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© Niyazz via Canva.com Every patient, regardless of how they may identify, greatly benefits from preventive healthcare and early detection. Members of the LGBTQIA+ community face unique considerations when it comes to their health, and a proactive approach to preventive screenings and vaccines is important in order to address their individual health needs.  Dr. Karen Thiele, Family Medicine Physician with University Health and Assistant Professor of Family and Community Medicine at the University of Nevada, Reno School of Medicine, breaks down key steps that LGBTQIA+ patients should take to safeguard their health.  PrEP and PEP  Pre-exposure prophylaxis (PrEP) is a strategy to prevent human immunodeficiency virus (HIV) infection. It is an important measure for those who are HIV-negative but may be at risk of contracting it. The highest risk sexual practice is receptive anal intercourse, due to the relative fragility of rectal tissue. This medication can stop HIV from spreading in the body and help patients maintain their HIV-negative status. PrEP is available in both pill form, which is taken every day, and injection form, of which the first two injections are initiated one month after another while all other injections are initiated every two months.  Post-exposure prophylaxis (PEP) is an antiretroviral drug regimen taken after potential HIV exposure to prevent an HIV-negative individual from converting to HIV-positive status. PEP is only for emergency situations and must be started within 72 hours of exposure – sooner is always better than later – and must be taken for 28 days.  PrEP and PEP are available in many ways, including visiting your primary care provider (PCP) or an urgent care location.   HPV Immunization  All genders and identities can protect themselves against human papillomavirus (HPV), a sexually transmitted infection (STI) that can lead to the risk of cervical, mouth, head, neck, throat, anal, vaginal, penile and vulvar cancers. HPV is so common that nearly all sexually active people, regardless of sexual orientation and practices, will be exposed at some point in their lifetime.  The HPV vaccine (common brands include Gardasil and Cervarix) is a safe and effective method to prevent HPV, according to the Centers for Disease Control and Prevention (CDC). This vaccine protects against infections that can lead to HPV-related cancers and precancers, as well as genital warts. While patients should start receiving the vaccine at 9 years old years old, unvaccinated adults up to the age of 45 can also receive the vaccine through their PCP – better late than never!  STI Testing  Sexually-transmitted infections form from bacteria, viruses or parasites that can be transmitted by person-to-person sexual contact through semen, vaginal, blood and other bodily fluids. According to the U.S. Department of Health and Human Services, there are more than 20 million estimated new STI cases across the nation each year.   Luckily, most STIs are preventable. Annual STI testing for HIV, gonorrhea, chlamydia and syphilis is important to stay on top of your sexual health. Because these STIs may sometimes have no symptoms, screening is recommended regularly and with any change in sexual partners. Depending on the specific condition, tests for these infections include urine, swab and blood tests. Speak with your primary care provider on a screening schedule that works best for you.  Prostate Exams  Prostate exams look for early signs of prostate cancer in patients who still have a prostate. The CDC recommends those who are at least 55 years old get regular prostate screenings; however, for patients with a family history of prostate cancer, screenings may be recommended as early as 45 years old.  These exams are done via two common methods – a prostate specific antigen (PSA) blood test and a digital rectal examination (DRE). Your provider can help you determine your risk and when you should start getting screened.  Pap Tests and Pelvic Exams  Patients of all genders who have a cervix, uterus, vagina and/or ovaries will benefit from regular pelvic exams and Pap screenings. A pelvic exam consists of a provider looking inside the vagina and at the cervix for anything unusual. A Pap test, also known as a Pap smear, involves your provider using a small, soft swab to collect cervical cells to check for early signs of cancer.  Generally speaking, people with these organs should have a Pap test every three years starting at age 21 through the age of 30. After age 30, patients should receive a Pap test with HPV co-testing every five years until age 65. These recommendations are changing based on new research, so it is important to have a conversation with your PCP about the current guidelines so you can make an informed choice about what schedule you should follow. A gynecologist or your primary care provider can counsel you and perform these screenings.  Mammograms and Breast Exams  People with breast tissue, especially dense breast tissue, are at risk for breast cancer, and regular breast screenings are your best line of defense. At-home breast self-exams are the first step – you will want to check your breasts for any lumps, changes, fluid leaks, irregular tissue thickening or anything else that feels unusual.  The Breast Cancer Risk Assessment tool, provided by the National Cancer Institute, is a good place to start to identify your risk. Talk with your primary care provider about the risks and benefits of starting screening at age 40 so you can make an informed decision about when to start. If you have any family history of breast or ovarian cancer, your PCP will offer you genetic testing for BRCA 1 and 2 mutations. Nevadans over the age of 18 can also get BRCA genetic test for free by enrolling in the Healthy Nevada Project.  Mammograms are important screening tools, but for a significant portion of people with breast tissue, density of the breast tissue may make mammograms less helpful in detecting cancer. Your primary care provider can help you decide what additional imaging (such as breast ultrasound) might be best for you.

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Colorectal cancer is the second-deadliest cancer in the United States – largely because it goes undiagnosed. Dr. Christi Matteoni, Division Chief of Gastroenterology at Renown Health, discusses the symptoms and key screenings used to detect this type of cancer, along with risk factors and lifestyle changes that could affect the likelihood of getting the disease. What are some of the signs and symptoms of colorectal cancer?  Many cases go undiagnosed because polyps can develop and become cancerous without any symptoms. Additionally, since colorectal cancer begins as small polyps, symptoms usually aren’t seen until later stages. This is why screenings are especially important.  For those who do experience symptoms, the signs are often tied to your bowel habits. This can include changes such as constipation or diarrhea, narrow or dark stool, rectal bleeding, abdominal cramping, weakness and fatigue or unintended weight loss.  What are some of the risk factors associated with this type of cancer?  There are risk factors that can and cannot be controlled. Uncontrollable factors include age, race, personal and family histories as well as certain genetic syndromes that are important to discuss with your provider.  This type of cancer is more common in people over the age of 50, African Americans and those of eastern European Jewish (Ashkenazi) descent. This type of cancer is also more common in those who have been diagnosed with polyps, Crohn’s disease, ulcerative colitis and long-term inflammatory bowel disease. important to discuss any of these risk factors with your provider.  There are also lifestyle factors that can help reduce your risk. Factors include being overweight, having a diet high in red and processed meat, as well as smoking and consuming excess alcohol.  Conversely, diets high in fruits and vegetables and a regular exercise routine can help lower your risk.  If someone has some of these risk factors, what should they do? Do they need to get tested?  If you are 45 or older and have any of these risk factors, we recommend you speak with your primary care provider about a formal colorectal risk assessment.  The most common form of screening is colonoscopy. This screening lets your doctor examine the length of your colon, map out any potential problem areas and remove polyps. For most people, colonoscopies are recommended every 10 years starting at age 50. However, depending on your results and risk factors, you may need to begin screening sooner or get screened more frequently.  What do diagnosis and treatment look like for this type of cancer?  There are several diagnostic options for colorectal cancer, including endoscopic ultrasound; CT, MRI and PET scans; and biopsy and pathology reports. These technologies allow your doctor to get images of your colon and evaluate what treatment is needed, as well as how the treatment is progressing.  Treatment varies for each individual working with their doctor. In the case of colorectal cancer treatment, the William N. Pennington Institute for Cancer offers chemotherapy, radiation therapy, surgery and clinical trials.

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When a sudden illness or injury occurs, the emergency room (ER) provides immediate medical attention to those in need. Understanding the top reasons for visiting the ER can help people make informed decisions about seeking emergency care. Here are the five most common reasons people in Nevada visited an ER in 2023. 1. Abdominal pain  One of the top reasons people visit the ER is abdominal pain. The abdomen has many organs, including the stomach, liver, small and large intestines, gallbladder and pancreas. Significant pain in this area can be a cause of concern.  Warning signs of a serious problem include abdominal pain with fever, vomiting, and not being able to move or perform everyday tasks due to pain. Seeking medical attention when experiencing these symptoms is essential. Emergency physicians can perform abdominal exams, assess the condition and rule out significant threats.    2. Fever  High fevers that do not get better with medicine and are accompanied by other symptoms can cause concern. This can indicate that the body is fighting off an infection or illness.  Fever with symptoms like vomiting, pain, altered mental status, shortness of breath or inability to perform daily functions are warning signs to watch out for. Adults and children should visit an ER, where the team can assess the causes of the fever.   3. Chest pain and shortness of breath  Chest pain and discomfort, or pain in the upper body can suggest warning signs of a heart attack. If a person is experiencing signs of a heart attack, call 911 immediately to ensure timely treatment or assessment by a medical professional. Heart attack symptoms include:  Chest pain, including pain that can be described as chest pressure, heaviness or squeezing   Discomfort in the chest, arms, back, neck, shoulders and jaw  Difficulty breathing   Sweating with any of the above symptoms   When visiting a Renown ER for chest pain, a trained medical professional will promptly perform an Electrocardiogram (EKG) in an area where preliminary assessments, also known as triage, take place. Individuals experiencing shortness of breath or trouble breathing, whether from a respiratory infection, asthma complications or other pre-existing conditions should not ignore symptoms as these can signify more serious issues.  Warning signs of respiratory distress may include:  A significant change in breathing rate A significant change in the amount of energy used to inhale or exhale when breathing Changing of the skin color to blue, gray or paleness, which can indicate a lack of oxygen Nasal flaring  Chest retractions, which can suggest difficulty bringing air into the lungs What this looks like: the chest sinking in just below the neck, breastbone or rib cage while breathing 4. Neurological symptoms  Sudden and severe headaches or seizures may prompt individuals to visit the ER if symptoms are extremely disorientating or debilitating. These symptoms could be indicative of various conditions, including strokes or neurological disorders that require prompt evaluation.  If a person is experiencing signs of stroke, call 911 immediately to ensure timely treatment.  Stroke symptoms include:  Numbness, weakness or loss of movement in the face, leg or arm, especially on one side Confusion, including trouble speaking or understanding Trouble with vision or loss of balance  When choosing emergency care for signs and symptoms of stroke, a Comprehensive Stroke Center can provide patients with immediate intervention, including evaluation, treatment and education. 5. Cough/flu-like symptoms  Emergency departments are staffed by medical professionals trained to prioritize and treat emergency and trauma situations. Receiving care at an ER should be reserved for severe symptoms and life-threatening conditions. It’s best to schedule a visit with a primary care physician for mild cold and flu symptoms. Most urgent care locations are equipped with rapid testing options, including RSV, COVID-19, influenza, mononucleosis, urinary issues and strep throat. It is critical to distinguish between common respiratory infections and more severe cases, such as pneumonia or complications from the flu.   Symptoms that may warrant a visit to the ER include:  Rapid decline in the ability to perform regular daily activities  Coughing or throwing up blood  Severe dehydration and inability to drink fluids High fever not responsive to medication  Understanding top ER visits in Nevada  While these ER complaints are common reasons for emergency room visits in Nevada, it's important to remember that emergency care is available for all immediate medical needs. Do not hesitate to seek help at an emergency room if someone experiences a sudden or severe health concern. Quick and appropriate action can make a significant difference in keeping you and your loved ones healthy.  Renown Health is the largest locally governed, not-for-profit healthcare network in northern Nevada, providing leading emergency and trauma care by board-certified emergency physicians 24/7 at three locations, including the region’s only pediatric emergency department. Renown Health emergency rooms prioritize swift assessments, advanced diagnostic tools and compassionate care, providing leading emergency and trauma care. Trust Renown ER for not just emergency care but exceptional care. Learn more at renown.org/ER.

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