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Renown Health President and CEO Tony Slonim, MD, DrPH, discusses efforts nationwide to develop a more effective and efficient way to deliver care. explains the benefits of Renown Health’s population health study with the Desert Research Institute and 23andMe.

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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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Did you know: More than 2.9 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today. Prostate cancer is common, but also treatable, especially when caught early. Dr. Michael Hardacre of the Renown Institute for Cancer explains. With the exception of skin cancer, prostate cancer is the most commonly diagnosed form of cancer in American men. In fact, the American Cancer Society offers these key statistics: About 1 man in 9 will be diagnosed with prostate cancer during his lifetime. Prostate cancer develops mainly in older men and in African-American men. About 6 cases in 10 are diagnosed in men aged 65 or older, and it is rare before age 40. The average age at the time of diagnosis is about 66. The good news: This form of cancer is very treatable when also detected early. Michael Hardacre, MD, radiation oncologist with Renown Institute for Cancer, is here to explain more about prostate cancer screenings and their role in early detection. What is the prostate? The prostate is a gland that only males have, and it makes part of the seminal fluid. Prostate cancer begins when the cells in the prostate gland start growing uncontrollably due to a change in the cell’s genes. Researchers are working to find what leads to the disease. Certain types of prostate cancer are hereditary, or passed on through genes. However, most types of prostate cancer are acquired and developed later in life. What are some of the signs of prostate cancer? Common signs of prostate cancer include: Frequent urination Weak urine flow Painful urination or inability to urinate Blood in urine or semen Painful ejaculation Erectile dysfunction If you notice any of these signs, talk with your primary care doctor. Although it may be intimidating to talk about any of these signs or symptoms, the earlier prostate cancer is detected, the better the options for treatment. How can you screen for or detect prostate cancer? The good news is that prostate cancer can often be found before symptoms appear, because screening is as simple as a blood test. Your doctor will look for levels of a prostate-specific antigen in the blood. If the results come back with anything concerning, then additional testing would be recommended. A transrectal ultrasound can also be used, which is usually painless and only takes about 10 minutes to complete. This exam gives the doctor an image of the prostate to measure its size, which can help determine the density of the prostate-specific antigen. If this test comes back with any suspicious results, then your doctor may recommend a biopsy. What are the treatment options? Depending on each case, treatment options for men with prostate cancer might include: Watchful waiting or active surveillance Surgery Radiation therapy Cryotherapy (cryosurgery) Hormone therapy Chemotherapy Vaccine treatment Bone-directed treatment It’s important to discuss all of the treatment option with your doctors, including goals and possible side effects, to help make the decision that best fits your needs. Some important things to consider when choosing a treatment option also include: The stage and grade of your cancer Your age and also your expected life span Any other serious health conditions you have Your feelings (and your doctor’s opinion) about the need to treat the cancer right away The likelihood that treatment will cure your cancer (or help in some other way) Your feelings about the possible side effects from each treatment Renown Institute for Cancer | 775-982-4000 At the Renown Health Institute for Cancer, our experienced team provides the support and care to maintain the highest quality of life and then achieve the best possible outcome, all in one location that’s close to home. Our dedicated team, clinical expertise and also advanced treatment options allow us to tailor care to each patient. Learn about: Our Team Cancers We Treat Screening and Prevention Treatment Options

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You probably know testosterone (T) plays an important role in how boys physically develop into men. But is that all you know? What happens when a man's T levels are off? Are there symptoms men should look for? And what are the treatment options? Dr. Bobby Kahlon, MD, Renown Medical Group provides answers in a Testosterone Q&A.   What does testosterone do for men?  "Testosterone is known as the 'manly hormone' for a reason," says Dr. Kahlon. "Though women also naturally produce small amounts of it, men produce testosterone at much higher concentration levels. And it affects men in more physical and obvious ways. How much hair a man has on his chest, how deep his voice is, or how muscular he is are all attributable in some way to testosterone. It's also responsible in large part for sex drive and bone strength and affects how men think, learn and experience their surroundings."  Testosterone in men:   Powers virilization (male physical characteristics) and sexual function Builds muscle mass and strength  Supports bone density  Improves cognition  T Trivia: Discover Magazine reveals that “manly” testosterone and other sex hormones evolved long before we did — 500 million years ago — from the ultimate “female” hormone, estrogen. Can you have too much or too little testosterone?  Though high testosterone isn't a concern for most men, low testosterone or low T occurs more frequently and develops for two primary reasons.  Dr. Kuhadiya explains, "Subnormal testosterone concentrations occur either due to pituitary or testicular failure and the causes for each need to be discussed with your physician."  Pituitary failure: Approximately one-third of men with obesity, type 2 diabetes, or metabolic syndrome (which includes increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels) have low free — or "bioavailable" — testosterone. These health conditions can cause the pituitary gland to "fail" to release follicle stimulating hormone (FSH) and luteinizing hormone (LH) which are essential for triggering testosterone and sperm production. And that can cause low testosterone (hypogonadism). Testicular failure: Though less common than pituitary failure, testicular failure may also be responsible for low T. It's caused by diseases or illnesses affecting the testicles, injury or trauma to the testicles, or certain medicines and treatments such as chemotherapy or opioid pain medication. Providing your complete medical history to your doctor is always the first step toward a proper diagnosis.  What are the symptoms of low T?  The following indicators could be a sign that you have low T, say the doctors.  Lack of motivation and determination, including mild depression  Loss of physical endurance and muscle strength  Loss of or diminished early morning erections  Reduced libido (sex drive)   Erectile dysfunction (ED — difficulty achieving or maintaining an erection)   Gynecomastia (male breasts)  Small testes  T and Time: T levels in men naturally begin to decline by about 1% a year starting at age 30.  How do you test for low T?  "There are different methods for testing testosterone levels," says Dr. Kuhadiya. "Each approach uses a blood sample to evaluate total testosterone, which includes free and attached testosterone that combines with proteins albumin and sex hormone-binding globulin (SHBG). For the most accurate results, testing is based on samples collected in the morning after fasting, and from tests on two different days."  What treatment options are available?  "Well, your best natural option may be YOU," says Dr. Kahlon. "Men with pituitary failure are often able to treat their low T by losing weight to increase levels of the hormone. And even if you don't lose weight, exercise can help boost your testosterone. Unfortunately, if you have testicular failure, weight loss and exercise may not have the same effect."  So, are there other options? "You may want to consider Testosterone Replacement Therapy (TRT)," says Dr. Kuhadiya. "TRT is only available to men who are hypogonadal — with a clinical diagnosis of low T. Injection, gel, skin patch and nasal spray are available TRT options. The best option is the one that works best for the patient. Convenience, insurance coverage and cost are all factors to consider." Dr. Kahlon's TRT preference? Daily gel treatments, which are applied directly to the skin. On the other hand, Dr. Kuhadiya recommends intramuscular injections, which take place once a week or every two weeks.  But both doctors agree on this: physicians and their patients need to weigh the benefits and risks of TRT before proceeding with treatment — especially if your low T condition may require lifelong treatment. "In my clinical practice, I have seen some very good long-term results with an improved quality of life," says Dr. Kuhadiya. "However, in certain situations, TRT may increase the risk of heart disease and is not recommended for men with a history of prostate cancer." Dr. Kahlon adds, "Patients receiving any type of hormone therapy need to be closely monitored throughout the treatment process for any changes in their health."   How do you feel about steroids and T boosters?  "I don't recommend them, certainly not for hypogonadism," advises Dr. Kahlon. "There is no evidence to support anabolic-androgenic steroids or testosterone boosters as a safe or effective treatment for low T in men."  "In fact, there continues to be emerging evidence they may lead to side effects that could potentially harm the liver and the pituitary and endocrine functions of the body," warns Dr. Kuhadiya. "And that damage may be irreversible."

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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.

Read More About Why are Annual Exams & Routine Screenings Important?

In recent years, healthcare has undergone many important transitions. One of the greatest changes has been the transition from a fee-for-service model to a value-based care model. Historically, healthcare organizations were paid for the amount of services they performed. This payment model resulted in more tests and procedures ordered, which, in turn, increased our country’s health care costs. However, now our government incentivizes health systems to provide the highest quality of care at the lowest cost possible. This new payment model is called value-based purchasing or value-based care. In this model, providers focus on delivering more coordinated and effective care. Additionally, healthcare organizations track important metrics like patient engagement, population health, and hospital readmissions. At Renown Health, we know that progress on these metrics represents real improvements in our patients’ lives. Shifting Focus from Illness to Wellness Healthcare organizations have traditionally viewed a hospital stay as the center of a patient’s wellness journey. At Renown Health, we believe a key part of our job is to help people live well every day. This means we focus not only on treating illness and injury but also on prevention efforts to keep people out of the hospital. For example, our employees help patients hazard-proof their homes to prevent falls, as falls are the leading cause of injuries in older adults. We also provide affordable health screenings to catch disease in its early stages, when it is more treatable. Renown Health also recognizes that many of the diseases our patients face – from diabetes to cancer – have social and environmental origins. We know that creating a healthier community will have a positive impact on their physical and mental health. Renown Health partners with local organizations to address community-based issues like addiction, pedestrian safety, air and water quality, climate change, and nutrition. Working together, we can lower the number of people who need care and improve the health and wellbeing of our community. Creating healthier environments and communities will help us prevent disease, which in turn will help us decrease spending and improve health. Most importantly, it will help people live up to their full potential. Dr. Slonim on Twitter | @RenownCEOTonyMD Interested in hearing more of Dr. Slomin’s thoughts on health and healthcare? Engage with him on Twitter. Follow Tony

Read More About Renown Health Vision for Value Based Care

As a clinician and a cancer survivor, I know that hope is an essential force that drives people to work through difficult situations. I also believe there’s a strong correlation between hope and wellness. Hope inspires us to make healthy choices today with the understanding that these behaviors will benefit us in the future.   In addition, an optimistic outlook helps patients face illness and injury with strength and confidence. While it’s easy for some people to maintain a positive outlook, it’s common to feel hopeless on a bad day. An important part of our job as healthcare providers is to help patients cultivate hope and build a strong foundation that carries them through their medical journey. The Importance of Family A common source of hope, for me and many others, is family. My family has recently welcomed our newest member, my first granddaughter, Emory. Becoming a grandparent has inspired me to reflect on the many blessings in my life. It’s not only been a opportunity to reflect, but also look ahead to the future. I often dream about the things Emory will accomplish one day, the kind of person she will become, and the world I want her to live in. These aspirations have renewed my determination to work hard and lead by example. At Renown Health, we know that hope and resilience are just as important in the recovery process as excellent medical care. That’s why we work with our patients to find sources of strength and inspiration in their own lives. We’re committed to helping our patients keep fighting the good fight for a healthier tomorrow.

Read More About My Inspiration to Keep Fighting Becoming a Grandparent

Hospital food gets a bad rap and maybe it’s deserved. However, at Renown Health we strive to serve patients, visitors and staff meals that are both nutritious and delicious. In this video and blog post, Renown Health President and CEO, Tony Slonim, M.D., Dr.PH., FACHE, shares his thoughts on hospital food and modeling healthy lifestyles.   Everyone knows that what we eat matters for almost every aspect of our health. Eating well can prevent chronic disease, control weight, improve our mood and even strengthen our bonds with loved ones as we come together to enjoy a family meal. Yet despite this knowledge, balancing work or school responsibilities, family life and everything in between can make eating healthy feel like an uphill battle. Recognizing this challenge, Renown Health invests in programming to help our community embrace healthy lifestyle habits – starting with our own employees. Knowing that people often look to their healthcare providers to model healthy behavior, we are deliberate in our efforts to help our employees and their families live well. We also provide healthy dining options in our on-campus restaurants and through our food and nutrition services team. We believe that providing nutritious, appetizing meals helps patients to recuperate from illness or injury, helps their families recharge, and helps our staff fulfill their promise of providing outstanding care. We hope that by serving as models of healthy behaviors, our employees will inspire others to join us in this journey. Dr. Slonim on Twitter | @RenownCEOTonyMD Interested in learning more of Dr. Slomin’s thoughts on health and healthcare? Engage with him on Twitter. Follow Tony

Read More About Beyond Jello A Healthier Approach to Hospital Food

I am regularly amazed by medical advancements and innovation in the United States. However, even as we make significant progress in many areas of medicine, there is still much more work to be done in others. One such area is patient safety.   What is Patient Safety? When we talk about patient safety, we are discussing how hospitals and healthcare organizations protect patients from errors, injuries and infections. Anyone can make a mistake at work, but in healthcare these mistakes can result in serious outcomes. In 1999, the Institute of Medicine released a report that estimated 98,000 deaths per year result from medical examination or treatment. The most recent study in 2013 suggested these numbers could range from 210,000 to 440,000 deaths per year. Many of these deaths result from preventable medical errors. This is inexcusable and shows how much more work our industry still needs to do to improve patient safety. Making Patient Safety a Priority Patient Safety is our number one priority at Renown Health. We dedicate a lot of time to establishing, reviewing, and revising our processes to prevent errors. Despite the obvious importance of patient safety, this issue is largely left to individual hospitals and health systems to manage. There is a surprising lack of national attention around this truly important issue. However, a silver lining of the COVID-19 pandemic is that it is igniting interest in hygiene and infection prevention. Patients want to learn more about the processes that are in place to prevent the spread of infections. In addition to the many protocols that guide our treatment of injuries and illness, Renown Health has implemented the following measures to prevent the spread of communicable diseases: Requiring everyone entering Renown sites to wear a mask or face covering. Establishing new processes to help patients and visitors practice social distancing. Limiting the number of visitors in our facilities. Screening all employees and patients for symptoms. Enhancing our already-thorough cleaning and disinfection processes. I hope patient safety and infection prevention remain in the national spotlight long after the COVID-19 pandemic has ended. The healthcare industry must come together to develop stronger systems and regulations to minimize preventable medical errors. We have a responsibility to our patients to do better.

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There are many lenses through which to view health. As you would expect, medical providers typically focus on the health of individual patients. For example, doctors consider a person’s symptoms, their current lifestyle, their past medical history, and their family’s history to diagnose medical conditions and recommend treatments. The Public Health Perspective Public health professionals look beyond the health of an individual and instead focus on the health of an entire community or population of people. They strive to achieve “the greatest good for the greatest number.” As the CEO of a health system, I feel fortunate to have education and training in both medicine and public health. As Renown Health’s leader, it is my responsibility to care for the people and communities we serve. That involves bringing world-class staff and innovative medical care to northern Nevada. We also focus on prevention by looking for ways to improve health outside of our facilities. That means partnering with local organizations to address the social, economic, and environmental factors that shape our health. Or working with local government to create policies that help to prevent disease and injury. In order to make a genuine and long-lasting impact on health, we must foster a community that helps our neighbors live well. Public health is especially important during times of crisis, such as the COVID-19 pandemic that we’re experiencing now. During these times, health systems must be able to swiftly shift focus from prioritizing the needs of individual patients to considering what is best for our local population. For example, we may need to temporarily limit hospital visitors or educate the public about how to socially distance in order to stop the spread of disease. Being prepared to make this shift and having strong relationships with our local health department and community organizations help us better serve the public. In both good times and bad, I am thankful that my public health background provides me with the perspective to look beyond our health system and embrace the health our community.

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At Renown Health, we often discuss the importance of both healthcare – how we treat people when they are sick or injured – and health – how we keep people well in their mind, body and spirit. This conversation is as important for the patients we serve as it is for our healthcare providers.   It’s well known that the medical field can impose challenging and even unhealthy expectations for healthcare workers. Long hours and physically and emotionally demanding work can lead to burnout. Yet, until recently, these issues were rarely discussed openly. Because the role of healthcare providers is to care for other people, they may feel uncomfortable asking for help themselves. The good news is that more and more physicians and professional associations are talking about burnout. Hospitals are also taking action to address concerns like mental and emotional fatigue. We need our workforce to be healthy in mind, body and spirit. That’s why we support our team by educating them on the warning signs of burnout. Renown Health also trains management-level employees to care for those who need help. We encourage employees to talk openly about these challenges and encourage them to access the many services available to our employees that can help them live well. Caring for people is central to Renown Health’s mission. We believe this applies to both our patients and our teammates.

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