Communities (TMHC), Renown Health and the Washoe County Health District received the BUILD Health Challenge® award, a $250,000 grant to support Caring For Reno’s Elders (C.A.R.E.) program. The award comes as a collaborative result of more than 30 local organizations submitting a proposal for the funding. Renown Health announced that the organization is matching the grant alongside other pledged funding from the community, bringing the current C.A.R.E. support to $580,000. Together the entities will focus on senior loneliness and the health issues it creates. The partners are honored that Truckee Meadows was selected as one of 18 communities to receive funding from BUILD in the 2019-2021 term. “C.A.R.E will be a community approach to enhance life quality for elders by reducing social isolation and loneliness, issues that seriously impact senior health,” said co-team leader Kindle Craig, Sr. Director Renown Institutes. “Loneliness is the root cause of many issues including suicide1 , chronic disease2 and a reduction in lifespan3 . Washoe County senior suicide rates are two and four times the national rate for those aged 65 and 85 years, respectively4 . That is unacceptable.” Sharon Zadra, TMHC executive director and co-team leader, said this project will tackle barriers to socialization such as access to affordable housing, transportation and healthcare.  “We’ll bring the entire community on-board, long-term, to increase social connectedness and reduce health and mortality issues associated with loneliness by starting a cross generational ‘Kindness Epidemic,’” Zadra said. The BUILD Health Challenge is a national program focused on bold, upstream, integrated, local and data driven projects that can improve community health. The award provides funding, capacity building support and access to a national peer-learning network to enhance collaborative partnerships locally to address our community’s most pressing health challenges. The C.A.R.E team expresses special thanks to the BUILD Health Challenge for its support of this initiative. “Loneliness and isolation in our senior population leads to declines in both mental and physical health, and increased mortality,” said Kevin Dick, Washoe County District Health Officer. “We are incredibly honored to join the BUILD cohort, teaming with TMHC and Renown Health to bring long-term solutions by building a cohesive social network to improve the health of our elders.”  The BUILD Health Challenge® is made possible with the support of: BlueCross BlueShield of South Carolina Foundation, the Blue Cross and Blue Shield of North Carolina Foundation, Blue Shield of California Foundation, Communities Foundation of Texas, de Beaumont Foundation, Episcopal Health Foundation, The Kresge Foundation, Methodist Healthcare Ministries of South Texas, Inc., New Jersey Health Initiatives, Robert Wood Johnson Foundation, and W.K. Kellogg Foundation. TMHC, Renown Health and WCHD have worked united for the last five years, rallying diverse partners and community leaders to influence and advocate for the region’s capacity to ensure a healthy community.

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What is an institute for cancer — and why does it matter that we have one right here in Reno? Here, a radiation oncologist answers those questions and more.  Sadly, our community health needs assessment shows cancer is the second leading cause of death in Washoe County. But many residents may not know there is an institute for cancer right here in Reno that can care for you or your loved one after diagnosis. Dr. Michael Hardacre, a radiation oncologist with Renown Institute for Cancer is here with more. What is an institute for cancer? The way I like to think of it: An Institute has healthcare providers highly trained in patient-centered care. For example, when you have cancer, many times you’ll see a lot of doctors. A program brings those doctors together — so you really have one team working together. An Institute takes that one step further. Say there are other needs beyond the doctor’s office such as nurse navigators, dietitians, physical therapists to help you get on track, etc. An Institute really proactively thinks of the need of the cancer patient. It then makes sure all those things are available to them throughout their treatment. The term “institute for cancer” identifies a cancer program that is comprehensive and multidisciplinary in nature. For Renown, that means that we have the specialists in medical oncology, surgical oncology and radiation oncology working together with other specialists to assure that a patient has coordinated care throughout the entire treatment course of cancer care. Together with cancer prevention and diagnostics, genetic assessment, supportive care, clinical trials, and cancer survivorship, the institute for cancer provides care for the community, families and patients along the entire spectrum of cancer care. What types of cancer do you treat? We’re fortunate to be able to provide cancer treatments for all types of cancers, and we’re one of the major referral centers for northern Nevada. Most commonly, just like much of the country, lung cancer, prostate cancer and breast cancer are the most frequent we see. Our care spans brain, to neck cancer and everything in between. As an accredited comprehensive community cancer program, Renown Health provides services for all cancer types. The highest volume cancers treated at Renown are breast, colorectal, lung, genitourinary, blood and gynecologic cancers. Most treatments can be done right here in Reno, but when there are specialty needs such as stem cell or bone marrow transplantation, we partner with quaternary centers, like Stanford, to assure a smooth transition of care both to and from the quaternary center. What kinds of care and treatments are offered? We offer a wide range of comprehensive care. We treat the cancer itself — surgical, radiation oncology, medical oncology in the form of chemotherapy or pills. Also addressed: dietary needs, physical therapy and navigation through this whole process. People may be surprised by the scope and scale of the Renown Institute for Cancer. For instance, our Radiation Center has the latest technologies to treat cancers. This includes the Linear Accelerators, which are machines with treatment planning software tools. In addition to the traditional external radiation treatments provided in most centers, Renown performs specialty treatments using High-Dose Brachytherapy, a treatment with an active radiation “source” and in Brain Stereotactic Radiosurgery, assuring that patients can stay right here in northern Nevada — close to home. What does that mean for the quality of care? I think it’s always great in any environment to have external people come into your program and not only share what’s happening nationally and what we could do better, but also to validate “are you doing things at the highest level you can?” That accreditation process is just one way to give us that seal of approval. We’re lucky enough this year to get the gold award by the American College of Surgeons — its highest honor. We were honored to receive it. Why is important that you’re an accredited institute? Accreditation assures our community that quality is a top priority for us. Each of the accrediting bodies has a set of standards that identify service and quality standards. Renown Institute for Cancer has the following accreditations: American College of Surgeons’ Commission on Cancer: Full Cancer Program accreditation, standards address issues from cancer prevention/diagnosis to treatment to survivorship and/or end-of-life. Renown received the Gold Level Accreditation in 2018, the highest level of accreditation possible; American College of Surgeons’ National Accreditation Program for Breast Centers: Full Breast Center/Program accreditation, standards address issues from breast cancer prevention/diagnosis to treatment to survivorship and/or end-of-life; American College of Radiology – Radiation Therapy: Full Radiation Oncology accreditation for radiation equipment, treatment planning, treatment and treatment follow-up; and American College of Radiology – Mammography Services.

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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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