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In this article reprinted with permission from the Galena Times,  Dr. Max J Coppes, Physician-in-Chief, Renown Children’s Hospital, and Nell J. Redfield, Chair of Pediatrics, UNR Med, talk about adolescents vaping, and how an estimated additional 10 million teens are at risk to start using e-cigarettes. What are E-cigarettes? E-cigarettes are battery-operated devices heating a liquid (e-juice) into an aerosol to be inhaled. Breathing in this flavor vapor, which usually contains nicotine, anti-freeze or other cancer-causing chemicals is called ‘vaping.’  There are many forms of these electronic nicotine delivery devices - and they're not always obvious. They not only appear to be cigarettes, cigars, or pipes, but also pass for everyday items, such as flashlights, flash drives or pens.   The Effects of Vaping and E-cigarettes Regardless of the nicotine delivery, vaping is addictive and is quickly becoming a public health concern. Nicotine levels in e-cigarettes vary greatly, and they may also contain toxic chemicals. Currently there is a wide range of variability among vaping products. In other words - they deliver different ingredients, hardware, levels of nicotine, and possible toxic chemicals to the user. This makes it challenging to create an overall public health recommendation on their use. Nevertheless, there is no confusion about the harmful effects of the chemicals used in e-cigarettes to the young brain, which develops until age 25. Studies show e-cigarette use serves as an introductory product for teens to go on using ‘regular’ tobacco products. The American Academy of Pediatrics has several recommendations on their use. Such as increasing the minimum age to buy tobacco products, including e-cigarettes, to age 21 nationwide. (Update: nationwide the age as of January 2, 2020 is now 21.) A common misunderstanding with teenagers is the belief e-cigarettes are less harmful than other tobacco products. Moreover, there is a wide range of flavor choices, from mint, mango, crème brûlée to cucumber to attract users. As of September 6, 2019, The Centers for Disease Control and Prevention is reporting over 450 possible cases of lung illness associated with the use of e-cigarette products in 33 states.    What Should Parents Know about Vaping? Parents and teachers should know JUUL is a very popular e-cigarette among teenagers, capturing about 68% of the market. JUUL is sleek, small, hides easily, and resembles a flash drive. Surprisingly it charges in an USB port, and can also instantly be mistaken for a real flash drive. One JUUL cartridge contains twice the nicotine found in other e-cigarette cartridges. This roughly equals the amount of nicotine in an entire pack of cigarettes. To repeat, the use of JUUL in young people continues to grow, and this is why parents and teachers need to be aware. Be alert, teach, communicate, and talk to your child about the serious risks of smoking in all forms, whether at home or parties. Tell them how difficult it is to quit and why they should not start. Loving your children is caring; caring for their current and future health and well-being.

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Eating healthy is a daily challenge for many, but for those with cancer it is an even harder struggle. A cancer diagnosis not only impacts those diagnosed, but family members and friends too. One key area of concern is making sure your loved one stays well by eating healthy food every day. Here are some essential cancer nutrition tips from Renown Health registered dietitians Jessica Blauenstein and Amy Laster. Help to Prepare Meals and Snacks for Daily Cancer Nutrition Make it grab and go. Easy-to-make meals help reduce the burden of having to cook and prepare food. Having easy to grab snacks on the counter or in the fridge can help ensure your loved one has access to those nutrients when needed. Sit outside of the kitchen. This allows your loved one to avoid cooking smells which can make them feel sick as a side effect of cancer treatments. Also try serving them cold foods such as sandwiches, cheese and crackers, or shakes which have a mild scent. Try drinkable meals. Some people with cancer find it easier to sip their calories over the course of 30 minutes to an hour. Consider smoothies or supplemental shakes such as Ensure Enlive or Boost Plus as snacks not meal replacements. A great foundation for a smoothie is a protein source (Greek yogurt, protein powder, nut butters or milk) with a carbohydrate (fruits, juice or berries). Add other ingredients as desired, such as spinach, kale, and ground flaxseed or chia seeds to give it more vitamins, minerals, and fiber. Snack Ideas for Those Undergoing Cancer Treatment The following ideas are both quick and easy to make for your loved one. Chicken or tuna salad with whole grain crackers or as a sandwich on whole grain bread Greek yogurt mixed with cereal, fruit and/or nuts Cottage cheese with banana, cinnamon and/or peanut butter Favorite fruit with 100% natural peanut or almond butter spread - Try peanut butter with bananas, apples, or even celery Their favorite veggies dipped in a salad dressing of your choice - For example, carrots with hummus or ranch dressing Cheese and whole grain crackers - Add tomato slices with a dash of oregano on top for more flavor Eggs scrambled with cheese, vegetables and/or salsa Peanut butter and jelly sandwich on whole grain bread A baked sweet potato with some favorite toppings Hard boiled eggs and/or egg salad with whole grain crackers, or as a sandwich on whole grain bread Oatmeal or cream of wheat prepared with milk, fruit and/or nuts Sometimes your loved one may not feel like eating or refuse to eat. If treatment side effects are impacting your loved one’s ability to eat, please visit the websites below containing recipes tailored to treat side effects. Cook for Your Life ELLICSR Of course you may also consult a registered dietitian and/or the patients care team, if you have more cancer nutrition concerns. No Appetite? Assisting with Cancer Taste Changes Taste changes are common during cancer treatment. Patients experiencing these changes may not feel like eating, which can negatively impact their nutrition. Help your loved one overcome taste changes with these cancer nutrition strategies: Metallic or bitter taste in food - add something sweet such as maple syrup, honey or jelly. You may also try adding fat, such as a nut butter, avocado or regular butter. Pickles or vinegar could help with this too. A taste like cardboard - try adding salt and extra flavor to foods with seasonings and spices. Some examples are onion, garlic, chili powder, basil, oregano, rosemary, tarragon, barbecue sauce, mustard, ketchup, or mint. Lemon juice, citrus, vinegar, or pickles may also help with this as well Food tastes too sweet - try adding six drops of lemon or lime juice. Add small amounts until the sweetness is gone. Very salty taste - try adding ¼ teaspoon of lemon juice. Try plastic utensils instead of metal, especially if your loved one is struggling with foods tasting metallic. Dipping small bites of food into either lemon juice or vinegar can have a “palate cleansing” feel and may improve taste perception. This helps avoid getting tired of the flavor after a few bites. Try marinating food or meats in sweet fruit juices, salad dressings, or sweet-and-sour sauce. Other “palate cleansing” foods are lime juice, orange juice, mangos, lemongrass, parsley, cilantro, mint, ginger, basil, and pickled foods. Use aroma to make foods appealing, avoiding any smells that may cause nausea. In particular, cinnamon, nutmeg, cloves, coriander, cumin, ginger, and black pepper can add an aromatic flavor. Also include herbs such as oregano, rosemary and thyme. Think texture. Consider trying wafers, crunchy nut butters, carrots, celery, cucumbers, chips, rice crispies, corn flakes, crackers, panko crumbs, nuts, or seeds if you are able to chew and swallow them safely. Remember that patience with your loved one's changing appetite and tastes can be the strongest form of support you can provide. Nutrition Tips for Cancer Survivorship and Beyond If eating large meals is difficult for your loved one, encourage them to snack throughout the day. Aim for 4-6 snacks or small meals per day. Focus on consuming 2-3 protein-rich foods each day such as lean animal meats, fish, eggs, soy or a protein supplement with 20-30 grams of protein per serving. Eat a variety of brightly colored fruits and veggies. Aim to make half of each meal fruits and vegetables. Eat less than 18 oz. (cooked weight) of red meat per week. Limit cold cuts, bacon, sausage, and hot dogs. Avoid excess salt and saturated fats. Cut back on simple carbs. (i.e. desserts, candies, white bread/pastas, french fries, packaged foods, chips) Drink in moderation- if at all- one drink per day for women, two for men. Get enough vitamin D (through diet and/or supplement) Avoid tobacco of any kind. Keep a healthy weight and stay up on exercise. Other Ways to Help a Loved One with Cancer Assist with Chores Allow your loved one to relax as you help take care of chores around the house, such as cleaning, cooking and grocery shopping. This may reduce overall stress and can be helpful for those that get tired after their treatments. Physical activity can still be beneficial, so be sure to do an activity together that they enjoy and is approved by their doctor. Be Patient It can be very difficult to see a loved one go through cancer treatment. Remember to be patient with your loved one. There may be things we want them to do or eat that we know would be good for them, however, meet your loved one with grace and understanding. It is ultimately their decision on what to do, just be there to support and assist them as they go through this challenging time. Additionally, Renown hosts free “Eating Well After Cancer Treatment” nutrition classes for cancer survivors.  Our next cancer nutrition class series starts Thursday, June 3, 2021, and will be hosted virtually. It is open to anyone in the community. For more information or to register please click here.

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A slobbery kiss, a wagging tail, a judgement-free smile. There are few things better than the love and attention of a canine companion. At Renown Health, we have a loyal and playful group of pet therapy teams. This volunteer program uses animal-assisted interactions (AAI) and animal-assisted therapy (AAT) to provide comfort, reduce boredom, increase social interactions, improve mood, boost general well-being and – perhaps most importantly – bring smiles to our patients’ faces. Benefits of AAT & AAI: Lowers blood pressure and heart rate by relieving anxiety Helps in pain management Eases feelings of depression, loneliness, boredom and isolation Stimulates communication Encourages physical activity For more information about the program, a complete list of our teams or to get involved, click here. Meet Keno and Linda Linda, Keno’s human, has volunteered as one-half of a therapy dog team for more than 14 years. Keno is her third Newfoundland, and he is a sweet and cuddly 2-year-old pup, who, according to Linds, thinks is a lap dog. “My mother was in assisted living for almost 10 years, and I saw what an impact a therapy dog can have,” Linda said. When she moved to Reno from Portland six years ago, she immediately contacted Renown. A Memory the Stands Out: A patient in the ICU was not responsive because of oxygen deprivation due to almost drowning. Linda and Keno went into the patient’s room at his physical therapist’s request, and the therapist asked the patient to reach out and pet the dog. After the third request, he moved his hand toward the dog, and his mother burst into tears. It was the first time the patient had moved since his accident. Linda and Keno went back several days in a row, and soon the patient was talking, sitting up and eating on his own.   Meet Madi and Clark Madi, Clark’s human, is an employee at Renown, and Clark made it a family affair by joining the team in Sept. 2021. Clark is a unique pup with an amazing demeanor who adores everyone as much as they adore him. He is a hardworking Goldendoodle who loves to be a goofball at home when he’s off the clock. Why They Became a Therapy Dog Team: Madi was inspired to get Clark trained as a therapy dog because, as an employee at Renown, she was always so happy to see dogs walking around, and she knew that I wanted to provide that same relief to others. Her favorite thing about being a Renown volunteer is the joy it spreads to those working and the patients they are caring for.   Meet Richard and Raven Raven is a four old Belgian Malinois who has been working as a therapy dog for two and a half years. She is calm, friendly and loves having her tummy rubbed. “The therapy dog teams are just one little part of Fighting the Good Fight,” Raven’s human Richard said. A Memory that Stands Out: Raven and Richard were assigned to the Sierra oncology ward one shift and visited a woman who had a picture of her dog displayed next to her bed. Raven immediately went to the bedside and the patient started petting her. As she spent more time petting Raven, Richard could see the stress disappearing from her face. He later learned that it was the patient’s first chemotherapy infusion, and Raven gave her the peace and the strength she needed to face the chemotherapy head-on.   Meet Savannah and Hallie Hallie and Savannah’s journey as a therapy dog team began in 2017 at the Morgan Stanley Children’s Hospital in New York and has also taken them to San Francisco General Hospital and Stanford Hospital. The duo moved to Reno in 2020 and immediately joined the Renown Pet Therapy Program. A friend, energetic and cuddly American Cocker Spaniel, Hallie especially loves spending time with the young children at the hospital. A Memory That Stands Out: Savannah remembers one visit to a patient in the Children’s Emergency Room who was struggling with suicidal thoughts. Having struggled with mental health herself, Savannah felt a deep connection to the patient and a need to help. She recalls placing Hallie on the patient’s bed a seeing a “very small hint of a smile.” Savannah later learned that the Renown nurses hadn’t seen the patient smile in days. It was that moment that made Savannah realize what a profound impact Hallie can have on patients.   Meet Chivas and Donna Chivas was a McNab/Border Collie mix who volunteered at Renown with her human Donna for two years. With help from Donna, Chivas was a master at reading situations in the hospital and reacting accordingly. For example, if a patient was afraid of dogs, she would sit with her back to the person so she didn’t come off as threatening. Contrarily, she would lie down on the floor when playing with young children to let them pet her on their level. Why They Became a Pet Therapy Team: This dynamic duo started out as a member of a local pet therapy group. During the height of the COVID-19 shutdown, they participated in outdoor pet therapy parades for various hospitals in the area. Donna and Chivas met Renown Volunteer Coordinator Wendy Peuket at one of the parades and she inspired Donna to pursue becoming a registered therapy dog team for Renown's Therapy Dog Program. Chivas sadly passed away unexpectedly in early December 2021, and the world is a whole lot dimmer place without Chivas’ light shining brightly.

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This holiday season, don't forget about your favorite furry friends by baking these easy, AKC-approved dog treats. Simple ingredients and quick baking times make this the ideal last-minute surprise. Make it a gift by picking up affordable canisters (usually abundant at dollar and thrift stores) and filling them with homemade treats. It makes the merriest, pet-friendly gift of the season!

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According to the Centers for Disease Control (CDC), e-cigarette use isn’t just up among adults, but it has also tripled in usage for teens. Dr. Jose Cucalon Calderon, a Pediatrics Physician at Renown Health and an Assistant Professor of Pediatrics at the University of Nevada, Reno School of Medicine, provides helpful insight into e-cigarettes and the dangers it poses to kids and teens.   What Are E-Cigarettes? E-cigarettes are electronic nicotine delivery devices. e-cigarettes use liquid nicotine as an alternative to traditional smoked cigarettes. e-cigarettes contain nicotine which is an addictive substance with known toxic side effects that, when released in very high doses, that can have health consequences and causes addiction. Nicotine is described as “toxic,” but the most "toxic" part of e-cigarettes' is everything else within the E-juice. Nicotine mainly keeps people coming back for more. According to the CDC, e-cigarettes are also advertised using the same themes and tactics that have been shown to increase youth use of other tobacco products, including cigarettes. In 2021, approximately 76% of students reported exposure to tobacco product marketing through traditional sources, and approximately 74% of students who used social media had seen e-cigarette–related content. What Does This Mean for the Health My Teen? We know that nicotine can affect brain development in kids and teens, so it is important to educate your teen on the risks of exposure. If you have young children in the home, it is important to be vigilant as well. One teaspoonful of liquid nicotine can be fatal for a young child. How Do I Monitor My Teen for E-Cigarette Use? Monitoring your children can be tricky for parents. E-cigarettes can be harder to detect, unlike traditional cigarettes that were easy to detect by smell and residual odor. E-cigarette use, or “vaping,” is often associated with a dry cough or chronic throat/mouth irritation. Overall, increasing research shows strong links between mental health conditions and posterior combustible tobacco use along with increased risk of marijuana use. Nicotine is addictive, but it does not cause altered mental status like the other drugs of abuse can. All parents are strongly encouraged to talk to their children about the potential dangers of e-cigarettes.   What are the health risks of vaping? Vaping devices have been on the market for a relatively short period of time, with evidence-based health effects and complications still being discovered. Vaping effects poses many harmful risks to children and teens. The risks of vaping include: Chest pain Difficulty breathing Dizziness Headaches Impaired response to infection in the airway Inflammatory problems of the airway Nausea Nicotine addiction Seizures Vomiting   For more information for both parents and teens about quitting smoking or vaping, you can click here. Parents can also use this tip sheet from the U.S. Surgeon General to talk to their child about vaping. The Substance Abuse and Mental Health Services Administration free national helpline number is 1-800-662-4357 (HELP). It is available 24/7, 365 days a year offering confidential treatment referral and information (in English and Spanish). If you or someone you know is facing a substance (or mental health) problem, please reach out to them.

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If you’ve ever spent time at Renown, you may have noticed there are some four-legged volunteers roaming the halls greeting patients, visitors, and staff. Since 1997, Renown has been fortunate enough to have its very own therapy dog program. As of today, there are 43 dogs in the program, and each of them have gone through countless hours of training to offer healing, comfort and support to those seeking treatment within our health system. Each of these therapy dogs have their own special personalities, but they all share the same mission: to make a paws-itive impact on everyone they meet.  One therapy dog that has touched many lives at Renown is Raven, a five-year old Belgian Malinois mix. Raven's Story In March of 2019, Reno residents Richard and Vickie Lange rescued Raven from an animal shelter in Portola, California. When the Langes made Raven part of their family, they immediately started her in obedience training. After seeing her do so well, they thought of an idea that would not only help Raven reach her full potential but also allow them to give back to others – they decided to train Raven to be a therapy dog.

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