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Did you know certain medications can interact with everyday food and drink? We asked Pharmacy Manager Adam Porath how to take these important medications safely. One in five Americans between the ages of 40 and 75 are currently taking a statin drug to reduce their cholesterol level or to prevent atherosclerosis (hardening of the arteries). Many others also take anticoagulants (blood thinners) to prevent blood clots from forming, which can increase the risk of stroke. Adam Porath, pharmacy manager with the Renown Institute for Heart and Vascular Health’s Anticoagulation Program, explains how to safely take these medications. What is a statin? A statin is a drug that can lower cholesterol by helping your body absorb cholesterol or by blocking a substance your body needs to make it. The American Heart Association cites a global study reporting the benefit of statins to help reduce heart attacks and strokes. Common statins include atorvastatin (Lipitor), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor). Which foods or drinks should be avoided while taking statin drugs? Grapefruit juice is the only food or drink that has a direct interaction with statins. Statins do not directly interact with any food but people taking statins should moderate their intake of saturated fats to help lower their LDL cholesterol and overall risk of cardiovascular disease. What is a blood thinning drug? Blood thinning drugs, such as warfarin, rivaroxaban (Xarelto), apixiban (Eliquis), dabigatran (Pradaxa) and edoxaban (Savaysa), are used to prevent stroke. Which foods or drugs should be avoided while taking blood thinning drugs? If taking warfarin, alcohol and cranberries (including juice) should be avoided. Patients taking warfarin should be aware of foods that contain Vitamin K (green leafy vegetables) and try to maintain a consistent diet of these foods. Warfarin interacts with many over the counter and prescription medications. Patients should consult a pharmacist when starting, stopping, or changing doses of any medication when taking warfarin. Also, patients taking any blood thinning medication should avoid over-the-counter pain relievers (i.e. aspirin, ibuprofen, etc.) How do I know whether to take my medication with food or not? Consulting with a pharmacist is the best resource to determine if a medication should be taken with or without food. In general, all statins and blood thinners can be taken with or without food. The only exception is Xarelto (rivaroxaban), which should be taken with the largest meal of the day If you are a Renown patient you can also review your prescriptions online, request a refill or ask a question via MyChart. With MyChart, you can access all your healthcare information securely 24/7.

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Many factors are contributing to the rise of early onset puberty in girls. Learn what they are below and how you can support your daughter. The number of girls experiencing early puberty has increased dramatically over the last few years and continues to grow. More and more girls in the U.S. are starting to show signs of development before the age of 8. Recent studies show that up to 10 percent of Caucasian girls and 23 percent of African American girls are showing signs of puberty by age 7. What’s Contributing to Early Puberty in Girls? Determining the exact cause is difficult. But experts agree that several factors may be contributing to these growing numbers. Increasing rates of childhood overweight and obesity. Excess body fat alters the levels of hormones responsible for the acceleration of pubertal timing. Physical inactivity may decrease melatonin levels, which can also trigger pubertal development. Increased animal protein intake. Higher total protein, animal protein and meat intake in children ages 3 to 7 have been associated with earlier onset of menstruation. High protein intake elevates IGF-1 levels and promotes growth, which could accelerate the onset of puberty. Poor diet. Children with lower-nutrient diets tend to enter puberty earlier. A diet rich in processed foods and meats, dairy, and fast food is disruptive to normal physical development. Exposure to EDCs (endocrine-disrupting chemicals). EDCs are synthetic chemicals found in plastics, pesticides, fuels and other industrial chemicals that inhibit or alter the action of natural hormones. Because EDCs accumulate in the fatty tissues of animals, animal foods contain higher levels of these chemicals than plant foods. Exposure to BPA (bisphenol A). BPA is an industrial petrochemical found in a variety of products including plastics, tin-can linings and even cash register receipts. Because it acts as a synthetic estrogen it may speed up pubertal development. Soy products. Soy contain isoflavones which are converted to phytoestregens in the body, and are similar to the hormone estrogen, Dr. Chelsea Wicks says. “Soy consumed from natural food sources is likely safe and will not cause abnormal hormones levels. However, when consumed in large amounts, such as with soy supplements or in more processed foods, there have been links to chronic medical problems due to elevated estrogen levels. I feel a good answer to this is to continue working on eating fresh foods and trying to avoid the processed, packaged foods as this will be best for overall general nutrition as well,” she adds. What You Can Do While some genetic factors play a role in the early onset of puberty, parents can help lessen environmental causes of the condition. Encourage and help your child to maintain a healthy weight with proper nutrition and exercise. Avoid exposure to hormones such as estrogen and testosterone that may be found in hair products, medications and nutritional supplements. Avoid exposure to EDCs and BPA. Offer your child a diet centered around whole plant foods rather than animal foods, which will help keep protein intake within a safe range and reduce consumption of EDCs. Create a supportive environment for your daughter. Avoid commenting on her appearance and instead focus on her achievements, academic successes or artistic talents. Speak to her openly and honestly about the physical changes she’s experiencing — that although these changes are normal, she’s simply developing early — and that ultimately her peers will undergo the same changes. Encourage your daughter to continue participating in social activities and pursuing her interests, and reassure her you are always open to discuss any questions or worries. If you are concerned that your child may be going through these changes before expected, speak with your pediatrician. Sources: Early Puberty: Causes and Consequences When Is Puberty Too Early? Precocious Puberty (Early Puberty) Precocious Puberty

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Dr. Max J. Coppes, Physician-in-Chief Renown Children’s Hospital, and Nell J. Redfield Chair of Pediatrics, UNR Med, talks about how much is too much when it comes to teens and social media. Social apps (Facebook, Instagram, Twitter, WhatsApp, Snapchat, TikTok, etc.) have become an integral part of most people’s lives. In contrast to traditional media — where one source goes to many receivers — social media operates in a dialogic transmission system. Many sources interact, sometimes simultaneously, with many receivers and provide for superior interactivity between its users. Not surprisingly, it also plays a significant role in our children’s lives once they are old enough to understand how to access and use these apps. On average, children start exploring social media at around ages 10 to 12. They rapidly discover that electronic communication allows for unique and personalized ways to make and keep friendships. They also use it to develop and expand family ties, get help with homework, share music, art, and experiences, and learn and discover the world. Social Media and Teens Surveys suggest that more than 90 percent of teenagers use social media. Additionally, approximately 75 percent have at least one active profile by age 17. Access to social media is greatly facilitated because more than two-thirds of teens have their own mobile devices with internet capabilities, a substantial change relative to previous generations. The use of social apps can have many positive aspects. But we now also recognize that it can also have negative impacts. The use of hazardous sites or the inherent risks of using social media (identity theft, being hacked, cyber-bullying, etc.) are indeed damaging to children. Any use of hazardous social apps is too much and carries serious hazards. But what about the use of “normal” and/or “safe” social media? Well, data suggest that too much use of “non-hazardous” apps can indeed affect health. How Much Do Teens Use Social Media? First, some basic data. For example, how much do normal teenagers use social media? A study from Pew Research found that more than 50 percent of 13- to 17 year-olds go online several times a day. This quickly increases during the teenage years to more than 70 minutes per day. Teenage girls have the highest usage at just over 140 minutes per day. It is important to recognize that non-school related use of the internet and social media is often beheld by teenagers as important for developing their self-esteem, their acceptance among peers, and their mental health in general. As parents, we recognize that the use of social media can indeed contribute, in many positive ways, to our children’s growth. At the same time, we also worry about them spending too much time online. We worry about their ability to communicate effectively in face-to-face settings or in writing. Many of us also feel and/or worry that our children are addicted. Social Media and Addiction Recent studies suggests that the overuse of social media indeed mirrors addiction. Reports now show that teenagers and college kids experience anxiety when deprived from their connected devices and consequently feel a compulsion to access their social applications. The emotional symptoms they experience are very similar to those seen in substance abuse. In fact, the American Psychiatric Association is considering making internet addition a bonafide diagnosis. Pediatricians therefore encourage limits on the use of social media, a recommendation more easily suggested than accomplished. So when should a parent consider seeking help? Aside from unhealthy use of these apps (cyber-bullying, sexting, online users asking for sexual relations, etc.), which should always trigger concern, the use of social media for more than 120 minutes per day should trigger parental concern. If you feel unable to address the overuse of social media, contact your pediatrician for help and guidance. Renown Children’s Hospital Whether it’s seeing a pediatrician, getting a sports physical or looking for advice, our care is centered around supporting and nurturing patients and families at our many locations. We have pediatricians dedicated to children who have experience recognizing children’s illnesses. They also have knowledge about tests and treatments for young ones to ensure your child gets the best care possible. Explore Children’s Services

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If you’re a parent, you’ve probably been there — the sometimes-nightly struggle to get your little ones off to bed. Elaina Lantrip, an APRN with Renown Pediatrics, offers some tips and explains how your child’s electronics may be getting in the way of a good night’s sleep. These days, kids are consuming media from a very early age on all types of devices — from tablets and phones to TVs. While they can benefit from some media use, it can have a negative impact on bedtime. We asked Elaina Lantrip, an advanced nurse practitioner with Renown Pediatrics, for some advice on downloading a better bedtime routine. What are the most important practices for parents to establish for their children’s bedtime routines? I often have parents tell me that their child won’t go to bed — or to sleep. Parents frequently ask for tips on bedtime routines that work. My first question is whether their regular bedtime routine involves television, iPad, tablet, phone or anything with a screen. It’s very important that bedtime includes a bath, reading a story, talking, singing and bonding with young ones, rather than using any devices. Why shouldn’t children have a device at bedtime? A growing body of research supports that screen time at bedtime contributes to delays in a child’s falling to sleep; overall inability to reach the important REM, or deep sleep; waking up during the night; nightmares and night terrors. For older youth, engaging with social media before bedtime can bring up stresses, emotions and relationship issues with peers that don’t exactly create peaceful bedtime thoughts. Bedtime should be a screen-free, stress-free, peaceful time of day. It’s a great time for parents to promote self-esteem, talk through things going on in the child’s life, to encourage and build them up. Children grow up fast — bedtime is a great the opportunity with younger children to cuddle up and read a story or sing a lullaby. What are other major considerations in making bedtime smooth and relaxing for kids and their parents? Another factor that contributes to positive sleep habits includes children getting enough activity during the the day so they’re genuinely tired at night. Also helpful are ambient noise makers, peaceful music, avoiding sugar two hours prior to bedtime, consistency in bedtime routine, comfortable pajamas and comfortable temperature in the home. Is it important to keep the child’s bedroom dark? Dimming the lights is important, regardless of the time of year. This is another reason to ban screens, as they emit light that stimulates wakefulness.

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Young children under 4 and adults over 65 are especially vulnerable to heat exhaustion. Avoid heat exhaustion this summer with some expert tips. Northern Nevada summers can be downright hot, and although the balmy temperatures can feel great, they may cause heat-related illness, also known as heat exhaustion. Infants and children under 4 and adults over 65 are particularly vulnerable to heat exhaustion because their bodies adjust to heat more slowly. Without proper intervention, heat exhaustion can progress to heat stroke, which can damage the brain and other vital organs and even cause death. The Warning Signs of Heat Exhaustion Heavy sweating Elevation of body temperature Paleness Muscle cramps Tiredness, weakness, dizziness Headache Fainting Nausea or vomiting Cool and moist skin Fast and weak pulse Fast and shallow breathing Heat stroke happens when the body’s temperature rises rapidly and the body loses its ability to sweat. The Symptoms of Heat Stroke Body temperatures rising to 106 degrees or higher within 10 to 15 minutes Red, hot and dry skin (no sweating) Rapid, strong pulse Throbbing headache Dizziness or nausea Prevention and Treatment Make sure your air conditioner works Stay indoors and drink plenty of fluids Limit strenuous outdoor activities to mornings and evenings Drink plenty of water throughout the day Avoid caffeine and alcohol Do outdoor activities in the shade and wear light, loose clothing Take plenty of breaks and drape a wet bandanna around your shoulders to cool down If you suspect you or someone else is headed toward heat exhaustion or heat stroke, call 911 immediately.

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Halloween is around the corner. So while you're prepping pumpkins for carving, putting together creative costumes and coordinating trick-or-treating plans, safety is one more detail to remember.   Masks, haunted houses, witches, ghosts and ghouls — it all spells Halloween, and what could be more frighteningly fun, right? For children, however, Halloween can indeed be frightening and not so fun.  According to Dr. Kristina Deeter, Physician-in-Chief of Renown Children’s Hospital and Chair of Pediatrics for the University of Nevada, Reno School of Medicine, it is common for younger children to express Halloween fears — being afraid of monsters, the dark or really anything out of the norm. “It's normal for children to struggle with separating reality from fantasy,” she explains.   For children who fall into this category, the month of October can be traumatizing. Halloween may not come until the end of the month. Still, in the weeks building up to the spookiest night of the year, little ones are bombarded on all sides with decorations — mummies, skeletons, coffins, vampires, you name it. For a child with a blossoming imagination who, as Dr. Deeter said, is still learning to differentiate real from pretend, this can cause additional fears and anxieties. In commemoration of Halloween Safety Month, Dr. Deeter shares safety tips for the spooky holiday from the American Academy of Pediatrics:  Dressing Up & Heading Out  Plan costumes that are bright and reflective. Ensure shoes fit well and that costumes are short enough to prevent tripping, tangling or coming into contact with flames.   Consider adding reflective tape or striping to costumes and trick-or-treat bags and baskets for greater visibility.  Masks can limit or block eyesight. Instead, consider non-toxic makeup and hats, which should fit properly to prevent them from sliding over the eyes. Test makeup ahead of time on a small patch of skin to test for allergies before full application.  When shopping for costumes, wigs and accessories, look for and purchase those with a label clearly indicating they are flame resistant.  If a sword, cane or stick is a part of your child's costume, make sure it is not sharp or long. A child may be easily hurt by these accessories if he stumbles or trips.  Do not use decorative contact lenses without an eye examination and a prescription from an eye care professional. While the packaging on decorative lenses will often make claims such as "one size fits all," or "no need to see an eye specialist," obtaining decorative contact lenses without a prescription is both dangerous and illegal. This can cause pain, inflammation, serious eye disorders and infections, which may lead to permanent vision loss.  Review with children how to call 9-1-1 (or their local emergency number) if they ever have an emergency or become lost.  Carving Pumpkins  Leave the carving to the grownups. Have children draw the pumpkin design with markers, but keep knives away.  Consider using a flashlight or glow stick instead of a candle to light your pumpkin. If you do use a candle, a votive candle is safest.  Candlelit pumpkins should be placed on a sturdy table, away from curtains and other flammable objects, and not on a porch or any path where visitors may pass close by. They should never be left unattended.  Prepping Your Home  Keep your entryway safe for trick-or-treaters by removing all items from the porch or front yard that a child could trip over, like garden hoses, toys, bikes and lawn decorations.  To ensure visibility, check outdoor lights and replace burned-out bulbs.  Sweep leaves (or snow) from sidewalks and steps.  If there are dogs in the home, take steps to ensure they don't jump on trick-or-treaters. Hunting for Treats  Young children should always be accompanied by a parent or responsible adult.   Give each child and adult a flashlight (with fresh batteries).  If older children are heading out to trick-or-treat alone, plan and review a route you can agree on, as well as a specific time they are supposed to return home.   Only visit homes with a lit porch light. Never enter a home or a car for a treat.  Notify law enforcement authorities of any suspicious or unlawful activity immediately.  Since pedestrian injuries are the most common injuries to children on Halloween, remind youngsters to take crosswalk safety precautions.  For more key tips regarding Halloween safety for your young trick-or-treaters, visit our partners at Safe Kids Worldwide for a variety of spooky safety resources.

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October is Domestic Violence Awareness Month in the United States. We spoke with Renown Health experts and local domestic violence prevention organizations who gave us a deeper look into understanding the warning signs of abuse and the many proactive and reactive resources in our community that you can reach out to today.  Domestic violence, also referred to as domestic abuse, is an everyone issue. Whether you identify as male or female, an adult or a child, single or partnered – domestic violence can affect anyone. In fact, it may be closer to home than you might think.   According to the Nevada Quality Parenting Initiative, in Nevada, 43.8% of women and 32.8% of men experience domestic violence in their lifetime, and the risk of that figure rising is imminent. This year alone, the Domestic Violence Resource Center (DVRC) in Reno experienced a 55% increase in overnight emergency stays, according to the Reno Gazette-Journal.   This problem also, unfortunately, extends to children. More than 5,000 children in Nevada were reportedly primary or secondary victims of domestic abuse in 2021, as stated by the Nevada Coalition to End Domestic and Sexual Violence.  “Domestic violence can manifest in many different ways,” said Kami Price, Supervisor of Social Services for Renown Health. “Abuse isn’t always strictly physical. It can also be emotional, verbal, sexual and even digital. Understanding those differences can help you prepare accordingly and respond safely if you or a loved one are experiencing domestic violence.”   Knowing what to look out for is crucial in protecting yourself and others against the effects of domestic abuse and taking action when warning signs appear. The National Domestic Violence Hotline shares the common signs of an abusive partner, no matter how old they are or what gender they identify as:  Telling you that you never do anything right.  Showing extreme jealousy of your friends or time spent away from them.  Preventing or discouraging you from spending time with friends, family members or peers.  Insulting, demeaning or shaming you, especially in front of other people.  Preventing you from making your own decisions, including about working or attending school.  Controlling finances, including taking your money or withholding money for needed expenses.  Pressuring you to perform sexual acts you’re not comfortable with.  Pressuring you to use drugs or alcohol.  Intimidating you through threatening looks or actions.  Threatening to harm or take away your children or pets.  Intimidating you with weapons.  Destroying your belongings or your home.  "People experiencing domestic violence may feel as though they are trapped,” said Kami Price. “The reality is – this often couldn’t be further from the truth, especially with the resources we have at our disposal in northern Nevada.”  Respected Resources Ending the Silence on Domestic Violence  While these facts and figures might be staggering, those experiencing domestic violence at any age are not alone. There is hope at the end of the tunnel, especially here locally.  Devoted to meeting the growing needs of the communities we serve, Renown Health proudly supports and sponsors several organizations in our community that are committed to educating children and adults on the signs and symptoms of domestic violence, along with what each child and family member can do today to prevent abuse in the household. These essential organizations are on the frontlines of shifting attitudes from “I don’t want to get involved” to “How can I help?”  Serving children across northern Nevada, the Child Assault Prevention (CAP) Project offers “education and prevention programs designed to increase children’s safety from bullying, abuse and assault” and break the cycle of domestic abuse. During 2021 and the first half of 2022, CAP led about 500 different workshops, teaching 10,000 second-grade and fourth-grade children in Washoe, Storey, Lyon and Churchill Counties how to keep themselves safe from domestic violence.   “As domestic violence is on the rise, open communication, early intervention and education are key to protecting children from the effects of domestic violence," said Rebecca LeBeau, Executive Director of the CAP Project. “That’s why I begin speaking about child assault prevention and stranger danger to kids as young as six years old. It's important to explain the true reality of domestic violence to both children and adults, tailoring language specifically to whatever age they are, and allowing them to process it. Kids of all ages will learn how to deal with extremely dangerous situations this way.”  According to Rebecca, common symptoms of abuse to be on the lookout for at school include grades dropping, a lack of focus and feelings of not wanting to return home after the school day ends. If someone in a child’s home is being hurt or abused, children are always encouraged to speak with a trusted adult or school counselor. From there, organizations like the CAP Project develop a safety plan moving forward.  Adults and family units aren’t alone either. The DVRC provides a wide variety of services to Washoe County residents experiencing domestic abuse. To date, the DVRC has helped more than 100,000 victims of domestic violence, and with the recent launch of their crisis text line, they are poised to serve many more. Like the CAP Project, the DVRC also believes that education is one of the first lines of defense against domestic violence.  “Education on what domestic violence looks like is so much more than talking about physical violence,” said Aria Overli, Volunteer Coordinator at the DVRC. “Educating the community, and particularly youth, about what healthy relationships look like is a major factor in preventing abuse. Understanding the intersection of how other issues – such as race, mental illness and immigration status – affect domestic violence risk factors is key to addressing those issues.”   The list doesn’t stop there. Renown Health Foundation has provided financial support for many more organizations that are dedicated to ending the silence on domestic violence, sexual violence and family abuse, including:  The Children’s Cabinet – A child-focused organization offering many support services for youths and families, including Safe Place, a program that partners with local businesses to offer safe locations for children to seek help if they feel threatened at school or at home. The organization also provides free family counseling, providing a pathway to better communication for families experiencing a myriad of issues ranging from domestic violence to substance abuse.  Awaken – A nonprofit committed to increasing awareness and education regarding sex trafficking and providing housing and healing to all survivors.  Safe Embrace – The largest and most inclusive safe house in Reno-Sparks for survivors of domestic and sexual violence, offering a wide range of resources including counseling, emergency transportation, court support and more.  Eddy House – A safe space for at-risk individuals aged 18-24 recovering from the effects of domestic abuse, unsafe housing conditions, homelessness and more.  Being an advocate starts with us – if you see something, say something. Keeping a transparent line of communication is key to preventing, noticing and combating domestic violence.   “The more you reach out and talk about the issues, the better,” closed Kami Price. “No one has to go through their struggles alone.”

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