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

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Learn more about a Renown Health nurse who formed a nonprofit to help other families through loss. After the unexpected loss of her young husband, a Renown Health nurse turned her grief into helping other families navigate the loss of a family member. Jen Walker, RN, MSN, director of clinical excellence, lost her high school sweetheart and husband of eight years when he passed away in October 2015, while their two boys, age 7 and 9, lost their father. Walker, a nurse at Renown since 2003, was overwhelmed by the outpouring of support she received from the Reno community. It inspired her to want to help others in the same situation. “After Travis passed, the community did some amazing things for me,” Walker says. “I got really motivated to do the same thing and to give back, so that’s when I came up with starting The Journey Within.” The Journey Within organization provides support and resources for young families who have lost a close family member. Before officially starting her organization, Walker used some of the money she received after her husband passed and personally donated to three families. And with the help of four board members, Jen officially started The Journey Within in February 2017, and they have helped six families so far. One of the board members is her sister, Anny Goff. “She thought of creating this foundation in the darkest time of her family’s life,” Goff says. “She knew there would be other families that would need help and support and immediately wanted to help others. It showed incredible strength and courage to keep moving forward.” Nursing Careers at Renown Health Nurses at Renown Health demonstrate a commitment to patients and their families through the integration of care, clinical expertise, education, evidence-based practice and the pursuit of quality patient outcomes. Learn more about our mission, vision and values and the benefits of a career in nursing at Renown Health today. Explore Nursing at Renown Walker’s organization supports families through financial donations, which she funds through two yearly fundraisers. The Travy Tourney is a golf tournament held in memory of Travis, and the “Let’s Toast to Travis Fundraiser” event raffles prizes and merchandise. Along with financial support, The Journey Within helps families connect with other community resources, such as counseling and grief therapy services. Walker hopes to expand her nonprofit’s fundraising and support for families beyond the Reno-Tahoe community. Because of her outstanding work at Renown and in the community, Walker recently received a 20 Under 40 award from the Reno-Tahoe Young Professionals Network. She has also received a Women of Achievement award, a Leader of the Quarter award and has been nominated four times for Northern Nevada Nurses of Achievement. “She is strong and resilient and cares a lot about people,” says Jen Richards, chief nursing officer, acute care services. “She never settles for the status quo and is always pushing our team to do better.” In navigating her own loss and starting a nonprofit to give back, Walker has learned a lot about the community. “I’ve gained a tremendous amount of respect for the community as a whole, but especially for the young community,” she says. “Seeing the young people in the community who have been willing to give back and live really selflessly has been amazing to me.” As someone who lost her husband, helping young families who have gone through the loss of a close loved one can hit close to home for Walker, but that doesn’t stop her — it fuels her. “That’s one of the hardest parts about doing this — it takes you back a little bit,” she says. “But it’s just a very good reminder of ‘why.’ Because when I get to talk with these families, I realize that now I am that person who is there to listen. I just want them to know that they’re talking to someone who’s been through something similar.”

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Experiencing knee pain during exercise or while undertaking daily activities? The knee is the largest joint in our body, so it goes without saying a lot hinges on its functionality. Here are a few exercises to help.   Is exercise a real pain in the knee for you? Does getting up in the morning require a few minutes for your knees to adjust to walking around? As it turns out, knee pain is common, and it can result from injury, overuse or the breakdown of cartilage over time. Often, this pain is a result of faulty mechanics in your body, according to Jessica Ryder, a physical therapist with Renown Physical Therapy and Rehab. “We see weakness at the hips causing a lot of stresses at the knee,” she says. Exercises that Alleviate Knee Pain Try these three exercise to strengthen your glute muscles and maintain proper alignment in your knees. Hip Lift Lie flat on your back with your knees bent and feet flat against the floor. Lift your hips into the air until your body is in a neutral position, then lower your hips back down. Repeat this motion several times until you feel a gentle burn in your glute muscles. Step Down Stand with one foot on a stair or step. Slowly bend your knee and drop the other foot toward the floor. Slowly extend back up to your starting position. While doing this exercise, it’s important to move slowly, maintain control and ensure that your knee is in line with your toes. Do as many reps as needed until you feel a small fatigue in your muscles. Repeat this exercise on the opposite leg. Side Step with Exercise Band Place an exercise band around your ankles. Stand in a slight squat and then take several steps to the side until you feel a small fatigue on the outside of your hips. While doing this exercise, keep your upper body still and focus the exercise to your hips. The band will try to move your knees toward each other Repeat in both directions. Hometown Health and Renown Health are proud to be the official insurance plan and healthcare partners of the Nevada Wolf Pack. Renown Physical Therapy and Rehab | 775-982-5001 Through outpatient physical, occupational and also speech therapy, Renown Physical Therapy and Rehab gives patients hands-on, individualized treatment. Our therapists use evidence-based methods to help patients return to an active, productive lifestyle. Learn More About PT

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Registered Nurse Tori Tembey (left) shared how her co-worker and fellow RN Jennifer Payne helped a patient with his pet's end-of-life arrangements. "It was such a selfless act that Jennifer took the time to do this for the patient.” Tembey says. Pets become members of our own family, and when they are ill or at the end of their lives, it can be devastating for their owners. During a hospital stay, a Renown patient was faced with the difficult decision to euthanize their terminally ill pet. A Renown registered nurse stepped in to help in some pretty remarkable ways. Back in high school, Jennifer Payne wanted to be a veterinarian. She worked in a veterinary hospital and planned to attend veterinary school, but struggled with some of the situations she faced. “I have a lot of compassion for animals,” Payne explains. “And some of the things I saw while working at the vet — like people bringing in their cat saying, ‘I’m moving, you need to put this cat down’ — wasn’t OK with me, and wasn’t what I wanted to do.” She changed course and went into nursing, but recently drew upon her early experiences working with pets and their owners to help a Renown patient in an extraordinary way. Payne now works in the trauma intensive care unit at Renown Regional Medical Center, where she recently observed a county animal control officer visiting a patient. The patient was visibly upset — they learned their dog was terminally ill and in poor health, and a veterinarian was recommending euthanasia. The patient had lost another dog just before Christmas. The patient hoped to have his ill dog similarly cremated, but animal control does not perform cremation. “I overheard all of this and thought, ‘this is the most horrible thing I’ve ever heard,’” Payne says. She offered to pick up the dog, have him cremated and bring the ashes to the patient. She also took up a collection with her Renown colleagues to pay for the cremation. The next day — her day off — Payne and her young daughter picked up the ashes and brought them to the patient at the hospital. “He couldn’t even talk because he was crying so much,” Payne says. “He said ‘I can’t thank you enough for all you’ve done. You’re a wonderful person.’ There was a friend in the room who asked what my daughter’s name was, and I said ‘Estelle.’ The friend said, ‘Estelle, your mother is an angel.’” Payne, who has a golden retriever of her own, says she knows what it’s like to have “fur babies,” and she could see how important this dog was to the patient. “It was great to be able to do this for him,” she says. Renown salutes nurses like Jennifer Payne, who are making a genuine difference everyday in the lives of patients and in the community.

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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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In recent years, workplace violence against healthcare workers has been on the rise. According to the Occupational Safety and Health Administration (OSHA), about 75 percent of nearly 25,000 reported annual workplace assaults occur in healthcare and social service settings. Those who don’t work in healthcare may be surprised to learn that violent altercations are so common in our field. Hospital settings can create fear and stress for patients and their families. Pain, mind-altering medications and drugs, and difficult prognoses can amplify these feelings. While inappropriate responses may be understandable, violence cannot be tolerated. As the leader of a health system, protecting our employees is an issue that I take seriously. Reporting Workplace Violence Unfortunately, sometimes employees don’t report dangerous incidents fearing they might be blamed, or not realizing it’s a reportable offense. At Renown Health, we take these events seriously. We have clear, mandatory policies and protocols for reporting and investigating violent incidents. Each incident is investigated to ensure follow through and accountability. We also teach de-escalation skills to our hospital security teams, clinicians, and other frontline employees. As an added layer of protection, Renown Health has a first-rate security team that closely monitors activity on our campuses, addressing potential issues before they escalate. Our organization values our partnerships with community organizations including local law enforcement agencies like the Washoe County Sheriff’s Office and the Reno Police Department. Renown Health maintains a close relationship with these partners, and we alert them when our care teams experience an increase in violent incidents. I also recognize that workplace violence is a national problem that demands collaborative solutions. That’s why I am also proud to serve as a member of the American Hospital Association’s Hospitals Against Violence Advisory Committee. Nurses, doctors, paramedics, and frontline health workers care for us every day. It’s our responsibility to support them by ensuring they feel safe at work.

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Michael Elliott, MD, head of the Department of Pediatric Orthopedics and Scoliosis, answers some common questions about bone fractures. Is there a difference between broken bones and fractures? No, these are two different names for the same injury. Of course the common term is a broken bone. Using either name will describe your concerns. Medical personnel typically describe a broken bone as a fracture to a specific bone. For example, a broken wrist is also a fractured distal radius. To clarify, this describes the injured bone and the precise location. How do I know  if my child has broken their bone? Many times children will fall and complain of their arm or leg hurting. In most cases the pain goes away and the child will return to their activities. When there is a deformity to the limb (curve in arm) and the child is complaining of pain, it is probably a fracture. If the arm or leg looks straight, look to see if there is any swelling or bruising. Both are signs of a possible fracture. Finally, if the limb looks normal but the child continues to complain, gently push on the bone. Likewise if it causes the same pain, then they likely have a fracture and should have an x-ray. My child fractured their growth plate, what does this mean? Growth comes from this area of the bone. In detail, these are located all over the body but typically at the end of the bones. With this in mind, fractures to these areas can result in the bone growing abnormally. Because of potential shortening of the arm or leg, or bones growing crooked, it is important to follow fractures closely (up to 1-2 years or longer). It is better to identify a problem early. Small problems can be treated with small surgeries. What if the bones of the x-ray do not line up? Because children are growing, unlike adults, their bones will remodel and straighten with growth. The amount of remodeling occurring depends on a child’s age, the bone fractured and the location. In many cases an angled bone will grow straight over the course of a year. For this reason, someone with experience in caring for children needs to follow bone growth. How long does it take fractures to heal? Factors deciding when a cast can come off include: Child’s age. Bone fractured. Fracture location. Young children heal faster than teens, teens heal faster than young adults, who heal faster than older adults. In young children most fractures heal in 4-6 weeks. However, teens generally take 6 weeks to heal, and adults can take much longer. Although your child  is out of their cast, it may not be healed completely to return to all activities. Placing a splint is during this time is common. This typically gives them added protection for several weeks after their cast is removed -  in case they forget their limitations. What if my child is still limping? Whether a child is in a walking or non-weight bearing cast, removing it often leaves them stiff and sore. Therefore many children will walk as though they still have a cast in place. In most cases this resolves in about three weeks. Regardless, if your child is still limping or walking abnormally after three weeks, contact the treating doctor. They may benefit from physical therapy or a repeat evaluation.  (This article was original published in the July 2019 issue of South Reno Kids & Sports.)

Read More About Bone Fractures in Children Honest Expert Advice

Renown Health recently wrapped up the twentieth annual Nursing Excellence and Excellence in Critical Care Conferences, the conference theme was the Courageous Calling and over 400 nurses from specialty fields across the region attended to learn, reflect, build relationships and obtain continuing education units (CEUs).   Celebrating The Courageous Calling During the first day of the Nursing Excellence Conference, local and national leaders presented topics including redefining resilience, documentation liability, transgender healthcare and caring for the homeless population. Among the list of impressive speakers were Chief Nurse Executive at Renown Health, Melodie Osborn, and Nora McInerny, writer and host of the "Terrible Thanks for Asking" podcast.   On day two,speakers focused on the critical care specialties within nursing, including intensive care, emergency room, pediatric intensive care and neonatal intensive care. Topics covered included post-COVID-19 pulmonology with Dr. Graham, traumatic brain injuries with Dr. Demers, COVID-19 reflections with Anicia Beckwith, a discussion about "Mis C” with Dr. Healy, innovations in imaging with Dr. Rangaswamy and cardiology with Dr. Danaf. Thank you to our sponsors and raffle donors for making this event possible: Erik Olson and Larry Duncan, Jana Elliott, Melodie Osborn, Becky Haase, Lori Tuntland, Dr. Akbar, Dr. Lous, Mel Morris, Grand Sierra Resort, Renown Health Gift Shops, Renown Health Directors of Nursing, Renown Health Marketing & Communications Department, Renown Health Dermatology, Laser, & Skin Care and Renown Health Foundation.   Learn more about finding purpose in the health of our community when working at Renown Health here.

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