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Nutrition is a vital aspect of patient care. At Renown Health, the Food & Nutrition Services (FNS) teams take their mission of delivering patients high-quality, cost-effective, nutritious and attractive foods to the next level. From a thrice-daily trayline service with a wide variety of delicious food to the personalized dietitian services that ensure every patient gets the nutrients they need for optimal healing and recovery, Renown’s FNS teams at Regional, South Meadows and Rehab are unmatched.  Food for the Good Fight  The hustle and bustle of early morning food preparations gears the FNS team up to, as Renown Regional Food Service Worker Molly Kalsman puts it, “provide patients with adequate nutrition to heal.” From morning until nighttime, the team prepares three meals a day along with late trays and snacks.  This isn’t your run-of-the-mill hospital food, either. Think anywhere from cheeseburgers and salads to pork roasts and baked potatoes. As you can imagine, food of this caliber requires all hands on deck in the kitchen, especially during trayline times, to ensure all patients receive quality meals that meet their individual nutrition needs. “We make an impact with good service and great food,” said Mario Nunez, a Food Service Worker at Renown South Meadows.  As the food service workers are hard at work cooking and assembling, the nutrition representatives visit each patient to learn their individual dietary restrictions, allergies and food preferences. For Julie Macaluso, Nutrition Representative at Renown South Meadows, “letting the patients choose their meals” is one of the highlights of her job. “We go over meal choices for their stay, so the patient can pick out something they would like to eat and find enjoyable,” added Tara Sprehe, Nutrition Representative at Renown Regional.  The immense care and attention our nutrition representatives give to every patient paves the way for our clinical dietitians to build a nutrient-dense diet plan based on the individual patient’s preferences. Dietitians are the only licensed providers that can leverage nutrition to treat, manage and prevent illness and disease to improve patient outcomes. Every day, our experienced dietitians “make recommendations in the adjustment of macro and micronutrients in order to best manage a person’s health status in the setting of trauma, diabetes, heart disease and other morbidities,” said Jessica Blauenstein, a Registered Dietitian and Board-Certified Specialist in Oncology Nutrition at the William N. Pennington Cancer Institute. Overall, for this department, the phrase “that’s not my job” will never be heard, according to Lupe Ayala, a Cook at the Renown Rehabilitation Hospital. Day-in and day-out, it’s a massive group effort – and that’s the way they like it.  Setting the Service Bar High  Hitting milestones and accomplishments comes naturally to this crew. The FNS team sets the bar incredibly high for food and service standards across the Renown Regional, South Meadows and Rehabilitation hospitals.   The key ingredient? Synchronized teams that operate like a well-oiled machine. The meticulous trayline schedules and assembly lines, the cooks that put their heart into patient meals, the nutrition representatives and dietitians who ensure patient food wants and dietary needs are being met... the list goes on. And to top it all off, these teams certainly know the meaning of “service with a smile.”  Their efforts do not go unnoticed. “I am very proud of the team I have,” said Monica Lara-Yanez, Supervisor of Food and Nutrition Services at Renown South Meadows. “They have improved their knowledge and participated in cross-training, and they are very efficient doing their jobs and helping each other. Moreover, they care about the service we provide.”  One major accomplishment the FNS department achieved in recent years was implementing Room Service Connect, which aids in direct communication with patients, letting them know what foods are available to them during their stay at Renown based on their dietary needs. Locating trays of food has also never been easier. According to Tara Sprehe, “This system is also beneficial for letting food service workers know when a diet has been upgraded, discontinued, changed to NPO status or downgraded. This reduces the risk of giving the patient a diet that is not appropriate for them,” which saves both time and money for the department.  At the end of the day, the FNS department has one mission, and it’s the same mission we all employ as Renown team members: do it for the patient.  “It’s all about patient care,” said Jesse Holman, Cook Lead at Renown Regional. “That is the best accomplishment!”  A Dedication to Renown   The patients, the providers, and the passion: these are the most common themes that keep the FNS department passionate about Renown and their team. Whether they are just starting out in a career in food service or have established themselves in the clinical field, the FNS department proudly upholds the greatest standards of nutritional care that enhance Renown’s status as a top healthcare leader in northern Nevada.  “I choose Renown because it is a very distinguished institution with an amazing reputation, offering a lot of benefits and growth opportunities to employees,” said Monica Lara. “It makes me feel proud to say, ‘I work at Renown.’” Renown Rehab Food Service Worker Margretta Corbet echoes this sentiment, adding, “There are good people here with happy dispositions.”  Many FNS team members are especially enthusiastic about Renown’s robust benefits and career growth opportunities. For Molly Kalsman, working at Renown gives her the experience necessary to enter a career in dietetics. “Food service and hospital experience is encouraged to be accepted into a dietetics internship program, and Renown was the perfect opportunity for me to gain that experience,” said Molly. Carleigh Bates, Nutrition Representative at Renown South Meadows, is on a similar path: “Renown is a vehicle for so many things I am aspiring towards, such as getting my foot in the door for working in healthcare, improving the experiences of patients and gaining experience that will aid in my future goals.”  Carleigh emphasizes that the team’s commitment to Renown’s mission is at the core of what they do every day. “We impact patient care by providing nutrition to fuel their wellness and improve their stay.”  Lupe Ayala wraps up this strong conviction from the team very well: “I didn’t choose Renown; Renown chose me.”  Fight the Good Fight With Us This future-minded, patient-centric department is growing! The Food & Nutrition Services teams at Regional, South Meadows and Rehab are actively hiring eager, collaborative new team members. Natasha Frisbie, FNS Lead at Renown Regional, reports that the team has “successfully hired and trained 24 new employees in the past three months” and is still expanding. “Teamwork, communication, and enthusiasm are very valuable skills to have in this department,” said Molly Kalsman.   If you or anyone you know is looking for their next growing career opportunity, apply today!

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Once upon a time … in Incline  This issue’s featured member began writing the latest chapter of her life story by retiring on Lake Tahoe’s north shore in Incline Village, NV.  “I had several criteria when selecting a place to retire,” says MaryBeth. “And a healthy lifestyle was number one. The people who have settled in Incline are very active with both their minds and their bodies. It’s not a stagnant population, it is unusually robust. I’ve made wonderful friendships here and we really watch out for each other, which means the world to me.” “I also wanted four seasons a year,” she continues. “And most importantly, I wanted a place that my son, Addison, would love to visit and share with me – and world-class skiing just minutes away scored extra points with both of us!” Zürich and Beyond  Skiing was something MaryBeth and Addison took to with a passion while living in Zürich, Switzerland. A business move to the land of the Alps (and Swiss chocolate) provided the perfect opportunity for an international education for her son and a culturally eye-opening experience for the family.  “I was unprepared for what it was going to be like living in a foreign place, and I learned a lot about empathy as a non-native and the kindness of strangers, or not. Our seven years there gave us many easily available travel adventures on the other side of the globe, and the friendships I made with people around the world have been lifelong.” “Divas” of the Garden  “Tall and showy” is how MaryBeth lovingly describes the “Divas” of her garden, aka the delphiniums. Located in the sunny part of her yard, the plants explode in a variety of colors that accentuate her home’s landscaping and are a well-earned reward for her mountain gardening challenges. “The very first thing you must do when creating a new garden is amend the soil,” explains MaryBeth. “It’s not sexy, but it’s necessary! And that’s when you learn that every shovelful of “mountain” dirt is loaded with rocks of every size – it’s fantastic exercise!” And her neighbors appreciate the hard work. “I’ve made so many friends of all ages in the neighborhood while working outside in my garden,” shares MaryBeth. “They stop, chat, inquire about the plants and take photos all the time.” Then with a smile, she adds, “You could call it my art.” Aging-In to Life with Medicare At 64 and on the cusp of Medicare eligibility, MaryBeth recently tasked herself with learning what she could about the plans and options that would soon be available to her and was overwhelmed. “I made the mistake of entering my phone number on a Medicare website for “wanting more information” and had no less than 15 calls a day from health insurance brokers – from all over the country!” she exclaims. “What one person would tell me would then be questioned by the next. I eventually quit answering the phone.” However, finding a Medicare plan that meets all of her needs is still a priority. “First and foremost, since I am a traveler (at least before the pandemic) I want to have a healthcare plan that will cover me in any state,” MaryBeth explains. “I would also like a policy that allows for alternative treatments, such as acupuncture – which I’ve had great success with in the past. I know that getting a good Rx plan now will save me money down the line, and I also want to be able to see a specialist without seeing a provider first for a referral.”

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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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