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Breast cancer is the leading cause of cancer deaths in women in the U.S. That’s why early detection is so important. Dr. George Krakora, a radiologist with Renown Institute for Cancer, explains what to watch for and how new technology can lead to early detection. Most women know the importance of breast health and staying current with annual breast exams, but may not know that both screening guidelines and technology is evolving. So we asked George Krakora, MD, a radiologist for the Renown Institute for Cancer, what every woman should know about breast cancer detection and which screening method is right for them. First off, when should women start getting breast exams? Generally, women should start getting breast exams using mammography or ultrasound after they turn 40 years old. But we also want women ages 18 to 39 to talk to their primary care provider and ask for what’s called a formal risk assessment to see if screening is needed sooner. And you want to make sure your care provider is giving you a breast exam starting at age 25. It’s also a good idea to be familiar with how your breasts look and feel so you can report any changes to your care provider. What are the risk factors for breast cancer? Are there any preventive steps women can take? There a few risk factors you can’t control, like your age, family history of breast or other cancers, and if you have dense breast tissue. Your risk for breast cancer increases as you get older, and most breast cancers are diagnosed after age 50. Knowing your family history is important because a history of cancer and shared lifestyle can raise your risk. Your breast density can also increase your risk: Women with high breast density are four-to-five times more likely to get breast cancer than women with low breast density. But the good news is there are quite a few things you can do to prevent breast cancer, like not smoking, watching your alcohol intake, and maintaining a healthy weight with good diet and exercise. There are a lot of newer screenings out today. What is the difference between 2-D and 3-D mammography? In a 2-D mammogram, the tech takes X-rays of the breast. These pictures can show the radiologist if there are any lumps or tumors you might not be able to feel. In 3-D mammography, the process is largely the same but more X-rays are taken and it takes a few seconds longer for each image. This kind of exam detects 41 percent more cancers and reduces the number of false-positive results given to patients. This improvement in technology is great for both patients and their care providers. 3-D mammography provides better images of the breast, which allow doctors to more clearly diagnose and avoid false positives, especially in women with dense breast tissue. And what about a whole breast ultrasound. What is that? A whole breast ultrasound uses sound waves to detect cancerous tumors in the breast without using any radiation — it’s an ultrasound just like pregnant women get to check up on their baby. And the exam only takes about 20 minutes. We recommend these exams for patients whose mammograms have shown that they have dense breast tissue. Dense breast tissue can make it harder for doctors to see any abnormalities, lumps or tumors in a mammogram, so this technology ensures better early detection.

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According to the American Cancer Society, approximately 14,100 new cases of invasive cervical cancer will be diagnosed, and 4,280 women will die from cervical cancer. However, cervical cancer is preventable with regular screening tests and the HPV vaccine. It’s important to note that medical advances have allowed progress in diagnosing and treating cervical cancer. While it used to be one of the most common causes of cancer death for American women, the incidence of death has significantly declined. What to Know About the HPV Vaccine HPV vaccination is the best way to prevent cervical cancer and is recommended for all youth starting as early as age 9, or for teens and adults up to age 45 who didn’t start or finish the series. In Nevada, only 50.1% of teens ages 13-17 have been vaccinated for HPV.  There are 13 types of HPV, and the vaccine Gardasil 9 protects against 9 of those HPV strains, greatly reducing the incidence of cervical cancer among vaccinated individuals. What to Know About Cervical Cancer Screenings The CDC says the most important thing you can do to help prevent cervical cancer is to have regular screening tests starting at age 21. And there are two common tests that can detect early stages of cervical cancer (or precancer) and improve health outcomes. The pap test (or pap smear). This screening looks for precancers. Women should begin getting pap smears when they’re 21. The human papillomavirus (HPV) test looks for the virus that can cause these cell changes. Cervical Cancer Screening Schedule The American Cancer Society offers the following guidelines for screenings: All women should begin cervical cancer screening at 21. Women between 21 and 29 should have a pap test every three years. Beginning at 30, the preferred way to screen is with a pap test combined with an HPV test every five years. This is called co-testing and should continue until age 65. A pap test (or pap smear) is performed during a regular screening appointment to look for precancers, cell changes on the cervix that might become cervical cancer if they are not evaluated or appropriately treated. Typically outpatient procedures can reduce the risk of long-term health impacts that prevent pre-cancerous cells from becoming cancer cells. Women over 65 who have had regular screenings in the previous ten years should stop cervical cancer screening as long as they haven’t had any severe precancers found in the last 20 years. How to Get Screened Request an appointment with your primary care physician or OBGYN to schedule a screening.

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March is Colorectal Cancer Awareness Month, and we want you to receive the best preventative care possible. Early detection can help prevent serious illness, yet many people still choose to skip their annual exams and routine screenings. Bonnie Ferrara, MD, MPH, Section Chief for Primary Care at Renown Medical Group, further explains the importance of this simple, easy way to stay healthy. Why are annual exams so important? The benefits of early detection and prevention to save lives and reduce the impacts of disease have been proven. These exams are the perfect opportunity to get your health questions answered. “This is your chance to sit down with your provider and talk about your overall health and your family’s health history as well as your concerns for the future,” says Bonnie Ferrara, M.D., family medicine. “It’s the opportunity for your provider to talk with you about your lifestyle, tobacco use, exercise and alcohol use, all of which make a difference in your future longevity.” The annual wellness exam is also an ideal time for most adult patients to discuss health screenings. In addition, these visits are the perfect time to address issues that may not directly relate to a particular medical problem or immediate illness. A good rule of thumb is to schedule these appointments around your birthday each year to make sure you and your provider are both updated on your care. Why would you need an annual exam if you aren’t feeling sick? According to Dr. Ferrara, seeing your care provider when you aren’t sick is one of the best times. “It is better if you try to arrange this visit when you are not feeling ill,” she says. “It is an opportunity to talk about wellness. Not only how to contribute to your wellness but also the changes that you can make that will make huge dividends in the future for your wellness. In addition, it allows us to do some education about what to expect in the coming years as far as your health and lifestyle changes.” What can you expect at an annual exam? Annual exams usually check your: History – lifestyle behaviors, health concerns, vaccination status, family medical history Vitals – blood pressure, heart rate, respiration rate and temperature General appearance – your care provider can find out a lot about you just by watching and talking to you Dr. Ferrara adds, “If this is a Medicare annual wellness exam, it is an opportunity to talk to your provider about depression and dementia as well as be tested for those.” You can also leverage your annual exam to speak to your provider about managing your chronic health problems. "As a provider, these visits give us the opportunity to hear how the medications and lifestyle changes we have recommended are working and if you are having problems with these, we have the opportunity to make suggestions of how to do things better for the future," Dr. Ferrara.

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Parkinson’s disease – you may have heard of it because Neil Diamond and Ozzy Osbourne were recently diagnosed with it. Or perhaps you know Michael J. Fox is a strong advocate and funds research through his foundation. Neurologist Jonathan Spivack, MD, discusses this disease, while physiatrist Stephanie Jones, DO, explains how physical therapy can help as a supplemental treatment. According to the Parkinson’s Foundation about ten million people worldwide currently have this disease. What is Parkinson’s Disease? “Parkinson’s disease is a neurodegenerative disease that progresses slowly and definitely, though at variable rates,” explains Dr. Spivack. “Symptoms go beyond the classic motor changes. It results from a loss of specific dopamine-producing brain cells. Specifically, this loss is likely due to a mix of genetic and environmental factors,” he adds. Dopamine allows communication between particular nerve cells responsible for movement. If you have Parkinson’s dopamine levels gradually drop, causing a loss of motor skills. Generally, most patients with the disease are over age 65. Early Signs and Symptoms Diagnosing Parkinson’s can be difficult as some of the symptoms happen during the natural aging process. The Parkinson’s Foundation identifies the following 10 early signs of PD: Tremors or shaking of your hand, fingers or chin Small handwriting Loss of smell Sudden movements during sleep Stiffness when walking or moving Constipation Softer or lower voice volume Mad facial expression Feeling dizzy or faint Hunching or stooping posture A single sign may not point to the disease, but if you (or a loved one) has multiple signs, talk to your healthcare provider.

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Dr. Derek Beenfeldt first joined the Renown family in 2014 as a family medicine physician after graduating from University of Nevada, Reno, School of Medicine (UNR Med) in 2011. His son Davis was only 10 years old when Dr. Beenfeldt decided to change careers and attend medical school. Ten years later, Davis is following in his dad’s footsteps as a third year student at UNR Med. “I am proud of Davis for taking on the challenges and the commitment that I know goes along with attending medical school,” Dr. Beenfeldt said. “I also feel lucky that we have a medical school with such a great reputation and resources close to home.” The affiliation is a great source of pride for Dr. Beenfeldt. Not just because two important organizations in his life are joining forces, but he also sees it as both entities taking on an immense responsibility – the challenge to be better for incoming students, and subsequently to improve healthcare in Nevada. Davis is currently going through his rotations and spending countless hours a week at Renown Regional. His dad is right there by his side supporting him along the way. “It has been really interesting to have discussions about the UNR medical school with Davis, I recognize the names of many of the professors and courses from when I was a student,” Dr. Beenfeldt said. “I tried to be empathetic, as I can relate to how difficult and stressful this time is for him. Dr. Beenfeldt currently works as chief medical officer for Renown’s insurance arm Hometown Health, and Davis is still browsing specialties. “I don’t know what kind of medicine I want to focus on yet, but I feel lucky that I can attend medical school so close to home and have the option to continue helping my fellow Nevadans after I graduate.” UNR Med at a Glance UNR’s Medical School was established in 1969 Over the last 50 years, UNR Med has educated 3,900+ physicians More than 30% of UNR Med physician graduates continue to practice in Nevada UNR Med is the state’s oldest medical school

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Unfortunately, men are less likely to visit their doctor for exams, screenings, and consults than women. So with the help of Bonnie Ferrara, MD of Renown Health, we've put together a list of eight screenings to help men stay on top of their health game. 1. Blood Pressure Tests Ages 20+ Blood Pressure tests measure the pressure in your arteries as your heart pumps. Biennial (every two years) checks are recommended if you have normal blood pressure or more frequently if you have high blood pressure (hypertension) or low blood pressure (hypotension). The United States Preventative Services Taskforce cites normal blood pressure below 120 systolic (top number) and 80 diastolic (bottom number). 2. Cholesterol Screening Ages 20+ High levels of cholesterol increase your risk of stroke and heart disease. A simple blood test will help your healthcare provider determine your numbers and if you're at risk. If you have a family history of diabetes or heart disease, you may need yearly screenings. But, again, your doctor can provide the best course of action.

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Don’t worry, there’s still time to enroll in a Medicare plan! You’ve probably noticed all the advertisements lately encouraging Medicare beneficiaries to enroll before AEP ends on Dec. 7. But what is AEP, and how can you ensure the best decision for Medicare enrollment? If you’ve been asking yourself this same question, you’re in the right place. Here we’ll explore some of the most important things you need to know before you choose your Medicare plan for 2023. What is AEP? AEP stands for Annual Enrollment Period, and for Medicare this takes place Oct. 15 – Dec. 7 every year. You might hear people refer to AEP as Open Enrollment or the Fall Enrollment Period. All Medicare beneficiaries can enroll during this time, and their new policy will take effect on Jan. 1 of the following year. If you’re already enrolled in Medicare Parts A & B, you can use AEP to enroll in a Medicare Supplemental or Advantage Plan. You can also choose to drop your Supplement or Advantage Plan and revert to traditional Medicare.

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Lung cancer is the leading cause of cancer deaths in both men and women in the U.S. The good news is the five-year survival rate increases dramatically if lung cancer is treated before spreading to other parts of the body. Julie Locken, MD, of Renown Health Imaging, explains more. What are the signs and symptoms of lung cancer? As you might expect, most lung cancer symptoms appear in the chest and can affect your breathing. Watch for signs such as: Persistent cough Constant chest pain Shortness of breath Wheezing Bloody or rust-colored phlegm Hoarseness Swelling of the neck Pain or weakness in the shoulder, arm or hand Recurring pneumonia, bronchitis or other lung infections Loss of appetite and loss of weight can also be signs of lung cancer That said, there are usually no symptoms in the early stages of lung cancer, which means getting screened can truly be a lifesaver. If you have a history of smoking, you should get screened as a precaution.  What are the risk factors of lung cancer?  Around 80% of lung cancer cases stem from a history of smoking tobacco. But there are other known causes, such as secondhand smoke, radon, asbestos and diesel exhaust. It’s important to do what you can to eliminate exposure to all of these to reduce your lung cancer risk.  People with an immediate relative – a parent, sibling or child – diagnosed with lung cancer and people between 50 and 80 years old are also at higher risk and may need to consider screening.  People who are at the highest risk are those with a history of smoking tobacco, particularly smokers who averaged one pack of cigarettes per day for 20 years or more, as well as former heavy smokers who quit in the last 15 years.

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Early detection is a significant piece of the breast cancer puzzle. Susan Cox, Renown Health Director of Cancer Operations, discusses what you need to watch for and how the latest technology can help detect potential cancer sooner. When should women start getting breast exams? It depends on risk factors: Average-risk women: Most medical organizations recommend the first mammogram between 40 and 44. Higher-risk women: Dependent on their high risk, which will dictate when they start screening, but generally around the age of 30 and not before 25 years old.

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According to the U.S. Department of Health and Human Services, there are more than 20 million estimated new sexually transmitted infection (STI) cases in the United States each year, with rates continuing to increase.  What you may not know is most STIs are preventable. We talked with Renown Adolescent Medicine Specialist, Caroline Barangan, MD to learn more about STIs.  How Can You Get an STI?  The CDC (Center for Disease Control) says that STIs are acquired through sexual contact. There are bacteria, viruses or parasites that can cause an STI which may pass from person to person in blood, semen, vaginal and other bodily fluids.  How Do You Know if You Have an STI?  STIs can have a range of signs and symptoms such as:  Warts, bumps or sores on or near the penis, vagina, mouth or anus Swelling, redness or severe itching near the penis or vagina Discharge from the penis Vaginal bleeding that’s not your period Painful or uncomfortable sex Vaginal discharge that has an unpleasant odor, causes irritation or is a different color or amount than usual  Weight loss, diarrhea or night sweats Aches, pains, fever and chills Jaundice (yellowing of the skin and whites of the eyes) Painful or frequent urination  Sore throat if you engage in oral sex It’s important to know that the majority of people who have an STI commonly have no symptoms at all, which is why it’s important to get regularly tested once you have had any sexual activity. Young people less than 25 years of age should be screened on a yearly basis at minimum.

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“In sickness and in health” are words we often hear when celebrating the momentous occasion of marriage with our friends, families and loved ones. For James Breckenridge, these words were the foundation of the love and commitment he and his wife Carolyn showed to each other during their 30 years of marriage. In health, James and Carolyn shared a love of traveling. Hopping in their van, driving across the continental United States and enjoying the views along the way will be a memory James cherishes forever. Unfortunately, their excursions would be cut short when Carolyn fell ill, rerouting to their local hospital, Renown Health. Carolyn has spent more time at the hospital than the average person – including recovering from COVID-19 at Renown South Meadows Medical Center. However, hospital admittance for Carolyn meant the same for James, providing support to his wife during her stay. Following more than 40 years of exceptional experiences with Renown and their most recent discharge from the hospital, James wrote a letter recognizing the efforts of the team members and healthcare providers who not only cared for Carolyn but also James. To Whom It May Concern James began his letter by applauding two Renown Regional nurses they got to know well during their recent visit. Tiffany and Ashley went the extra mile to care for Carolyn attentively. From simple tasks like gathering requested supplies to answering James’ questions in detail, they helped provide a comfortable environment for the couple. To these nurses, these tasks may have felt like another day at work. Still, James’ letter commends them for their acts of service, reminding us that every interaction we have with a patient can be a memorable one. Tiffany and Ashley weren’t the only team members who received recognition in James’ testimonial. He also took a moment to recognize the various nurses, certified nursing assistants, therapists and doctors they encountered during their care journey. All provided the excellent and helpful experience we aim for at Renown. Healing Memories James first brought Carolyn to Renown Regional Medical Center, formerly known as Washoe Medical Center, in 1980, but it was 1996 when things changed for him. Carolyn was admitted to the hospital for a procedure they originally anticipated would come with a difficult prognosis. To their surprise, doctors found the opposite. It was in that joyous moment that James’ perspective of hospitals shifted, now viewing them for what they truly are – a place people go to get better. “Every time I walk around Renown Hospital, I remember all the times Carolyn was healed there,” James wrote in the latter half of his letter. Healing Isn't Just for the Patient James took advantage of the many support resources accessible to family members during their time at Renown. These donor-funded hospital initiatives are a valuable mental health resource in difficult circumstances. Whether it was an afternoon stroll with his wife through Fianna’s Healing Garden or quiet time alone in the Spiritual Center, James never hesitated to turn to these resources in his time of need. “Although I know the Tahoe Tower is the modern, state-of-the-art part of Renown, I prefer the Sierra Tower because that is where most of my memories are.” Even a simple daily walk to the on-campus Starbucks was a notable part of his day – grabbing a cup of coffee for himself and often a treat for Carolyn. An Inspiration in Healthcare When asked to describe Renown in one word, James chose “inspirational.” His collective experiences with Renown, James said, “helped him to be a better healthcare advocate” when his wife received care at other hospitals. As a healthcare leader, we challenge ourselves to go above and beyond for the health of our entire community. Collaborating with our patients and their families is at the center of everything we do at Renown. Positive reviews mean the absolute world to us, and something about this handwritten letter feels even more special. We could not be more appreciative to James for sharing how our vision to inspire better health in our community was reflected in his 40 years of experience with Renown. We were saddened to hear of Carolyn’s passing during a recent meeting to thank James for his letter. We take solace hearing James’ beautiful memories of his wife and knowing that Renown Health was there in times of sickness and health. We offer our sincere condolences to James, Carolyn’s children and their family members.

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This week is Healthcare Environmental Services Week (Sept. 11 - 17, 2022). Join us in celebrating our Environmental Services department at Renown Health! Cleanliness in a healthcare environment begins and ends with the hard work of an environmental services (EVS) department, and at Renown Health, our EVS teams are no exception. This department not only provides sterile care areas for every patient, but they are passionate about keeping Renown’s patients, visitors and employees safe. Everyone who comes through the doors of any Renown location is immediately greeted with the embrace of a thoroughly clean and disinfected space, and they can rest assured that they are receiving care in the safest environment possible – and it’s all thanks to the dedication of EVS.  Transcending the Meaning of Clean  Talk about “squeaky clean!” All EVS team members follow a meticulous cleaning procedure to maintain patient safety in every care area. No corner or crevice is ever left behind – and the entire team is passionate about ensuring no spot goes untouched. Cris Hughes, Manager of Environmental Services and Linen for Renown, emphasizes that her team “is the frontline defense in stopping the spread of infections.”  There is no question that the work the EVS team does every day around the clock is crucial to protecting the lives of patients. “I love coming to work to clean and disinfect,” said Mary Orozco, Environmental Services Technician at Renown Regional. “I feel like I’m saving lives.”  After setting up carts with special cleaning chemicals, each team member heads to their assigned care areas and follows this step-by-step process (while changing gloves and using hand sanitizer in between each step to prevent contamination):  Step 1: Collect and dispose of all the trash in the room.  Step 2: Disinfect every item and surface. According to this department, blood is the most common bodily fluid left behind after a patient leaves a hospital room.  Step 3: If there is a bed in the room, make the bed with fresh linens.  Step 4: Mop the floors, ensuring every nook and cranny is thoroughly cleaned.  Each team member goes through a rigorous environmental services training process, where they are taught the four-step procedure outlined above. Renown EVS Technicians are Certified Healthcare Environmental Services Technicians, otherwise known as CHEST-trained.   The CHEST program “pairs quality education for high-performing health care environmental services professionals with evidence-based training sessions,” according to the Association for the Health Care Environment. CHEST certifications are also the key pathway to being promoted from housekeeper to EVS technician and being cleared to handle blood and other bodily fluids. Upon completion of the program, Renown is committed to promoting housekeepers to the next step in their career.  The EVS technicians do such a good job that they have been continually celebrated by patients and visitors alike. “The patients and their families give so much support for my work that they even want to ‘take me home' with them,’” said Josephine Ubando, Environmental Services Technician at Renown South Meadows.  Brittany Sylvester, Supervisor of Environmental Services for Renown, reiterates the department’s devotion to their jobs, as well as their talents that transcend the meaning of clean: “The EVS team has so much dedication to keeping our hospitals safe for our patients. They work so hard, and the passion they have is remarkable.”  We Have Your Back  How many of us can appreciate a great leader who helps provide optimal experiences at work? Most likely, you just internally raised your hand. In the EVS department, all team members consistently brought up one person in particular that always supports them in every endeavor: Cris Hughes.   “Cris motivates me,” said Dianda Enchante, Environmental Services Technician for Renown Regional. “Cris practices open communication and always follows up. We know she has the team’s back.”  “I wish we could have a monument outside to show appreciation for our leads because they are amazing,” said Josephine Ubando. “We have the best supervisor and manager.”  For Rosario De Gomez, Environmental Services Technician at Renown South Meadows, Cris and her team leads are part of the reason why she has stayed at Renown for 23 years. “My team lead and manager are good people,” she added.  Cris responded back to the piles of praise, saying that she could not be prouder of her team. “I feel their accomplishments and challenges, kind of like a mom does.”  Imelda Castillo, Environmental Services Team Lead at Renown South Meadows, is also humbled by her employees and their compliments towards her. They continuously inspire her to strive for excellence in her job after 21 years of working for Renown. “I want to celebrate everyone,” said Imelda. “We are a team!”  A strong team indeed. Sha’vonne Mclean, Quality Assurance Analyst for Renown, “could go on and on about the work that goes on in the EVS department.” Sha’vonne emphasizes that the EVS technicians and housekeepers are the backbones of our health system. “We as a team are responsible for the health and wellness of Renown, from top to bottom,” she added. “EVS works countless hours doing what they do best: cleaning and disinfecting. The hard work that happens in this department especially makes them deserving of the spotlight.”   The immense support coming from every EVS team member – especially trickling down from their team leads and manager – only adds to the level of passion for infection prevention and patient safety they each hold in their hearts. And by having each other’s backs, they in turn have YOUR back as well.  A Strong Culture Match  The culture the EVS team has fostered in their department is so powerful that many EVS career holders have surpassed several years, and in some cases, even decades.   Several team members in this department started their EVS careers at Renown between 10-20 years ago – and they never left. Their commitment to Renown’s mission and vision shines through in their work and their years-long tenure with us.  “I come from a culinary background, and let me tell you, this is a totally different experience,” said Brittany Sylvester. “I have learned so many things about the process of keeping a hospital properly cleaned and disinfected for our patients in the community. I just love being a part of this team and the culture at Renown.”  New employees who would like to embrace an environment where they are continually lifted up by their teammates are always welcome to join Renown EVS team. Communication, collaboration and a good attitude are needed to match the energy and level of support this team brings to work every day.  “I have never seen harder workers than those in our EVS team,” said Sha’vonne Mclean. “A good majority of our team members have been here a long time, and yet, their energy never wanes. They are inspirational.”  “The sense of pride we have makes me so happy,” adds Rosario De Gomez. “We are very passionate about everything we do here.”

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